No North Dakota Behavioral He Health System Study Bevin Croft, MPP, PhD Human Services Research Institute
AG AGENDA DA 01 01 03 03 Di Discussion Ke Key Findings 02 02 04 04 Ai Aims s & Ap Approach Re Recommendations
AI AIMS & AP APPROACH
St Study udy Ai Aims 1 2 3 4 Condu Co duct an an An Analyze e curren ent Provid Pr ide ac actio ionab able Establish Es recommendations re st strategies s for in-de in dept pth review of utilization ut n and nd for r enhancing the No North Da Dakota’s expenditure ex im implementin ing integra ration, cost- re recommendations behavioral health be patterns by pa pat payer effec ef ectiven enes ess and d sy syste stem sourc so rce recovery re ori rientation of f the sy syst stem to effec ef ectivel ely mee eet community n com needs
Data Sources Me Medicaid Claims ms and St Stakeholder St State Se Service Do Document Review Interviews In Ut Utilization Data Data on utilization and Gather and 66 in-depth synthesize interviews with cost for existing reports, 120 individuals who white papers, stakeholders received Medicaid-funded and other with in-depth material relevant knowledge of or DHS to study aims the system behavioral health services
Pr Projec ect Scope pe Promotion, Mental Health Adults and Prevention, and Substance Treatment, and Use Issues and Children Recovery Brain Injury
A po popu pulation he health h focus includes 4% 4% SM SMI • Individuals with mild, moderate, and intensive se service needs ds 13% Other 13 mental health me co condition • Individuals with und undiagno nosed be behavioral health he h cha hallenges , including those from hard-to-reach populations • Adults and children at risk of developing behavioral health conditions for whom 83% 83% lo low-co cost, proact ctive prevention No No diagnosed st strat ategies s could avert the mental health condition me need for behavioral health interventions
A good and modern behavioral health system spans numerous program types and agencies to provide the right mix of services at the right time. Residential Community Services for Prevention Community- Treatment Crisis and Education Outpatient Justice- and Early Based and Inpatient and Treatment Involved Intervention Services Services Treatment Awareness Populations Foster Care
KE KEY FINDINGS AND RE RECOM OMMENDATION ONS
Residential, inpatient, and long-te Re term care facility services ac accoun unted for a a maj ajority of mental al heal alth system treat atment se service expenditures s in FY2017. Youth MH Yo Adult MH Ad Outpatient 10 Ou 10% Residential Re 9% 9% Youth MH Yo Residential Re Ad Adult MH 11 11% Ou Outpatient 15% 15 MH Inpatient MH 20% 20% Youth Case Yo Ma Manageme ment Long-Te Lo Term Care 8% 8% Facilit Fa ility Ad Adult Case Total estimated mental health 25% 25% Ma Manageme ment treatment expenditures were $59 2% 2% million
Re Residential and inpatient expenditures accounted for about 85% 85% of substance use disorder treatment services in FY20 2017. SU SUD Inpatient 7% 7% Yo Youth SUD Outpatient 1% 1% Ad Adult SUD Outpatient 14 14% SUD Residential SU 78% 78% Total estimated substance use disorder treatment expenditures were $19 million
A A single, overar arching, inclusive, an and d comprehensive im implementatio ion plan is is needed to coordin inate planned and and ong ngoing ng efforts. 1.1 Reconvene system stakeholders, including service users and their families 1 – De 1 Develop a 1.2 Form an oversight steering committee to co comprehensi sive coordinate with key stakeholder groups im implementatio ion pl plan 1.3 Establish work groups to address common themes identified in this report
Th There’s a relative sc scarcity of funds s for prevention and ea early inter erven ention wo work—wh which many stakeholders vi viewed as a mi missed opportunity. . 2.1 Prioritize and implement evidence-based social and emotional wellness initiatives 2.2 Expand existing substance use prevention efforts, restore funding for the Parents Lead program 2 2 - In Invest i in 2.3 Build upon and expand current suicide preven pr ention on an and ear early interventio in ion prevention activities 2.4 Continue to address the needs of substance exposed newborns and their parents 2.5 Expand evidence-based services for first- episode psychosis
We We noted significant re regional vari riation in in the pr propo portions of individuals rec ecei eiving ser ervices es, and per persons with br brain injury fa face sub ubstant ntial barriers to ac accessing ng ne neede ded d services. 3.1 Coordinate and streamline information on resources 3.2 Expand screening in social service systems and primary care 3 – En 3 Ensur ure all North Dakotans have Da 3.3. Ensure a continuum of timely and accessible ti timely access to crisis response services behavior beha oral al heal health h se service ces 3.4 Develop a strategy to remove barriers to services for persons with brain injury 3.5 Continue to invest in evidence-based harm- reduction approaches
Only 41 On 41.7% of of wor orking-ag age adul adults who received d pu publ blicly funded ed outpa patien ent men ental hea ealth ser ervices es we were employed in in 2016. 4.1 Ensure access to needed coordination services 4.2 Continue to shift funding toward evidence-based and promising practices 4.3 Expand the continuum of SUD treatment services 4 4 – Ex Expand d for youth and adults ou outpat patient ent and and 4.4 Support and coordinate efforts to enhance the community-bas co based ed availability of outpatient services in primary care service se ce array 4.5 Address housing needs alongside behavioral health needs 4.6 Promote education and employment among behavioral health service users
In F In FY 2 2017, 1 , 16% o of a all p ll publi lic b behavioral h l healt lth service dollars se s in North Dakota went to se services s de delivered d in n lo long-te term care facilities, w , with a a per per capi pita co cost of $12,713. 4.7 Restore/enhance funding for Recovery Centers 4.8 Promote timely linkage to community-based 4 – Ex 4 Expand d ou outpat patient ent and and services following a crisis co community-bas based ed 4.9 Examine community-based alternatives to se service ce array (c (continued) behavioral health services currently provided in long-term care facilities
St Stak akeholde ders de described d a a “d “double bottleneck” in in the syst sy stem—wi with some children and yo youth underserved wh while ot others are receiving services at a higher level th than is needed. 5.1 Improve coordination between education, early childhood, and service systems 5.2 Expand targeted, proactive in-home supports for at-risk families 5 5 – En Enhance and d streamline sy st syst stem of 5.3 Develop coordinated system to enhance care for ch ca children and treatment foster care capacity and cultural youth yo responsiveness 5.4 Prioritize residential treatment for those with significant/complex needs
We observed a great amount of en We ener ergy and atten ention to to improving the system’s capacity to to meet et the needs of ju of justic ice-in involved in indiv ivid iduals wit ith behavio ioral health needs ne ds. . 6.1 Ensure collaboration and communication between systems 6.2 Promote behavioral health training among first- 6 – Co 6 Continue to responders and others implement and im refine cri re riminal 6.3 Review behavioral health treatment capacity in ju justice strategy jails 6.4 Ensure Medicaid enrollment for individuals returning to community
Issues w Is with ce certifica cation and lice censing, a , as w well a ll as st staffing g and retention, w , were f frequently ly r raised a as k key ba barriers to o ensuring a well-qu qualified workforce. 7.1 Establish single entity for supporting workforce implementation 7.2 Develop single database of statewide vacancies 7 7 – En Engage in for behavioral health positions ta targeted efforts ts to 7.3 Provide assistance for behavioral health re recru ruit and re retain competent co students working in areas of need in the state behavior beha oral al heal health h 7.4 Raise awareness of student internships and wo workforce rotations 7.5 Conduct comprehensive review of licensure requirements and reciprocity
We We applaud current initiatives to expand peer peer su support se services. T . These s services m must b be d deli livered accordi ac ding ng to nat national nal prac actice standar andards ds in in a manner th that t mainta tains th the integrity ty of peer support. t. 7.6 Continue establishing training and 7 – En 7 Engage in credentialing program for peer services ta targeted efforts ts to 7.7 Expand credentialing programs to prevention re recru ruit and re retain co competent and rehabilitation practices behavior beha oral al heal health h 7.8 Support a robust peer workforce through wo workforce training, professional development, competitive (c (continued) wage
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