Ohio: Program Structure Southwest Region (Butler, Clermont, Clinton, Northwest Region (Lucas, Erie, Hancock, Preble and Warren Counties): Allen, Auglaize, Hardin, Putnam, Sandusky, Wood, Seneca and Wyandot Counties): • Each county currently has county-funded • State is providing technical assistance and hotline and mobile crisis services. funding. • Services differ by county in terms of access • Funded through Engage 2.0 SAMHSA Grant. to mobile crisis services. • Serving children between the ages of 0 • All counties serve both youth and adults at through 21 years with behavioral health risk of harm to self or others. concerns. • Created change team of cross-system • Created change team of cross-system members. members.
Ohio: Program Components Southwest program will include: Northwest program will include : • 24/7 hotline • 24/7 hotline access in all counties using 4 Mobile Response Team to respond face- • different numbers in 5 counties. to-face within 30-60 minutes. • 4-6 weeks intensive services determined • Program components differ by county. through clinical assessment and service Current project aims to identify consistent coordination planning. program enhancements. • Warm handoff to additional community care coordination or wraparound services, as needed.
Ohio: Barriers/Challenges Southwest: Northwest: • 4 different hotlines/numbers • How to implement MRSS in rural vs. • 4 different implementation models urban counties with varying degrees of coverage • Geographical barriers- how to set a • Concerns about sustainability for goal of 30 minutes response time new programs with a large area Lack of clarity about which • How to make MRSS regional with 11 • components should be regionalized counties
Ohio: Meeting Objectives The top 3 learning objectives that we would like to discuss are: • Day-to-day operation of MRSS • Staffing • Cost/reimbursement
San Francisco, California Participant Name Title/Role Organization (if applicable) Barrett Johnson Program Director Family and Children's Services Alison Lustbader Program Manager Intensive Services Community Behavioral Health Services Gary Levene Senior Supervising Probation Officer Juvenile Probation Department Dana E. Blackwell Senior Director Casey Family Programs Paula Hernandez Assistant Chief Probation Officer Juvenile Probation Department Sara Schumann Director of Probation Services Probation Department Linnea Koopmans Senior Policy Analyst The County Behavioral Health Directors Association of California (CBHDA) Lishaun Francis Senior Associate Children Now
San Francisco, California Participant Name Title/Role Organization (if applicable) Loc Nguyen CCR/ICWA Consultant The County Welfare Directors Association of California (CWDA) Nadia Sexton Consultant
San Francisco: Program Structure San Francisco and California are in the exploration phase of implementation: • San Francisco (child welfare, juvenile probation and children’s behavioral health) will be implementing during FFY 2018/2019 using Title IV-E Waiver and mental health funding. • Building an RFP for release in April or May of 2018. • Multiple counties in the Bay Area region are exploring a regional system . • California County Welfare Directors’ Association (CWDA) is exploring legislation/funding for statewide system .
San Francisco: Program Structure (cont.) • California is a county-administered system with state oversight for child welfare, juvenile probation and behavioral health. • Counties have various structures. • San Francisco has a close partnership between the human services agency, behavioral health and juvenile probation. • Initial target population consists of children and youth in care who are served by one of the three systems (CW, JP and BH). • Specific components are not established at this stage. • San Francisco is pursuing mobile response/care coordination/emergency placements together
San Francisco: Barriers/Challenges Challenges include: • Securing long-term funding/legislation • Identifying key components to develop • RFP development (In SF and Bay Area region) Barriers include: • Developing a system that can serve multiple jurisdictions with different structures and levels of partnership. • Ensuring equitable coverage and care in a large, diverse state with urban and rural areas.
San Francisco: Meeting Objectives • Understanding how mobile response integrates with existing services • Understanding strategies for development of public/private staffing structures to initiate and maintain mobile response • Identifying potential funding methodologies and structures
Alumni Team Introductions • Alaska • Nevada • Broward County, Florida • North Carolina • Guam • Oklahoma • Indiana • Philadelphia, Pennsylvania • Kansas • Stark County, Ohio • Muskegon County, Michigan • South Carolina
Alaska: Alumni, December 2017 Participant Name Title/Role Organization (if applicable) Kacea Bjork Mental Health Clinician State of Alaska Division of III/ Program Manager Behavioral Health Marita Bailey Clinical Director Sitka Counseling Jim McLaughlin Mental Health Clinician Alaska Div. of Behavioral III Health Chris Byrnes Director of BH Yukon-Kuskokwim Health Emergency Services Corporation
Alaska: Program Structure Alaska is in the Planning Stage • Applied for an 1115 waiver which includes Mobile Crisis Response for youth with SED, individuals with SUD, and adults with SMI • Statewide service, with implementation rolling out in different regional hubs over a 1-3 year period • Division of Behavioral Health (DBH) hopes to develop partnerships with child protection as the focus of the waiver is on early intervention for families involved in / referred to protective services • Funded through Medicaid, there may be some grant funds available but Alaska’s system is moving away from reliance on grant funding
Alaska: Program Components As identified in the 1115: Mobile Response for youth, adults with SMI and youth/adults with SUD will include • the following: • Clinical professionals meet face to face with individuals experiencing a crisis wherever the crisis occurs • Assessment and de-escalation of the situation • Referral of the individual to appropriate services • Goals: • reduce ED visits, and psychiatric hospital admissions • control transportation costs, develop regional capacity to provide psychiatric emergency residential services • and increase access to outpatient care.
Alaska: Program Updates Increased focus on value of home-based services • • Service type included in waiver • Medicaid rates set to be rebased 7/1/18 to ease financial burden of providing these services Continuing to identify gaps in services • • DBH will take on Autism services and continue providing services to individuals with FASD or TBIs who do not meet criteria for disability support services • Increasing attention on access to care issues and the role of telemedicine in ensuring timely access to care
Alaska: Barriers/Challenges • Size and Geography Will this service be available statewide? • • How can this service be adapted for rural/remote locations? • System Redesign Considerations • Government to government considerations in collaborating with tribal partners Workforce development: • • Ensuring skills at crisis intervention for mental health, substance use disorders and I/DD
Alaska: Meeting Objectives • Develop a feasible plan for implementing Mobile Response in rural/remote areas of Alaska • Accessibility/availability of services Partnering with tribal health organizations • • Safety considerations • Travel in adverse weather conditions • Gain a better understanding of how Mobile Response can be applied to serving individuals with an SUD or adults who experience SMI • Learn from other states who have successfully implemented this service
Broward County, Florida: Alumni, December 2016 Participant Name Title/Role Organization (if applicable) Norma Wagner Director of Operations/ System of Care Broward Behavioral Health (fund the local mobile response team) Coalition Leilani Fandino Clinical Coordinator Henderson Behavioral Health Brittany Jacobs YES Team Supervisor Henderson Behavioral Health
Broward County: Program Structure Mobile response is funded by: • the Broward Behavioral Health Coalition (BBHC) - managing entity funded by the state to contract for mental health and substance use services • local county human services department Mobile response provider (Henderson Behavioral Health) is a private non-profit agency There are two teams in Broward County: • One primarily serves adults • Youth Emergency Services (YES) responds to calls involving youth. • YES works closely with the child serving systems including child welfare, juvenile justice, school system, and the local providers
Broward County: Program Components Mobile Response Teams: • Are staffed by clinicians, some of whom are licensed • Respond to calls and will go anywhere they are needed • Work with local law enforcement, particularly with our CIT-trained officers
Broward County: Program Updates • The name has changed from Mobile Crisis Teams to Mobile Response Teams • No additional funding has been provided to expand these teams - until recently due to the tragedy from the school shooting
Broward County: Barriers/Challenges Funding is an ongoing issue • Recruiting qualified clinicians at the salary provided •
Broward County: Meeting Objectives • Learn how to incorporate peer specialists and family peers as part of the response team • Identify other sources of funding to expand teams • Learn how to decrease response time
Guam: Alumni, December 2016 Participant Name Title/Role Organization (if applicable) Annie F.B. Unpingco Administrator, Child Adolescent Guam Behavioral Health and Services Division-I Famagu’on-ta Wellness Center Elisa Duenas Care Coordinator Guam Behavioral Health and Wellness Center Paul Rolinski Emergency Medical Dispatcher Guam fire Department Daren Burrier Guam Fire Department Assistant Fire Chief Reina Sanchez Clinical Administrator Guam Behavioral Health and Wellness Center
Guam: Program Structure MRSS is still in the planning/development phase, not yet operational • Phase 1: Strengthen the existing crisis hotline located in the Child Inpatient Unit of GBHWC. Plan to move it to a separate facility in the community and change name to “Helpline.” • Phase 2: Mobile Response: Partnership between several government agencies; the Guam Fire Department (manages the 911), the Guam Police Department (GPD), and other child serving organizations; Child Welfare, GDOE, Judiciary, Sanctuary, non profit. • Started using trained University students to help answer incoming calls. • Primary population of focus is children, youth and families, but will eventually be accessible to all statewide (i.e. island community of 160,000 pop.), to address high suicide rate. • Guam Behavioral Health and Wellness Center (GBHWC) is the lead state agency (mental health & substance abuse). • Funding for equipment comes from SOC expansion/implementation grant. Local funding for office space and administrative support staff. •
Guam: Program Components • Calls can come directly through the Helpline number • Calls into 911 will be screened and behavioral health/mental health issues will be dispatched to the Helpline. • When mobile response is activated, GPD becomes a critical partner in ensuring safety of staff responding. *Triage with other key partners such as clinics, VA, housing, etc. will be worked on as well as for referral sources.
Guam: Program Flow
Guam: Barriers/Challenges • Identify and obtain federal and local funding to implement and sustain MRSS
Guam: Meeting Objectives Learn About: • How others operate MRSS from the point of entry, including processes, program evaluation, and specific strategies related to suicide. • What documentation and data are important to collect and how they can be used to improve services. • Funding sources such as grants for supporting and sustaining MRSS
Indiana: Alumni, December 2017 Participant Name Title/Role Organization (if applicable) Sirrilla D. Blackmon Deputy Director Youth Services, Division of Mental Health and Addiction Prevention, Cultural Addiction Linguistic Competency Jennifer Tackitt-Dorfmeyer Executive Director Choices Coordinated Care Solutions Elizabeth Oyer VP of Applied Research & Choices Coordinated Care Evaluation Solutions
Indiana: Program Structure • 92 counties and 25 Certified Community Mental Health Centers (CMHCs) that serve as the safety net for the state • Populations served: • Serious Mentally Ill /Serious Emotionally Disturbed • Chronically Addicted • Dually Diagnosed • Current array of mental health and addiction services are supported by MH Block Grant, SA Block Grant, Medicaid and other third party payers • Program implementation of new services will be supported through the Office of Medicaid and the Division of Mental Health and Addiction Department of Child Services (DCS) utilizes contractual agreements with CMHCs and other providers to • ensure youth involved with child welfare receive mental health services Youth with behavioral health issues who are involved with juvenile justice access services through DCS, • services that are court ordered or receive alternative community supports
Indiana: Program Components • Indiana currently does not have a statewide MRSS program that meets the needs of youth who are experiencing a crisis in the community Indianapolis has a Mobile Crisis Act Team (MCAT): • • Initiated through the Indianapolis Mayor’s office. This is a partnership with the Indianapolis Police Department, the public hospital and the local Certified Community Mental Health Center (CMHC). MCAT targeted population are individuals who reside in an identified high risk crime areas. The team also has a relationship with the state Bureau of Developmental Disabilities Services. Allocation from the State Targeted Response to Opioid Crisis grant was awarded to two agencies to develop a mobile crisis response model: Choices Emergency Response Teams (CERT) is a 24 /7 mobile crisis team based in Ripley County. CERT will • provide crisis response to consumers who reside in seven Indiana counties. • Centerstone Opioid Crisis Response Teams (OCRT) , mobile crisis response intervention teams to engage individuals experiencing opioid use disorder (OUD) and mitigate instances of opioid overdose in the catchment area comprising of seven Indiana Counties.
Indiana: Program Updates The Commission for Improving the Status of Children (CISC) has four task forces that address the needs of children in the state: • Child Safety • Mental Health and Substance Abuse* • Education Outcomes • Cross System Youth and Juvenile Justice *Development of the MRSS program for Indiana is the focus of the Service Creation subcommittee under the Mental Health and Substance Abuse Task Force with final approval from the CISC. • The Service Creation subcommittee: • Has met monthly since the December 2017 MRSS peer meeting; meeting information was shared with the group • Identified other programs within the state and invited them to present their models • Developed a timeline to keep this initiative on track • Is collecting data on emergency room visits and crisis services by analyzing Medicaid claims data. • Will identify data elements to support the need for this program in the state • Would like to glean any data related to providing services for youth and families since the newest mobile crisis response programs are targeted for individuals with substance use disorders
Indiana: Barriers/Challenges Potential barriers that may impede success are: • Workforce issues • Cross agency implementation • Logistics
Indiana: Meeting Objectives • Garner feedback regarding if we are on track (process vs procedure) • Receive technical assistance • Network with other states to discuss their implementation process
Kansas: Alumni, December 2017 Participant Name Title/Role Organization (if applicable) Kelsee Torrez SOC Project Director KDADS Nicole Stafford SOC Project Coordinator PACES Jeanne Urban-Wurtz Director of Behavioral Health KDADS
Kansas: Program Structure • There are 26 Community Mental Health Centers (CMHCs) in Kansas • CMHC staff are available 24/7 for crisis calls and to assess for hospitalization CMHCs serve anyone in their catchment area; SOC youth are ages birth- • 21, with SED, mostly school aged, residing within 16 counties. • Some CMHCs are under the county’s jurisdiction, others are independently operated with a board of directors. CMHCs are locally (county, state) and federally (Medicaid, Block Grant, • etc.) funded
Kansas: Program Components Modified MRSS program implementation efforts are currently underway at one CMHC: • CMHC is working with their largest school district to reduce school suspensions • Mobile will respond to the school and provide stabilization services in lieu of disciplinary action • Currently working to identify funding, staffing, and training while developing policy
Kansas: Program Updates • Kansas is currently in the planning stages of piloting MRSS programming: • Reviewing best practices, methods, and program structures • Drafting policy and procedures • State is drafting a MRSS pilot program, so more CMHCs can implement MRSS
Kansas: Barriers/Challenges • Identifying funding for infrastructure development • Culture change (punitive vs trauma informed care practices) • Policy and procedural development and implementation at both state and local levels • Training of staff • Determining appropriate response times for each call (triage system) • Developing a data/outcomes tracking system
Kansas: Meeting Objectives Learn more about: • The process and structure of other states’ response strategies: dispatcher, response team, leadership roles, etc. • Medicaid reimbursement and sustainable financing options • Policy, procedure, and training that reflects SOC values • MRSS expansion from one location to a state-wide service
Muskegon County Michigan: Alumni, April 2017 Participant Name Title/Role Organization (if applicable) Kelly France Transition Age Services Manager HealthWest Clinical Lead MYalliance SOC – Muskegon County Rhonda Emery Youth Manager Healthwest Clinical Lead Myalliance SOC Kate Kesteloot Scarbrough Executive Director Mediation & Restorative Services at the Brian Mattson Center for Restorative Justice
Muskegon County: Program Structure • Two-fold approach: 1. HealthWest implementation 2. Juvenile Urgent Response Team (JURT) and Community Leadership Team • Serving any youth/family in Muskegon County, 24/7 • Partnerships with: • Juvenile Justice (JTC) • Community Leadership Team, hoping to get more proactive, less reactive • County wide, mental health crisis driven • Medicaid, braided funding, JURT
Muskegon County: Program Components • Currently a HealthWest program • Utilizing SOC core values, CANS assessment process, home/community based • Clinician teamed with a “stabilizer” are dispatched upon request • Primary team 8a-7p M-TH, 8-5 Friday, on call coverage nights and weekends • Braided funding with Family Court for JTC response • Used as entry to county mental health system
Muskegon County: Program Updates • Full time team of 3 master level clinicians, 3 stabilizers • “Air traffic controller” and “On-call coordinator” • School “Cheat Sheets” • School based clinicians as extensions of MRSS • Contract with Family Court for JTC response • JURT funding for training and system mapping • Entire overhaul of access to mental health system
Muskegon County: Barriers/Challenges • Capacity issues • increase in referrals/calls since implementation • “Fix all” mentality • One program set up to fail without community training and development • Mental Health Services for youth in Muskegon County • all time high: ACES, opioid epidemic. • Schools • how to respond to schools with HIPAA, FERPA and parental consent
Muskegon County: Meeting Objectives • Community Leadership: • how to bring the proactive, trauma informed training and development to the community? • Capacity! • How to get buy in from community partners for a community MRSS response so all the weight is not on one agency • FUNDING • TRAINING
Nevada: Alumni, April 2017 Participant Name Title/Role Organization (if applicable) Ann Polakowski Clinical Program Manger II Division of Child and Family Services
Nevada: Program Structure • Program is housed in the Division of Child and Family Services (DCFS), in the Department of Health and Human Services • Serve any youth age birth to 18 presenting with an emergent behavioral or mental health concern requesting immediate support, assessment • A behavioral health program within DCFS, partnering with child welfare, juvenile justice, parents, private and public providers • Statewide • Funded by a blend of state and grant funding, some insurance billing revenue
Nevada: Program Components • Phone screening and triage • Immediate in person (or tele med in the rural area) response by team of two: • A master’s level mental health counselor and bachelor’s level psychiatric caseworker • Crisis Assessment Tool (CAT), Crisis Needs Assessment and Safety Planning • Recommendation following assessments may include the following: • Hospitalization • Stabilization and case management for up to 30-45 days • Refer back to current services • Family may decline or no services are needed
Nevada: Program Updates • Increased access for youth accessing rural mobile crisis by using Clark County 24/7/365 crisis line • Dedicated overnight teams Increased partnerships with community, additional response sites and • referrals • Tracking additional stressors for calls, including bullying • Monthly statewide Mobile Crisis Response Team (MCRT) managers meetings Increased response to child welfare, juvenile justice populations • Team sited at our juvenile assessment center • • Partnering with Safe Voice
Nevada: Barriers/Challenges • System continues to have a “wrong door” • Technology • Lack of respite services, informal wraparound supports • Increase in legal 2000 • Rural MCRT sustainability
Nevada: Meeting Objectives Networking and idea sharing with teams in other states for new • and innovative ideas to advance practice How other states have been able to secure informal wraparound • supports and respite services as part of their continuum of care for youth in crisis • Tools other states are using for mobile assessment, safety planning
North Carolina: Alumni, April 2017 Participant Name Title/Role Organization (if applicable) Tim Lentz Clinical Director/Provider Catawba Valley Behavioral Health Allison Gosda Whole Person Care Director Partners Behavioral Health Management Eric Harbour Child Team Lead NC Division of MH/DD/SAS
North Carolina: Program Structure • Mobile Outreach, Response, Engagement, and Stabilization (MORES) pilot developed by team of state, MCO, provider and peer representatives. • Once developed, pilot handed off to MCO for implementation. • Focus on children, youth and young adults ages 3-21. • Will work within the systems of care approach. Pilot will start in two counties, Burke (rural) and Gaston (urban) • • Funding through an alternative payment arrangement, supporting established service codes through EPSDT
North Carolina: Program Components Mobile Outreach, Response, Engagement, and Stabilization (MORES) - M obile Intervention for Youth & Young Adults Experiencing escalating emotional or behavioral symptoms or traumatic circumstances Youth’s ability to function has been compromised Disruption in the Youth’s environment – family, school, community, including transition in/out of foster care
North Carolina: Program Updates MORES Services implemented May 1, 2018, replacing Mobile Crisis: • Improved clinical effectiveness of current treatment & better outcomes • Strengths & needs assessment: • resolve the precipitating event and keep the youth in the home • Case management & care coordination • connect & engage youth/family in services • Skill/Asset development • assist in skill reinforcement to maintain stabilization Family Partner • • s upport and preserve family structure • Alternative payment arrangement for bundling of services • MORES Comprehensive Competency & Training Plan • Community outreach & communication • Complements partner’s System of Care expansion grant
North Carolina: Barriers/Challenges Pilot Limited to Medicaid Youth Training & Transition of Current Staff Family Partner Recruitment
North Carolina: Meeting Objectives 1. Learn about shared funding options for mobile crisis management services (DSS, DJJ, and school systems). 2. How to overcome barriers with community partners? 3. Ideas on how to move from alternative payment mechanism to value based payment system.
Oklahoma: Alumni, December 2016 Participant Name Title/Role Organization (if applicable) Sheamekah Williams Senior Director Oklahoma Oklahoma Department of Systems of Care Mental Health and Substance Abuse Services
Oklahoma: Program Structure Children Mobile Response & Stabilization System • State contracted system • Serves children, youth and young adults • 0 -25 years old • Youth in Transition/ Young Adults 18-25 • Youth in state custody • Systems of care model (i.e. Wraparound) • Funded through SAMHSA/CMHI federal and state allocations
Oklahoma: Program Components • Available 24/7 - 365 • Accessed through statewide call center 1-800 number • 77 contracted counties in Oklahoma • Mobile Response and Stabilization Teams • Immediate and deferred services • Community based authorization • 24/7 licensed behavioral health provider (LBHP) • 8 week Stabilization Services • In home and community behavioral health aides
OK: Medical Necessity Criteria for Acute Psychiatric Admission Medical necessity criteria for acute psychiatric admissions for children (OAC 317:30-5-95.25) Acute psychiatric admissions for children must meet the terms or conditions contained in (1), (2),(3), (4) and one of (5)(A) to (5)(D), and one of (6)(A) to (6)(C) of this subsection. 1. Yes No A diagnosis that is the primary focus of treatment outlined from the most recent edition of "The Diagnostic and Statistical Manual of Mental Disorders" (DSM) with the exception of V-codes, adjustment disorders, and substance related disorders, accompanied by a detailed description of the symptoms supporting the diagnosis. In lieu of a qualifying primary diagnosis, children 18-21 years of age may have any sequential personality disorders. 2. Yes No Conditions are directly attributable to a psychiatric disorder as the primary need for professional attention (this does not include placement issues, criminal behavior, status offenses). Adjustment or substance related disorder may be a secondary to the primary diagnosis. 3. Yes No It has been determined by the reviewer that the current disabling symptoms could not have been managed, or have not been manageable, in a less intensive treatment program. 4. Yes No Child must be medically stable. 5. Yes No Within the past 48 hours, the behaviors present an imminent life threatening emergency such as evidenced by: A. Yes No Specifically described suicide attempts, suicide intent, or serious threat by the patient. B. Yes No Specifically described patterns of escalating incidents of self-mutilating behaviors. C. Yes No Specifically described episodes of unprovoked significant physical aggression and patterns of escalating physical aggression in intensity and duration. D. Yes No Specifically described episodes of incapacitating depression or psychosis that result in an inability to function or care for basic needs. 6 . Yes No Requires secure 24-hour nursing/medical supervision as evidenced by: A. Yes No Stabilization of acute psychiatric symptoms. B. Yes No Needs extensive treatment under physician direction. C. Yes No Physiological evidence or expectation of withdrawal symptoms which require 24-hour medical supervision.
Oklahoma: Program Updates • Mobile Response and Stabilization Teams • Behavioral Health Aides • Access to 24/7 LBHP • Community Based Authorization • Medicaid and state funding for mobile response • Face to face telehealth services for crisis • Implementation of iPad utilization
Oklahoma: Barriers/Challenges • Rural and frontier • Workforce shortage • Respite options • Co occurring MH/DD • Not enough substance abuse beds
Oklahoma: Meeting Objectives • Explore strategies for crisis revision for the ID and DDS population • Identify training for clinicians serving the ID and DDS populations • Building Bridges Initiative for working with inpatient providers
Philadelphia PA: Alumni, April 2106 Participant Name Title/Role Organization (if applicable) Lauren DellaCava Clinical Director, Children’s Services Community Behavioral Health Philadelphia, PA • The Department of Behavioral Health and Intellectual disAbilities (DBHIDS) is responsible for administering a broad array of supports, treatment, intervention and prevention programs for children, adults, and families impacted by mental health, substance use and intellectual disabilities. • DBHIDS functions as single payer for Medicaid, Federal, State and Local Grant (Medicaid managed by City) dollars for behavioral health services and serves more than 150,000 Philadelphians each year. • Community Behavioral Health (CBH) sits within DBHIDS and manages the full spectrum of behavioral services for child and adult Medicaid recipients.
Philadelphia: Program Structure • Joint Procurement of City/County of Philadelphia’s DBHIDS and CBH • 2 components: • Children’s Mobile Crisis Team (CMCT) serves all youth under 21 in Philadelphia, regardless of insurance status • Children’s Mobile Intervention Service serves all CBH and uninsured youth in Philadelphia under age 18, up to age 21 for youth with ID/ASD • Child welfare and school district are key cross-systems partners and stakeholders. • Partnership of city and BH-MCO; DBHIDS Office of Mental Health delegates dispatches CMCT teams; clinical care management oversight provided by CBH • Start-up funding covered by county reinvestment dollars; treatment services will be billed to Medicaid, city will cover funding for non Medicaid youth
Philadelphia: Program Components Children’s Mobile Crisis Team Children’s Mobile Intervention (CMCT) Service (CMIS) Length Up to 72 hours Up to 8 weeks Staffing Clinical Director Clinical Director Full Time Clinical Supervisor Board Certified Child Psychiatrist or 5 Crisis Workers (Bachelor’s Level) Certified Registered Nurse 2 Family Advocates Practitioner (CRNP) 2 Clinical Team Supervisors 5 Master’s Level Intervention Specialists 3 Mental Health Case Managers Capacity (at scale) 3 teams Up to 150 children
Philadelphia: Program Updates Both services, along with a new brick and mortar Children’s Crisis Response Center and Crisis Stabilization unit have been recently procured: • CMCT launched in November 2017 CMIS soft launched with one provider in September 2017, city wide in • December 2017 • CRC and CSU opened January 2018
Philadelphia: Barriers/Challenges • System wide understanding of resolution-focused treatment • Education of stakeholders across a large system • Overall capacity in the children’s system • Access to appropriate technology for tracking/monitoring
Philadelphia: Meeting Objectives - Strategies for ongoing training needs - Best practices for monitoring and sustainability - Additional ideas for partnership with cross-systems stakeholders
Stark County, Ohio: Alumni, December 2016 Participant Name Title/Role Organization (if applicable) Jeff Allen Executive Director Crisis Intervention and Recovery Center Michele Boone Director of Clinical Services Stark County Mental Health and Addiction Services
Stark County: Program Structure Mobile Response Youth Program (MRYP): • Serves all of Stark County children, youth and young adults birth to age 18 • .5 FTE Manager, 1 Supervising Clinician, 3 Clinicians, 2 Case Managers (CPST), and 1 Family Peer Supporter • Funded by Stark County Mental Health and Addiction Recovery • SAMHSA System of Care grant, Medicaid, Local levy • Mobile response requests can be made by any individual or any system at any time • No request for service refused
Stark County: Program Components • 3 Response Pathways – Rapid, Accelerated or Supportive • Behavioral health consultation, crisis management, assessment, care plan, linkage, and postvention • Embedded clinical practices • Intervention aim is to avert hospitalization and out of home placement of youth in crisis • Suicide postvention response
Stark County: Program Updates • Added three of the team positions due to increased need Trained and implemented C-SSRS, Brown Stanley Safety Plan, and • Collaborative Assessment and Management of Suicidality (CAMS) • Began postvention caring contacts • Collaborative with Akron Children’s and Aultman Hospitals Data tracking sheet and reporting – ongoing evolution •
Stark County: Barriers/Challenges • Implementation of Ohio Behavioral Health Redesign • Clarity about documents needed to bill Medicaid
Stark County: Meeting Objectives • Talent management and retention ideas • Lessons learned from other states and providers of service • Learn about any new or emerging evidence based practice or best practice
South Carolina: Alumni, April 2016 Participant Name Title/Role Organization (if applicable) Christian Barnes-Young Assistant Deputy Director of South Carolina Department of Community Mental Health Mental Health, Division of Services Community Mental Health Services Amanda Gilchrist Program Director, Community South Carolina Department of Crisis Response and Intervention Mental Health, Division of Community Mental Health Services
South Carolina Program Structure Community Crisis Response and Intervention (CCRI): • Currently 100% state funding – Anticipate county funding once local outcomes are demonstrated • South Carolina has a robust state agency network including departments of social services (DSS), juvenile justice (DJJ) and mental health (DMH) – Funded through contract with the Department of Health and Human Services (DHHS) – Will create multi-agency stakeholder meetings regarding continuity of care and service delivery improvements • Statewide, with a focus on customizing services to meet the needs of the area served
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