Georgia Department of Behavioral Health &
Developmental Disabilities
State of Georgia Planning Initiative
on Mental Health
Planning Initiative
• The December 2008 report of a gubernatorial Mental
Health Service Delivery Commission;
• Priorities raised by advocates and providers in a series of
meetings with Drs. Shelp and McDonald;
• A Voluntary Compliance Agreement with the federal
Office of Civil Rights in the Department of Health and
Human Services regarding Olmstead issues and the need
to demonstrate compliance; and, a CRIPA Settlement
Agreement with the federal Department of Justice;
• A new state organizational structure and new senior
management hired in response to the recommendations of
the Commission report to create a separate Department of
Behavioral Health and Developmental Disabilities (DBHDD).
Community Partners
•
Federal Center for Mental Health Services (Bill Hudock), the federal Center for Medicare and
Medicaid Services , the Carter Center (Tom Bornemann PhD), the Bazelon Center for Mental
Health Law (Bob Bernstein, PhD), Atlanta Legal Aid Society (Talley Wells and Sue Jamieson),
Georgia Legal Advocacy Office (Josh Norris and Ruby Moore), Georgia Association of
Community Service Boards (Darril Gay PhD Tom Ford, Tod Citron), national experts in
inpatient hospital care (American Health and Wellness Institute), the Behavioral Health
Services Coalition of Georgia (Ellyn Jeager)which represents over twenty-five organizations
including Mental Health America of Georgia and the National Alliance for Mental Illness, the
Mental Health Planning and Advisory Council (Pierluigi Mancini, PhD), the Georgia Consumer
Support Network (Sherry Jenkins Tucker) as well as national expert in peer support (Larry
Fricks), Georgia Council on Substance Abuse (Neil Kaltenecker), Georgia Parent Support
Network (Sue Smith, Ed D), Georgia Psychiatrists Physicians Association (Lasa Joiner), private
housing providers/ specialists (Jean Toole, Ken Whiddon and Paul Bolster), Sheriff’s
Association (Sheriff Terry Norris), Georgia Board of Regents (Ben Robinson), Emory University
(Bill McDonald, MD and Eve Byrd, MSN, MPH), Medical College of Georgia (Peter Buckley,
MD), Mercer University School of Medicine (Melton Strozier, PhD), Georgia Hospital
Association (Matt Crouch), and stakeholders and advocates from across the state to evaluate
and develop a comprehensive plan for community support for patients with SPMI.
Georgia Behavioral Health Stakeholders
Priorities and Process Discussion
June 15, 2009
Carter Center
Mental Health Service Delivery Commission
Final Report
Recommendations
 Community-Based Crisis Stabilization
 Supported Housing
 Continuum of Case Management Services
 Common Preferred Drug List
 Supported Employment
 Transportation
 Uniform Children’s Benefit Package
 Adult Services
 Behavioral Health Collaborative
 Inpatient Services
Coordinating Council
• Chaired by Dr. Shelp
– Includes the commissioners of DCH, Human Services,
Corrections, Juvenile Justice, a member of the House, a
member of the Senate, an adult receiving DBHDD services,
a family member of a consumer and an adult parent of a
child receiving services
– Projects to include
• developing a common formulary and HIE
• areas in which the DBHDD can maximize funding from federal and
private sources
Populations of Focus
• Long term residents of State Psychiatric Hospitals who can be served in
the community and are subject to attention under the Olmstead decision
and the Voluntary Compliance Agreement with the federal Office of Civil
Rights.
• People who are recently or frequently readmitted to the State Psychiatric
Hospital.
• People who currently are, or recently were, incarcerated and who have
mental health and potentially co-occurring substance use condition
treatment needs.
• People who are chronically homeless and who have mental health and
potentially co-occurring substance use condition treatment needs. This
population typically is difficult to serve, more apt to have expensive and
complex physical illnesses, and apt to deteriorate significantly in the
absence of appropriate treatment and supports.
• Children and adolescents with severe emotional disturbances
In the next one to three years:
• Increase community behavioral health services
capacity
• Improve access to local community based behavioral
health services
• Improve inpatient care
Increase community capacity:
Expand the Medicaid Plan
• Partnership with DCH: Dr. Meadows and Catherine
Ivy
• SSI/ SSDI Outreach, Access Recovery program or
SOAR process
• DBHDD and DCH are obtaining technical assistance
from CMS on cost reporting to improve the Medicaid
reimbursement for providers
• Targeted Case Management (TCM) and a state 1915i
Medicaid plan amendment
1915i
• Bill Hudock (federal Center for Mental Health
Services), John O’Brien (federal Center for
Medicaid and Medicare), Wendy Tiegreen
(DBHDD) and Catherine Ivy (DCH)
• Medicaid plan amendment and not a waiver
– Only two states have a 1915 amendment (Iowa and
Wisconsin)
– Budget neutrality not required
– Can be limited with waiting list and specified to region
1915i
number served
•
•
•
•
•
Year 1: 7/1/2010- 6/30/2011- 175
Year 2: 350
Year 3: 550
Year 4: 775
Year 5: 975
1915i:
Population served
• Stay in a state psychiatric hospital of over 60 days in the last 12
months;
• Three (3) or more hospitalizations/crisis stabilization admissions in
the last 24 months;
• Hospitalized in a state psychiatric hospital in the past year AND
chronically homelessness defined by either one of the following:
– a) continuously homeless for one full year; OR
– b) having at least four (4) episodes of homelessness within the past
three (3) years;
• Hospitalized in a state psychiatric hospital in the past year AND
multiple incarcerations in the last 12 months;
• Currently resides in a behavioral health treatment or support
residence AND meets a LOCUS level 4, 5, or 6 at the time of
evaluation indicating the risk of rehospitalization or homelessness.
1915i:
Person-Centered Planning & Service Delivery
• The care coordinator will provide information
both verbally and in writing to the participant
about the person-centered planning process,
their opportunity to include others to
participate in the planning the services
available through the program and that they
will be able to select qualified service
providers of their choice.
1915i:
Supports provided
• Supporting housing retention (such as crisis coping skills, dispute
resolution and peer mentoring,);
• Building and maintaining independent living skills (such as meal
planning and preparation, household cleaning, shopping,
budgeting, community resource access and utilization and wellness,
recreational and social activities);
• Facilitating mental health, medical, dental and (when indicated)
substance abuse appointments and treatment;
• Family services including family reunification facilitation and
parenting classes;
• Medical and non medical transportation;
• Monitoring or directly providing personal care services. All
recovery-building activities are intended to support successful
community living through utilization of skills training, cuing and/or
supervision as identified in the individualized supports plan.
1915i:
Supportive employment
• Supported employment is a comprehensive approach to vocational
rehabilitation whereby the employment specialist works with the
individual, the family, and the treatment team (practitioners who provide
services such as case manager, therapist, psychiatrist) to integrate
supported employment with mental health treatment toward promoting
recovery. The goal of supported employment is to help people with the
most severe disabilities participate in the competitive labor market, work
in jobs they prefer with the level of professional help they need, and help
people advance in their careers. Major activities may include: employment
assessment – assessment is based on a person’s interests, skills, and prior
experience and primarily occurs in the community; job training –
assistance for the individual to begin work, learn the job and interact
appropriately with co-workers, customers, and supervisors (coaching,
teaching, assistive technology, and accommodations); ongoing support to
maintain employment – offered are career development, access to
educational opportunities, coaching, vocational educational classes, job
counseling, transportation, changes in the treatment plan, and assertive
outreach to the client.
1915i:
Addiction Services
•
•
•
In addition, the planning team must have access to:
An addiction specialist (Certified Addiction Counselor II (or equivalent) or
addictionologist for planning consult (not face-to-face) if the evaluation indicates
an addiction issue co-occurring with a psychiatric issue; AND
A psychiatrist for providing consult as needed to assist with the functional
goals/objectives set forth during planning
Increase community capacity:
Expand the Provider Network
• Well developed provider network
– Medicaid waiver programs including the Service
Options Using Resources in a Community
Environment (SOURCE), Community Care Services
Program (CCSP), and Independent Care Waiver
Program (ICWP) for patients with traumatic brain
injury.
Increase community capacity:
Expand the Provider Network
SOURCE
FY09
18415
FY08
16315
FY07
13236
FY06
9442
FY05
7623
FY04
4952
FY03
Series1
2785
FY03
2785
FY04
4952
FY05
7623
FY06
9442
FY07
13236
FY08
16315
FY09
18415
Increase community capacity:
Expand the Provider Network
• Audrey Sumner completed fidelity scores to
the Dartmouth Assertive Community
Treatment (ACT) model of the sixteen ACT
programs
– ACT teams in the state will meet next week with
the Olmstead planning committee to determine
which Olmstead patients can be transitioned into
the community with housing
– Pathways to Housing Program
Increase community capacity:
Expand the Provider Network
• Pathways to Housing Program
– Housing first
– Train the trainer
– 75 clients
– Presently in procurement
Increase community capacity:
Improve the supportive housing network
• Housing subcommittee (Stan Jones and Jean Toole with Talley Wells)
– Engage DCA: Doug Scott and Ron Pounds
– Georgia’s model housing collaboratives between CSB’s and local
housing authorities will a conduct a workshop providing technical
assistance to other CSB’s and housing authorities regarding applying
for grants to develop supportive housing programs.
– The Georgia Community Service Board Association has agreed to
develop a strategy, to be completed by April 2010, for increasing the
capacity of supportive housing currently being provided by CSBs
– List of administrative policies and procedures mandated by the state
which increases the providers’ administrative costs for providing
housing and decrease their service dollars therefore decreasing their
capacity.
Increase community capacity:
Develop systems of care for children and
adolescents
• Child and adolescent subcommittees (Chairs
Sue Smith and Cynthia Wainscott)
– Modeled after WrapAroundMilwaukee
• provide comprehensive, individualized and cost
effective care to children who have serious emotional
or mental health needs, and are referred through the
Child Welfare or Juvenile Justice System and are at
immediate risk of placement in a residential treatment
center, juvenile correctional facility or psychiatric
hospital.
Increase community capacity:
Develop systems of care
• Grant for 3.8 million to develop systems of
care using the federal funding for the
Community-Based Alternatives for Youth
(CBAY) demonstration project designed after
evidence based WrapAroundMilwaukee
• Four care management entities (CME’s) of 283 children
with severe emotional disturbances using the
Wraparound Milwaukee system of care
• Synthesis software
Increase community capacity:
Develop systems of care for children and adolescents
• $480,000 grant from SAMHSA for the Healthy
Transitions Initiative.
– young adults aged 16 to 24 years old with serious mental
conditions transited to adulthood in areas such as
education, employment, housing and other services. The
youth will have both a transition coach and a family liaison.
• DBHDD is evaluating the contracts with the Psychiatric
Residential Treatment Facilities (PRTF’s) and putting
specific outcomes into the contracts as well as adding
some needed crisis beds for children and adolescents
with developmental disabilities.
Improving Inpatient Care
• Developing partnerships with the Medical
Universities in Georgia
• Developing the skills of state hospital
employees
• Engaging outside experts to improve care in
the hospitals as recommended by the Bazelon
Center and other advocacy groups
Improve access to local community
based behavioral health services
• Coordinate hospital discharges
– Web based system to coordinate discharge
planning and hospital follow up.
– Centralized network for accessing mental health
services, the Georgia Crisis and Access Line,
managed by Behavioral Health Links
Improve access:
Behavioral Health Links
• BHL
– Named one of the 2009 Top 50 Government
Innovations out of 600 applicants by the Harvard
Kennedy School’s ASH Institute for Democratic
Governance and Innovative Applications
– Proposal to manage follow up appointments with
community providers and provide basis clinical
information via an EMR
– Could evaluate clinical resources in the
community
Improve access:
Provide community hospital care for patients when appropriate
Improve access
• Increase the length of stay (LOS) regulation for
the Crisis Stabilizations Programs (CSP’s) from
7-10 days to 30 days by renegotiating the LOS
with DCH
Improve access:
Communication with providers
• Telemedicine and an electronic health record
(EHR)
• DBHDD met with leadership from the CSB’s in
a series of technology workgroups to discuss
developing a common EHR and HIE.
• DBHDD has been working with Paula Guy, RN,
Executive Director of the Georgia Telehealth
Partnership, Inc
Improve access:
Medical care for community patients
• Bill to provide medical care in CSB’s
• Coordinate efforts to serve Georgians with
mental illness across state government
agencies
– Behavioral Health Coordinating Council
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Georgia Department of Behavioral Health