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September 13, 2018

Advancing Public Policies for People with Mental Illness, Chemical Dependency or Developmental Disabilities   

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Francine Sinkoff, Editor

The Arc Westchester Awarded $242,000 in Grants from NYSARC Trust Services

Erie County: Systemic Collaboration to Reduce Urgent Care

In May of 2017, the Erie County Department of Mental Health partnered with CCSI's Center for Collaboration in Community Health on the Erie PSYCKES Project, with the goal of reducing the use of acute services (Emergency Room, behavioral health hospitalizations and re-hospitalizations) for clients treated in the behavioral health community. This project uses the acute service utilization data available in the Psychiatric Services and Clinical Knowledge Enhancement System 
(PSYCKES), a web-based tool developed by the New York State Office of Mental Health, that uses administrative data from the NYS Medicaid claims database to generate quality indicators and summarize treatment histories. PSYCKES data are used to inform effective interventions at the client, program, agency, and system levels and to help clients get their needs met at lower levels of care. 
The main features of the Erie PSYCKES project include the Erie PSYCKES Tool which offers a visual representation of acute service utilization data from PSYCKES in a secure, easy to understand, interactive web-based data dashboard. The Erie PSYCKES Tool has been the focal point of the project's multi-stakeholder group meetings attended by organizations involved in many facets of care, as well as a separate collaborative effort between four behavioral health agencies working together to share best practice approaches to reducing the use of acute services for their clients. Read more here.
SAMHSA PODCAST:  The Role of Pain Management in Recovery from Serious Mental Illness

This podcast features national experts on the intersection of serious mental illness and chronic pain who describe practical tools and strategies for incorporating person-centered, strength-based approaches to this complex clinical scenario. Join host Dr. Curley Bonds, chief deputy director for clinical operations at the Los Angeles County Department of Mental Health, and his guests as they explore meaningful ways to mesh scientific evidence and best practices with the whole of an individual's life, including relationships, communities, goals, and preferences.

Click HERE to listen to the podcast.
Many 'Recovery Houses' Won't Let Residents Use Medicine To Quit Opioids

A Horrific Crime on the Subway Led to Kendra's Law. Years Later, Has It Helped?

Judges as Champions for Suicide Prevention

More Than One-Third of College Freshmen Report Mental Health Disorder

Request for Proposals: Evaluating Alternatives to Arrest

The Laura and John Arnold Foundation recently announced a Request for Proposals for evaluations of emergency response programs and alternatives to arrest for vulnerable populations. The Foundation is l ooking for proposals to evaluate the following:
  1. Emergency response programs for individuals in moments of crisis,
  2. Post-crisis stabilization facilities, and
  3. Treatment and services funded by governments or other entities.
Evaluations should focus on outcomes for individuals whose vulnerabilities include mental illness, substance use disorders, and/or homelessness.
Governments need better data, tools, and systems to direct vulnerable people to appropriate and effective resources outside the criminal justice system. Through this RFP, the Foundation hopes to identify evidence-based policies and programs that can reduce the use of force, arrest, and/or incarceration, and connect vulnerable populations to evidence-based treatment and services.  Letters of Interest are due by 11/5/19. For more details, please see the full RFP .
OMH Statewide Virtual Town Hall Featuring
Commissioner Ann Sullivan, MD
November 13, 2018


September 13, 1 - 2 pm, Manatt Health

Cultural Competence in Psychiatry
September 13, 4 - 5:30 pm, NAMI
Utilization Management for Children and Family Treatment and Support Services
September 18, 10 - 11 am, CTAC/MCTAC

Advancing Value-Based Payment in Medicaid Managed Long-Term Services and Supports: Opportunities for Community-Based Care
September 18, 1:30 - 3 pm, Center for Health Care Strategies

Pioneering Medicaid All-Cost Claims Study Demonstrates Decrease in Health Care Costs with Digital Behavioral Health Care
September 20, 11 am - 12 pm, National Council for Behavioral Health

September 26, 12 - 1 pm, PsychU

September 26, 12 - 1 pm, CTAC/MCTAC

September 27, 12 - 1 pm, CTAC/MCTAC

The College Years: How Students with Lived Experience Navigate Academics and Mental Health Management
October 10, 11 am - 12 pm, Transitions to Adulthood Center for Research

innovaTel Telepsychiatry: Back to School: Helping Children and Parents
October 17, 1 - 2 pm, National Council for Behavioral Health

October 17, 2:30 - 3:30 pm, Manatt Health

Access and Engagement in the Value Equation: Solutions That Work
October 25, 12 - 1 pm, CTAC/MCTAC

October 30, 2:30 - 3:30 pm, Manatt Health



Children & Families Committee Meeting
September 18: 11:30 am - 1 pm, GTM

Fall Full Membership Meeting
September 24 - 25, Rochester


OASAS Agency Meeting 
October 10: 10 am - 12 pm
1450 Western Ave., Albany

OMH Agency Meeting
October 10:  1 - 3 pm
44 Holland Ave., Albany

Mental Hygiene Planning Committee Meeting - IN PERSON
October 12: 11- 12:30 pm
1450 Western Ave., Albany / GTM

Contact CLMHD for all Call In and Go To Meeting information, 518.462.9422 
NYS OASAS Announces Opening of New Youth Clubhouse Operated by the St. Regis Mohawk Tribe

The New York State Office of Alcoholism and Substance Abuse Services (NYS OASAS) this week announced the opening of a new youth clubhouse in Akwesasne, operated by the St. Regis Mohawk Tribe. The clubhouse, the first in tribal territory, will provide a place for young people ages to 15 to 20, who are either in recovery, or at risk of addiction, to develop social skills that promote long-term health and a substance-free lifestyle. The clubhouse is being funded with more than $294,000 awarded to New York State under the Opioid State Targeted Response Grant, which is administered by the federal Substance Abuse and Mental Health Services Administration.

The clubhouse provides a community-based, non-clinical setting for promoting long-term recovery through skill building, recreation, education, wellness, evidence-based prevention programs and other social activities. Clubhouse participants will have the opportunity to learn employment skills, receive help with school work, and participate in recreational activities, including basket weaving, belt looming, painting, and yoga.They will also work with and support each other to achieve personal and recovery-specific goals. Read more here.
New Alternative Payment Model Tackles Holistic Addiction Recovery

A national multi-sector alliance of healthcare industry leaders is looking to incentivize providers and payers to deliver coordinated, holistic addiction recovery services to patients through a new alternative payment model.

Nearly 21 million people have a substance abuse disorder. Yet only one out of ten individuals receive treatment, according to  data from the Surgeon General.

To combat the substance abuse crisis impacting about one in three households, Leavitt Partners, Facing Addiction with NCADD (The National Council on Alcoholism and Drug Dependence), Remedy Partners, and other groups recently  developed the Addiction Recovery Medical Home model.

The alternative payment model aims to financially incentivize providers, payers, and other addiction recovery stakeholders to treat individuals with substance abuse disorders as if they had a chronic condition.

The healthcare system currently treats chronic conditions using "standards of excellence," the alliance explains. The standards inform consumers, health systems, and payers about best practices for treatment and services that should be delivered to patients. Read more here.
NY Physical Therapists Say Reimbursement Change Could Combat Opioid Crisis

New York physical therapists are calling on the state to change the way it reimburses them for treating injured workers, arguing that a gradual increase to the current cap on services could prevent thousands of opioid addictions each year.

TheNY Physical Therapy Association asked the state Workers' Compensation Board in July to raise the cap on reimbursement for follow-up physical therapy services to levels set by other states. The cap that's currently in place, it argues, is the strictest in the nation and a barrier to care that could help people rely less on opioids, and get back to work faster. Read more here.
Most Doctors Are Ill-Equipped to Deal With the Opioid Epidemic. Few Medical Schools Teach Addiction.

BOSTON - To the medical students, the patient was a conundrum.  According to his chart, he had residual pain from a leg injury sustained while working on a train track. Now he wanted an opioid stronger than the Percocet he'd been prescribed. So why did his urine test positive for two other drugs - cocaine and hydromorphone, a powerful opioid that doctors had not ordered?

It was up to Clark Yin, 29, to figure out what was really going on with Chris McQ, 58 - as seven other third-year medical students and two instructors watched.

"How are you going to have a conversation around the patient's positive tox screen results?" asked Dr. Lidya H. Wlasiuk, who teaches addiction awareness and interventions here at Boston University School of Medicine.

Mr. Yin threw up his hands. "I have no idea," he admitted.

Chris McQ is a fictional case study created by Dr. Wlasiuk, brought to life for this class by Ric MaurĂ©, a keyboard player who also works as a  standardized patient - trained to represent a real patient, to help medical students practice diagnostic and communication skills. The assignment today: grappling with the delicate art and science of managing a chronic pain patient who might be tipping into a substance use disorder. Read more here.
Millions In Disability Housing Assistance Headed To States

People with disabilities in nearly every state will receive help accessing housing in the community thanks to an infusion of millions in federal dollars.

The U.S. Department of Housing and Urban Development said this week that it's issuing $98.5 million in housing assistance specifically tagged to help those with disabilities.

The funding is part of the agency's Section 811 Mainstream Housing Choice Voucher Program, which helps housing agencies assist people with disabilities ages 18 to 62 who are leaving institutional settings for community-based living situations as well as those at risk for institutionalization or homelessness.

The money will go to public housing authorities in 47 states and Washington, D.C. and is expected to provide vouchers to nearly 12,000 individuals. Read more here.
Thinking Small: Pediatric Facilities Built with Behavioral Health in Mind

A middle-school student in Ohio was worried about her friend's mental health, so she told her teacher.

The school is part of Columbus-based Nationwide Children's Hospital suicide prevention screening network, where 
Nationwide clinicians provide on-site mental health screening, trained teachers lead discussions on the topic, and students fill out questionnaires and can suggest friends who they believe need assistance.

The school and Nationwide facilitated an emergency assessment for the girl, which revealed that she felt guilty she couldn't have done more for a different friend who committed suicide the prior year.

Overarching hopelessness led her to map out a plan to take her own life. But with the help of her friend, the school and Nationwide, she improved. "If we just gave the schools a packet or tried to do it all ourselves, it isn't sustainable," said Dr. David Axelson, chief of psychiatry and medical director of behavioral health at Nationwide. "We need schools to buy in and teachers to do it on an ongoing basis." Read more here.
New School Year, New Mental Health Lessons: 2 States Now Require It

As students across the country start a new school year, some will be learning about mental health for the first time.

In two states, New York and Virginia, public schools are now required to incorporate mental health into their curriculum. New York's law, which took effect July 1, applies to elementary, middle and high schools. In Virginia, the state is developing standards for integrating mental health education into ninth and 10th grade -- the age  when half of mental illnesses start cropping up.

These laws come at a time when teen suicide rates have  doubled among girls and risen 30 percent among boys in recent years. At the same time, the stigma surrounding mental health is lessening -- though still prevalent -- in part because of the opioid epidemic, which has more people talking openly about addiction and mental health.

The New York law leaves it up to schools to craft what the curriculum looks like. Read more here.
Developing A Value-Based Care Model With Peer Support-Two Case Studies

The benefits of peer support service are widely known-the use of peer supports can result in reductions in hospital admissions, reduction of inpatient days, and increased use of outpatient services. Additionally, the model helps to improve consumer outcomes, including increased consumer empowerment, increased sense that treatment is responsive, and increased social support and social functioning. As a result, the use of peers and peer support programs can lend itself to success with value-based arrangements.

Last month at The 2018 OPEN MINDS 
Management Best Practices Institute, we heard from two organizations that have value-based arrangements related to peer supports during the session, The Future Of Peer Support Services: Successful Models For A Value-Based Market, led by OPEN MINDS Senior Associate Ken Carr.

First to speak was Briana Gilmore, Senior Strategy Consultant at Community Access in New York City, a 400-employee organization that provides supportive housing, recovery supports, and advocacy services. What makes Community Access unique is its aim to have at least 51% of staff with "lived experience." Community Access has a performance-based contract with the city of New York for their assisted competitive employment program; 20% of their contract payment is based on their success in supporting a number of individuals they work with in maintaining employment for three month, six month, and nine month intervals using the "find, get, keep" model. Read more here.
Healthcare Groups Laud the FCC's $100 Million Connected Care Pilot Program

Providers are largely excited about the Federal Communications Commission's efforts to boost telehealth adoption, though some warn the program needs detailed metrics for success, according to comments made in response to the agency's request for input on the Connected Care Pilot Program.

Organizations praised the FCC's efforts to improve patient outcomes by expanding access to telehealth for low-income people, particularly veterans and those in rural areas.

The FCC announced the program in July 2018. The agency plans to allocate $100 million from the telecom-funded Universal Service Fund to encourage telehealth and virtual healthcare services for low-income people. Read more here.
Payment Innovation in Federally Qualified Health Centers: Lessons from California
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Significant movement has occurred over the past few years among states, managed care organizations (MCOs), and providers, including federally qualified health centers (FQHCs), to adopt value-based payment (VBP) arrangements. In California, FQHCs and the state came together to design an  Alternative Payment Methodology (APM) Pilot to allow greater flexibility for improving care delivery, reducing costs, and simplifying the burdensome payment system. Under the proposed pilot, the Prospective Payment System (PPS) payment and wrap-around would be replaced by an upfront, clinic-specific capitation rate.

For both the FQHCs and the state, one of the biggest selling points of the proposed approach was the flexibility that it would afford FQHCs to innovate with how care is delivered to patients. While ultimately California did not move ahead because the proposed model would have required a federal waiver of PPS and a change in state law, many positive lessons can be drawn from California's design and the extensive pilot development process. Read more here.
The Conference of Local Mental Hygiene Directors advances public policies and awareness for people with mental illness, chemical dependency and developmental disabilities.  We are a statewide membership organization that consists of the Commissioner/ Director of each of the state's 57 county mental hygiene departments and the mental hygiene department of the City of New York.