Maryland
MHBG FIVE (5) PERCENT SET-ASIDE
NASMHPD 2014 Conference
BRIAN HEPBURN, M.D.,
DIRECTOR,
MARYLAND BEHAVIORAL HEALTH ADMINISTRATION
Congress increased FY2014 funds to the MHBG program by 5%, then
required that the new funds be applied to early SMI interventions. The
funding is dedicated to provide supports and services for those "with
early serious mental illness" and not for primary prevention or
preventive intervention for those at risk of serious mental illness.
States are encouraged to fund programs to meet the needs of persons
with early psychotic disorders, specifically first episode psychosis. States
may address these needs either through enhancing existing program
activities or development of new activities.
Maryland’s NIMH RA1SE Project –
Recovery After an Initial Schizophrenia Episode
Maryland established an early psychosis intervention program in Baltimore in
July, 2009 as a key element of the NIMH RA1SE research project.
The RA1SE Connection Program is an intensive outpatient treatment team with
weekly sessions of evidence-based services including medication management
with a psychiatrist, psycho-education and skills training with licensed social
workers, substance abuse treatment, and supported education and employment.
 The intermediate-term goal of the Connection Program is to provide communitybased recovery-oriented individualized services to persons who are within the
first one to two years of developing psychosis and schizophrenia to improve
functioning and reduce symptoms.
The long-term goal is to prevent the development of long term disability and to
promote independent, integrated community living.
Five Percent (5%) Mental Health Block Grant Set-Aside
for Early Intervention
The Baltimore-based Connection program’s clinical services will
be insufficient to meet the needs of young people with first
episode psychosis (FEP) throughout the state.
It is estimated that one team is needed for 500,000 population.
Given Maryland’s population of approximately 6 million, this
would suggest that approximately 12 teams are needed.
Five Percent (5%) Mental Health Block Grant Set-Aside
for Early Intervention
 RA1SE-type first-episode psychosis services are now called “Coordinated Specialty Care”
(CSC) in federal guidance.
The 5% mental health block grant set-aside will be used to further expand CSC through
funding to support Maryland’s Early Intervention Program (EIP), a State-funded program
currently under development in Maryland.
The EIP will be comprised of three components: 1) Outreach and Education Services, 2)
Clinical Services; and 3) Regional Early Intervention Learning Collaborative Teams.
 Research will be integrated into each of these components
Five Percent (5%) Mental Health Block Grant Set-Aside
for Early Intervention
The 5% mental health block grant set-aside will primarily address the second component
of the EIP, Clinical Services, implementing Coordinated Specialty Care (CSC).
The funding will support infrastructure and management, as well as data
collection/evaluation, of two new CSC Early Intervention Teams under the EIP, serving the
same population as the RAISE Connection program described above.
Although some of the services provided by the new teams will be reimbursable, a
considerable number of them will not. Additionally, time spent in training, and more
importantly, in outreach/education to the broader community are not reimbursable.
Five Percent (5%) Mental Health Block Grant Set-Aside
for Early Intervention
The 5% mental health block grant funding will provide the critical support needed to
structure the teams to maximally provide the appropriate support to those with early
psychoses, as well as to provide outreach and education, in order to identify as many in
need of these services as possible. The Coordinated Specialty Care Team roles include:
 Team Leader – overall coordination of services, individual therapy, case management,
crisis intervention, information gathering, safety planning, outreach/education.
 Recovery Coach – Social Skills training, weekly participation group, monthly family
group, school coordination, outreach/education.
 Employment/Education Specialist – Job development, addressing work and schoolrelated goals/problems, outreach/education.
 Psychiatrist – Prescribing, shared decision making, education.
EIP Team Training
a. psycho-education about psychosis
b. assessment and diagnosis of early psychosis
c. prescribing and management of recommended pharmacological treatments
d. engaging young people and their families in care
e. use and implementation of evidence-based practices for improving social
functioning, reducing substance abuse, re-engaging in work or school or pursuing new
educational/work opportunities, working with families, and assessment of and
planning for safety.
f. use of supported education and employment geared towards young adults
g. safety planning
h. providing care within a model of mental health recovery.
EIP Team Training
The Evidence Based Practice (EBP) Center of Behavioral Health Systems Improvement
Collaborative, funded by the Maryland state authority at the University of Maryland
Department of Psychiatry will provide training and consultation to the new teams. This
will include use of evidence-based supported employment, co-occurring disorders,
pharmacotherapy, and family psycho-education geared towards young adults.
There will also be use and implementation of EBPs for improving social functioning and
working with families. Evidence supported tools will also be utilized for assessment of
aggression and violence, suicide risks, reducing substance use and re-engaging in school
and pursuing new educational opportunities.
EIP Data and Evaluation
The Systems Evaluation Center within the Behavioral Health systems Improvement
Collaborative at the University of Maryland will oversee the collection of data to ensure
that Maryland meets the reporting requirements for this project.
Additionally, as time and resources allow, the Center will perform additional evaluation
activities in order to identify “lessons learned” during the Maryland implementation that
can be applied to future system and program development.
The Systems Evaluation Center and the Evidence-Based Practices Center will work
together to develop and implement a fidelity assessment plan for the project.
RA1SE Connection Team - Lessons Learned
Have strong support by the Mental Health Authority and flexibility in funding. The
insurance profile and needs may vary from site to site.
Have trust and confidence in the relationship between the SMHA/University/Providers.
(If new relationship, much attention needed to nurture relationship.)
Try to use consumers insurance when possible. In Maryland’s experience approximately
half had private insurance. The benefits package will be very different then the Medicaid
package. (This becomes an issue when estimating financial needs.)
Develop close relationship with Medicaid. To maximize enrolling individuals on MA and
to learn from them regarding ways to establish alternative financing through waivers.
RA1SE Connection Team - Lessons Learned, continued
Need to have close relationship with program sites. The sites will have competing
priorities. There need to be regular meetings and continued emphasis on the importance
of the project.
Get buy in from stakeholders groups. They can help with advising the project but also are
good ambassadors for the program to legislators etc.
Need a good evidence based practice training and implementation infrastructure – as
provided through EBP Center at University of Maryland.