THE RECOVERY COLLABORATIVE OF OKLAHOMA

STATE OF OKLAHOMA THE RECOVERY COLLABORATIVE OF OKLAHOMA OKLAHOMA DEPARTMENT OF MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES OKLAHOMA HEALTH CARE AUTHORITY OKLAHOMA DEPARTMENT OF HUMAN SERVICES

INTRODUCTION The system that provides mental health and substance abuse services to low-income Oklahomans is facing a time of unprecedented change and opportunity. This circumstance is primarily due to a philosophical shift that has occurred in the practice of mental health and substance abuse treatment services. This change in approach began with the advent of the Consumer Movement in the early 1970s and continues today with the ongoing development of recovery-oriented mental health and substance abuse treatment practices. These practices provide consumers the opportunity to direct their own recovery processes. The implementation of these treatment practices is supported by a growing body of evidence validating that recovery-oriented treatment practices are more effective in providing positive outcomes for mental health consumers and substance abuse clients. This philosophical shift occurs at a unique time for the State of Oklahoma. The mental health and substance abuse delivery system in Oklahoma has undergone a number of recent program changes and is also faced with significant financial pressures created by declining state tax revenues during 2002 and 2003. The conjunction of these circumstances has highlighted the need for Oklahoma to reinvent its mental health and substance abuse delivery system for low-income individuals. The Oklahoma Department of Mental Health and Substance Abuse Services, the Oklahoma Department of Human Services and the Oklahoma Health Care Authority have already begun to take steps to meet this challenge. Together with people in recovery, advocacy organizations and providers, these agencies have formed a taskforce known as, the Recovery Collaborative of Oklahoma. This group is charged with the responsibility of developing a mental health and substance abuse treatment system that incorporates the philosophies of the Recovery Model, utilizes Evidence-Based Practices, and optimizes the utilization of state and federal resources.

THE MISSION TO DEVELOP AND IMPLEMENT MODIFICATIONS TO THE OUTPATIENT BEHAVIORAL HEALTH DELIVERY SYSTEM SERVING OKLAHOMA ADULTS THAT WILL ENHANCE THE QUALITY OF SERVICES PROVIDED, FOCUS THOSE SERVICES UPON RECOVERY AND THE NEEDS OF THE CONSUMER, AND ENSURE THAT STATE AND FEDERALLY FUNDED HEALTH CARE IS PURCHASED IN THE MOST EFFICIENT AND COMPREHENSIVE MANNER. OUR VALUES 1. CONSUMER DRIVEN o AT EVERY STEP OF THE PROCESS NOTHING ABOUT US, WITHOUT US! 2. RECOVERY ORIENTED o PEOPLE CAN AND DO RECOVER AND OUR SERVICES SHOULD SUPPORT AND ENCOURAGE THEIR PROCESS 3. COMMITTED TO PROVIDING THE HIGHEST QUALITY CARE o THROUGH THE UTILIZATION OF EVIDENCE-BASED PRACTICES AND CONTINUOUS QUALITY IMPROVEMENT 4. UTILIZE INTEGRATED DATA SYSTEMS, POLICIES AND PROCEDURES 5. EASILY ACCESSIBLE 6. EFFICIENT PURCHASING OF HEALTHCARE MAXIMIZES LIMITED RESOURCES o BY FOCUSING ON SUCCESSFUL PROGRAMS

OUR VISION The Recovery Collaborative of Oklahoma will create a well-organized mental health and substance abuse treatment system that provides consumer-focused, recovery-oriented services to low-income Oklahomans. This system will utilize uniform policies, procedures and systems across different agencies and will maximize the utilization of available resources. BACKGROUND THE TREATMENT REVOLUTION The Consumer Movement began as a protest by former patients of mental hospitals against involuntary commitment and treatment modalities, such as electroconvulsive treatment and certain psychotropic medications. During the last 30 years, the Consumer Movement has been highly successful in empowering consumers and refocusing the mental health and substance abuse delivery system to meet their needs. During the early 1990s, a new philosophy regarding the most effective methods for delivery of mental health and substance abuse services began to emerge from the consumer movement. This philosophy, known as the Recovery Model, embraces the idea that people can and do recover from mental illness. To support this goal, all treatment interventions are planned and carried out in a real partnership that occurs between the mental health consumer and their treatment team members. 1 The Recovery Model changes the focus of mental health treatment decisions from the provider to the consumer and more actively engages the consumer in their own recovery. This philosophy asks the treatment system to assist consumers as they identify key goals such as successful employment, stable housing and interpersonal relationships that will lead them toward recovery. The treatment system then collaborates with the consumer to achieve those goals. This approach to providing mental health and substance abuse services is a dramatic departure from the provider driven systems of years past. The Recovery Model is supported by a mounting body of research, which supports the assertion that consumer driven mental health, and substance abuse treatments are more effective in producing quality outcomes for consumers than the traditional medical or clinic models.

The Federal government has expressed strong support for the Consumer Movement and the concepts of the Recovery Model. The 1999 release of Mental Health: A Report of the Surgeon General, expressed strong support for the consumer movement and the implementation of recovery-oriented treatments. In keeping with the recommendations of the Surgeon General s report, the Substance Abuse and Mental Health Services Administration (SAMHSA) has developed a set of recovery-oriented, consumer-driven treatment practices, known as Evidence-Based Practices that put the philosophies of the Recovery Model into action. The momentum supporting the implementation of the Recovery Model and Evidence- Base Practices reached critical mass in 2003 with the release of the final report of The President s New Freedom Commission on Mental Health, Achieving the Promise: Transforming Mental Health Care in America. The New Freedom Commission proposed a number of recommendations to state and federal government agencies that would dramatically improve the quality of services provided to mental health consumers. The New Freedom Commission Report voiced unequivocal support for the philosophies of the Recovery Movement and called for the implementation of SAMHSA s Evidence-Base Practices in state and publicly funded health care systems. THE CURRENT OKLAHOMA SYSTEM The mental health and substance abuse treatment system in Oklahoma has evolved, piecemeal, over time, into a complex and often fragmented delivery system containing a number of different agencies and providers. Primary responsibility for providing mental health and substance abuse services to low-income adults in Oklahoma is divided between ODMHSAS (the State Mental Health and Substance Abuse Authority), and the Oklahoma Health Care Authority (the State Medicaid Agency). The system is further complicated for consumers in that eligibility for Medicaid services is determined by the staff of a third agency, the Oklahoma Department of Human Services (DHS). This splintering of responsibilities presents mental health consumers and substance abuse clients in Oklahoma with a confusing and often uncoordinated process for obtaining assistance. Oklahoma is not alone in this regard. The Final Report of the President s New Freedom Commission on Mental Health cites the fragmentation of programs across different agencies as a major barrier to developing effective recovery-oriented behavioral health programs throughout the country 2. The fragmentation created by disparate objectives, policies and outcome measures among similar programs within different

agencies creates a situation where consumers often do not receive the most appropriate clinical and support services. This fragmentation also inhibits the abilities of both agencies to provide clinical policy leadership to providers and consumers regarding initiatives like the Recovery Model and Evidence-Based Practices. The need for services from this fragmented system is at an all time high. ODMHSAS provided mental health and substance abuse services to 57,933 persons during 2003. OHCA provided mental health and substance abuse services to an additional 14,243 Oklahomans during that same period. The 2003 National Survey on Drug Abuse and Health estimates that 266,063 Oklahoman s, or 10.40 percent of the general population, are in need of mental health services while 145,823 or 5.7 percent of the general population are in need of substance abuse treatment services. The number illustrates the fact that there is a significant gap between those in need of services and those who end up receiving treatment. During 2003, ODMHSAS provided services to less than 11 percent of Oklahomans in need of mental health services and less than 12 percent of those in need of substance abuse treatment services. The size of this treatment gap is illustrated in the following graph. Oklahoma MH and SAS "Service Gap" Total Number Needing Oklahoma Population 3,511,532 MH &/or SAS Services 411,886 Number Served by ODMHSAS 57,993 Persons with Unmet Treatment Needs 353,953 This gap presents a significant challenge to State of Oklahoma. Untreated mental health and substance abuse disorders have been shown to be a major risk factor for poor physical health outcomes. Diseases such as heart disease, cancer and accidental death

are often linked to unmet mental health and substance abuse treatment needs. The costs for treating these diseases further drain the resources of an already overburdened public health system. Providing a more accessible and effective mental health and substance abuse delivery system will provide better opportunities for recovery and will avoid costs in other portions of the system. THE RECOVERY COLLABORATIVE OF OKLAHOMA The leadership of ODMHSAS, OHCA and DHS recognized the impact that this fragmentation was having upon providers and the behavioral health consumers they serve. In an effort to address this problem, the three agencies entered into a partnership in 2002 and committed to the development of a higher quality behavioral health system that was consumer oriented and took advantage of established best practices to assist mental health consumers and substance abuse clients on their road to recovery. This partnership led to the establishment of the Adult Outpatient Behavioral Health Collaborative. This group, which was later renamed, the Recovery Collaborative of Oklahoma, is comprised of senior staff from the three agencies who are responsible for carrying out the mission of the inter-agency Collaborative. In addition to the agency staff, a group of behavioral health consumers and advocacy organizations meet on a regular basis to advise the activities of the Collaborative. They provide meaningful feedback about the effects the proposed program and system changes will have upon consumers. The State of Oklahoma has been presented with a unique opportunity. The Recovery Collaborative is reinventing one of the most important components of the Oklahoma public health system. Our charge is to develop a consumer-focused, recovery-oriented behavioral health delivery system that optimizes the opportunities for the citizens of our state to recover and fully realize their potential to as successful members of our community.

GOALS SERVICE DELIVERY To ensure that mental health and substance abuse programs and services respond to the needs of the adult pubic health consumers by providing coordinated care, focused on recovery, with an emphasis on evidence-based practices. INFORMATION SYSTEMS To develop and implement integrated eligibility, case management and claim processing systems for agencies serving low-income mental health and substance abuse consumers in Oklahoma. These modifications will reduce the administrative burden on providers and simplify access to services for consumers. ELIGIBILITY To provide and improve mental health and substance abuse care access to the underserved and vulnerable adult population, aged 18 and older, of Oklahoma. OUTCOME DATA / MONITORING To utilize outcome data and quality assurance information for decision making and systems improvement. FUNDING / RESOURCES To explore and implement available, valid options for program financing and the efficient use of human resources. ADMINISTRATION & POLICY To foster quality in the design and administration of the inter-agency behavioral health collaboration.

INFORMATION SYSTEMS GOAL: To develop and implement integrated eligibility, case management and claim processing systems for agencies serving low-income mental health and substance abuse consumers in Oklahoma. These modifications will reduce the administrative burden on providers and simplify access to services for consumers. OBJECTIVES: 1. To Develop and Implement a Electronic Eligibility Determination System that Streamlines and Integrates the Medicaid and ODMHSAS Eligibility Initiation Processes. 2. To Develop and Implement an Integrated Claims Payment System that Reimburses for Medicaid and ODMHSAS Services. o This System will Maintain Support for all Current ODMHSAS and OHCA Reporting Functions 3. Design and Implement a Data Collection and Reporting System for all ODMHSAS and Medicaid Consumers 1 GEORGIA S CONSUMER DRIVEN ROAD TO RECOVERY A MENTAL HEALTH CONSUMER S GUIDE FOR PARTICIPATION IN AND DEVELOPMENT OF MEDICAID REIMBURSIBLE PEER SUPPORT SERVICES, DIVISION OF MENTAL HEALTH, DEVELOPMENTAL DISABILITIES AND ADDICTIVE DISEASES OFFICE OF CONSUMER RELATIONS, 2003, 5 2 New Freedom Commission on Mental Health, Final Report 2003