This large group meeting is hosted by the National TA Network for Children’s Behavioral Health (TA Network), operated by and coordinated through the University of Maryland. This presentation was prepared by the National Technical Assistance Network for Children’s Behavioral Health under contract with t he U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Contract #HHSS280201500007C. Disclaimer: The views, opinions, and content expressed in this presentation do not necessarily reflect the views, opinions, or policies of the Center for Mental Health Services (CMHS), the Substance Abuse and Mental Health Services Administration (SAMHSA), or the U.S. Department of Health and Human Services (HHS).
APPROACHES TO ADDRESSING BEHAVIORAL HEALTH DISPARITIES IN MEDICAID MANAGED CARE SYSTEMS Selena Webster-Bass Alaska Nebraska
Learning Goals Describe behavioral Discuss community Identify approaches health disparities, examples of to addressing health root causes and the culturally disparities using the impact of social responsive National Culturally determinants engagement and and Linguistically outreach, use of Appropriate Services data and (CLAS) Standards intervention strategies.
The Changing Face of America
Behavioral Health Disparities • Behavioral health disparities continue to exist in the United States across various sub-populations including disadvantaged communities, racial and ethnic groups, LGBTQ+ communities, youth with disabilities and transition age youth. • Compared with the majority population, racially and ethnically diverse groups are: – Less likely to receive quality care. 1 – More likely to use hospitals and inpatient facilities for mental health services rather than community-based services; 8 and – Less likely to receive mental health care when needed ; 11
Contributing Factors to Behavioral Health Inequities • Several factors at the individual, provider, community and systems levels contribute to behavioral health inequities. • Social Determinants • Cultural values • Social stigma • Reliance on faith, family and friends for mental health support • Lack of access and utilization of behavioral health services • Structural Inequities • Trauma (Historical, Adverse Childhood Experiences etc.) • Agencies’ lack of organizational -level considerations in honoring and addressing the cultural needs of diverse populations • Implicit and explicit bias of providers • Shortage of behavioral health providers • Lack of racially and ethnically diverse providers
Equity Center for Story-based Strategy and the Interaction Institute for Social Change in April 2016. The artist is Angus McGuire. https://www.storybasedstrategy.org/the4box.html 2
Addressing Behavioral Health Inequities Examples of Approaches to Addressing Behavioral Health Inequities 2 • Application of the National Culturally and Linguistically Appropriate Services (CLAS) Standards • Use of culturally adapted interventions that use care managers to increase engagement among individuals with Limited English Proficiency (LEP) and limited health literacy • Decrease systems fragmentation by establishing integrative care models that use care managers to link families to primary care, mental health services, social supports and preventive care • Use of technology for appointment reminders, self-management, community education, telemedicine and stigma reduction • Establish broad data standards for behavioral health and social determinants to improve health disparities tracking • Clinical interventions that promote the early identification of mental illness symptoms and removal of financial barriers • Build a diverse and culturally responsive workforce Source: Closing the Gaps: Scaling up to reduce mental health disparities in the United States (2013) https://www.nimh.nih.gov/research-priorities/scientific-meetings/2013/closing-the-gaps- scaling-up-to-reduce-mental-health-disparities-in-the-united-states.shtml 2
National Culturally and Linguistically Appropriate Services (CLAS) Standards Advance Health Equity Eliminate Improve Health Quality Disparities
National CLAS Standards Themes Governance, Continuous Communication Leadership and Quality and Language Workforce Improvement and Assistance Development Accountability Culturally and Linguistically Appropriate Practices
CLAS and Medicaid Integration Domains Examples • Governance, Leadership Establishing cultural and linguistic competency committees • and Workforce Inclusion of racially and ethnically diverse providers and Development traditional providers • Cultural and linguistic competency Training for Providers • Use of plan surpluses • Communications and Complete access to interpreter services • Language Access Partnering with community organizations for interpreter trainings, interpreter pools and provider trainings • Translation of managed care plan materials • Continuous Quality Clear definition of populations and service areas for which Improvement & health services are required • Accountability Use of Community Health Workers Program • Community participation in plan services development
CLAS and Medicaid Integration Governance, Leadership and Workforce Development • Assess organizational readiness for change • Conduct organizational assessments with document reviews • Develop a Cultural and Linguistic Competency (CLC) Plan • Embrace 2-D diversity (Inherent and Acquired) of organizational leaders and staff • Establish cultural and linguistic competency training policies • Conduct a training assessment and develop training plans • Implement, monitor and evaluate trainings • Include peer support as a reimbursable service within managed care organizations
CLC Plan
CLAS and Medicaid Integration (cont.) Communication and Language Access • Issue interpreter services guidelines – Certification Exams – Capitation rates for multilingual services • Establish guidelines for provider proficiency • Simplify the process for producing and approving translated plan materials
CLAS and Medicaid Integration (cont.) Continuous Quality Improvement and Accountability • Data systems capable of tracking and providing information about care delivery, differentiated by population characteristics – Assess the validity of demographic databases used by managed care plans and departments – Assess the utility of information gathered during initial assessments – Link cultural demographic factors to utilization patterns and process measures – Collect and analyze Consumer Assessment of Health Plans Survey (CAHPS) data to gain insight into youth/family satisfaction and engagement with services – National accreditation programs for managed care providers should include a cultural competence component by which differences in process and outcomes measures by racial/ethnic or linguistic group can be examined.
Use of Cultural Competence Data
Jacksonville System of Care: Collaborative Care Model
JSOC: Collaborative Care Model • Interdisciplinary team of primary care and behavioral health professionals • Increasing access to health care coverage through use of Care Coordinator/Utilization Specialist • Language access – Contracts for interpreter and translation services • Cultural assessments with youth and families – Race/Ethnicity – Socioeconomic Status – Sexual Orientation, Gender Identity and Expression (SOGIE) – Faith/Spirituality – Geographical – Resident status • Referrals to multicultural resources • Cultural data tracking, collection, monitoring and evaluation • Tracking suicidal and homicidal attempts/crisis stabilization unit (CSU) recidivism, 7-day follow-up appointments post discharge from CSUs, care coordination follow-up to ensure psychiatric and therapy appointments within 30 days
Participating States and Counties Alaska Nebraska
MEETING THE BEHAVIORAL HEALTH NEEDS OF ALASKAN NATIVES IN REMOTE COMMUNITIES Terry Hamm DBH – Medicaid Provider Assistance Services
Alaskan Behavioral Health Aide Program
Behavioral Health Aides (BHA) https://vimeo.com/97368656
Alaska Tribal Health System • Alaska is “remote” not “rural.” • The majority of Alaskan communities are only accessible by air or ferry. • Alaska is divided in Tribal Health Regions • Each region has a “hub” community. Hub communities: – Are the largest community in the region and house all services for the surrounding villages – Most hub communities have either a hospital or large primary care clinic
Alaska Tribal Health System
BHA History • To meet the behavioral health needs in Alaska’s remote communities of the Alaska Native Tribal Health System, a para-professional class of behavioral providers was developed. • Behavioral Health Aides follow in the foot steps of the Community Health Aides, that have provided basic medical care for over 30 years.
Recommend
More recommend
