Posts Tagged ‘mental illness’

5 Years of Behavioral Health Innovation Paying Dividends (Part II)

April 22nd, 2014

dividendsOver the next couple of weeks I’ll continue reflecting about some of the innovative strategies that we’ve implemented with our behavioral health community partners over the last several years to improve the health status of folks with a serious mental illness. Last week I wrote about the Integrated Health Homes initiative.

Another success has been improvements in our Crisis Response System.  In Maricopa County, Magellan, with providers and partners, restructured and overhauled the system to reduce congestion at emergency rooms- decreasing the amount of time first responders spend processing an admission to behavioral health acute care service from 2.5 hours to 7 minutes.  A strong performance by any standard.  Next week, I’ll cover improvements to the kids system of care.

5 Years of Behavioral Health Innovation Paying Dividends (Part I)

April 15th, 2014

MPeople with a serious mental illness die more than 30 years earlier than people without those challenges.  Over the next few weeks, I’ll be reflecting about some of the innovative strategies that we’ve implemented with our behavioral health community partners over the last several years to improve the health status of folks with a serious mental illness.

I’ll start with a project that began with modest funding from SAMHSA, through a grant meant for small pilots to test concepts in our community.  In 2009, we and AHCCCS jointly applied for and got a Transformation Transfer Initiative grant which was used to initiate a peer-based whole health program Maricopa and Pima Counties.  The goal of the program was to help transform the behavioral health system into one that applies a holistic approach to consumer health.

Magellan Health Services of Arizona launched the first phase of Integrated Health Homes as part of this initiative- bringing together mental health and physical health care.  The model was a partnership between Magellan, Maricopa Integrated Health System, and CHOICES Network, Partners in Recovery, People of Color Network and Southwest Network.  By 2013, there were 10 Integrated Health Homes in Maricopa County that have been providing coordinated care for members.  Thousands of people have received coordinated care and achieved better outcomes through these health homes.  Here are some additional typical health home participant vignettes that profile service recipients who can benefit from the initiative.

In the coming weeks, I’ll cover improvements in the Crisis Response System, the kids system of care, children’s substance abuse, coordination with the correctional system, and performance dashboards.

Troubled Teens: At Risk and Not Overlooked

February 19th, 2013

Our Vision at the Arizona Department of Health Services is ”Health and Wellness for all Arizonans”. Part of that Vision for folks living with behavioral health issues or a mental illness means achieving and maintaining self-reliance and independence.  To get there, some individuals simply need outpatient services occasionally.  Some need wrap-around community or home-based services.  Others need more intensive treatment in a licensed residential setting.  Our goal is always to provide the most effective kind of evidence-based treatment for that person.

For example, our home and community-based wrap-around services have been so effective that we’ve reduced care in licensed high-level Residential facilities by 75% in the last couple of years in Maricopa County.  We did this by building up home- and community-based wrap-around services like in-home counseling, high needs case management, home care training, peer support, respite, family support, and skills training.  However, outpatient treatment and home and community based services can’t always provide the level of treatment folks need, and some people need the more intensive treatment that only a  licensed and regulated residential facility can provide. 

A series of reports in the Republic this week suggests that some residential treatment facilities in our state are substandard.  While no regulated facility is perfect, our teams of inspectors are well-trained and highly-motivated to ensure each of our licensed residential treatment facilities meets our standards. Those that don’t must implement an immediate corrective action plan. Additionally, the DHS team has been overhauling many of its regulations to make sure our standards focus on the most important components of care.

We inspect residential treatment facilities once a year, and more often than that when there are complaints. When we’re inspecting facilities, our teams make decisions based on evidence. We talk to the residents and the staff; we look at patient and personnel records (including videotape); we observe facility practices and examine physical evidence. We require two forms of evidence to substantiate an issue. This practice helps us separate legitimate complaints and concerns from those that are baseless or intentionally fabricated.

We also receive dozens of reports every day as part of our regulatory oversight of all of our licensed facilities. We carefully and promptly evaluate each report and respond accordingly. Many of the reports that we receive are routine and pose no health or safety problem. When we receive a report that could pose an immediate safety concern, we send staff to the facility immediately like we did with an assisted living facility over the weekend.

Successful residential treatment facilities are pro-active, follow their policies and procedures without fail, are meticulous in reporting and documentation, and seek ongoing education. They’re not afraid to admit a mistake. Our job is not just to ensure that facilities comply with our standards, but also to maximize their effectiveness. That’s why our licensing teams also focus on ways to improve our licensed facilities.

Unlike newspaper reporting, our actions as an agency must be based in fact and rooted in the evidence demonstrated by a comprehensive review of the facility. Folks can view factual information about the more than 7,400 facilities licensed by the Arizona Department of Health Services by visiting www.azcarecheck.com.

Integrated Care Responses On Deck

January 8th, 2013

We all need to take care of both our physical and behavioral health needs in order to be healthy. The mind and body aren’t separated- and neither should the health-care delivery system- especially for folks with a serious mental illness. Folks with a serious mental illness die more than 25 years earlier than the general population… an unacceptable health disparity in anybody’s book. The increased mortality is largely from treatable medical conditions caused by modifiable risk factors like smoking, obesity, substance abuse, and not accessing primary and acute medical care. Population health issues. 

We recognized the need to address this unacceptable health disparity when we put together our Strategic Map and Plan that includes integrating behavioral and acute healthcare. It’s been a long haul and a lot of work- and we passed a major milestone today when folks submitted their bids on our Request For Proposal (otherwise known as RFP) for the delivery of behavioral health services in Maricopa County.  We received bids from: 1) Magellan Complete Care of Arizona, Inc.; 2) Cenpatico of Arizona LLC; 3) Arizona Physicians IPA, Inc. (APIPA), d/b/a UnitedHealthcare Community Plan, operating as UnitedHealthcare Whole Health; 4) Mercy Maricopa Integrated Care; and 5) Partners in Integrated Health, LLC. 

Our evaluation team will begin their analysis shortly…  and we expect the evaluation process to take 8 weeks or so.  The entity that ends up getting the contract will be responsible for delivering both preventative, acute and primary care along with Recovery-based behavioral health services for folks in the public behavioral health system in Maricopa County beginning on 10/1/13.  

It’s difficult to put into words how much work has gone into this solicitation. I know that many of you put this work on top of all your normal work, had put off other projects, and sacrificed some of your home-life for this product- and I just really want you to know that I appreciate it. It’s going to save lives. Stay tuned.

Get Trained in Mental Health First Aid Today

December 19th, 2012

The tragedy in Connecticut has reminded us all about how important mental health and mental health treatment is to ensure that we have a society that functions in a way that we’d all like.  To be truly effective, a behavioral and mental health system needs to make sure parents, teachers, doctors and emergency department staff, firefighters and first responders, law enforcement, and correctional staff just to name a few, are able to identify when there might be a problem and what to do to get help.  One of the evidence-based tools that can really help is called Mental Health First Aid.  

Mental Health First Aid is a novel, evidence-based public education program designed to teach people a five-step process to assess a situation, select and implement appropriate interventions and help a person in crisis or who may be developing the signs and symptoms of mental illness. The groundbreaking training equips people to provide initial help until appropriate professional, peer or family support can be engaged. Participants also learn about risk factors and warning signs of specific illnesses such as anxiety, depression, psychosis and addiction. 

Mental Health First Aid is an interactive 12-hour course that presents an overview of mental illness and substance use disorders.  It introduces participants to risk factors and warning signs of mental health problems, builds understanding of their impact, and overviews common treatments. Those who take the 12-hour course are certified as Mental Health First Aiders.  At the end, they have the skills, resources and knowledge to help an individual in crisis connect with appropriate professional, peer, social, and self-help care. 

After the tragic shootings in Tucson in 2011, our behavioral health team including Stephanie Uetrecht, Ali de la Trinidad, Cielo Mohapatra, Anne Rock, Kathy Bashor, Claudia Sloan, Bob Sorce  and Dr. Laura Nelson coordinated with our Regional Behavioral Health Authorities and Providers to put together a series of Mental Health First Aid courses across the State to build Arizona’s awareness infrastructure.  Throughout 2011, the teams certified nearly 100 Trainers, who in turn have trained thousands of community members over the course of this year.

As a result, Arizona has among the most robust number of instructors in Mental Health First Aid in the country.  If you or your team want to get involved and certified as a Mental Health First Aider can visit the Mental Health First Aid website and even find an instructor in your community.  Simply go to the website above, put in your city and zip code, along with the diameter in miles that you want to search- and you can find the Trainers we trained in 2011 that can help bring your team up to speed.

Suicide Prevention: A Winnable Battle

December 18th, 2012

Back in 2009, AZ had the 9th highest rate of suicide in the U.S.  In that year 1,060 Arizonans took their own lives- so it’s easy to see why suicide prevention is an agency priority and is featured in our Strategic Map as a Winnable Battle.  Since we’re responsible for the state’s behavioral health system- we have a leverage point…  especially for the folks that receive services through our public behavioral health system including crisis services. 

One of our primary interventions for this Winnable Battle has been our collaborative Suicide Deterrent System, which was launched in 2009 by Magellan (our Regional Behavioral Health Authority in Maricopa County).  It’s evolved into a training initiative for behavioral health professionals to a comprehensive national model addressing one of the most at-risk populations – folks diagnosed with mental illness. Since kickoff, the initiative has trained more than 3,000 behavioral health care staff to recognize the signs and symptoms of suicide in persons with mental illness, and to help them stay safe and seek help.  The program has also addressed family engagement and support groups for suicide attempt survivors- and has developed clinical tools and procedures for assessing risk and appropriately intervening. 

The ADHS and Magellan Health Services of Arizona won a Council of State Governments Innovation Award this year for the Suicide Deterrent System.  The objective of the Suicide Deterrent System is to make suicide a “never event” for those served by our public behavioral health system.  Nationally, most public sector behavioral health care systems have made suicide prevention a business side-line…  relying mostly on crisis interventionist specialists.  Our model recognizes that to be successful, we need to provide safe, effective, patient-centered, timely, efficient, and equitable care. Our systems approach brings the core business of state-funded behavioral health care to tackle the challenge, including a systematic “do whatever it takes” approach, top leadership commitment, measurement and reporting and robust performance improvement. 

Our collaborative initiative has changed the mindset about suicide prevention. By providing knowledge, skills, tools and management support, this project has made suicide intervention a core responsibility of all behavioral health staff. It recognizes the complexities of suicide and addresses: 1) Behavioral health workers’ skills/confidence to intervene (Applied Suicide Intervention Skills Training – ASIST); 2) Connectedness for those contemplating suicide (attempt survivor support groups, family engagement); and 3) Risk identification and stratification (clinical care and intervention).

Integrating Physical & Behavioral Health Services to Save Lives

October 11th, 2012

We all need to take care of both our physical and behavioral health needs in order to be healthy. The mind and body aren’t separated- and neither should the health-care delivery system- especially for folks with a serious mental illness. Folks with a serious mental illness die more than 25 years earlier than the general population… an unacceptable health disparity in anybody’s book. The increased mortality is largely from treatable medical conditions caused by modifiable risk factors like smoking, obesity, substance abuse, and not accessing primary and acute medical care. 

We recognized the need to address this unacceptable health disparity when we put together our Strategic Map and Plan. It’s been a long haul and a lot of work- and we passed a major milestone this week when we released our Request For Proposal (otherwise known as RFP) for the delivery of behavioral health services in Maricopa County. The entity that ends up getting the contract will be responsible for delivering both preventative, acute and primary care along with Recovery-based behavioral health services for folks in the public behavioral health system in Maricopa County. The new contract is scheduled to start on 10/1/13. 

It’s difficult to put into words how much work has gone into this solicitation. I know that many of you put this work on top of all your normal work, had put off other projects, and sacrificed some of your home-life for this product- and I just really want you to know that I appreciate it. It’s going to save lives. You can check out the full solicitation on the State’s Procurement website hub- called ProcureAZ.

Dr. Nelson- Our Friend & Amiga

July 25th, 2012

One of our priorities over the last 3.5 years has been to ensure that we develop and train our workforce so that we maintain business continuity and have the ability to transition effectively to new leadership when the time comes (part of Strategic Map element E1).  We’ll be putting our prep work to the test in the coming weeks- as Dr. Nelson will be leaving her posts as Deputy for Behavioral Health and as Chief Medical Officer on August 24 to work at Mercer.  But by keeping our strong behavioral health team together- we’ll continue to keep up our momentum and continue delivering high quality behavioral health services for the people we serve. 

Under Dr. Nelson’s leadership, we’ve shifted the Department’s behavioral health system to focus on the core principles of Recovery and have adopted outcome-based performance measures to monitor and to improve the performance of Arizona’s behavioral health system, resulting in real and measurable improvements in people’s lives.  We’ve re-focused our efforts at the Arizona State Hospital to improve the quality of care for our patients and families, incorporating a Culture of Care that improves our performance every day. 

 Dr. Nelson is well recognized throughout the entire behavioral health system as a dynamic and competent leader and will surely be missed.  She’s even developed a solid national reputation, most recently receiving the President’s Award from the National Association of State Alcohol and Drug Abuse Directors.  We all know that about her – but it sure is nice to hear that type of praise on a national stage.  It reminds us that we are lucky to have someone with her skills advocating for those with mental illness in Arizona. 

I have to admit that I’m a little bit misty as I write this- as I think back to what Dr. Nelson and I have been through together (and what we’ve achieved as an Agency) since we started our quest together back in January of ’09.  Believe me, I know it’s hard to lose leadership like this…  but we’ll continue with our mission as a team.  Anytime an organization loses leadership as strong as Laura it’s a challenge…  but it can also be an opportunity for growth.

 

Accolades

July 16th, 2012

Our own Dr. Laura Nelson was recognized for her outstanding leadership and skills as President of National Association of State Mental Health Program Directors. Her service was rewarded at the annual conference for State Alcohol and Drug Abuse Directors where she received the presidents award for her work!  While presenting the award, the president called Dr. Nelson, “an impeccable advocate for substance abuse and mental health services”.  Mark Singer continued praising her with words like impeccably professional, polite, ethical, caring and considerate.  We all know that about her – but it sure is nice to hear that type of praise on a national stage.  It reminds us that we are lucky to have someone with her skills advocating for those with mental illness in Arizona.  

Congratulations amiga.

Multiple Chronic Conditions- an Expensive Public Health Threat

October 17th, 2011

I’ve written several pieces over the last few weeks highlighting our efforts to better integrate primary healthcare into the treatment plans for folks with mental illnesses- but the issue of providing better coordinated care for folks with multiple chronic medical conditions is really far bigger than this integration issue.  More than 25% of Americans have multiple chronic conditions like arthritis, asthma, chronic respiratory conditions, diabetes, heart disease, and high blood pressure.  Treating folks with multiple conditions is both complicated and expensive- and more coordinated efforts are a key to improving both.  In fact, 66% of all health care spending in the US goes toward caring for the 27% of folks with co-occurring chronic medical conditions. 

The US Department of Health and Human Services (HHS) knows full well that better care coordination for these folks is critical if the nation is going to do a better job of improving health care efficiency and containing costs.  There are a number of efforts underway to address these issues- many of which are summarized in a strategic framework document that HHS put out a few months ago called Multiple Chronic Conditions: A Strategic Framework.  The framework is just that- an outline of a strategy- and it includes a vision statement, goals, objectives, and discrete strategies to guide HHS in coordinating its efforts internally and collaborating with stakeholders externally. 

By the way, our tobacco & chronic disease team is leading the state’s efforts to help folks better manage their illness.  One of their tools is the Stanford Chronic Disease Self Management Program- which is an evidence-based program which empowers folks to recognize and address the factors which impact their chronic conditions.  Through Healthy Living, individuals can develop and implement personalized action plans, take ownership, and achieve improved health outcomes that are both manageable and sustainable.  Our team (under the leadership of Ramona Rusinak) and the Arizona Living Well Institute has identified this as a core element of its overall strategic direction.