What is CCS? Eligibility

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1 What is CCS? Department of Health Services Division of Mental Health and Substance Abuse Services Bureau of Prevention, Treatment and Recovery Services Comprehensive Community Services (CCS) Comprehensive Community Services (CCS) is a recovery focused, integrated behavioral health program for adults with severe mental illness and/or substance use disorders and children with severe emotional disturbance. CCS is unique for, not only its focus on both mental health and substance use disorder, but the inclusion of both children and adults, and the focus on other physical illness and impact on multiple system use. CCS provides a coordinated and comprehensive array of recovery services, treatment and psychosocial rehabilitation services that assist individuals to utilize professional, community and natural supports to address their needs. CCS is a community based program in which the majority of services are provided in the clients home and local community. The program is person centered and uses client directed service plans to describe the individualized services that will support the client to achieve their recovery goals. While CCS services are client centered, services are provided by a team of professionals, peer specialists and natural supports, all coordinated by a CCS service facilitator. CCS services are eligible for Medicaid reimbursement for those individuals that qualify for Medicaid. However, only Counties and Tribes are allowed to be State certified to provide CCS services. In CY 2011, 26 counties in Wisconsin provided CCS and 1469 clients were served statewide. CCS is unique among the behavior health psychosocial rehabilitation programs, as each county offers a different array of behavior health services based on local resources and need. All CCS services are governed by the Administrative Code, DHS 36. Both the Code and Medicaid allows for CCS services to be client directed, flexible and individualized. CCS programs are designed to be community based, enhance client s recovery and satisfaction and continually build on quality improvement. First, CCS service arrays are developed to interface and enhance available behavioral health services and crisis services. Second, CCS programs focus on quality improvement through client satisfaction and progress toward client outcomes. Third, CCS programs appoint a coordination committee comprised of various stakeholders and develop and implement a quality improvement plan to evaluate the effectiveness of CCS and incorporate the feedback of clients and the committee. Eligibility CCS services are available to children diagnosed with serious emotional disturbance (SED) and adults who have a diagnosis of a mental illness (MI) and/or a substance use disorder (SUD) and require more than outpatient counseling but less than an intensive wraparound psychosocial rehabilitation program. In addition to a mental illness or

2 substance use disorder, the client must have an impairment that limits one or more major life activities, which results in the need for services. Eligibility for CCS is determined by a Department of Health Services approved functional screen. Eligible individuals have needs that fall into the following categories: Group 1: Children and adults in need of ongoing, high-intensity, comprehensive services who have diagnoses of a SED/MI and/or SUD and substantial needs for psychiatric or substance abuse treatment. Group 2: Children and adults in need of ongoing, low-intensity comprehensive services who have a diagnosed SED/MI and/or SUD. These individuals generally function in a fairly independent and stable manner but may occasionally experience acute psychiatric crises By providing services to both groups of individuals, CCS decreases the need for these individuals to rely on costlier high end services, such as emergency rooms and hospitals and improve client s recovery and outcomes. Enrollment Participation in CCS happens when an individual is referred to a county or tribe for CCS services; at which time the individual completes an application for services. The county then completes a functional screen to determine the individual s eligibility. When the client is determined to be eligible, the program will identify any immediate needs and the program s mental health professional will authorize CCS services. If the client has a substance use disorder, a substance abuse professional will also sign the authorization for services. To complete the enrollment process, an admission agreement is signed by the client and the mental health professional. If an individual is not eligible for CCS services, they are given a written notice of determination and referred to non-ccs services. Assessment, Planning and Services Assessment: CCS requires the completion of an assessment summary to be done within 30 days of an application for services. CCS assessments are comprehensive, client centered; strength based and identifies current needs in a whole person approach. The CCS service facilitator, and if appropriate, the substance abuse professional, assesses the client s strengths and needs in 16 domains. This comprehensive assessment takes into consideration, not only the client s needs for treatment for mental illness or substance use disorder, but needs in physical health care and social and environmental needs. Assessment areas include: Life Satisfaction Basic Needs, such as self-care and community living skills Family and social involvement Community Living Skills

3 Housing Employment and Education Finances and Benefits Physical, mental and substance abuse care Trauma and significant life stressors Crisis prevention and management Service Planning: After the assessment process, each client within CCS participates in a service planning process to develop their service plan. The service plan is comprehensive and details what services and supports will be provided, by whom, in what time frame and the overall goals for the service plan period. CCS services are individualized, that is to say, that services and supports are designed to uniquely match the strengths and needs of the client. Clients and service facilitators utilize the CCS service array to create a client s own service plan. Services: Mental Health and Substance Use Disorder Treatment: CCS provides for mental health and/or substance use disorder treatment in the least restrictive setting for the client. Most services are provided in the community; however, CCS does include residential treatment. Examples of services are medication monitoring, case management, and therapy. Psychosocial Rehabilitation: CCS provides psychosocial rehabilitation services and supports to address the many varied needs of the clients it serves. Psychosocial rehabilitation (PSR) is more than just psychiatric or substance use disorder treatment. It is a variety of services or supports which foster rehabilitation and recovery in a number of physical, emotional, social or environmental areas. Identification of strengths and needs in these areas addresses the fact that symptom reduction is enhanced by improvements in social and environmental supports and resources. Examples of services are assistance with grocery shopping, household chores and meal prep; assistance with money management, and support for treatment of health conditions, support with social interactions including school involvement. Recovery & Self-Direction: CCS is based on self-direction and assists clients to achieve the level of functioning, stability and recovery they desire. In order to be person centered, CCS professionals are to incorporate the client s perspective regarding of his or her recovery, experience, strengths, challenges, resources and needs in the assessment and planning process. CCS is a unique combination of client-direction and professional input. In addition, CCS programs recovery-based approach to service provision incorporates the involvement of family and other members of consumers social networks. Recovery Team: In the initial stages of CCS admission, it is important for the client and service facilitator to identify members of the recovery team. This team includes the client, the service facilitator, the mental health and/or the substance

4 Outcomes abuse professional and service providers, family members, natural supports and advocates. The recovery team is instrumental in the provision of services and supports, participates in the assessment and service planning process, and the ultimate goal of assisting the client in the recovery process. Decrease need for multiple systems and/or high end services: DHS Functional Screen Data shows that individuals, who are eligible for CCS, are at risk for utilizing or being involved in additional higher cost services, such as use of the emergency room, inpatient hospital, and corrections. In 2005, individuals participating in CCS in 16 counties were above the state average in utilization of emergency rooms, hospitals, civil commitments, physical aggression, criminal justice involvement, suicide attempts, and self-injurious behavior. Within one year of involvement in CCS, these clients reduced their involvement in numerous systems and higher end services. Screens showed that emergency room utilization decreased from 6.2% to 4.1%, inpatient from 23.2% to 19.1%, civil commitment from 21.1% to 14.9%, physical aggression from 11.9% to 8.2%, criminal justice from 7.2% to 6.2%, suicide from 6.2% to 4.1% and self-injurious behavior from 8.2% to 7.7%. Integration of Behavioral and Physical Health Care: CCS clients are, not only at risk for using higher cost services; they are at increased risk for having more than one illness. In 2011, 10% of CCS clients were reported to have high blood pressure, 10% diabetes, 7% asthma and 17% were obese. The CCS Outcome Analysis (2007) showed that 55.84% of CCS clients have Mental Illness, Substance Use Disorders and Physical Illness. The additional physical illnesses, to mental illness and/or substance use disorder, put clients at risk for health complications and early death. Increase of Recovery and Positive Outcomes: In addition to reduction of risk factors, CCS is successful in increasing clients recovery and interaction with family. According to the CCS Program Evaluation Project (2009), CCS is successful at providing Recovery Oriented Services. The Recovery Oriented System Indicators (ROSI) Survey was used to assess the extent to which consumers experience the CCS program as recovery-oriented. Clients reported that they experienced staff as empowering and person centered in their interaction with clients. In the 2011, of all the CCS client discharges, 47% of clients were discharged for needing less intensive care and treatment than is provided in CCS. In fact, this percentage was more than double the number of CCS clients discharged for needing more intensive care and treatment than is provided in CCS. The programs also assist clients with connecting to and being assisted by their families. In the CCS Program Evaluation Project (2009), 80% of clients reported feeling supported and listened by their family. Family members were also surveyed and reported feeling positively impacted by their involvement with clients. This is of particular interest for CCS programs because of the focus of inclusions of family in the recovery team. Quality Improvement and Use of Evidenced Based Practices: CCS programs strive to provide quality services through the use of evidence based practices (EBP). In 2011,

5 62% of CCS Programs utilized the at least one of the six Substance Abuse and Mental Health Services Administration (SAMHSA) EBP toolkits. The highest used EBP was Illness Management and Recovery (IMR) with 38% and Supported Employment (SE) with 38%. IMR focuses on education of the client regarding the illness and symptoms and management of both in the journey of recovery. SE is and EBP that focuses on the importance of work with relation to recovery and assists the client in finding and securing employment, as well as, managing their illnesses during employment. Subsequently, 29% of CCS use Integrated Dual Disorder Treatment (IDDT) which supported individuals with co-occurring mental illness and substance use disorder and 24% use Supported Housing, which assists individuals to secure and maintain safe housing. The least used EBPs in CCS are Medication Management which uses best practice coupled with patient input in making medication management decisions was at 14%. Family Psychoeducation which involves the development of a partnership among consumers, families, practitioners, and supporters was used in 10% of CCS. These EBPs assist the CCS programs to provide quality and relevant services to individuals who are increased risk for co-occurring substance abuse and mental health, homelessness and unemployment.

6 References Mahoney, C., Greenberg J., & Studer, L. (2009). CCS Evaluation Project: Summary Report for Phase I University of Wisconsin-Madison School of Social Work Department of Health Services ( ) Co-Occurring Disorders And One-Year Outcomes For Mental Health/Alcohol and Other Drug Abuse Functional Screen Participants Department of Health Services (2011) Comprehensive Community Services Report