February 2007 NACBHDD Newsletter
The Newsletter of the National Association of County Behavioral Health and Developmental Disability Directors
In this Issue...
Specifics on the search process: the timeline and the job posting and description
As reported in the January newsletter, NACBHD President and CEO Melissa Staats resigned her position in the organization effective December 31 to become the Director of Mental Health in Westchester County, New York. (Staats continues to be a member of NACBHD.) In the meantime, Tom Joseph, Senior Associate, Waterman & Associates, is working to ensure that NACBHD is represented on all policy issues. (For an overview of Joseph's experience, see below.) The search for a new Executive Director is underway, and a number of applications have been received. The search committee, chaired by Leon Evans, Executive Director, the Center for Health Care Services, San Antonio, Texas, is in the process of reviewing them. (Applications may be submitted until March 31, 8:00 p.m. EST.) The posting for the position is reprinted below. It can also be viewed at the NACBHD website under "Job Bank."
The National Association of County Behavioral Health and Developmental Disability Directors (NACBHD) is seeking a dynamic leader to serve as its Executive Director. The incumbent shall be responsible for overall operation of the agency, represent the interests of the membership on matters of public policy, and strive to strengthen community-based systems that predominately serve the most vulnerable members of our nation's communities.
NACBHD is comprised of county/city government and county sponsored behavioral health and developmental disabilities services authorities from across the country. The Executive Director shall report and be accountable to the Board of Trustees. This position is located at NACBHD's Washington, DC headquarters.
Interested applicants are requested to send a resume and salary history by email only to firstname.lastname@example.org. Please indicate "NACBHD Executive Director Position" in the email subject line. Cover letters may be addressed to Mr. Leon Evans, Chair, "Executive Director Search Committee." The deadline for submissions will be 8:00 p.m. EST, March 31, 2007.
Joseph has spent his entire professional career in the health and human services arena of county government. He started working with the National Association of Counties (NACo) in 1982, and worked for NACo for 16 years. His first project was a developmental disability-related effort educating elected and appointed officials regarding Section 504 of the Rehabilitation Act, which preceded the Americans with Disabilities Act. Later in the 1980s, he became a lobbyist for human services assistance issues. In the late 1980s, he moved over to the health side of lobbying, which gave him an opportunity to get to know more of the mental health directors. He staffed some NACBHD meetings in the late 1980s and early 1990s, when NACBHD was called the National Association of County Mental Health Directors. At the end of his tenure at NACo, he was deputy director of the entire legislative department, where he oversaw all policy issues. In 1998, he left NACo to help Los Angeles County (population 10 million) set up lobbying in Washington. After working for Los Angeles County for eight years, in 2005, Waterman & Associates presented Joseph with the opportunity to work on the public sector side, dealing solely with representing counties and county affiliates in human services areas. His work has focused on individual counties and county associations, and he has covered many of the issues NACBHD and NACBHD members have encountered over the years.
As of January 30, NACBHD is now located at:
25 Massachusetts Avenue, N.W.
Washington , D.C. 20001
The telephone number, fax, e-mail addresses and Web address remain the same:
Phone: (202) 661-8816, Fax: (202) 661-8871
SAMHSA has a new Administrator, Terry Cline, Ph.D., nominated by the President on November 13 and confirmed by the Senate on December 9. SAMHSA falls under the Department of Health and Human Services, and the $3.3 billion agency is involved in improving "the accountability, capacity and effectiveness of the nation's substance abuse prevention, addictions treatment, and mental health service delivery systems."
Dr. Cline was appointed Oklahoma's Secretary of Health in 2004, and at the same time, he served as Oklahoma's Commissioner of the Department of Mental Health and Substance Abuse Services, a position he held since January 2001. During this time, he "supported the creation of grassroots coalitions to improve the health status of local communities." The SAMHSA press release about Dr. Cline (see link below) goes on to mention: "As a result of these partnerships significant advances were made in transforming the State's service delivery systems, including the creation of Oklahoma's Integrated Services Initiative which creates a holistic approach to treatment needs, a wide expansion of drug courts throughout the State and the introduction of mental health courts into Oklahoma along with a Statewide focus on recovery and recovery support services."
For a complete overview of Dr. Kline's experience, see the SAMHSA press release about him at http://www.samhsa.gov/About/bio_cline.aspx.
NACBHD spoke with Dr. Cline recently about his plans for SAMHSA and how he views the role of counties.
Although Dr. Cline does not come from a county-administered state (Oklahoma), how does he view the relationship between SAMHSA, states, and local/county authorities?
Dr. Cline views the relationship with counties as very important, and notes that counties are in the position of being closest to the provision of services, and therefore, of understanding what works best for consumers. He does come from a state with 77 counties, where the needs varied drastically between counties. He feels county government is key to addressing these issues.
How does he see the role of counties in the system?
Dr. Cline says there is a very important role for counties in the overall system, and a very important role for the government in ensuring decisions reflect the needs at the county level and complement services at the county level.
What are his goals and vision for SAMHSA and how can NACBHD assist him in furthering that vision?
"We are pulling together information from various stakeholders, and would appreciate input," says Dr. Cline. SAMHSA is continuing to use the Matrix Model, which involves cross-cutting principles, and concentrates on accountability, capacity, and effectiveness of service. The Matrix Model is an important framework for those who interact with SAMHSA. See www.samhsa.gov for more information. There is a link to the SAMHSA matrix on the home page.
In addition, Dr. Cline emphasizes SAMHSA's recovery-oriented focus with a vision of a life in the community for everyone. It is critical to all SAMHSA does, and includes building on the strengths of communities and families. Dr. Cline characterizes the recovery-oriented focus as a "great guiding principle for us."
What about SAMHSA reauthorization?
Dr. Cline views this as an important year legislatively, with SAMHSA reauthorization taking place some time this year, and he emphasizes, the process of SAMHSA reauthorization is a chance for Congress to hear from stakeholders, as well as from SAMHSA. The reauthorization process brings a lot of attention to SAMHSA, and coupled with that is the appropriations process, which is an important time to highlight services from the perspective of counties and other stakeholders.
Dr. Cline emphasizes that he values collaboration and partnership and he understands their value in furthering the vision of SAMHSA; he feels these partnerships need to be built upon to be successful.
Where does the concept that "mental health is integral to physical health" fit into his plans? (See the Update on the Campaign for Mental Health Reform for information on legislative activity around this issue)
Dr. Cline explains that he was also Secretary of Health while in Oklahoma, and his tenure in this position was the first time a person with a behavioral background held the job. He characterizes the relationships built as "actually a pretty easy sell," and he emphasizes it is why partnerships are so important -- both entities have a stake in what the other does. On the other hand, he describes the inability to work out these partnerships as a signal for failure in the past, and he cites the National Association of State Mental Health Program Directors October 2006 Morbidity and Mortality in People with Serious Mental Illness, which found that individuals in the public mental health system die 25 years earlier than others. To access this report, see www.nasmhpd.org. Click on "Publications."
The Federal Executive Steering Committee, which is made up of 20 different federal agencies and departments, is examining this issue, and Dr Cline notes, there needs to be strong relationships with county governments and state associations, because he says, "Where the rubber meets the road is at the community level." For more information on the Federal Executive Steering Committee, see www.samhsa.gov/Federalactionagenda/NFC_execsum.aspx.
(See the Update on the Campaign for Mental Health Reform for information on the Campaign's meeting with Dr. Cline.)
Tom Joseph provided the following update on the President's FY 2008 budget:
The President released his FY 2008 budget proposal on February 5. The budget would freeze funding for the Substance Abuse and Mental Health block grant, and cut regional and national significance program grants. Over $25 billion in cuts would be made to Medicaid over the next five years through regulatory and legislative proposals, including proposals to restrict Targeted Case Management, rehabilitation services, and restrictions on local financing and payments to public providers. For further information please see the budget update prepared by Maeghan Gilmore and Tom Joseph. Click here to access the update.
Bill Emmet, Director of the Campaign for Mental Health Reform, of which NACBHD is a partner, provides an update on recent Campaign activities.
Campaign members, including NACBHD representatives Maeghan Gilmore and Tom Joseph, had a very good meeting with new SAMHSA administrator Terry Cline. Emmet says the Campaign expressed its desire for SAMHSA and the Campaign to work closely together; that may mean primarily that each entity keeps the other well-informed. Emmet notes that SAMHSA reauthorization is problematic from the Campaign perspective in that there are some authorized programs for which there is no funding, even though the value of these programs has been well-documented. For example, while jail diversion is not in the reauthorization, the budget shows just enough money to award only a couple of grants despite the fact that the issue this program is designed to address is a well-documented problem. In addition, there are a number of very good programs that have not been funded, and the Campaign wants to make sure SAMHSA has the flexibility in running programs to meet the overall mental health service needs of the country.
Emmet notes that the issue of mortality and morbidity for individuals in the public mental health system has been looked at closely, most recently in the National Association of State Mental Health Program Directors' October 2006 Morbidity and Mortality in People with Serious Mental Illness report that revealed that individuals in the public mental health system die 25 years earlier than other individuals. The Campaign wants the Department of Health and Human Services, through SAMHSA, to identify why and make sure that there are funds for people in the system to access the appropriate medical care, and in addition, give individuals in the public mental health system programmatic priority.
The Campaign continues to meet monthly, with some components meeting more frequently, and they hope to have a sponsor for the proposed legislation by the end of March.
NACBHD recently spoke with Karen Sanders, Associate Director for Publicly Funded Services, at the American Psychiatric Association about MentalHealthPartD, or www.mentalhealthpartd.org, a website sponsored by advocates including the American Association of Community Psychiatrists, the American Association for Geriatric Psychiatry, the American Psychiatric Association, the National Alliance on Mental Illness, the National Association for State Mental Health Directors, the National Council for Community Behavioral Healthcare, Mental Health America (formerly the National Mental Health Association), Treatment Effectiveness Now, and NACBHD. Sanders periodically provides updates on critical issues and developments related to the implementation of the Medicare Modernization Act Part D. Following is an outline of the latest developments.
Sanders describes a few areas of concern:
For more information on the legal briefs, including the briefs on Cymbalta and Geodon, click on "legal briefs," in the Exceptions and Appeals area on the left-hand side of the home page of www.mentalhealthpartd.org.
Special Needs Programs
Sanders says that while there is not a lot known about Special Needs Programs, or SNPs, which use Medicare Advantage, these programs could be a new way to access funding, and she believes this area is an important one for NACBHD members to stay informed about, as it likely to impact institutions, dual eligibles, and those with chronic conditions. Previously, SNPs have not been used in the mental health arena, but in targeted disease management areas such as cardiovascular disease and asthma. (2007 is the first year that SNPs have elected to service the seriously mentally ill population.) SNPs involve the ability to adjust services for a particular diagnostic area of patient needs. There are already SNP contracts in various states and 34 contracts for institutions.
Working with CMS and "triaging" the path to resolving problems
MentalHealthPartD continues to participate in a monthly conference call with CMS, during which they typically discuss questions as well as patterns of concern or trouble, such as the inappropriately high generic copays mentioned above. And, in terms of resolving problems, Sanders says that CMS continues to recommend contacting the regional CMS office as the first line approach if one feels that the plan is going against the CMS regulations. If this does not work, then the national office should be contacted.
The American Psychiatric Association is working with the National Alliance on Mental Illness and Mental Health America (formerly the National Mental Health Association) to propose legislation so that access is maintained and protected for the six classes of treatment.
Look for an update on this legislative activity in the April or May newsletter.
NACBHD covered the Combating Autism Act in the January newsletter. As a follow-up to the information provided in that article, Deidra B. Abbott, MPH, of Alicia Smith & Associates, LLC, has suggested the following autism-related resources:
For the President's statement on the legislation and a summary, see www.whitehouse.gov/news/releases/2006/12/print/20061219-3.html.
For autism-related resources, see Combat Autism at www.combatautism.org.
A mental health parity bill has been passed in the Senate, and advocates are preparing for field hearings to promote the issue. The Mental Health Parity Act of 2007 recently was passed by the Senate HELP Committee, and full Senate action is expected within months. In the meantime, a nationwide campaign is underway to hear from consumers directly impacted by insurance discrimination and the need for parity in an effort to enact a comprehensive law. See the information from NAMI below for information on the Act and the information following that for a description of the Campaign to Insure Mental Health and Addiction Equity, as well as information on locations and dates for the hearings.
From a February 14 E-news release from the National Alliance for Mental Illness (NAMI):
On February 14, the Senate Health, Education, Labor and Pension Committee (HELP) voted 18-3 in favor of S.558, the Mental Health Parity Act of 2007. NAMI congratulates Committee Chairman Edward M. Kennedy (MA) and Ranking Member Michael Enzi (WY) for their leadership in bringing this measure to the full Senate. After the vote, Sen. Kennedy indicated that he will push for full Senate action on the bill within the next few months.
Important Information About Parity Hearings Around the Country
On February 21, NACBHD's Director of Government Affairs and Public Policy Maeghan Gilmore posted the following information on field hearings to insure mental health and addiction equity. That information is reprinted below:
Background: As has been widely reported, Congressmen Patrick J. Kennedy (D-RI) and Jim Ramstad (R-MN) have launched a nationwide campaign, conducting hearings (technically, forums) in major cities across the country. As described by the Members, The Campaign to Insure Mental Health and Addiction Equity will hear testimony from ordinary American citizens whose lives have been touched by mental illness and addiction. Affiliates of Mental Health America and the National Alliance on Mental Illness are helping organize these forums. The testimony will undoubtedly help advance the case for enactment of a comprehensive law to end insurance discrimination against those who need mental health and addiction treatment. The Congressmen expect to introduce legislation aimed at ensuring that health plans offer fair coverage for mental health and addiction care. Importantly, the new House Leaders have promised Congressmen Kennedy and Ramstad that they will bring their bill, the Paul Wellstone Mental Health and Addiction Equity Act, up for a vote.
Schedule status: The scheduling of these forums is still unfolding. With the understanding that the dates and locations of these forums are still fluid, and subject to change), the information below is being provided to assist in establishing linkages between those who are helping organize the hearings and local consumers, families, providers, advocacy groups, and others. For the latest updates on confirmed hearings and locations please check the Campaign website, www.equitycampaign.net. (We will also attempt to update this list to reflect revisions in scheduling and additional information on points of contact.)
Local coordination and witnesses: It is hoped that disseminating this information widely to interested parties will help make each of these hearings a powerful and well-attended event. Both elements are critical. Those organizing the hearings will welcome help, particularly in identifying people whose experience and testimony regarding insurance discrimination can put a "human face" on the need for insurance equity. (While many encounter problems with insurance claims, the focus of these hearings is principally on the widespread practice in employer-provided health plans of imposing (1) arbitrary limits on the number of covered outpatient visits or days of hospitalization for treatment of mental health or substance-use disorders, and (2) greater cost-sharing burdens than are imposed on care of other health problems.) For those receiving this information in communities where hearings are taking place, please support this effort by urging local affiliates, organizations, colleagues, and friends to help the Congressmen by "filling the hearing room" to support their extraordinary effort. Please understand that time constraints will almost certainly limit the number of witnesses who can participate. Recommendations regarding proposed witnesses should be directed to the pertinent affiliate contact below, and it is strongly suggested that any recommendation be accompanied by a capsule outlining what the proposed speaker would say (to assist in identifying the most powerful testimony possible).
March 12 (confirmed)
Pittsburgh (location TBD)
Host: Rep. Murphy
Point of Contact: Rachel Freund, MHA of Allegheny County
email@example.com, 412-391-3820 ext. 16
March 16 (confirmed)
New York City, NY (location and time, TBD)
Host: Rep. Rangel
Point of Contact: Wendy Brennan, NAMI NYC, firstname.lastname@example.org, 212-684-3365
March 30 morning (confirmed)
Tulsa, Oklahoma (location TBD)
Host: Rep. Sullivan
Point of Contact: Stacy Wilson, MHA in Tulsa, email@example.com; 918-382-2407
March 30 3:00 pm (confirmed)
Point of Contact:
Janie Metzinger, Mental Health America of Greater Dallas, firstname.lastname@example.org, 214-871-2420 x114
March 31 (under consideration)
Point of Contact: Melissa Mitchell, MHA of Greater Houston email@example.com
NAMI Hearts and Minds Program Addresses Severe Physical Health Risks
The following information is reprinted from the National Alliance on Mental Illness (NAMI) web site. It highlights a new program that addresses the critical physical health risks that may be encountered by those with mental illness, and it is available from the NAMI web site at no cost. Hard copies of all materials are available at reasonable cost from the NAMI Store.
Research has demonstrated that people living with severe psychiatric conditions may have an increased risk of heart disease and related conditions. For this reason NAMI has designed the Hearts & Minds program, a 13-minute, inspirational video and a 26-page booklet. The purpose of the program is to raise awareness and provide information on diabetes, diet, exercise, and smoking.
The program also includes basic information on addictions, recovery, stigma, and treatment. Along with information on diabetes and sleep apnea, Hearts & Minds contains tips for exercise, diet -- including a shopping list template, recipes, and a food diary.
To access Hearts & Mind materials, see www.nami.org, and click on "Hearts & Minds." Available information and resources include a DVD that can be downloaded to computers, PDF files from the Hearts & Minds booklet that can be viewed and printed, a Facilitator Guide with additional material, and suggestions for facilitating an educational group.
NAMI's Hearts & Minds Program is made possible in part by an unrestricted educational grant from Eli Lilly. For more information on Hearts & Minds, please contact Lorener Brayboy at firstname.lastname@example.org.
Statement from SAMHSA Administrator Regarding the FY 2008 Budget
SAMHSA has posted the following letter from Administrator Terry Cline, Ph.D., regarding the FY 2008 budget, on the SAMHSA web site.
I am pleased to present the Substance Abuse and Mental Health Services Administration's (SAMHSA) fiscal year (FY) 2008 Congressional Justification. SAMHSA's FY 2008 budget totals $3.2 billion, a 5 percent reduction from the FY 2007 Continuing Resolution. This budget request continues support for the President's and Secretary's priority initiatives and reflects the goals and objectives in the Department's FY 2004 - FY 2009 Strategic Plan. In addition, the PART process continues to be a critical tool for evaluating program effectiveness and developing budget and legislative strategies.
This justification includes the FY 2008 Annual Performance Plan and FY 2006 Annual Performance Report as required by the Government Performance and Results Act of 1993 along with a more direct link in the budget discussion with program performance. Performance measurement and reporting at SAMHSA provide a comprehensive set of measures and outcomes in 21 major areas offering results-oriented information that enables SAMHSA to share with stakeholders its progress toward achieving three strategic goals:
Accountability: Measure and report program performance
Capacity: Increase service availability
Effectiveness: Improve service quality
SAMHSA's implementation of performance management has created a consistent framework for linking agency-wide goals with a matrix of program priorities and targeting resources to build resilience and facilitate recovery of adults, children and families. It has provided a shared vision of what needs to be accomplished with our partners and provides a consistent and effective way to measure its achievements and to strive for continued improvement.
Terry L. Cline, Ph.D., Administrator
From a February 7 SAMHSA press release:
SAMHSA Will Fund Up to 7 Grants in 2007 for Adolescents at Risk for Suicide
SAMHSA is soliciting applications for the FY 2007 Adolescents at Risk for Suicide grant program to evaluate voluntary school-based programs that focus on identification and referral of high school youth who are at risk for suicide or suicide attempts.
It is expected that up to 7 awards will be funded. Annual awards are expected to continue for up to two years. The actual awards may vary, depending on the availability of funds. Grant funds may not be used to pay for direct treatment services. These grants will be awarded by SAMHSA's Center for Mental Health Services.
WHO CAN APPLY: Eligibility is limited to local educational agencies and domestic, public and private nonprofit entities working in conjunction with local educational agencies.
HOW TO APPLY: Applications for No. SM-07-006 are available by calling SAMHSA's Clearinghouse at 1-877-SAMHSA7, or by downloading from www.SAMHSA.gov/grants/index.aspx or www.grants.gov. Applicants are encouraged to apply on line using www.grants.gov.
APPLICATIONS DUE DATE: Must be received by April 6, 2007
ADDITIONAL INFORMTION: Applicants with questions on program issues should contact Cynthia K. Hansen at 240-276-1869 or e-mail Cynthia.Hansen@samhsa.hhs.gov . For questions on grants management issues, contact Kimberly Pendleton at 240-276-1421 or Kimberly.Pendleton@samhsa.hhs.gov.
This program is being announced prior to the FY 2007 appropriation for SAMHSA's programs, with funding estimates based on the President's budget request for FY 2007. Applications are invited based on the assumption that sufficient funds will be appropriated for 2007 to permit funding of a reasonable number of applications solicited. All applicants are reminded however, that we cannot guarantee that sufficient funds will be appropriated to permit SAMHSA to fund any applications.
From a February 21 SAMHSA press release:
New Report Highlights Housing Solutions for People with Psychiatric Disabilities
The problems of board and care homes, also known as adult homes, for people with psychiatric disabilities is the focus of a new report, Transforming Housing for People with Psychiatric Disabilities Report, now available from the Substance Abuse and Mental Health Services Administration (SAMHSA).
The new report offers ten detailed recommendations to improve the quality of life of board and care home residents. In addition, the history, demographics and common concerns of these homes are detailed in-depth. A list of measures being implemented to improve the lives of residents and recommendations calling for a recovery-oriented approach based on the principles of self-direction and community integration are provided as well. The report also calls to end reliance on board and care homes and to improve conditions in existing homes.
Transforming Housing for People with Psychiatric Disabilities Report is available on the Web at http://mentalhealth.samhsa.gov/publications/allpubs/sma06-4173/ .Copies may be obtained free of by calling 1-877-SAMHSA-7 (1-877-726-4727). Request inventory number 4173. For related publications and information, visit http://www.samhsa.gov/.
From a February 21 SAMHSA press release:
SAMHSA Updates Guidance on Outpatient Treatment for Substance Abuse
Updated guidance to help clinicians and administrators improve outpatient treatment for substance abuse was recently released by the Substance Abuse and Mental Health Services Administration in two new Treatment Improvement Protocols (TIPs).
TIP 46, Substance Abuse: Administrative Issues in Outpatient Treatment, and its companion text, TIP 47, Substance Abuse: Clinical Issues in Intensive Outpatient Treatment, address the challenges in the growth of outpatient treatment.
Today's directors of outpatient programs must confront serious management issues, such as their own need for training in administrative skills and counselor turnover. TIP 46 focuses on the core staffing and retention issues, while exploring managing staff stress and supporting career development. Also addressed are program growth and promotion, expanding cultural diversity, and building financial stability.
TIP 47, aimed at clinicians, presents 14 guiding principles of intensive outpatient treatment (IOT) and supporting research. It explores how IOT fits in the continuum of care and what services a program should provide. The TIP also confronts clinical issues, describes approaches in detail, and addresses the needs of diverse populations.
The TIP series is a set of best practice guides for health care and substance abuse treatment providers. TIPs are produced by nonfederal consensus panels composed of clinical, educational, research and administrative experts. These two new TIPs update the guidance provided in TIP 8, Intensive Outpatient Treatment for Alcohol and Other Drug Abuse, which was published in 1994 before the expansion of this treatment approach to a wider variety of clients and the added focus on cost containment through managed care.
TIP 46 is available on the Web at http://download.ncadi.samhsa.gov/prevline/pdfs/tip46small.pdf and TIP 47 at http://download.ncadi.samhsa.gov/prevline/pdfs/TIP_47.pdf. Copies may be obtained free of charge by calling SAMHSA's Health Information Network at 1-877-SAMHSA-7 (1-877-726-4727). Request inventory number BKD545 for TIP 46 and BKD551 for TIP 47. For related publications and information, visit http://www.samhsa.gov/.