August 2004 NACBHDD Newsletter
The monthly newsletter for the National Association of County Behavioral Health and Developmental Disabilities Directors
In this Issue...
NACBHD and Trilogy Enter Into Strategic Alliance
Unprecedented alliance will help counties rapidly meet goals of President’s Commission
NACBHD and Trilogy Integrated Resources have entered into a strategic alliance to promote the implementation of a nation-wide information, education, advocacy, mutual support, and policy development website-based network, which will be individualized to specific states and local communities, and will help counties rapidly meet the goals outlined in the Final Report of the President’s New Freedom Commission on Mental Health. In an unprecedented public/private partnership for NACBHD, NACBHD will market the Network of Care, developed by Trilogy and recognized by the President’s Commission as a model program, to NACBHD member organizations.
Bob Egnew, NACBHD’s Director of Public Policy, is enthusiastic about NACBHD’s unprecedented step to market a tool that will ultimately help consumers and families and its decision to take a key role in the promotion and dissemination of the Network of Care throughout the country. And, he is equally enthusiastic in describing the Network’s ability to mobilize the mental health community and attack the root causes of stigma – lack of quality information and lack of scientific information. The NACBHD leadership hopes that, over time, all states represented by NACBHD will adopt the Network of Care.
The Network of Care has four targeted user groups: 1) consumers and family members; 2) community-based organizations that provide services; 3) local county mental health authorities, and 4) local service providers. Case managers are frequent users of the network.
Egnew reviewed the highlights of the Network of Care, which can be adapted locally or regionally, as appropriate, as follows:
A shared set of values: support of consumer and family-driven care at the community level and belief in a recovery-based system
NACBHD and Trilogy share a core set of values. Both support the development of consumer and family driven mental health services at the
community level; and both are committed to the well being of individuals served within the public mental health system. Both believe the
general public needs ready access to information regarding effective treatment and services, and both believe in a recovery-based treatment
system that is consumer and family-centered, and is designed to empower its consumers. Underlying this is the common belief that knowledge
is key – that consumers have an inherent desire to have accurate information in order to empower them to make the best health care decisions
possible regarding any specific behavioral health condition they or their family may face. And, the Network of Care utilizes internet
technology to empower consumers and families to make the best possible decisions by putting high quality information in the hands of consumers
and families.
A “Win/Win” for all
Bruce Bronzan, founder and president of Trilogy, characterizes the alliance as a “win/ win all around.” Bronzan demonstrated the program at the
Annual Conference and reports that it was extremely well received -- with seven or eight states wanting full demonstrations soon. Meetings in
other states are already being planned by the NACBHD leadership.
The network is built on a platform to be replicated, and is easily replicated at an extremely reasonable cost. (The development costs for the Network of Care in California were borne by the state, with replication and adaptation to specific locales.) The Network of Care for Mental Health is currently in Fresno County, San Diego County, and San Mateo County, California; Onondaga County, New York; and Clermont County, Lorain County, and Stark County, Ohio. (There is also a Network of Care for Seniors/People with Disabilities and a Network of Care for Kids in several counties in California.) Either NACBHD staff or Trilogy staff will present the Network to local NACBHD members. The information then can be transferred electronically.
The partnership provides an enhanced value and opportunity for all parties, including lowering the costs for local county-sponsored behavioral health authorities, which will benefit to both NACBHD and Trilogy. Specifically:
Meeting the goals of the President’s Commission
The President’s Commission spoke decisively about the need to harness the information revolution to assist in the transformation of the country’s
mental health system. NACBHD and Trilogy are both committed to having all Americans receive timely and accurate information about behavioral health
conditions and services in order to assist in the transformation of the public behavioral health care system. The Network of Care developed by
Trilogy, in partnership with the state of California Department of Mental Health, was cited in Goal 6 of the Final Report of the President’s
Report: Technology is Used to Access Mental Health Care and Information, as a model program in terms of enabling consumers and families to
find pertinent information and facilitating the access to services. And, the Network of Care’s creative use of the Internet meets not only all
of the recommendations found in Goal 6, but every other goal in the report as well. A brief description of the Network’s ability to meet the goals:
Goal 1: Americans Understand that Mental Health is Essential to Overall Health
The Network website attacks the root causes of stigma, lack of quality information and lack of scientific information, by providing information and education to the general public regarding the biological nature of mental illness and by providing information regarding the availability and effectiveness of treatment. Its library, news (current daily on the home page), community services, legislative, and advocacy sections give the community a strong, public place for the enhancement of mental health knowledge and promotion and most importantly, promotes the concept that mental illness can be successfully treated.
Goal 2: Mental Health Care Is Consumer and Family Driven
The Network of Care was created specifically for consumers and families to arm them with knowledge so that they can make the best possible decisions regarding the conditions they are facing. (Consumer based organizations such as NAMI and mental health associations had input into the original development of the site.) This empowers consumers to better navigate systems, thus providing a clearer personal roadmap to recovery. While quality of the information is high, most of the site is written at the 8th or 9th grade level, to be understandable across the population. In addition, the site provides for private record keeping (“my folder”), designed as the first stage of online case management surrounding individual treatment plans.
Goal 3: Disparities in Mental Health Services are Eliminated
Linguistic access. The Network provides information and access to mental health and substance abuse services that are linguistically and culturally accurate, with more quality materials added to the content as they are developed. The Network will be able to adapt to the languages most used in an area. In addition, machine translations for the entire content of the site are offered in Spanish, Cantonese, Mandarin, Japanese, Korean, and Russian.
Use in rural areas. The free and easy internet access to the service is especially suited to rural and remote areas and is in fact, used in such areas at a significantly higher rate than in urban areas. Also, in rural areas, the sites are normally designed to find services in the entire region not just the single county that may not have the range of services needed.
Goal 4: Early Mental Health Screening, Assessment, and Referral to Services Are Common Practice
The Network has the capacity to search specifically for services for children, and the News section brings all children’s mental health related news to the home page for broader exposure by the general public. The Network is a ready-made tool for use by school counselors, teachers, administrators, and parents.
The search engine has the capacity to search specifically for agencies serving individuals with co-occurring disorders.
Goal 5: Excellent Mental Health Care is Delivered and Research is Accelerated
The Network originated from a public/private partnership between the state Department of Mental Health in California, the San Diego Department of Mental Health, and Trilogy Integrated Resources. Every existing replication is a public/private partnership with the Network and state or local public mental health officials.
The Network has a section devoted specifically to evidence-based practices, maintained in a public/private partnership with SAMHSA and NASMHPD’s Research Center, coordinated by Dr. Vijay Ganju.
Developmental disabilities network is planned
Bronzan reports that there have been quite a few requests around the country for a developmental disabilities Network of Care. While developmental
disabilities information is incorporated in the Network, Trilogy soon will be building a developmental disabilities site as its own separate Network
of Care. They plan to start work on this in about a month, with six to seven months to develop the site.
If you want to implement the Network of Care in your area or need additional information
If you have questions about the Network of Care or are interested in implementing it in your county or area, contact Melissa Staats at (202) 661-8816
or mstaats@nacbhd.org. For information on the Network of Care, see
www.networkofcare.org. For information on Trilogy Integrated Resources, see
www.trilogyir.com.
The Annual Conference: Highlights and an Interview with an Expert Developmental Disabilities Resource
Access conference highlights on the website
The Ninth Annual Conference, Developing New Leaders for the Future, was held July 15-17 at the Ritz Carlton in
Phoenix, and was a great success. NACBHD appreciates the fine presentations and discussions provided by all the speakers. If you were unable to
attend the conference or would like to revisit conference materials, highlights and presentation materials can be found on the conference area of
the website.
An interview with an expert developmental disabilities resource
NACBHD is working to develop advocacy efforts in the developmental disabilities area, and recently interviewed a valuable developmental disabilities
resource and a presenter at the conference, Bill Hixson, Psy.D., Clinical Director, Arizona Division of Developmental Disabilities. Dr. Hixson and
Bob Klaehn, M.D., Medical Director of the Arizona Division of Developmental Disabilities, gave a presentation focused on how to provide mental health
care to individuals with developmental disabilities.
Dr. Hixson and Dr. Klaehn were excited to be presenters and found NACBHD a warm and receptive group, with astute questions about serving those with developmental disabilities. Dr. Hixson says he is always willing to talk about serving those in the developmental disabilities community who also have mental health needs, a population in public service whose needs have been under-addressed over time.
Hixson and Klaehn are in charge of a department that serves 20,000 people with developmental disabilities; 15,000 are in the long-term care system using Title 19 funds (see below for more on Title 19). About 3,500 of these individuals are known to the behavioral health system and are coded with co-occurring disorders. And, about 50 are in the most secure, high cost, settings in the community – group homes with 24-hour supervision.
The “three rivers,” problem areas, and preserving community placements
As Hixson notes, states are trying to catch up in determining how to preserve community placements for individuals with developmental disabilities
and Axis 1 or 2 disorders. A particular area of concern is what he characterizes as the “convergence of three rivers” (or three systems) – the
acute medical care system, the mental health system, and the developmental disabilities system.
Hixson also discussed some barriers to bringing the “three rivers” together to preserve community placements. While the medical community has worked to increase the life span of many individuals with developmental disabilities across the country, the mental health system still suffers from attitudinal problems about those with developmental disabilities. There is an overt misunderstanding about the value and dignity of persons with developmental disabilities and clinical challenges, such as the question of whether cognitive dysfunction is part of the severe mental illness or the developmental disability.
Specifically, Hixson emphasizes problems in:
Be aware of and respectful of the differences in the systems
Hixson emphasized that those involved in working with this population need to be aware and respectful of the differences in the mental health and
developmental disability systems, and “not be shy about it.” He characterizes the mental health system as episodic and acute and the developmental
disabilities system as more long term.
What is working in Arizona?
As Hixson explains, in Arizona, the Title 19 waiver, through an intergovernmental agreement, allows the developmental disabilities system to be
responsible for bringing together the acute medical care and the mental health systems. Arizona leads the nation in home and community base waivers
and is the envy of many states, with person-centered planning and wrap-around child and family services. Each situation is looked at uniquely with
many specialists on the interdisciplinary team addressing even seemingly small situations. Arizona also has child and family teams, which allow the
family to be party to the planning. Hixson says they are making wonderful strides, but success depends on how they are able to structure the funding.
Historically, Arizona has been fortunate. With three institutions built in the 1950s, they saw the wisdom of moving straight into the community vs.
intermediate settings. Also, they were able to use the waiver and the money to move away from ICFMRs. Because of that foresight, they enjoy a good
relationship with the federal government. This method is ultimately less costly, and for consumers, it works well despite occasional problems. The
situation in Arizona makes them less reliable on hospital and institutions in general, but conversely, there is not much in the way of back-up.
Overall, the system has a good report card. There are not a lot of high profile criminal justice cases, and there is less hospitalization. There
is good crisis intervention, with a unit that helps with wrap-around and crisis intervention.
For questions or further information
Both Dr. Hixson and Dr. Klaehn are happy to talk with NACBHD members. They can be reached at bhixson@azdes.gov
and rklaehn@azdes.gov or at (602) 542-0419.
Transformation Continues to Move Forward
In addition to the strategic alliance between NACBHD and Trilogy to implement the Network of Care locally (see lead story), NACBHD is involved in several other transformation efforts, with two events slated for late this summer. An update:
APA, NMHA, and NAMI Hold Meeting on Preserving Medication Access
The American Psychiatric Association (APA), the National Mental Health Association (NMHA), and the National Alliance for the Mentally Ill (NAMI) recently held the conference: “Refining Messages and Strategies to Preserve Access to Mental Health Medications,” to examine advocacy and messaging issues with regard to maintaining open access to psychiatric medications within state Medicaid systems. Key issues covered include:
The full text of the conference proceedings is available for viewing.
The APA, the NMHA, and NAMI will continue to develop resources on the topics covered and identified, periodically checking in with states regarding new information. This information can play an important role as the Centers for Medicare & Medicaid Services establish regulations for the Medicare Prescribing Drug Improvement and Modernization Act.
Karen Sanders, Associate Director for Publicly Funded Services at the American Psychiatric Association says that the three organizations welcome questions from local authorities such as NACBHD. For information or questions, contact Karen Sanders at ksander@psych.org or at (703) 907-8590.
For more on medication access, look for an article on Medicare Part D in the September newsletter.
September is National Alcohol and Drug Addiction Recovery Month
September 2004 is the 15th annual National Alcohol and Drug Addiction Recovery Month. SAMHSA, along with HHS, and in partnership with national planning partner organizations, has created a user-friendly planning toolkit to help prepare for events and activities related to Recovery Month. Information about media outreach, targeted outreach, and resources can be accessed and toolkits can be downloaded at www.recoverymonth.gov. Hard copies can be ordered for free at 1-800-662-HELP.
Karen Scherra, Chair of NACBHD’s Substance Abuse Committee, and Executive Director of the Clermont Ohio MH&R Board, says that there will be a “Rally for Recovery” on September 23 at Ohio’s state capital. This marks the second year for the rally, with last year’s rally a great success.
Important Substance Abuse Resource: FAVOR
Faces and Voice of Recovery (FAVOR) works to mobilize families, friends, and allies of the millions of Americans recovering from addiction to end discrimination, broaden understanding, and develop a response to this public health crisis. Information about resources available from FAVOR, including an Enewsletter, is available at www.facesandvoicesofrecovery.org.
