Funding Strategies for Early Psychosis Intervention Models

Transcription

1 National Council for Behavioral Health Funding Strategies for Early Psychosis Intervention Models July 9, 2014 Supported by the National Association of State Mental Health Program Directors Technical Assistance Coalition

2 Webinar Logistics Select "Dialing-in to the Audio Conference Via Phone" Dial Enter the conference ID number: # Difficulty joining the call? Adobe Tech Support: Issue during the call? Dial *0 for immediate help.

3 National Council for Behavioral Health Dr. Steven Ronik CEO, Henderson Behavioral Health Cathy Adams Founder, Early Treatment and Cognitive Health Cathy Abshire Acting Division Director, Division of State and Community Systems Development, SAMHSA

4 Mental Health Block Grant 5% Set Aside First Episode Psychosis January 2014: Congress passed H.R.3547: Provides SAMHSA funds to support the development of evidence-based early psychosis treatment programs. Evidence-based programming: SAMHSA and NIMH have worked together to provide technical assistance on models for states to consider for use of their set aside funds.

5 NIMH & SAMHSA manuals. Ultimately, early intervention coordinated specialty care models are: Team-based Collaborative Recovery-oriented Overview & Resources Involve individuals experiencing first episode psychosis, treatment team members, and when appropriate, family members as active participants. Visit for additional early intervention resources.

6 Dr. Steven Ronik Chief Executive Officer Henderson Behavioral Health

7 Funding Landscape in Florida Mental health is low priority. Lack of emphasis on prevention. Lack of emphasis on early intervention. Have not accepted Medicaid expansion. Increase in commercial covered lives through the Federal Exchange.

8 At Henderson Behavioral Health Big emphasis on research: Participant in the CATIE trials. Mental Health Treatment Study. RAISE research. Big emphasis on early intervention. History of of using evidence-based services.

9 Funding Strategy for First-Episode Program Solicited private foundations. Worked with Development Department. Pitched the value in First-Episode work: Discussed some of the existing evidence. Our experience with RAISE. Obligation to our community to do this and why

10 Funding Strategy for First-Episode Program Worked with local and state funders around the 5% set aside. Made case for our experience based on participating in RAISE since Informed State of existing commitment from private foundation to enhance the setaside funding.

11 Have to Keep On Tryin Sometimes one door closes and another opens. Did not receive special project for first-episode, but did receive the other commitments. So need to have multiple and simultaneous pitches and asks.

12 Focus of the Pitch Organizational commitment and track record of innovation and commitment to science. Obligation to our community. Right thing to do and illustrate cost savings.

13 Contact Info Dr. Steven Ronik Chief Executive Officer Henderson Behavioral Health

14 Catherine Adams LMSW, ACSW, CAADC

15 First Episode Treatment Experience Participated in the RAISE ETP program. Integrated treatment team provided: Pharmacological Management using a computerized decision support system Family Education Program (FEP) Supported Employment and Education (SEE) Individual Resiliency Training (IRT) recovery based individual therapy Treatment provided to clients for at least two years.

16 Team members Project Director Team lead and supervisor Responsible for program recruitment Family Therapist May be the project director IRT Clinician (1-2 clinicians) SEE Therapist Prescriber (MD or APN) RAISE ETP Team

17 RAISE ETP Units of Service: Year 1 Role IRT Family Client Contact ~ 2 contacts per month; weekly to start and then gradual reduction ~ 10 contacts per client/family; PRN thereafter SEE Prescriber ~ Bi-weekly contacts until employed or in school with monthly follow-up after employed or school enrollment ~ 12 contacts per client

18 CEI RAISE ETP Experience Treatment providers valued the team experience. Weekly team meetings were well attended and provided a venue for problem solving. A majority of patients fully engaged in the program and participated in all the RAISE services. Most patients returned to work and/or school. Very few patients were re-hospitalized over the course of the program. 6 of 18 were re-hospitalized.

19 First Episode Implementation: Organizational Structure Director works with agency administration, recruits clients, and leads the team Agency Administration Director Recruitment from referral sources First Episode Team

20 First Episode Implementation: Team Selection When selecting a first episode team, consider the following points: 1. Interest in early treatment and younger populations. 2. Recovery-oriented mindset. 3. High level of respect for clients independence and selfdetermination. 4. Supportive of a shared decision making model of care. 5. Flexible in tailoring interventions. 6. Open to partnerships with family/natural supports. Voluntold is not a viable staff selection strategy for this model.

21 First Episode Implementation: Determine Program Criteria When developing inclusion criteria for the program consider: Population size Referral sources Team capacity Organizational structure of CMH

22 First Episode Implementation: Graduated Start-up Project Director also served as FEP clinician. Participants are added to existing caseloads of selected case managers/therapists. Ongoing triage of case manager workload and adjustments made to accommodate for more intensive demands of the intervention. SEE Clinician FTE adjusted as clients are enrolled. Participants are added to prescriber caseload and adjustments to current caseload are made as needed. RN support remained embedded in existing med clinic.

23 First Episode Implementation: Funding Prepare to bill private insurances. - Many first episode patients in RAISE were privately insured. Credential treatment staff. Obtain authorizations if required. Monitor collections/pursue missed payments. Consider negotiating with large private insurers in area to bundle services and bill as a package of interventions.

24 Michigan s Behavioral Health Landscape Capitated system where PIHPs/CMHs are Medicaid behavioral health managed care organizations. Funds are allocated based on the number of covered lives or Medicaid beneficiaries. Recent Medicaid expansion resulted in significant reduction in General Fund dollars. Privately insured individuals were not typically eligible for services (exception made for the RAISE research implementation).

25 Michigan: First Episode Treatment Michigan received SAMHSA approval for the 5% set aside. The proposal will create 2-3 first episode teams across the state. The teams will provide: Family therapy, individual therapy, case management, supportive employment and education, and medication management. Currently, the state is initiating an RFP for which interested agencies can respond. Treatment teams will begin providing services in late 2014.

26 Contact Info Catherine Adams LMSW, ACSW, CAADC Early Treatment & Cognitive Health

27 Q & A Have specific questions on 5% MHBG Set Aside? Cathy Abshire is here to answer! Cathy Abshire is the Acting Division Director, Division of State and Community Systems Development, SAMHSA. Have questions for other presenters? Type your questions into the text box on the right side of your screen.

28 Stay Tuned! Stay tuned for the National Council s next early intervention webinar: Community Outreach and Prevention as an Element of Early Intervention in Psychosis Tues., July 22, from 2:00-3:30pm EDT. To be notified about this webinar, please Adam Swanson at AdamS@TheNationalCouncil.org.