FY Budget Presentation

Transcription

1 Office of Mental Health and Substance Abuse Services FY Budget Presentation

2 Health Care Budget Overview Budget responds to the current economic challenge by permanently reducing costs Allows for a $346 million expansion in health care across all commonwealth agencies ($329 million for DPW) Increases the number of children receiving health care through CHIP by 10,300 Maintains adultbasic enrollment at 2008 levels Builds on progress to rebalance the long term living system Supports DPW safety net programs and investments in quality and results

3 The FY10-11 DPW budget prepares PA to meet rising demand MA enrollment is expected to grow 3% In child welfare, the number of children needing outof-home placement will continue to decline, allowing more children to be served in their homes 150 new individuals will be able to access MR community services to avoid institutionalization More children will be able to participate in early learning programs, and more individuals will be able to access needed mental health and substance abuse services

4 Risks to the Budget 1. The Economy if the recovery is slower than expected, revenues will be below target 2. MCO Pharmacy Rebates if Congress fails to act, we will have less pharmacy savings 3. Enhanced FMAP if Congress fails to extend the enhanced match for Medical Assistance, the budget will not balance

5 Office of Mental Health and Substance Abuse Services

6 OMHSAS: Guiding Principles The Mental Health and Substance Abuse Service system will provide quality services that: Facilitate recovery and resiliency for adults and children Are responsive to individuals unique strengths and needs throughout their lives Focus on prevention and early intervention Recognize, respect, and accommodate differences as they relate to culture/ethnicity/race, religion, gender identity and sexual orientation Ensure individual human rights and eliminate discrimination and stigma Are provided in a comprehensive array by unifying programs and funding building on natural and community supports unique to each individual and family Are developed, monitored and evaluated in partnership with consumers, families and advocates Represent true collaboration with other agencies & service systems

7 DPW: OMHSAS-Administered Behavioral Health Funding Community Mental Health Services Base Funds CHIPPs/SIPPs BHSI- Mental Health MH Block Grant/SSBG/Other Federal Other Categoricals State Mental Hospitals DPW Administered Drug and Alcohol Act 152 BHSI- Drug & Alcohol Medicaid BH FFS HealthChoices Behavioral Health Special Pharmaceutical Benefits Program ( SPBP)

8 OMHSAS: Unified Systems Strategy County-based Medicaid state plan services utilizing county base funding for state match 1991 CHIPP dollars follow person from State Hospital to community Streamline appropriation Community/Hospital Appropriation Act 152 Dollars administered by OMHSAS 1997 BHSI funds for MH and D&A established and administered by OMHSAS HealthChoices BH program administered by OMHSAS (Southeast) 1998 OMH changes name to OMHSAS 1999 HealthChoices expansion to Southwest 2001 HealthChoices expansion to Lehigh/Capital Service Area Planning Initiatives; County Planning Children s Integrated Services Initiative (ICSI) HealthChoices expansion to Northeast Counties BH FFS Transfer HealthChoices Expansion to 23 counties HealthChoices Expansion to all 67 counties Assume responsibility for SPBP program Enhanced cross system initiatives; maximization financial supports Funding transfer to ODP to support persons with Intellectual Disabilities/MH Funding transfer to PCCD to support Forensic Initiatives, including Center of Exec. Braided Funding pilot for persons with Traumatic Brain Injury Joint Funding with OCDEL for Early Childhood Mental Health Initiative Joint Funding of Evidence Based Practices ( PCCD, OCYF) Funding commitment of reinvestment funds to PHFA for housing for persons with MI

9 Movement of Funding from State Administration to County Administration Percentage of OMHSAS Funding Under County Admin. 71% HealthChoices Dollars Under County Admin. $3,429,592,084 28% Community Grant 72% State Dollars Under County Admin. $354,355,067 Dollars Under State Admin. $914,662,672 14% Community Grant 15% State Dollars Under State Admin. $582,530,796 Percentage of OMHSAS Funding Under County Admin Community Grant Program HealthChoices Note: State Mental Hospital and Medicaid Fee-For-Service Funding are under State Administration.

10 Mental Health and Drug and Alcohol Service System Comm Based Grants, $590,618,000 15% BHSI/Act 152, $71,558,107 2% SM Hospitals, $403,954,000 10% MH/D&A MA FFS, $107,018,689 3% HealthChoices, $2,838,974,084 70% Total Funding $4,012,122,880

11 OMHSAS FY Budget Summary Fiscal Year Fiscal Year Fiscal Year APPROPRIATION SOURCE Actual Available Recommended MH Services State $707,890,000 $728,730,000 $710,354,000 Federal 264,158, ,847, ,769,000 Other 11,995,000 10,449,000 10,449,000 TOTAL $984,043,000 $1,010,026,000 $994,572,000 BHSI/Act 152 BHSI (State) $43,739,000 $55,331,000 $55,331,000 IGT (Other) 12,107, MAOP/Act 152 (State) 16,205,094 15,674,107 16,227,107 TOTAL $72,051,094 $71,005,107 $71,558,107

12 OMHSAS FY Budget Summary Fiscal Year Fiscal Year Fiscal Year APPROPRIATION SOURCE Actual Available Recommended MH/D&A MA Capitation State $1,250,078,683 $1,002,197,020 $1,104,686,007 Federal 1,321,554,705 1,557,728,860 1,734,288,077 TOTAL $2,571,633,388 $2,559,925,880 $2,838,974,084 MH/D&A MA Fee-For- State $54,867,643 $45,310,078 $47,672,488 Service Federal 42,418,180 54,521,637 59,346,201 TOTAL $97,285,823 $99,831,715 $107,018,689

13 OMHSAS FY Budget Summary APPROPRIATION SOURCE Actual Available Recommended Grand Total State $2,072,780,420 $1,847,242,205 $1,934,270,602 Federal 1,628,130,885 1,883,097,497 2,067,403,278 Other 24,102,000 10,449,000 10,449,000 TOTAL $3,725,013,305 $3,740,788,702 $4,012,122, recommended budget was $2,157,974,626

14 OMHSAS: FY Budget Unified System Strategy Mental Health Services $994.6 B total state, federal and other funds FY 09/10 freeze restored One time cost containment, $20M Provides sufficient funds to support the closure of Allentown State Hospital $ M for 155 CHIPPs 110 Discharges from Allentown State Hospital 30 Discharges from Norristown State Hospital 15 Discharges from Wernersville State Hospital» Transfer of $1.820 M to ODP for 13 individuals from the state hospitals to the waiver program» Funding targeted for up to an additional 17 persons with Intellectual Disabilities/ Mental Illness (Funding transfer in subsequent year) $5 M savings achieved through reimbursement from counties for the first 90 days that pre-trial detainees reside in the state mental hospital forensic units

15 OMHSAS: FY Budget Unified System Strategy BHSI Funding for MH and D&A - $ M $22,132,400 MH $33,198,600 D&A Act 152 funding is maintained at $16,227,107 for FY Expedited Plus enrollment-19 counties submitted; 1 county fiscal impact in HC Sexual Responsibility and Treatment Program (Act 21) Implemented in April 2004 on the grounds of Torrance State Hospital 28 men are now being served; no one has been discharged since first admission of program, planning for up to 2 releases SRTP program operation was transferred to the Commonwealth and operated by Torrance State Hospital (July 1, 2006) Special Pharmaceutical Benefit Program (SPBP) Increase in funding from $2.389 M to $2.619 M

16 67 HealthChoices Counties Behavioral Health HealthChoices 43 counties accepted right of first opportunity 1 direct state contract with BH-MCO (Greene County) Direct state contract with 23 counties operates in partnership with BHARP (county oversight entity) Incorporates broad behavioral health mandates Variety of models including full risk county contracts, subcontracts with Administrative Services Organization and full risk subcontracts

17 OMHSAS: HealthChoices As of January 1, 2010, there are 1.78 M people enrolled in HealthChoices, 2.1M projected in MA overall for FY Projected enrollment for SFY is $1.88 M FY funding projected to be $2.839 Bin the Southeast, Southwest, Lehigh/Capital, Northeast Zone, 23 county expansion zone and 15 county expansion zone: Legacy Zones ( SE, SW, L/C) $2.163B Expansion Zones (NE, SO, CO) $ 676M Mental Health portion* $2.507B Substance Abuse portion* $ 332M Reinvestment (savings) generated since 1997: $446M; 3.1% * includes administrative costs

18 General Our work in the coming year Monitor implementation of MH /SA Parity regulations Children Implement and monitor implementation of act 62 autism legislation ($30M estimated total savings) Adults Implement Psychiatric Rehabilitation State Plan

19 Statewide Gross Receipts Tax on MA Managed Care Revenues Statewide MCO Assessment ended 9/30/09 Effective 10/01/09, PA enacted a gross receipts tax of 5.9% on MA MCO revenue received from DPW by MA MCOs $354 M revenue in FY 10/11 Includes Behavioral Health MCOs

20 HealthChoices Cost Containment Proposal: 1) Seek return of uncommitted funds and unspent reinvestment funds from counties in HealthChoices behavioral health program. 2) Modify cap for risk and contingency funds. 3) Continue Shared Savings cap on reinvestment up to 3% (Legacy Zones) and 5% (Expansion Zones). FY 10/11 $3M state savings FY 09/10 $35M state savings; $33.4M returned to date

21 HEALTHCHOICES ZONES Erie Warren McKean Potter Tioga Bradford Susquehanna Crawford Wayne Forest Wyoming Cameron Venango Elk Sullivan Lackawanna Mercer Lycoming Pike Clinton Luzerne Clarion Jefferson Columbia Lawrence Clearfield Montour Monroe Butler Centre Union Carbon Armstrong Northumberland Snyder Northampton Beaver Indiana Mifflin Schuylkill Lehigh Cambria Juniata Allegheny Blair Huntingdon Westmoreland Perry Dauphin Berks Lebanon Bucks Washington Montgomery Cumberland Greene Fayette Somerset Bedford Lancaster FultonFranklin Chester Philadelphia Adams York Delaware SOUTHEAST Implemented Feb SOUTHWEST Implemented Jan LEHIGH/CAPITAL Implemented Oct NORTHEAST BH Implementation July 1, 2006 NORTH/CENTRAL STATE OPTION BH Implementation January 1, 2007 NORTH CENTRAL COUNTY OPTION BH Implementation July 1, 2007

22 State Hospitals/CHIPPs OMHSAS has 7 state hospitals and 1 long term nursing care facility * Since FY : 69% reduction in the state hospital census (through June 30, 2011) 55% decrease in staff complement Through the CHIPP funding: 2,909 individuals will have been discharged 14,305 individuals will have received diversionary services as a result of these discharges through June 30, 2010 $249,030,560 in funding for community programs and supports * South Mountain recognized as top state nursing home in the country- US News & World Report

23 State Hospital Closure Updates Harrisburg State Hospital closed on January 27, individuals were discharged to the community Cumberland county 4 years later! Mayview State Hospital closed on December 29, individuals were discharged to the community One year report! Announcement of the closure of Allentown State Hospital occurred on January 21, 2010

24 CHIPP Funding History (Cumulative) Fiscal Year Funding Level Beds Persons Served $ 52,903, , $ 60,627, , $ 66,702,352 1,072 4, $ 83,801,837 1,432 5, $ 100,608,283 1,523 6, $ 117,221,000 1,721 6, $ 135,619,558 1,931 8, $ 155,651,196 2,170 9, $ 164,409,141 2,203 10, $ 166,997,141 2,236 11, $ 172,508,492 2,269 11, $ 194,690,118 2,462 11, $ 197,781,292 2,541 12, * $ 229,584,081 2,738 12, $ 247,102,665 2,849 13, ** $ 249,030,560 2,909 14,305 Persons served include persons receiving CHIPP funds and others receiving diversionary services. *Transferred $4.037 M to support federal match for structured treatment services Funding level includes carryover **5.5 million in Reserve for Allegheny County

25 OMHSAS State Mental Health Facilities and Service Areas ERIE WARREN SUSQUEHANNA McKEAN POTTER TIOGA BRADFORD CRAWFORD Warren Clarks Summit WAYNE FOREST VENANGO ELK CAMERON SULLIVAN WYOMING LACKAWANNA MERCER LYCOMING PIKE LAWRENCE CLINTON LUZERNE CLARION JEFFERSON COLUMBIA Danville CLEARFIELD MONTOUR BUTLER UNION CENTRE CARBON MONROE ARMSTRONG SNYDER NORTHAMPTON BEAVER SCHUYLKILL INDIANA Torrance CAMBRIA BLAIR LEHIGH Allentown ALLEGHENY DAUPHIN PERRY LEBANON BERKS WESTMORELAND HUNTINGDON BUCKS Wernersville MONTGOMERY WASHINGTON GREENE MIFFLIN JUNIATA NORTHUMBERLAND CUMBERLAND LANCASTER SOMERSET BEDFORD FRANKLIN FAYETTE FULTON ADAMS YORK South Mountain Norristown CHESTER PHILADELPHIA DELAWARE Warren Staff 448 Patients 183 Torrance Staff 602 Patients 290 As of February 05, 2010 Danville Staff 373 Patients 175 Clarks Summit Staff 473 Patients 220 Allentown Staff 379 Patients 175 Wernersville Staff 469 Patients 217 Norristown Staff 743 Patients 369 South Mountain serving all counties Staff 283 Patients 134

26 Fiscal Year Unified Mental Health and Substance Abuse Services System Community Mental Health Persons Served: 218,827* Expenditures: $538,672,180 Ave. Expend. $2,462 BHSI (MH) Persons Served: 31,978 Expenditures $23,967,751 Ave. Expend: $749 MA FFS Persons Served: 91,156 Expenditures: $103,004,712 Ave. Expend. $1,130 HealthChoices Persons Served: 330,606 Expenditures: $1,959,682,174 Ave. Expend. $5,928 BHSI (D&A) Persons Served: 46,617 Expenditures: $33,426,597 Ave. Expend. $717 Act 152 (D&A) Persons Served: 6,223 Expenditures: $18,275,378 Ave. Expend. $2,937 State Mental Hospital Persons Served: 3,539 Expenditures: $387,997,439 Ave. Expend. $109,635 * not all counties submitted data

27 Program Initiatives Progress on Our Objectives

28 Approximately how many consumers are employed as peer specialists in your state? 21 of the 22 states answered this question. The range was from 9 to 500. Taken from the Pillars of Peer Support National Summit- November 17 & 18, 2009

29 General update: Certified Peer Specialists Number of trained CPS: 1160 Number of trained CPSS: 720 Number of programs enrolled: 67 Consumer Leadership Group identified additional goals OMHSAS with The Main Link, developed curriculum for specialized training centered on Forensic Peer Specialists; Second training next week! OMHSAS also supported older adult peer development

30 Impact of Certified Peer Specialists Service Area Planning Response Participation and Leadership in Community Support Planning for individuals leaving State Hospitals (Allegheny County, Beaver, Lehigh, Northampton, CMP) Transition Support and Linkages (All Service Areas) Certified Peer Specialists Report Compelling Stories of Recovery (Statewide) Opportunities for Employment, Recognition, Income (Statewide) Traditional Agency Response Impact of CPS on traditional agency, change of culture (Montgomery)

31 Impact of Certified Peer Specialists County Response Systems Change Agent ( Montgomery, Cumberland, Dauphin, Westmoreland, Erie, Philadelphia, and on and on..) County Plan Recognition of value to all Human Services (Bradford Co) State Response Employees at OMHSAS, DPW Civil Service Status (approved)

32 Justice Related Services PCCD/OMHSAS Partnership Forensic Peer Support Training Grant/Funding Announcement Funding Announcement contacts Ms. Jacqueline Weaknecht (PCCD) (717) Ms. Jessica Reichenbach (OMHSAS) (717) unding/5424/more_page17/551664

33 Justice Related Services Mental Health and Justice Advisory Committee Mental Health & Justice Center of Excellence Jointly fund grants to counties for mental health courts and jail diversion programs ($6.5M ARRA funds)

34 OMHSAS: Housing Reinvestment Expenditures Bridge $8,657,661 Master Leasing 7,783,353 Capital 15,209,429 PBOA 10,072,753 Management Clearing House 2,557,288 Housing Support 4,453,310 Housing Contingency 1,712,480 Fairweather 82,000 Other 1,650,198 Total $ 52,133,472 **Provides overview of type of use of one time funds Partners include OMHSAS, County MH, County Development Offices, Local Housing Agencies, Pennsylvania Housing Finance Agency and Technical Assistance Collaborative

35 Projected Supportive Housing Initiative Summary Type of Project # of Counties Projected # of Units Bridge Subsidies Master Leasing Capital Financing (units) Project Based Operating Subsidies Total Number of Projected Units/Subsidies 1600

36 Quality Management: How are We Doing. What difference are we making???

37 How we are doing: Service Area Planning During FY 07/08, 719 people were discharged from the civil hospitals (excluding Mayview). 37 people were readmitted CSP s were developed for 123 (17%) of the people discharged. Overall readmission rate for 710 people discharged was 5.1%. Readmission rate for people discharged with a CSP during this same period was 0.4%. This has held true for individuals discharged from Mayview State Hospital. This difference between the two readmission rates reinforces the value and importance of a CSP in sustaining a person s discharge and ultimately their recovery. Far fewer incidents when individuals have a Community Support Plan that includes Consumer and Family input!

38 Service Area Plan Updates: Goal 1 Consumers served in State Hospital System 6/03-6/09 Length of Stay for Consumers N u m b e r o f C o n s u m e r s Years Under 2 Years over 2 Years

39 Service Area Plan Updates Percentage of Individuals with a Length of Residence < 2 Years and > 2 Years Percentage Percentage of Individuals with a Length of Residence Less Than 2 Years and Greater Than or Equal to 2 Years Year Years Under 2 Years

40 Service Area Plan Updates Despite a decrease in the absolute number of individuals who have been in state hospitals for 2+ years- particularly with the closure of Harrisburg and Mayview State Hospitalsthe percentage remains relatively constant. We must remain committed to Goal 1 closing hospitals is the most effective method for achieving that goal

41 Quality Management Updates: HealthChoices Behavioral Health Performance Report 2009 Positive trends in OMHSAS Priority Areas Adult Mental Health Services The rate of eligible adults (ages 18-64) receiving MH services increased from 25% in 2007 to 26% in The Southwest region has consistently shown the highest utilization rates, with 29.8% of eligible adults receiving MH services in calendar year There was also an increase in the 2008 rate of adults with Serious Mental Illness receiving MH services, with 7% of this population receiving community based care. This was significantly higher than the estimated national average of approximately 3.1%. NOTE: To adjust for County size, weighted averages were used in reporting

42 Quality Management Updates: HealthChoices Behavioral Health Performance Report 2009 Drug and Alcohol: Adults (ages 18-64) receiving drug and alcohol services remained unchanged at 7% of eligible members in 2007 and The estimated national need is 4.8%. Those adults with Serious Mental Illness and a co-occurring substance disorder who received services remained constant at 2% of eligible members from 2004 to This was below the national estimated need of 3.1%. NOTE: To adjust for County size, weighted averages were used in reporting

43 Quality Management Updates: HealthChoices Behavioral Health Performance Report 2009 Minority Service Utilization Mental Health: Utilization of MH services by African-American adults (ages 18-64) increased from 18% of eligible members in 2004 to 22% statewide in With the exception of the North/Central State Option (which dropped by 1%), every region reporting multiple years of data showed increased use of MH services by African-American adults in 2008 (the last year data are available). Drug and Alcohol: African-American adults (ages 18-64) receiving drug and alcohol services increased from 7% of eligible members in 2004 to 8% in The minority population for some counties was so small it was not included in this indicator. NOTE: To adjust for County size, weighted averages were used

44 Quality Management Updates: HealthChoices Behavioral Health Performance Report 2009 Psychiatric Inpatient Readmission Rates Older adults (ages 65 and over) who were readmitted to community inpatient psychiatric hospitals within 30 days of discharge decreased statewide from 10% in 2007 to 8% in The adult (ages 21-64) readmission rate to community inpatient psychiatric hospitals within 30 days of discharge dropped slightly from 21% of discharges in 2007 to 20% in Calendar Year Children (ages 0-20) who were readmitted to community inpatient psychiatric hospitals within 30 days of discharge in 2008 decreased from16% in 2007 to a statewide average of 15% in NOTES: To adjust for County size, weighted averages were used. Unlike many other performance indicators, the readmission measure is an inverted rate, in that lower rates are preferable.

45 Quality Management Updates: HealthChoices Behavioral Health Performance Report 2009 Services following Inpatient Discharge The rate of adults (ages 21-64) receiving community behavioral health services within seven days of discharge from inpatient psychiatric care increased from 30% in 2004 to 39% in The Northeast Region reported the highest 2008 rate at 60.4%. The 7-day follow-up rate for children (< 21 years) discharged from inpatient psychiatric care increased to 56% in 2008 (from 48% in CY 2004). The national norm for this measure is 42.5%. OMHSAS has established a Gold Standard of 90% community follow-up care within seven days of hospital discharge. NOTES: To adjust for County size, weighted averages were used. The data reflect the fact that additional allowable procedure codes were added between 2004 and 2008 to these HEDIS (Health Effectiveness Data and Information Set) measures.

46 Quality Management Updates: HealthChoices Behavioral Health Performance Report 2009 Children s Service Utilization Mental Health Children (< 21 years) who were admitted to residential treatment facilities remained steady with 4% of eligible children receiving services in CY 2007 and The rate of children who remained in residential treatment facilities more than 120 days decreased in 2008 when compared to the prior calendar year, with 2% of these children having extended stays in Drug and Alcohol Adolescents (ages 13-17) receiving drug and alcohol services remained steady over time, with 1% of eligible members receiving services in 2004 and in NOTE: To adjust for County size, weighted averages were used

47 Other OMHSAS Quality Improvement Initiatives Quality improvement is an ongoing, collaborative process with all stakeholders. Several 2010 efforts of note: Convening Consumer and Family Satisfaction Survey Methodologies Workgroup to: Revise language within Appendix L of the HC BH contract to reflect current and projected survey activities. Expand use of the ROSI consumer survey statewide, for a targeted population of adults. Review existing 3 statewide survey questions and develop age-appropriate companion sets of 5-10 survey items. Develop a toolkit and implementation strategy for all C/FSTs, Counties, BH-MCOs and OMHSAS. Year 2 of Root Cause Analysis and Action Plan processes with BH-MCOs and Counties on select performance indicators. Development of an OMHSAS Dashboard, which will enhance management functions and improve data sharing.

48 Perspectives of Care: MHSIP The ultimate measure of services is how individuals are doing in their lives. An integral measurement strategy involves asking consumers and family members about their perceptions of care. Adults OMHSAS conducts an annual mailed MHSIP (Mental Health Statistics Improvement Program) survey with adult recipients of behavioral health services. The survey items are categorized into 7 national Domains, which are reported to the federal government in our mental health block grant. The 2009 findings showed that adults surveyed feel most positively about participation in their own treatment. Outcomes of Care commonly receives the lowest ratings of the domains. This performance indicator is one of nine National Outcome Measures.

49 Perspectives of Care: MHSIP 100% Pennsylvania Consumer Perception of Care 2009: Adult Survey Respondents Reporting Posivtively on MHSIP Domains 90% 84.67% 82.75% 85.59% 83.60% 80% 70% 64.15% 70.51% 63.37% 60% 50% 40% 30% 20% 10% 0% Access Quality and Appropriateness Outcomes Participation in Treatment Planning General Satisfaction Social Connectedness Functioning

50 Perspectives of Care: MHSIP Families Annually, OMHSAS also conducts a mailed MHSIP survey with family members of children and adolescent behavioral health service recipients. Social Connectedness and Functioning are the two domains most recently added to the structure of the MHSIP surveys. The 2009 findings showed that families surveyed feel most positively about two key items regarding their child s care: Cultural Sensitivity of the staff and Participation in their child s treatment planning. 62.4% of families surveyed believed that their child s outcomes were improved as a direct result of services received.

51 . Perspectives of Care: MHSIP Pennsylvania Consumer Perception of Care 2009: Family Member Survey Respondents Reporting Positively on MHSIP Domains 100% 90% 80% 83.89% 77.21% 89.26% 92.31% 79.97% 70% 62.41% 62.26% 60% 50% 40% 30% 20% 10% 0% Access General Satisfaction Outcomes Participation in Treatment Planning for their Children Cultural Sensitivity of Staff Social Connectedness Functioning

52 OMHSAS use of the Recovery Oriented System Indicators Measure (ROSI) in 2009 Consumer Survey Contracted with the Consumer Satisfaction Team Alliance of PA & 21 local satisfaction teams in a pilot program 576 adults with SMI surveyed face-to-face in 24 counties. Administrative Data Profile Counties reported their providers survey responses. The areas surveyed were: Peer/Consumer programs, Jail diversion, Affirmative action hiring policies by providers, Recovery-oriented mission statement & Consumers serving on provider governing boards

53 The "Top Ten" ROSI questions by percentage answered by participants in 2009 Dr. worked w/ me to get meds that were most Staff listens carefully to what I say Physical health is not ignored Staff have not interferred w/ personal relationships Residence feels like comfortable home Services have not caused me emotional or physical harm Staff do not use pressure, threats or force Respected as a whole person Respect for cultural background 91.6 At least one person who believes in me 96

54 Administrative ROSI: What percent of funds are allocated for peer/consumer delivered services? The Number of Counties reporting their allocated percentages for Peer/Consumer Programming in 2009 > 7% - 25% > 5% - 7% > 2.5% - 5% The Number of Counties reporting their allocated %s for Peer/Consumer Programming in 2009 > 7% - 25% > 5% - 7% > 1% - 2.5% 0-1% > 2.5% - 5% > 1% - 2.5% 0-1% What we learned by asking. No association between size of county and % What further question we had. Was the data accurate in the higher %s reported?

55 When we placed all of the counties together we could see the comparative differences in their allocated percentages reported number means higher spending by percentage in Counties for Consumer/Peer Programs Tioga Schuylkill Northampton Luz/Wyom Wayne Bucks 5 4 Chester Delaware Montgomery Philadelphia Allegheny Lehigh Arm/Ind Lack/Susq 3 Beaver CMP Butler Brad/Sull 2 Cam-Elk Berks Clarion 1 York/ Adams Clear/Jeffe Northumberland 0 Crawford Lyc/Clint Erie Lebanon Fayette Lancaster For/Warr HMJ Greene Frank/Fult Lawrence Dauphin McKean Cumb/Perry Mercer CMSU Centre Cambria Blair Bed/Som Venango Washington Westmoreland Potter

56 Transition to New Administration Identifying leadership team for transition to new administration Preparing briefing book for new Governor Developing public legacy document summarizing current initiatives and accomplishments Prioritizing initiatives to finish before the new administration

57 There s a Spring Day Coming!

58 You Are The Evidence!!!!!! I m The Evidence For how belief inspires How hope transforms and How giving heals the soul I m The Evidence For what can be achieved How feeling connected can ground and How there is invaluable worth in an act of faith I m The Evidence For how an example can lead How far encouragement can take you and How one step begins a journey towards endless possibilities 2008 Transformation Designs

59 Office of Mental Health and Substance Abuse Objectives 2010 Update

60 OMHSAS Objectives Transform the children s behavioral health system to a system that is family driven and youth guided Implementation of services and policies to support recovery and resiliency in the Adult Behavioral Health System Assure that behavioral health services and supports recognize and accommodate the unique needs of older adults

61 Children s Objectives Transform the children s behavioral health system to a system that is family driven and youth guided

62 Some Guiding Principles Trauma informed culture should serve as the background for all services to children and adolescents CASSP principles are assumed to be part of the children s Objective and Supporting Projects Youth and Family Teams will lead to a transformation of the children s behavioral health system

63 Children s Supporting Projects and Actions Establishment of Child-Family Teams to support Transformation Establish an Institute to provide training, support and monitoring of Youth and Family Teams - Complete Develop mechanism for Medicaid payment of Youth and Family Team process - Complete

64 Children s Supporting Projects and Actions Create Home and Community Based Alternatives to Residential Treatment Develop a White Paper addressing current environment, needs and recommendations for creating alternatives to the current residential treatment system - Complete Change existing rules to permit small group homes and therapeutic housing Under consideration Enroll Multi Dimensional Treatment Foster Care as a Medicaid funded service Nearly complete Maintain data base on RTF utilization Partly complete

65 Children s Supporting Projects and Actions Partner with Education to support the development of effective school based supports and interventions Have OMHSAS Children s Advisory develop White Paper on school based behavioral health services - Complete Engage youth to get their perspective on school based behavioral health services - Complete Review and update the existing Memorandum of Understanding with DOE, DOH, and DPW to detail responsibilities for SBBH Different approach being taken Continue to build the relationship with DOE and collaborate on projects such as SBBH Demonstration Grants, Positive Behavioral Interventions and Supports, etc. - Ongoing Reduce admission to segregated programs - Ongoing Identify efforts underway with BHMCOs on collaborative efforts with schools - Ongoing Enhance letters of agreement between Counties, BHMCOs and Schools Existent in some areas

66 Children s Supporting Projects and Actions Create Behavioral Health competency to honor the strengths and address the unique individualized needs of children and adolescents: - All ongoing In the child welfare system In, or at risk of entering, the Juvenile Justice system In the drug and alcohol system With Fetal Alcohol Syndrome Disorder That are Deaf or Hard of Hearing With Traumatic Brain Injury With Autism Spectrum disorder or other Pervasive Developmental Disorder With Physical Disabilities And infants and young children

67 Children s Supporting Projects and Actions Develop a process for identifying and implementing evidence based practices, promising practices and culturally relevant practices Utilize the SAMHSA National Registry of Evidence Based Practice, the NASMHPD Research Institute, the National Blue Print initiative and other sources to identify evidence based and promising practices In process Document the expansion of Multi Systemic Therapy, Functional Family Therapy and other evidence based practices in current practice - Ongoing Develop the Youth and Family Team process as the practice model for children s behavioral health to support evidence based practice - Ongoing

68 Children s Supporting Projects and Actions Develop strategies to address the needs of Transitional Youth Support Youth involvement in the OMHSAS Advisory Council - Ongoing Obtain Youth input in identifying needs, developing plans, implementing and monitoring service development for Transition Youth - Ongoing Summarize OMHSAS Transition Pilot projects - Complete Identify existing initiatives in other agencies - Ongoing Work with OMHSAS housing plan -Complete

69 System of Care Priority The System of Care Partnership will build on and enhance cross system efforts that have been underway for several years to integrate and more effectively provide services to youth. The System of Care Partnership will transform the current categorical and fragmented service delivery approach into a comprehensive community-oriented delivery system.

70 High Fidelity Wraparound Priority High Fidelity Wraparound has proven to be cost-effective for youth with complex, multisystem involvement. This approach has been implemented in 4 counties, 2 additional counties are now in training, and 2 more will begin in the near future. We want to expand to all counties in the Commonwealth.

71 Evidence Based Practice Priority We have successfully expanded the availability of FFT, MST, and MTFC which treat similar populations. Evidence-based programs that treat young children, youth with serious mental illness, traumatized youth, and youth with internalizing disorders (e.g., depression, anxiety) need to be identified and a strategy for making these additional EBPs available to Pennsylvania youth must be developed.

72 Early Child Mental Health Priority Expand ECMH consultation Provide Medicaid reimbursement for evaluation and services based on DSM-IV V-Codes Expand collaboration between physical and behavioral health; e.g., expand screening for social and emotional developmental delays and referrals to qualified behavioral health practitioners Support professional development options to increase the number of practitioners and providers with expertise in ECMH

73 RTF Priority Publish RTF Regulations as proposed Continue to work with bringing Sanctuary model to RTFs Implement actions to support the Continuum of Care goal of reducing the number of youth in RTF s, providing services instate for youth currently placed out-of-state, and ensuring that appropriate services in the least restrictive environment are available to youth. Work cooperatively to divert youth with predominant mental health issues away from juvenile justice placements and into community based programs that can meet their MH needs.

74 Transition Youth Priority Implement a training curriculum for peer specialist working specifically with transition age youth. Develop ways to address the housing needs of transition age youth and young adults. Create a developmentally sensitive system of behavioral health services for transition age youth and young adults in every county.

75 Call for Change Priority OMHSAS is developing a Call for Change, a strategic plan to implement the goal of transforming the children s behavioral health system to be youth guided and family driven. The plan will focus on improving access and streamlining the process for quality, effective behavioral health services for children and their families.

76 Adult Objective Implementation of services and policy to support recovery and resiliency in the Adult Behavioral Health System

77 Adult Supporting Projects and Actions Define and expand the range of and financial commitment to consumer-run services, supports and trainers New Freedom Initiative Project - Complete Gain baseline understanding of existing consumer- run services, supports and trainers statewide Ongoing Develop Centers of Innovation around Evidence- based and Promising Practices- Complete for Forensic Review national models and define the Pennsylvania model - Complete

78 Adult Supporting Projects and Actions Support community re-integration of individuals who have been in state hospitals over 2 years Close at least 2 state hospitals by 2010 by Development and implementation of individual community support plans Complete for individuals discharged from Mayview, Plan for Allentown Closure by December 2010 Development of community infrastructure In Process

79 Adult Supporting Projects and Actions Implement an integrated system of services and support for co-occurring mental health/drug and alcohol recovery Identify how to increase co-occurring and substance abuse awareness and activities within OMHSAS - Ongoing Develop joint licensing standards - Ongoing Issue guidelines around D&A confidentiality - Ongoing Develop practice standards for co-occurring screening and service provision - Complete

80 Adult Supporting Projects and Actions Implement the recommendations of the Housing Workgroup Assure that every county/joinder have develop a housing plan using the OMHSAS Housing Plan template - Complete Implement and evaluate the Allegheny SSI Supplement Demonstration project Complete Develop strategies and convert at least $1 mil in CRR beds to supported housing In Process Policy development regarding use of public mental health funds in Personal Care Boarding Homes Complete

81 Adult Supporting Projects and Actions Implement, monitor and expand peer specialist services Enroll providers statewide, assuring availability of at least 2 programs offering peer specialists in each county/joinder- Ongoing Assure availability of peer specialist certification training - Complete Assure formalized peer support structures are available for peer specialists - Ongoing Develop the capacity for certified peer specialists to serve specific populations older adults, individuals involved in criminal justice system In Process Work in collaboration with the Bureau of Drug & Alcohol Programs to develop use of certified peer specialists in the drug and alcohol system - Ongoing Examine the use of consumer run peer specialist employment agencies In Process Identify specific outcome measures for Quality Improvement monitoring In Process

82 Adult Supporting Projects and Actions Implement recommendations of the Forensic Workgroup Partner with PMHCA to develop resources to support Certified Peer Specialists in serving individuals in the Criminal Justice system In Process- Funding Announcement for Forensic Peer Training Work with the Governor s Office on cross-systems task group - Ongoing Inventory existing community diversion and re-entry services Complete/Ongoing Support Allegheny county national conference - Complete

83 Adult Supporting Projects and Actions Develop plan for expanding Employment opportunities to support recovery Collaborate on the delivery of trauma informed care Work with Hospital Association of PA to eliminate seclusion and restraint in community hospitals In Process Target resources to plan for the expansion of trauma- informed care statewide for individuals, including: Transition age youth, returning veterans, individuals involved with the criminal justice system In Process

84 Adult Supporting Projects and Actions Restructure the Medicaid State Plan to support recovery and resiliency Review current regulations and revise/develop regulations supporting recovery/resiliency-oriented services In Process

85 Older Adult Objective Assure that behavioral health services and supports recognize and accommodate the unique needs of older adults

86 Older Adult Supporting Projects and Actions Expand access to services for older adults with the flexibility to provide services wherever they are Ensure that implementation of peer services includes training of older adults as providers of the service to older adults as well as younger adults - Complete Monitor access of peer specialist and mobile mental health services to older adults In Process

87 Older Adult Supporting Projects and Actions Increase awareness of and planning for suicide prevention for older adults Adopt at least one recommendation of the Suicide Prevention Plan for Older Adults - Complete Coordinate an annual Suicide Prevention Day in Harrisburg - Complete

88 Older Adult Supporting Projects and Actions Review the impact of dual eligibility on service provision Compile Medicare and Medicaid inpatient and outpatient data for older adults Inpatient, Complete Develop information and resources to help older adults better understand services under Medicare and Medicaid (OMHSAS/AGING/APPRISE) In process Use regional behavioral health Older Adult forums to share information on Medicare/Medicaid Complete Increase collaboration with Area Offices of Aging - Ongoing

89 Older Adult Supporting Projects and Actions Expand access to the interagency planning project for older adults with complex needs Compile information for case reviews - Complete Encourage greater county participation through access to training and continued collaboration with Aging - Ongoing

90 Older Adult Supporting Projects and Actions Increase awareness of needs of older adults for substance abuse treatment and programs structured to accommodate those needs in a culturally competent manner Identify facilities appropriate to serve older adults To be determined Define type of services older adults are likely to use by getting their feedback - Ongoing

91 Older Adult Supporting Projects and Actions Ensure community consumer involvement by providing support to individuals transitioning from South Mountain Restoration Center into communities where they live Ensure consumer participation in discharge planning teams - Ongoing Ensure consumer resources are identified and utilized in community where they return - Ongoing

92 Older Adult Supporting Projects and Actions Continue to assure appropriate mental health services are available to older adults experiencing dementia who have behavioral health problems Continue to monitor complaints or concerns regarding access to care - Ongoing Engage in educational efforts with public and managed care partners - Ongoing

93 Older Adult Supporting Projects and Actions Develop a collaboration with physical health partners (Home Health, Visiting Nurses Assn, etc.) to promote behavioral health screenings for older adults Assess willingness of MCOs/providers to partner on provision of screenings - Ongoing

94 Older Adult Supporting Projects and Actions Ensure an active role for the Older Adult Advisory Committee in the Money Follows the Person (MFP) project Older Adult Committee will identify representatives to serve on the MFP Advisory Work Group anticipating receipt of grant award - Complete

95 Older Adult Supporting Projects and Actions Support efforts to promote a study of Older Adults through the Legislative Budget and Finance Committee (LBFC) When presented with a request for legislative analysis, respond with positive support and background research on the bill soon to be introduced - Ongoing Advisory Committee members may advocate for support, either as individuals or members of their respective organizations - Ongoing

96 HEALTHCHOICES OVERVIEW County Oversight MCO/ASO Comments Bucks Bucks Co. Behavioral Health Magellan Behavioral Health, Inc Full Risk Sub-Contract Chester Chester County Department of Human Services Community Care Behavioral Health Organization (CCBHO) Full Risk Sub-Contract Delaware Delaware County DelCare Program Magellan Behavioral Health, Inc. Full risk Sub-Contrat Montgomery Montgomery County Behavioral Health Magellan Behavioral Health, Inc Full Risk Sub-Contract Philadelphia City of Philadelphia Community Behavioral Health (CBH) County Operated 501 C-3 Behavioral Health Organization: County retains Full Risk Allegheny Allegheny HealthChoices, Inc. (AHCI) Community Care Behavioral Health Organization (CCBHO) Beaver Beaver County ASO w/value Behavioral Health of PA (VBH) Fayette Fayette County MH/MR Program ASO w/value Behavioral Health of PA (VBH) Greene OMHSAS Value Behavioral Health of PA (VBH) Southwest 6: Westmoreland, Washington, Indiana, Armstrong, Butler, Lawrence Counties Southwest Behavioral Health Management, Inc. (SWBHM) Each county also has limited oversight responsibility Value Behavioral Health of PA (VBH) Full Risk Sub-Contract ASO contract with VBH of PA; county retains Full Risk ASO contract with VBH of PA; county retains Full Risk Full Risk Contract Full Risk Sub-Contract

97 County Oversight MCO/ASO Comments Berks Berks County Community Care Behavioral Health Organization (CCBHO) Adams and York York/Adams MH/MR Program Community Care Behavioral Health Organization (CCBHO) Lehigh & Northampton Capital 5: Dauphin, Cumberland, Perry, Lancaster, Lebanon Lehigh & Northampton Counties Capital Area Behavioral Health Collaborative (CABHC) Magellan Behavioral Health, Inc. (MBH) HealthAssurance Pennsylvania, Inc. (HASPA) Community Behavioral Healthcare Network of PA (CBHNP) Full Risk Sub-Contract Full Risk Sub-Contract Full Risk Sub-Contract Full Risk Sub-Contract Northeast 4 Lackawanna, Luzerne, Susquehanna & Wyoming Northeast Behavioral Health Care Consortium (NBHCC) Regional Behavioral Healthcare Management, Inc. (RBHM) Community Care Behavioral Health Organization (CCBHO) ASO Sub-Contract with RBHM and CCBHO NBHCC holds risk North/Central State Option Counties OMHSAS Community Care Behavioral Health Organization (CCBHO) Full Risk Sub-Contract

98 North/Central County Option Counties County Oversight MCO/ASO Comments Bedford/Somerset Blair (Primary Contractor) Cambria (Primary Contractor) Carbon, Monroe and Pike Erie (Primary Contractor) Franklin/Fulton Lycoming/Clinton Crawford, Mercer and Venango Primary Contractor: Behavioral Health Services of Somerset & Bedford Counties (BHSSBC) Blair HealthChoices Behavioral Health of Cambria County (BHoCC) Primary Contractor: Carbon/Monroe/Pike Joinder Board Significa Insurance Group, Inc Community Behavioral Health Network of PA (CBHNP) Significa Insurance Group, Inc. Community Behavioral Health Network of PA (CBHNP) Value Behavioral Health (VBH) Community Care Behavioral Health Organization (CCBHO) Full Risk Sub-Contract Full Risk Sub-Contract Full Risk Sub-Contract Full Risk Sub-Contract Erie County Value Behavioral Health (VBH) Full Risk Sub-Contract Primary Contractor: Tuscarora Managed Care Alliance Primary Contractor: Lycoming/Clinton Joinder Board Primary Contractor: Northwest Behavioral Health Partnership, Inc. (NWBHP) Significa Insurance Group, Inc. Community Behavioral Health Network of PA (CBHNP) Significa Insurance Group, Inc. Community Behavioral Health Network of PA (CBHNP) Value Behavioral Health (VBH) Southwest Behavioral Health Management, Inc. Full Risk Sub-Contract Full Risk Sub-Contract Full Risk Sub-Contract

99 Service Area Planning Meetings Norristown: March 18 Allentown: March 19 Wernersville: March 19 Danville: April 1 Clark Summit: April 9 Torrance: April 15 Warren: April 16

100 RESOURCES. parecovery.org SAMSHA : State by State overview pa-co-occurring.org Service Delivery Specific to County Library of Resources State and Federal Legislation Local, State and National Advocacy Efforts Secure Personalized Features Interactive Features