Provider Forum
Clinton Macomb Public Library
November 14, 2013
How MCCMH is supporting and
encouraging recovery…and
how you can help
Macomb County Community
Mental Health, guided by the
values, strengths, and informed
choices of the people we serve,
provides quality services, which
promote recovery, community
participation, self-sufficiency,
and independence
Macomb County Community Mental Health Mission Statement

There is a new working definition of Recovery
from Mental Disorders and Substance Use
Disorders as follows:
A process of change through which individuals
improve their health and wellness, live a selfdirected life, and strive to reach their full
potential.
There is no set time requirement for recovery, as
it is recognized that this is an individualized
process whereby each person’s journey of
recovery is unique and whereby each person in
recovery chooses supports, ranging from clinical
treatment to peer services that facilitate recovery.
Through the Recovery Support Strategic
Initiative, SAMHSA has also delineated
four major dimensions that support a
life in recovery:
• Health : overcoming or managing one’s disease(s) as
well as living in a physically and emotionally healthy
way;
• Home: a stable and safe place to live;
• Purpose: meaningful daily activities, such as a job,
school, volunteerism, family caretaking, or creative
endeavors, and the independence, income and
resources to participate in society; and
• Community : relationships and social networks that
provide support, friendship, love, and hope

As staff, providers, loved ones, we can
have a major impact on how a person in
service feels about their own recovery,
their individual ability to recover and the
confidence to make it happen!
◦ Recovery is strength based…meaning
we need to identify and focus on
strengths and abilities, not negatives
or limitations.
◦ Identify, support, encourage strengths!
Health: overcoming or managing one’s disease(s) as well
as living in a physically and emotionally healthy way
• MCCMH is working to raise awareness of the
importance of Integrated Health Care.
– Participation in State Learning Community
– Case to Care Training made available to staff to focus
attention on role as Care Manager, to include primary
healthcare
– Building co-location and other integrated care
opportunities:
• McLaren Mobile Outreach Clinic
• Bruce Johnson, M.D.
• MyCare
– Focus on Integrated Care at Drop-in Centers…Healthy
Eating, Yoga, Information for persons in service and staff
– Person-Centered Plans are to be Recovery-Focused and
address all aspects of a person’s care.
Home: a stable and safe place to live
 Recently issued Residential Placement Protocol to
ensure people are served in the least restrictive
level of care possible
 Development of Person-Centered Plans to prepare
for Semi-Independent and Independent Living
 Approval of a contract with Community Housing
Network to bring a “Getting My Own Address”
support and informational group to Macomb County
 Assignment of a Certified Peer Support Specialist to
the MCCMH HUD-supported PATH program to assist
staff and consumers in identifying resources and
building strengths toward independent living
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Implementation of the Supported
Employment evidence-based practice
What other activities are occurring with
persons served to provide meaningful
activities?
Needs to be a focus throughout, from case
management, to group home providers, to
natural supports on development of
meaningful activities for persons served



Development of the role of Commonwealth
Administrator
Development/enhancement of social
networks connectedness and further
attention to development of meaningful
activities for persons served
More later…
Where do we go from here…?
 How do we assist the person served to
become less dependent on services, and
be able to more easily re-access services
when needed?
 Increase roles of Certified Peer Support
Specialists
 WRAP – Wellness Recovery Action Plans
 ???
Where is my contract???
Where is my contract???
All providers received
notification of current
contract extension until
December 31, 2013
Contracts
Where is my contract???
All providers received notification of current
contract extension until December 31, 2013
New contract cycle to start January 1, 2014
Contracts
Where is my contract???
All providers received notification of current
contract extension until December 31, 2013
New contract cycle to start January 1, 2014
The new contracts will run for
thirty-three (33) months
Contracts
Where is my contract???
All providers received notification of
current contract extension until
December 31, 2013
New contract cycle to start January 1, 2014
The new contracts will run for
thirty-three (33) months
Contracts will run until September 30, 2016
Continuing Emphasis on Recovery
“Mental health recovery is a
journey of healing and
transformation enabling a person
with a mental health problem to live
a meaningful life in a community of
his or her choice while striving to
achieve his or her potential.”
“Mental health recovery is a journey of
healing and transformation enabling a
person with a mental health problem to
live a meaningful life in a community of
his or her choice while striving to
achieve his or her potential.”
Section K - Recovery
Employment Opportunities for
Individuals With Disabilities
For example:
Employ a sufficient workforce of persons with life
experiences across all levels who are paid fair and
competitive wages commensurate with their position
and with other employees of the same pay grade, and
provide multiple opportunities for full and/or part-time
positions, and a viable career ladder;
Make affirmative efforts to employ individuals with
disabilities - recruit, place, with competitive pay scales,
fringe benefits, and training included.
For example:
Include language of recovery in all job
descriptions (paid and volunteer) and ensure
that job descriptions outline recovery-based,
person-centered, culturally competent
practices and specify that applicants with
'lived experiences' with behavioral health
issues are desired.”
Continuing Emphasis on
Peer Support Specialists
Continuing Emphasis on
Peer Support Specialists
Continuation of
Integration of Care
Contract Requirements
and Audits
MCCMH will continue to monitor the provider
panel to ensure that all providers are meeting
the contract requirements. MDCH is putting
greater emphasis on the PIHP’s to guarantee
that quality services are being provided.
MCCMH will be increasing the number and
type of audits with our provider panel.
Contract Requirements
and Audits
This means that MCCMH will continue to do the
Technical review audits on the “front door”
providers and the ancillary audit on all other
providers. These will continue to be carried out
by the Business Management Division of
MCCMH. In addition, new audits are being
developed and will be rolled out in the months
to come.
The Quality Improvement Division and
Business Management Division are
developing new audit tools. New audits
will focus on:



Evidence based practices
Integration of Care
Treatment Plans
Contract Requirements
and Audits
Why are we doing this?
We are all working together as an integrated
team for the benefit of the people we serve.
We are striving to improve the quality of life
for the people we serve.
Why are we doing this?
The goal of these audits and reviews is to:
 provide technical assistance/guidance on
documentation requirements and service
delivery;
 To facilitate lines of communication between
MCCMH and the provider panel.
Trends and Analysis
During last fiscal year, the Corporate
Compliance Division investigated 60 cases.
Friendly reminder of the day!
All staff are responsible for reporting all
potential corporate compliance issues!!
Trends and Analysis
Responsible Party for the
Compliance Issues
Sample = 60
Support
Corrdination
17%
Specialty
provider
Self 3%
Ancillary
Determined
Provider
Employer
43%
12%
Residential
3%
Home based Outpatient
13%
2%
Case
managemen
t
5%
ABA
Provider
2%
Trends and Analysis
Compliance Issue By Type
Training
Billing
5%
5%
Credentialing
2%
Documentation
Services
26%
38%
HIPAA
17%
Ethical
7%
Trends and Analysis
Compliance Infractions
Confirmed Yes/No
In Process
13%
NO
17%
YES
70%
Trends and Analysis
Investigation Outcomes
LARA
License
informed
Renewed
2%
2%
In Process
13%
No
Compliance
Correction
Concern
Plan
16%
Requested
50%
Reimbursem
ent
Requested
17%
Future Plans
MCCMH will be going for
NCQA accreditation
Focus will be on quality
Mental health problems and alcohol and drug use, are
among the most common and disabling health
conditions. They often co-occur with acute and
chronic medical problems and can substantially
worsen associated health outcomes. When mental
health problems are not effectively treated, they can
impair self-care and adherence to medical and mental
health treatments, and are associated with increased
morbidity and mortality, increased health care costs,
and decreased productivity.
Effective integration includes:
•
•
•
•
•
Workforce development and capacity
building
Utilization of validated and effective tools
to track clinical outcomes
Development of supports to consumers
and families
Development of policies supportive of
integrated practices
Development of routine and effective
outcomes, monitoring and evaluation
We Know:
That the population we serve experience:
•
•
•
•
•
High morbidity and mortality due to multiple conditions
High incidence and prevalence of obesity, diabetes,
hypertension, etc.
Elevated risk factors for coronary heart disease
Among this population there are issues such as: inadequate
physical activity, poor nutrition, smoking , side effects of
psychotropic medications, etc.
These health conditions are preventable through routine
health promotion activities, primary care screening,
monitoring, treatment and care management /coordination
strategies and/or other outreach programs at home or
community sites.
System Integration and
Transformation Needed
Usual Care
Fragmented (silo)
Not coordinated
Behavioral health care
- mental health
- substance abuse
Specialist care
Other care
Team
PC Physicians
Delivery System
Transformation and
Practice Redesign
Primary care
- Prevention
- Acute Care
- Chronic Care
Adapted from : Behavioral health and the patient center medical
home, 2012
BH Specialists
Specialists
Other licensed
health care providers
Coordination
Collaboration
Communication
Integrated Team-based
• Policy changes
• Wellness section of website for
community
• Educational opportunities for
providers and consumers
• Case consultation to better manage
complex cases
Integration of Health Care
and Quality
Accountabilities/ value added
services
Coordinate individuals care
among an organized team
of health care professionals
Utilize systems at the
practice level to achieve
higher quality of care and
better outcomes
Focus on whole person care
for individuals (including
behavioral health)
Performance Standards
Proactively work to keep
individuals healthy and
manage existing illness or
conditions
Coordination
of Care
Quality Audits
Outcomes
Services
Performance
• Continue training and coaching
providers to support successful
integration
• Develop a tool to monitor quality
• Create a Comprehensive, Continuous,
and Coordinated System of Care
•
•
Increased quality of life for
people we serve
Increased communication and
ownership of transformation by
providers
Nicole Dwyer, MALPC
Autism Administrator

Early Intervention Service Overview

Program Statistics

Program Successes and Improvements

Autism Council

Resources / Questions
MCCMH Autism Services
Early Intervention Service Overview
 Autism
Waiver Criteria:
Effective April 1, 2013
Medicaid/ MIChild Insurance
18 months to 6th birthday
Autism Spectrum Disorder Diagnosis
Have the developmental capacity to clinically
participate in the interventions
MCCMH Autism Services
Early Intervention Service Overview
Services Covered:
 Screening, Identification, & Referral:
 Access Center (586)948-0222
 Diagnostic and Cognitive Evaluation:
 Diagnostic Evaluation
 Cognitive Evaluation
 Adaptive Behavior Assessment
 Applied Behavior Analysis Services:
 Behavior Assessment & Intervention Plan
 Direct Applied Behavior Analysis Services
 Staff Supervision
 Parent/Guardian Training
MCCMH Autism Services
Program Statistics
Fiscal Year 2013 Statistics:
59 Cases Referred
 83%
Male; 17% Female
 55
different Primary Health Physicians
 23
different Macomb Zip Codes
 92%
of cases are being approved at higher level
of care (10-20 hours of service)
 Approximately
a 10% denial rate
MCCMH Autism Waiver
Geographic Breakdown
Red Dots indicate
Referral
Green Dots indicate ABA
Provider
Blue Dots indicate
Diagnosis/Cognitive
Provider
* 3 additional cases are being served out
of county through the County of
Financial Responsibility Process
 Insurance
Statistics:
Private Insurance Benefit has identified 175
children ages 0 to 18 years throughout the
State to begin ABA Services.
Medicaid/MIChild Benefit has identified 365
children ages 18 months to 6th birthday
throughout the State for ABA Services
38 children approved from Macomb
County (10% of MDCH Enrollment)
MCCMH Autism Services
Program Successes
Staffing Capacity Statistics:
 When Michigan passed the insurance, there were
only 30 practicing BCBAs in Michigan; This has
grown in one year to 80 BCBAs in Michigan (BACB
Website).

Multiple universities are now offering the BCBA
program
 Allowing for insurance reimbursement and hiring
BCBAs and Behavior Technician Staff (H.S. & BA
Level) have added employment opportunities for
residents of Michigan
 System
Improvements for Fiscal Year 2014:
Improve workflow efficiency
Decrease service start-up time
Continue to hire and retain qualified staff for
service components
MCCMH Autism Services
State Autism Council
 Through Executive Order No. 2012-11, Governor Snyder created
the Autism Council to review, adopt and implement that
Autism State Plan.
 The plan will provide comprehensive, lifespan supports to
individuals with ASD and their families through access to
information and resources, coordination of services and
implementation of evidence-based practices.
 8 Subcommittees have been identified under the Autism
Council that cover the lifespan of services and systems
 Early Identification and Intervention Subcommittee Update
 Opportunities to serve on a committee
Resources
 Macomb CMH Specific Information: www.mccmh.net
 Michigan Autism Information: www.michigan.gov/autism
 Parent/Guardian Support Group: http://www.macombasa.org
 Various Autism Related Resources:
www.autismallianceofmichigan.org
 For self-funded companies: www.michigan.gov/autismfund
 The Autism Resource Information Center (ARIC) for Michigan is
coming soon
Nicole.Dwyer@mccmh.net
(586) 469-5780
Macomb County
Community Mental Health





Medication Safety Program;
Mission, Philosophy, Goals, and
Objectives
Factors affecting medication
errors
Project methodology
Current data samples
Conclusion and
Recommendations
As there are inherent risks
associated with the
therapeutic use of
medications, such as
medication errors; our
program mission is to
ensure accurate and
appropriate usage of
medications.
Philosophy
 Medication errors are NOT the result of one
person making an error, but rather a series of
system failures that allowed an error to occur.
 Medication Errors ARE opportunities for
quality improvement.
 Responses to Medication Errors ARE
continuous proactive measures involving
identification of key elements, data
management, and process changes that
eliminates or reduce occurrences.
Reduce preventable medication errors and
improve consumer safety.
Medication Error defined by the NCCFMEP
as "... any preventable event that may
cause or lead to inappropriate medication
use or patient harm, while the medication
is in the control of the health care
professional, patient, or consumer”.
Program Objectives
Establish a new Policy governing the program core
process
Identify stake holders
Classify major factorial elements in medication
errors
Design new Digital Application tailored to the
program dynamics transforming mere data into
information then knowledge
Proactively collaborate process change involving
all stakeholders
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Patient Information: demographic and
clinical information
Drug Information: up-to-date, accurate, and
usable drug info
Communication : eliminate barriers
Drug Labeling, Packaging and Nomenclature
Drug Device Acquisition, Use and Monitoring
Key Causal Factors in
Medication Errors (continued)
• Environmental Factors: including poor lighting,
noise, interruptions and a significant workload
• Drug Storage, Stock, Standardization, and
Distribution
• Staff Competency and Education: is most
important in error preventions strategy
• Patient Education: ongoing consumer education
about medications
• Quality Processes and Risk Management:
redesign the systems and processes rather than
focus on correcting the individuals who make
errors
Sample data analysis
365 medication Errors
Total
Wrong dose administered
(blank)
10%
0%
Wrong consumer
Medication
administered at
wrong time
8%
Medication given
Medication given without
after physician
following instructions
order
1%
discontinued
Medication
1%misplaced
2%
0%
Medication Omitted
78%
MCCMH MEDICATION SAFETY
PROGRAM 2013
Total
Monitoring Prescribing
3%
Dispensing
Documenting
0%
9%
2%
Dispensing
7%
Administering
79%
MCCMH MEDICATION SAFETY
PROGRAM 2013
Error or potential
error occured but did
Total
Error occured and
contributed to, or resulted
not reach the
in, temporary harm to the
consumer
consumer and required
4%
intervention
1%
Error occured that reached
the consumer and required
Error occured that reached
the consumer but did not
cause harm
monitoring or intervention
to preclude harm
47%
48%
MCCMH MEDICATION SAFETY
PROGRAM 2013
Quiz: Select two medication errors
factors that we should give priorities
to:
1)
2)
3)
4)
5)
6)
Patient
7)
Information
8)
Drug
9)
Information
Communication 10)
Drug Labeling
Drug Device
Environmental
Factors
Drug Storage
Staff Education
Patient
Education
Quality
Processes
Is it the r i gh t
Consumer?
Is it the r i gh t
Time?
Is it the r i gh t
Route?
Is it the r i gh t Medicine?
Is it the r i gh t Dose?
Have I done the r i gh t
Documentation?
Name:_______________________
MCCMH MEDICATION SAFETY PROGRAM
2013
Thank you!
Tarek.Albitar@mccmh.net
586-530-1279
Mission Statement
Improve public safety and reduce
recidivism by criminal defendants who
suffer from severe mental illness by
efficiently utilizing both court and
community resources to connect these
individuals with the best and most
appropriate treatment options while
maintaining accountability for the crime
committed.
The 16th Judicial Circuit court will
implement a Mental Health Court
docket to assist seriously mentally ill
defendants with close supervision and
coordination among the criminal
justice system, the Court and mental
health treatment.
 Cases are subject to judicial discretion
and may include both felonies and
misdemeanors.

Goals
• Increase service referrals for mentally ill
justice involved individuals
• Reduce recidivism for mentally ill and
criminally involved participants
• Reduce number of mentally ill individuals in
the Macomb County Jail
• Find appropriate dispositions to criminal
charges by taking into consideration
diagnosis, charges and prior history
 Macomb
County residents 18 years
or older
 Diagnosed with Severe Mental
Illness or Developmental Disability
 Currently involved in criminal
justice system with pending court
matters, active probation or parole
sentences
Self report/interest to counsel, judge,
probation officer
 Initial screenings with pre-trial services
 CMH Diversion Staff
 Legal Guardians or Family Members
 Probate Court, Community Corrections
and/or Probation Officer

Identification of Participants
 Self report/interest to counsel, judge,
probation officer
 Initial screenings with pre-trail services
 CMH Diversion Staff
 Legal Guardians or Family Members
 Probate court, Community Corrections
and/or Probation Officer
Prosecutor’s Office reviews the
application to approve or deny
admission based on charge and victim
consideration
 Court Coordinator ensures the
individual meets target population
 CMH conducts assessment
 Assessment reviewed by Court Team
 Final decision for entry made by Judge

Court/Treatment Team
The Team is coordinated by the Judge and
includes:
 Macomb County CMH Case Manager
 MDOC Probation Officer
 Assistant Prosecutor/Representative
 Court Coordinator
 Defense Council Representative
Program Description
 Team approves clinical eligibility and
determines that sufficient supports
exist in the community to manage the
offender in a safe and effective
manner.
 Offender is assigned an MCCMH Case
Manager and a Macomb County
Probation Officer
Treatment will follow the PersonCentered Planning Process
 All participants will be tested randomly
for drugs and alcohol
 Approximate 18 – 24 month
commitment to implement effective
change based upon evidence-based
research and best practice

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Staff/Team meetings will occur
immediately before court review sessions
Individuals will have weekly appearances
before the Judge, diminishing in
frequency
Court Coordinator, CMH Case Manager,
Assistant Prosecutor, Defense Counsel
and Probation Officer will also be present
at court appearances
Program Description
 Incentives will be used including
judicial accolades, applause, gift
certificates, reduction in testing,
granting of privileges
 Sanctions are utilized in the event of
non-compliance and are individualized
 Termination from program may occur
for new offenses, lack of progress, etc.
and are deemed appropriate by team
and ultimately the Judge
Completion of minimum of 18 months
in program
 Full compliance with treatment,
medications and probation conditions
 All monetary obligations to the court
must be satisfied
 No new criminal charges pending
 Exceptions may occur as the program
is individualized to participants

GRADUATION
CEREMONY!!!
Macomb County Community
Mental Health
Office of
Substance Abuse



Funding Types: Medicaid, Adult Benefit Waiver,
MiChild, Uninsured-low income
Live in Macomb County
Meet criteria for Substance Use Disorder diagnosis
and medical need for services
Sub-acute Detoxification
 Residential Treatment
 Intensive Outpatient Treatment
 Methadone Assisted Treatment
 Outpatient Treatment
 Early Intervention
 Case Management
 Peer Support Services
 Recovery Housing
 Prevention

Peer Recovery Coach Services
Program provided by specially trained peers in long-term recovery,
designed to support and promote recovery and prevent relapse
through supportive services that result in the knowledge and skills
necessary for an individual’s recovery.
• Assist individuals in implementing and
following-through with continuing care
coordination, relapse prevention, and recovery
planning activities in the community.
• Addresses perceived contributors to relapse,
barriers to sustaining recovery, such as housing,
medical, vocational or interpersonal needs and
identifies resources to overcome obstacles
Recovery Home Services
Alcohol and drug free housing environments whose rules,
peer-led groups, staff activities and/or other structured
operations are directed toward maintenance of sobriety for
persons who exhibit relapse potential and/or lack of
suitable recovery living environments
•
•
•
•
•
•
•
Structured, safe, supportive place to live
Self-help, community based supports
Communicate and monitor resident responsibilities
Regularly held house meetings
Linkage to community supports and services
Support recovery skills
Monitor efforts towards employment/education
Research-based Information to keep
your communities healthy!
~Parents Talk to your kids
~High School Curriculum
~Fact Sheet for all community sectors
Register at… www.mcosa.net or
www.cvcoalition.org
Developed by MCOSA and Chippewa Valley Coalition
Drug Take Back Events
Proper disposal of old or unwanted
medications lowers availability and access for
youth. Youth think that since it is prescribed by
doctors it is less harmful.
Facts:
• One in seven teens in the USA report having abused
prescription drugs to “get high”.
• More than 60% of teens say prescription drugs are
easy to get from the home medicine cabinet, relatives’
homes or friends.
• Improperly disposed medications are being found in
the waterways and landfills which is a health concern
for everyone.
Upcoming Changes:
Further Integration of
Merge Substance Use
and Mental Health
Access Functions
•
•
•
Combining Mental Health &
Substance Use Disorder screening and
referral processes in one
location/function
Integrating data systems
Cross training of staff
• One entry point – one phone
number to call
• No wrong door
• Services best matched to
individual’s needs