BEHAVIORAL HEALTH: WHY IT MATTERS TO PUBLIC HEALTH & WHAT TO DO ABOUT IT. Michael Duffy SAMHSA Regional Administrator Region VI AR, LA, OK, NM,TX

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2 BEHAVIORAL HEALTH: WHY IT MATTERS TO PUBLIC HEALTH & WHAT TO DO ABOUT IT Michael Duffy SAMHSA Regional Administrator Region VI AR, LA, OK, NM,TX April 5, 2013

3 BEHAVIORAL HEALTH: A NATIONAL PRIORITY 3 Mission: Reduce the impact of substance abuse and mental illness on America s communities Vision: SAMHSA provides leadership & devotes its resources toward helping the Nation act on the Behavioral health is essential to health Prevention works Treatment is effective People recover knowledge that:

4 DIVISON OF REGIONAL/NATIONAL LIASON 4 Represent SAMHSA leadership in the Regions Provide SAMHSA staff feedback from the Regions Establish working relationships with: Regional representatives of OPDIVS (HRSA, ACF, CMS) and internal staff divisions (e.g., OASH) State authorities for mental health & substance abuse, provider groups, stakeholders. health departments. Coordinate support for State implementation of health reform. Coordinate, as needed, implementation of SAMHSA Strategic Initiatives & technical assistance within the regions. Help States to coordinate resources across SAMHSA to address emerging needs.

5 Region X: Seattle AK, ID, OR, WA David Dickinson th Ave, MS RX-02 Seattle, WA Region VIII: Denver CO, MT, ND, SD, UT, WY Charles Smith, PhD 1961 Stout Street Denver, CO Region VII: Kansas City IA, KS, NE, MO Laura Howard, JD 601 East 12th St Kansas City, MO Region V: Chicago IL, IN, MI, MN, OH, WI Jeffrey A. Coady, PsyD 233 N Michigan Ave Chicago, IL Region I: Boston CT, ME, MA, NH, RI, VT Kathryn Power, MEd JFK Federal Building Boston, MA Region II: New York NJ, NY, PR, VI Dennis O. Romero 26 Federal Plaza New York, NY Region III: Philadelphia DE, DC,MD, PA, VA, WV Jean Bennett 150 S. Independence Mall West Philadelphia, PA Region IX: San Francisco AZ, CA, HI, GU, NV, AS, CNMI, FSM, MH, PW Jon Perez, PhD 90 7th Street, 8th Floor San Francisco, CA Region VI: Dallas AR, LA, NM, OK, TX Michael Duffy RN, BSN 1301 Young St, Dallas, Texas Region IV: Atlanta AL, FL, GA, KY, MS, NC, SC, TN Stephanie McCladdie 61 Forsyth Street, S. W. Atlanta, GA 30303

6 BEHAVIORAL HEALTH: ONE OF AMERICA S TOP PUBLIC HEALTH CHALLENGES 6 GLOBAL & DOMESTIC IMPACTS PARADIGM SHIFT CHANGING THE CONVERSATION: A NATIONAL DIALOGUE

7 BEHAVIORAL HEALTH: ONE OF AMERICA S TOP PUBLIC HEALTH CHALLENGES 7 GLOBAL & DOMESTIC IMPACTS

8 10 LEADING CAUSES of DEATH US 2008, All RACES, BOTH SEXES 8 RANK ALL AGES 1. Heart Disease: 616, Malignant Neoplasms: 565, Chronic Low Respiratory Disease: 141, Cerebro-vascular : 134, Unintentional Injury: 121, Alzheimer's Disease: 82, Diabetes Mellitus: 70, Influenza & Pneumonia: 56, Nephritis: 48, Suicide: 36,035 WISQARS TM Produced By: Office of Statistics and Programming, National Center for Injury Prevention and Control, CDC Data Source: National Center for Health Statistics (NCHS), National Vital Statistics System

9 SUICIDE DEATHS AND ATTEMPTS 9 Annually, 11 M+ Americans seriously consider taking their own lives 8 M make a plan 2.5 M > 14 years attempt 38,000+ died from suicide in 2010 America loses ~ 100 people every 24 hours Not to battles of war, acts of terrorism, or natural disasters, but to suicide

10 MISSED OPPORTUNITIES = LIVES LOST 77 % of individuals who die by suicide had visited their primary care doctor within the year % had visited their primary care doctor within the month 18 % of elderly patients visited their primary care doctor on same day as their suicide THE QUESTION OF SUICIDE WAS SELDOM RAISED

11 Behavioral Health is Essential To Health By 2020, mental & substance use disorders (M/SUDs) will surpass all physical diseases as a major cause of disability worldwide One-half of U.S. adults will develop at least one mental illness in their lifetime U.S. 2006: M/SUDs were 3 rd most costly health condition behind heart conditions and injury-related disorders Mental illness and heart diseases alone account for almost 70 % of lost output/productivity 11

12 CHRONIC DISEASES: GLOBAL IMPACT 12 World Economic Forum: Global economic impact of 5 diseases could reach $47 trillion over the next 20 years BH will account for $16 trillion a third of cost Cancer Diabetes Behavioral Health Impacts Heart Disease Respiratory Disease

13 BEHAVIORAL HEALTH IMPACT 2+ million Americans report mental/emotional disorders as the primary cause of their disability (per CDC) Depression is the most disabling health condition worldwide; Alcohol # 3; SA # 10 M/SUDs: 24 percent of pediatric primary care office visits & almost ¼ of all adult stays in community hospitals Years Lost Due to Disability in Millions (High-Income Countries World Health Organization Data)

14 BEHAVIORAL HEALTH IMPACTS MH problems increase risk for physical health problems & SUDs increase risk for chronic disease, sexually transmitted diseases, HIV/AIDS, and mental illness Cost of treating common diseases is higher when a patient has untreated BH problems M/SUDs rank among top 5 diagnoses associated with 30- day readmission, accounting for about one in five of all Medicaid readmissions (12.4 % for MD and 9.3 % for SUD) PHYSICAL HEALTH Individual Costs of Diabetes Treatment for Patients Per Year $300,000,000 $250,000,000 $200,000,000 $150,000,000 $100,000,000 $50,000,000 $0 With behavioral health problems and diabetes With diabetes alone 14

15 Co-morbid depression or anxiety increases physical and mental health care expenditures BH PROBLEMS = HIGHER COSTS 15 Over 80% of this increase occurs in physical health expenditures Average monthly expenditure for a person with a chronic disease and depression is $560 dollars more than for a person without depression The discrepancy for people with and without co-morbid anxiety is $710 A HMO claims analysis found that general medical costs were 40 percent higher for people treated with bipolar disorder than without it

16 People with M/SUD are less likely to receive preventive services (immunizations, cancer screenings, smoking cessation counseling) & receive worse quality of care across a range of services PERSONS WITH BEHAVIORAL HEALTH=WORSE PHYSICAL HEALTH? BH problems are associated w/ increased rates of smoking and deficits in diet & exercise 16

17 STEEP HUMAN AND ECONOMIC COSTS Estimated total societal cost of substance abuse in the U.S. is $510.8 billion per year 17 Mental disorders: ~$94 billion in lost productivity costs per year THE ECONOMY Economic costs of mental, emotional, and behavioral disorders among youth: ~$247 billion Alcohol and drug abuse & dependence: ~ $263 billion in lost productivity costs per year

18 REGION IV PROFILE State Capital Population 1 Pop. Density 2 Joint SA Prevalence 3 SMI Prevalence 4 Suicide Rate 5 Arkansas Little Rock 2,915, Yes Louisiana Baton Rouge 4,533, Yes New Mexico Santa Fe 2,059, Yes Oklahoma Oklahoma City 3,751, Yes Texas Austin 25,145, Yes United States Washington, DC 309,349, N/A U.S. Census U.S. Census SAMHSA, NSDUH , Table 19. Dependence on or Abuse of Illicit Drugs or Alcohol in Past Year among Persons Aged 18 or Older. 4 SAMHSA, NSDUH , Table 22. Serious Mental Illness in Past Year among Persons Aged 18 or Older, by State. 5 CDC, National Vital Statistics System-Mortality (NVSS-M) 2008, per 100,000

19 WHO ARE THE UNINSURED? 37.9 Million 18 M (Medicaid) 19.9 M (Exchanges)* M w/bh

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21 OKLAHOMA MARKETPLACE INSURANCE EXCHANGES PROJECTIONS: MARKETPLACE INSURANCE EXCHANGES = 292,685 SMI (9.6%) = 28,098 SERIOUS PSYCH DISTRESS (20.8%) = 60,879 SUD (17.0%) = 49,757 TOTAL = 138,431

22 ESSENTIAL HEALTH BENEFITS 10 BENEFIT CATEGORIES (MHPAEA) 1. Ambulatory patient services 2. Emergency services 3. Hospitalization 4. Maternity and newborn care 6. Prescription drugs 7. Rehabilitative and habilitative services and devices 8. Laboratory services 10.Pediatric services, including oral and vision care

23 CHANGE THE NATIONAL DIALOGUE? 23 PARADIGM SHIFT

24 PUBLIC HEALTH OR SOCIAL PROBLEM? 24 Public Health Social Problem

25 PUBLIC HEALTH ISSUE OR SOCIAL ISSUE? Public Sees Social Consequences Rather Than Health Consequences Homelessness, gangs, jails, tragedies (e.g., shootings), disability, lost productivity, high government costs 25 M/SUDs Seen as Matter of Will Instead of Diseases To Be Prevented, Treated & Recovery is Possible Compare diabetes Requirements of Physical Health First Aid, But Not Mental Health First Aid

26 26 Public is less willing to pay to avoid mental illnesses compared to paying for treatment of medical conditions, even when mental illnesses (including SUDs) are recognized as burdensome (NICHD, 2011) Public willing to pay 40 % less than what they would pay to avoid medical illnesses Mental illnesses account for 15.4 % of total burden of disease (WHO), yet mental health expenditures in U.S. account for only 6.2 %

27 PERCEPTION: BH IS COMMUNITY PROBLEM 27 Adults with mental disorders experience high rates of unemployment and disability Unemployment rates are 3 to 5 times higher for people with mental disorders 44 percent of children in special education w/ emotional disturbances drop out of school highest of any category of disability Substance use reduces ability to parent and work; increases chances of involvement in criminal justice system or child welfare 1/2 of all incarcerated people have MH problems; 60 percent have substance use problems; 1/3 have both

28 PERCEPTION: Behavioral Health is a Social Problem Public dialogue about behavioral health is in a social problem context rather than a public health context Homelessness Crime/jails Child welfare problems School performance or youth behavior problems Provider/system/institutional/government failures Public tragedies Public (and public officials) often misunderstand, blame, discriminate, make moral judgments, exclude Ambivalence about worth of individuals affected and about the investment in prevention/treatment/recovery Ambivalence about ability to impact problems This leads to 28

29 SOCIAL PROBLEM VERSUS PUBLIC HEALTH PROBLEM Don t recognize until too late Inadequate responses Guards in schools Homeless shelters Jails

30 rand Rapids, MI Lost TRAGEDIES Sandy Hook School Newtown, CT Lost Tucson, AZ Lost Aurora, CO Lost Asher Brown Lost 13 yrs old Virginia Tech, VA Lost Nickel Mines, PA Lost Red Lake Band of Chippewa, MN, Lost Columbine High School Littleton, CO Lost

31 LEADING TO INSUFFICIENT RESPONSES 31 Increased Security & Police Protection Tightened Backgroun d Checks & Access to Weapons Legal Control of Perpetrator s & Their Treatment More Jail Cells, Shelters, Juvenile Just ice Facilities Institutiona l System Provider Oversight

32 FACTS: MENTAL ILLNESS AND VIOLENCE 3 to 5 % of violent acts attributable to individuals w/ SMI and most (76 %) do not involve guns People w/psychiatric disabilities far more likely to be victims than perpetrators of violent crime including : > 2½ times more likely to be attacked, raped, or mugged than general population Most common form of violence associated w/mi is not against others, but against oneself Most violence not predicted; most patients predicted to be violent are not

33 BEHAVIORAL HEALTH AFFECTS EVERYONE ~Half of Americans will meet criteria for mental illness at some point 33 > Half of Americans know someone in recovery from substance use problem Positive emotional health helps maintain physical health; engage productively w/ families, employers, friends; & respond to adversity w/ resilience and hope 66 percent believe treatment and support can help people with mental illness lead normal lives 20 percent feel people with mental illness are dangerous to others Two-thirds believe addiction can be prevented 75 percent believe recovery from addiction is possible 20 percent would think less of a friend/relative in recovery from an addiction 30 percent would think less of a person with a current addiction

34 DAILY DISASTER OF UNPREVENTED AND UNTREATED M/SUDs Any Mental Illness 45.5 million Substance Use Disorder 21.6 million Diabetes 25.8 million Heart Disease 81.1 million Hypertension 74.5 million 38.5 % receive tx % receive tx. 84 % receive tx % receiving screenings 70.4 % receive tx.

35 TOP REASONS Among the 8 million adults who had SMI in the past year and a past year SUD, only 6.9 percent received treatment for both conditions Among top reasons for not receiving treatment Inability to afford care (50.1%) Problem can be handled without care (28.8%) Not knowing where to go for care (16.2%) Not having the time (15.1%)

36 WHAT AMERICANS KNOW 36 Most Know or Are Taught: Basic First Aid and CPR for physical health crisis Universal sign for choking; facial expressions of physical pain; basic terminology to recognize blood and other physical symptoms of illness and injury Basic nutrition and physical health care requirements Where to go or who to call in an emergency

37 WHAT AMERICANS DON T KNOW 37 Most Do Not Know and Are Not Taught: Signs of suicide, addiction or mental illness or what to do about them or how to find help for self or others Relationship of behavioral health to individual or community health or to health care costs Relationship of early childhood trauma to adult physical & mental/substance use disorders

38 SO, HOW DO WE CREATE... A national dialogue on the role of BH in public life With a public health approach that: Engages everyone general public, elected officials, schools, parents, community coalitions, churches, health professionals, researchers, persons directly affected by mental illness/addiction & their families Is based on data, facts, science, common understandings/messages Is focused on prevention (healthy communities) Is committed to the health of everyone (social inclusion) 38

39 COMPREHENSIVE PUBLIC HEALTH APPROACH PREVENTION SCREENING EARLY INTERVENTION TREATMENT LONG TERM RECOVERY

40 PREVENTION WORKS 2009 IOM Report Preventing Mental, Emotional,& Behavioral Disorders among Young People: Progress and Possibilities Among adults, 50% mental, emotional and behavioral (MEB) disorders were first dx. by age 14 and 75% by age 24 MEB disorders among youth as commonplace as fractured limb Risk and resiliency factors can be addressed Common, early, consistent, multi-sector, continuous, community-based PUBLIC HEALTH approaches work Environmental, policy, culture and individual approaches work 40

41 MANY M/SUDS CAN BE PREVENTED Product of Biological, Environmental and Social Factors 41 Experiences Trigger or Exacerbate BH Problems Trauma, adverse childhood experiences, disasters and their aftermath, poverty, domestic violence, involvement with the criminal justice or child welfare systems, neighborhood disorganization and family conflict Addressing Risk Factors is Effective in Reducing Likelihood of M/SUDs Individual, family and community risk and protective factors Brain Impacts Chronic Acute Stress in Early Childhood Can Lead To: Future health problems (including depression and other BH problems) Damage to hippocampus Smaller physical size of developing brain

42 EARLY INTERVENTION REDUCES IMPACT 42 50% of All Lifetime Cases of Mental Illness Begin by Age 14; 75% by Age 24 On Average, > 6 Years from Onset of M/SUD to Treatment Effective Treatments Exist Need Treatment & Support Earlier Screening Brief interventions Coordinated referrals

43 IMPACT: CHILDREN AND TRAUMA > 6 in 10 U.S. youth have been exposed to violence in past year; nearly 1 in 10 injured Trauma disrupts normal development, has lasting impact, and becomes intergenerational Brain development, cognitive growth, and learning Emotional self-regulation Attachment to caregivers and social-emotional development Predisposes children to subsequent psychiatric problems Adverse Childhood Experiences (ACEs) potentially explain 32.4 percent of M/SUDs in adulthood

44 REPORTED PREVALENCE OF TRAUMA IN BH Majority of adults and children in inpatient psychiatric and substance use disorder treatment settings have trauma histories percent: Individuals in psychiatric hospitals have experienced physical or sexual abuse percent: Public mental health clients exposed to trauma >70 percent: Adolescents in SU Tx had history of trauma exposure

45 INTERGENERATIONAL ⅔ adults in SUD Tx report being victims of child abuse and neglect Women w/suds more likely to report a history of childhood abuse Many women w/suds experienced physical or sexual victimization in childhood or in adulthood and suffer from trauma Alcohol or drug use may be a form of self-medication for people w/trauma or mental health disorders

46 TREATMENT IS EFFECTIVE, BUT Today in America over 60 % of people (>26 million) who experience mental health problems and almost 90 % of people (>20 million) who need substance abuse treatment do not receive care 46

47 TREATMENT IS EFFECTIVE Need to understanding of the role of trauma and screen appropriately Need to promote use of evidence-based SBIRT Need to ensure appropriate use of psychotropic medications while availability of evidence-based psychosocial treatments Need to access to non-pharmaceutical treatment to potential for over-reliance on psychotropic medication as a first-line treatment strategy

48 PEOPLE RECOVER! Utilization of Peer Support Specialist to Assist in Long- Term Recovery Home Health Purpose Community

49 EXPAND YOUR RESOURCES EXPAND YOUR REACH SAMHSA.GOV National Center on Substance Abuse and Child Welfare National Child Traumatic Stress Network National Center for Trauma Informed Care BRSS TACS: T/TA to States, providers, and systems to adoption and implementation of recovery supports (e.g., peer-operated services, shared decision making, supported employment) for people w/bh problems NREPP: Searchable online registry of 260+ EB interventions - MH promotion, SA prevention, and MH/SA Treatment

50 CURRENT SAMHSA/HRSA EFFORTS 50 CHANGING THE CONVERSATION: A NATIONAL DIALOGUE

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52 SAMHSA HRSA Collaboration The Bureau of Primary Health Care supports the integration of primary and behavioral healthcare and is working closely with the SAMHSA-HRSA Center for Integrated Health Solutions (CIHS) to promote the development of integrated behavioral health services to better address the needs of individuals with mental health and substance use conditions. CIHS promotes the development of integrated primary and behavioral health services to better address the needs of individuals with mental health and substance use conditions, whether seen in specialty behavioral health or primary care provider settings. 21

53 Behavioral Health in Health Centers (HRSA Data) Access 2/3 provide on-site mental health services 1/3 provide on-site substance abuse services 53% have a formal tobacco cessation program Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a service that primary care providers provide Workforce 5,360 Behavioral Health Workforce Including: 401 Psychiatrists 403 Psychologists 1,394 Social Workers 874 Substance Abuse Providers 1,006 Other Licensed Mental Health Staff 1,282 Other Mental Health Staff Source: Uniform Data System,

54 OKLAHOMA BH Workforce in Health Centers (HRSA Data) Workforce: Behavioral Health Workforce Including: 2.55 FTE - Psychiatrists 1.15 FTE - Psychologists FTE - Social Workers Substance Abuse Providers FTE - Other Licensed Mental Health Staff FTE - Other Mental Health Staff Total BH FTE = Source: Uniform Data System,

55 Behavioral Health Patient Visits (HRSA Data) In 2011, there were over 5 million behavioral health visits, over 4 million specific to mental health, and close to 1 million specific to substance use. Breakdown of all Health Center Behavioral Health Clinic Visits Mental Health Visits 4,674,450 Substance Abuse Visits 1,056,754 Total Behavioral Health Visits 5,731,204 Source: Uniform Data System,

56 OKLAHOMA BH Patient Visits (HRSA Data) In 2011, there were over 5 million behavioral health visits, over 4 million specific to mental health, and close to 1 million specific to substance use. OKLAHOMA - -Breakdown of all Health Center Behavioral Health Clinic Visits Mental Health Visits 68,206 Substance Abuse Visits 334 Total Behavioral Health Visits 68,540 Source: Uniform Data System,

57 Behavioral Health Patient Diagnosis (HRSA Data) Number of Patients with Primary Diagnosis in Behavioral Health Alcohol Related Disorder 77,051 Other Substance Related Disorders 102,849 (Excludes Tobacco) Tobacco Use Disorder 129,918 Depression and other Mood Disorders 772,895 Anxiety Disorders Including PTSD 438,218 Attention Deficit and Disruptive Behavior 231,360 Disorders Other Mental Disorders 449,771 Total 2,021,005 Source: Uniform Data System,

58 OKLAHOMA BH Patient Diagnosis (HRSA Data) Number of Patients with Primary Diagnosis in Behavioral Health Alcohol Related Disorder 210 Other Substance Related Disorders (Excludes Tobacco) Tobacco Use Disorder 630 Depression and other Mood Disorders 6,357 Anxiety Disorders Including PTSD 3,524 Attention Deficit and Disruptive Behavior Disorders 255 2,457 Other Mental Disorders 3,517 Total 16,950 Source: Uniform Data System,

59 Tobacco Use and Health Centers (HRSA Data) Tobacco Specific Performance Measures: 1) Tobacco Use Assessment 2) Tobacco Cessation Counseling Patients Receiving Services from Behavioral Health Staffing Adults Assessed for Tobacco Use 7,696,564 (79.54%) Adult Tobacco Users Receiving Tobacco Cessation Intervention 1,110,973 (52.69%) Source: Uniform Data System,

60 Tobacco Use and Health Centers (HRSA Data) Tobacco Specific Performance Measures: 1) Tobacco Use Assessment 2) Tobacco Cessation Counseling Patients Receiving Services from Behavioral Health Staffing Adults Assessed for Tobacco Use 49,913 (80.6%) Adult Tobacco Users Receiving Tobacco Cessation Intervention 7,642 (41.3%) Source: Uniform Data System,

61 SAMHSA S Strategic Initiatives 1. Prevention 2. Trauma and Justice 3. Military 4. Recove ry 5. Health Reform 6. Health Inform ation Techn ology 7. Data, Outco mes & Quality 8. Public Aware ness

62 Region VI PBHCI State Team Meeting September 2013 State Primary Care Association Director State Primary Care Organization Director State Maternal Child Health Director State Medicaid Director State Mental Health Director State Substance Abuse Director State Provider Association Director State Recovery Oriented System of Care Director (ROSC) State National Prevention Network Director (NPN)

63 INTEGRATING INTO HEALTH CARE & COMMUNITY SETTINGS BEHAVIORAL HEALTH

64 Region VI HHS Health Prevention Collaborative Participatin g OPDIVS: SAMHSA RD ACF MCH CMS OASH HRSA Purpose: The HHS OPDIVS selected the priority of mental and emotional well-being & prevention of drug abuse (Rx drugs) and excessive alcohol use under the National Prevention Strategy

65 SAMHSA s Role in Health Homes

66 Health Homes Health Homes are designed to be personcentered systems of care for Medicaid enrollees with multiple chronic conditions They are intended to facilitate access to and coordination with an array of health care services, including: Primary care Acute care services MH/SUD services Long-term community-based care and support

67 Types of Health Home Providers Three types of provider arrangements: Designated provider Team of health care professionals that link to a designated provider Health team There also exist opportunities for participation by MH and SUD service providers in Health Homes

68 Addressing MH/SUD Needs through Health Homes: Required Consultation with SAMHSA

69 HEALTH COVERAGE IN 2014 Coverage Options for Adults without Medicare or Employer-Based Coverage 69 Income as a percent of the federal poverty level Medicaid Exchange with Tax Credits Exchange or Private Plan A Continuum of Coverage Everyone Fits Somewhere!

70 SAMHSA Enrollment Strategy Collaborate with national organizations whose members/constituents interact regularly with individuals with mental health and/or substance use conditions to create and implement enrollment communication campaigns Promote and encourage the use of Centers for Medicare and Medicaid Services (CMS) marketing materials Provide training and technical assistance in developing enrollment communication campaigns using these materials Provide training to design and implement enrollment assistance activities Channel feedback and evaluate success

71 Supporting Intermediaries Intermediary - focused efforts will be formed in six categories: Prevention MH & SUD Providers Coalitions Criminal Justice Consumer, Family, Peer, & Recovery Communitybased Social Services Homeless Services 71

72 Intermediary Efforts Supporting coalition groups in their commitment to promoting access to insurance for their constituents Inviting coalition groups to shape enrollment support policy, planning, training and materials development Providing leadership for other organizations 72

73 Three Stages of the Effort SAMHSA and coalitions will create training and technical assistance to encourage enrollment of individuals with M/SUD 73 SAMHSA will work with coalition organizations to offer training to their members/ constituents to develop enrollment campaigns and provide enrollment assistance Members/ Constituents will implement activities to motivate and assist their clients/ patients to enroll

74 The Help We Are Seeking From National Behavioral Health Organizations Provide input on the development of targeted training and technical assistance for their members/constituents Partner in the delivery and promotion of training and technical assistance to their members/constituents Offer feedback from members/constituents on their training and technical assistance experience and other needs 74

75 SAMHSA Enrollment Training Resources Bringing Recovery Support Services to Scale Technical Assistance Center Strategy (BRSS TACS) (8) $25,000 awards to recovery CBOs - to build collaboration & disseminate information about state enrollment activities & effective outreach strategies. BHbusiness : creating 30 learning networks of 30 behavioral health providers each to receive training on 5 different business skills to prepare them for the new health care environment Eligibility and enrollment (summer)- resource library and 15 minute videos of peers who have 75 applied training techniques.

76 Timeline Laying the Groundwork Coalition formation Health insurance literacy training and technical assistance February May 2013 Preparing for Enrollment Enrollment campaign training Enrollment assistance training June September 2013 Enrolling Eligible Individuals Continuation of enrollment campaigns Enrollment assistance October March

77 Enrollment Resources Healthcare.gov HHS Partners Resources Education/Outreach/HIMarketplace/index.html SAMHSA Enrollment Webpage State Refor(u)m Exchange Decisions Enroll America Best Practices

78 What are we trying to achieve? A person-centered system of care that achieves improved outcomes and better services & reduced cost A holistic approach of integrated care with an emphasis on prevention and longterm care

79 HELP US CHANGE THE CONVERSATION! 79

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