behavioral health services division (bhsd) of the human

Behavioral Health Services Division (BHSD) of the Human Services

Department (HSD) Response

to the

Results First Report: Evidence-Based Behavioral Health Programs to Improve Outcomes for Adults, 2014

BHSD appreciates the Legislative Finance Committee’s attempt to spotlight New Mexico’s serious problems with substance abuse and mental health issues. In the recent Results First Report: Evidence-Based Behavioral Health Programs to Improve Outcomes for Adults, it briefly highlighted New Mexico’s behavioral health (BH) needs and the many successful programs that are aiding in the promotion and sustainability of recovery for individuals with serious mental illness and chronic substance abuse. In line with this approach, the report takes the additional step of providing legislators with assessments of the Return-on-Investment (ROI) for many critical community BH services. The report promotes resource allocation, and reallocation, to prioritize spending on services with a high return and target efforts to high-risk, high-need areas of the state. Unfortunately, BHSD did not have an opportunity to respond to the report, and as a result, it is lacking important perspectives and provides an incomplete picture of the State’s problems related to: unmet needs for services, workforce issues, unique cultural challenges, critical impact of prevention efforts and environmental forces. For example:

o The report cites state and county BH related prevalence and other data but only reports on state spending and services for BH. However, there is no acknowledgment of the role of Medicare, VA, TriCare, and commercial insurance in addressing NM’s behavioral health needs;

o There is no reference to the role of the social determinants of health in NM which are some of the worst in the nation and therefore drive high incidences of BH-related conditions;

o There is no framing of BH within a public health model which requires effective and comprehensive environmental and agent specific strategies, not simply intervening in the lives of those who suffer from BH conditions;

o The report misses the fact that there are significant gaps in the continuum of BH care in most communities that include the lack of mobile crisis, crisis stabilization units, intensive-community-based services, transitional service options (supportive housing, supportive education and employment, group homes, respite, and therapeutic foster care) for those to be diverted or discharged from jails, prisons, hospitals, and residential settings. EBP implementation cannot be expected to make up for these significant service gaps;

o There is no reference to the ongoing needs of those with co-occurring (mental health and substance use conditions and/or developmental disabilities), and of those who represent the cultural diversity of NM but who have unique cultural needs (Spanish-speaking, Native Americans, and hearing-impaired) which EBPs often do not address;

o Behavioral health workforce challenges are dismissed in the report on the basis of national comparisons, but fails to examine how many practitioners are no longer practicing, are employed outside of the publicly funded BH system, or which of them carry an independent license to practice, and what the distribution of practitioners are to meet the needs in rural and frontier communities; and

o The report, in limiting its focus to EBPs has missed the broader context within which EBP adoption must occur to be successful: an adequate and qualified BH workforce, a streamlined BH regulatory environment, broad-based early and routine screening to identify those requiring intervention, implementation of primary prevention EBP strategies, and the provision of enhanced “systems of care,” instead of program specific strategies.

The report’s assessment of the ROI for individual evidence-based programs also lacks broad stakeholder input. In setting a monetary value on critical services, the report describes the method to calculate the return as: “incorporating NM statistics for cost, consequences, diagnosis rates and treatment rates.” This analysis does not consider the value to the individual of recovery from mental illness or addiction, the value of sobriety for a single mother, or the value of preventing a teen suicide. In addition, the report admits it “has not yet monetized the benefits of reduced homelessness which means the ROI likely understates the benefits” (Page 8). Publishing such assessments of ROI for critical public BH services without comprehensive methods, developed in consultation with a broad array of stakeholders, could mislead NM Legislators in budget decisions and hence impede the State’s effort to provide an effective array of both effective prevention and treatment services. HSD considers Centennial Care to be a major strategy to addressing New Mexico’s tremendous behavioral health needs -- and early reporting suggests it is working. Medicaid expansion and the integration of behavioral health services, with physical health and long-term care services, provides a potentially seamless system for 170,000 more Medicaid members. A uniform process of care coordination helps members with significant BH needs identify their needs and arrange for treatment. Behavioral health services are expanding to include more Opioid Treatment providers and Substance Abuse Intensive Outpatient (IOP) Treatment sites throughout the state, three new recovery services and a new focus on the need for trauma-informed care for children and youth. In the first six months, over 30% more Medicaid members are receiving needed BH services under the Centennial Care integrated model than received such care under the previous model.

In addition, LFC staff makes two conclusions that are highly misleading about this successful program that are not based in fact: o Report: “the state does not have a comprehensive grasp on how it spends the

estimated $209 million on adult behavioral health services, whether it is funding effective services, whether services are located in high need areas or whether services are producing expected results. This report estimates the state only spends 11 percent of its limited BH funding on proven and effective programs for adults.”(Page1). Contrary to the report, HSD has a detailed grasp on how it spends all of its BH dollars. For both Medicaid and non-Medicaid the state receives reports compiled by the five MCOs that address the quality and quantity of care. An extensive system of reports, on service utilization, access, financial and clinical practices, are gathered at regular intervals and reviewed by Medicaid staff to monitor the development of the system. Medicaid and non-Medicaid pays for encounters not programs. Many of the services LFC claims are not proven effective, actually wrap-around evidence-based programs, and include Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), Eye Movement Desensitization and Reprocessing (EMDR), among many others. Because the claims payment system does not accommodate a unique billing code modifier for every EBP provided, does not mean that 81% of BH services are sub-standard. It simply means that we our systems are unable to capture all of the EBP delivery that occurs.

o Report says: “The transformation to Centennial Care brings the behavioral health system nearly full circle for the approach to paying for services used before 2000. (Page 5) This conclusion disregards the benefits of integrated care to the Medicaid member and the benefit to providers of assistance with care coordination. Medicaid now provides comprehensive medical, behavioral health and long-term care services to an increasing percentage of the population instead of the previous patchwork of separate payers and funding streams. Unlike 2000, in 2014, over 170,000 previous uninsured New Mexicans received comprehensive Medicaid coverage in 2014, instead of having to patch together a variety of state and federal grant funded programs. The Medicaid benefit package is enriched with more comprehensive services which address the Essential Health Benefits included in the ACA. New services include preventive care, dental services for adults, habilitative services and expanded substance abuse and BH recovery services. Behavioral health services must now be covered at parity with physical health.

New Mexico’s new Centennial Care 1115 Medicaid waiver provides for the true integration of medical, behavioral health and Long-term Care Services at all levels: financing, administration, reporting, and service provision. Members with both Medicaid and Medicare have access to integrated services and care coordination to negotiate the two systems. Unlike 2000, in 2014, four MCOs develop and manage a unified and integrated Medicaid program instead of the previous system of multiple MCOs administering multiple separate waiver programs. Multiple ‘protections’ have been included in the design of Centennial Care to ensure that the service and funding levels for behavioral health and long-term care services are not reduced due to the integration of services, due to lessons learned from 2000.

For the first time in state history, Medicaid’s Centennial provides a uniform Health Risk Assessment (HRA) by which every Medicaid member is contacted by their MCO to identify the member’s health, behavioral health, long-term care and social support needs. At no point in the past, has this attempt at universal screening for the needs of the “Whole Person” been implemented. Unlike 2000, in 2014, the HRA for each member is used to identify members with significant needs and assign them to a standard process of intensive care coordination. For those members who do not report significant health needs, the Health Risk Assessment is repeated annually and the care coordination system at each MCO monitors the member’s utilization to identify any increased needs. Each Centennial Care member, with significant BH needs, is being assigned to an individual Care Coordinator to visit the member in their home and perform an in-person comprehensive needs assessment and develop a service plan. Care coordination works with each member to coordinate all medical, BH and LTC services, as well as, dental and ancillary services like Durable Medical Equipment, Pharmacy and Transportation. They coordinate the member’s appointments with providers and facilitate communications between providers during transitions of care. Depending on the member’s level of need, the Care Coordinator will contract the member quarterly or monthly by phone and visit the member to update the comprehensive needs assessment semi-annually or quarterly or at any time the member’s needs change. Unlike 2000, in 2014 numerous structures are now in place to set policies to coordinate behavioral health services. Two state-level statutory committees provide for on-going assessment of the state’s needs and oversight of the system. The NM BH Purchasing Collaborative meets quarterly to coordinate the BH services each agency manages. The Collaborative issues a Consolidated Behavioral Health Services Budget annually to the Legislature to provide a state-wide picture of the behavioral health services. The Behavioral Health Planning Council is a federally required, Governor appointed council of representatives of consumers, families, and providers. State law charges the council with advising the Governor and state in identifying needs and planning services. Since 2001, the Council’s statutory

responsibilities have been expanded to include substance abuse. HSD’s Behavioral Health Services Division (BHSD) staff work closely with the Medicaid program to coordinate the management of the non-Medicaid services funded through HSD.

Unlike other LFC reports, HSD was not offered an opportunity to attach it’s response to this Results First Report when it was published. Nor was HSD invited to testify when the report was presented to the LFC in public hearing. Providing our response would have assured that Legislators would have a more complete picture regarding the status of BH needs and services in NM.

2011-2014 NM BH Strategic Plan Review – Children’s Array of Services Section

BHSD-HSD 2011-14 Strategic Plan Review December 8, 2014 - Page 1

Comments By: __________________________

CHILDREN’S SERVICES No

Progress

Being Worked On By

Completed Comments

Actionable in 2011

Solicit input from the BH Planning Council and its

Subcommittees, consumers, family members,

and providers, on criteria and strategies to

expand and guide the sizing of the Children’s

Purchasing Plan – the services needed to build

out the array and the targets for shifting to more

community-based care

Work with the NM Health Care Reform Leadership

Team and other groups addressing health care

reform to ensure that children’s behavioral

health is part of their planning related to

prevention, wellness, health disparities,

consumer protection, education, outreach and

communication, and overall payment and

delivery system reform

Continue to promote and deliver training in evidence

based practices (e.g., train the Matrix Model and

the American Society of Addiction Medicine

(ASAM) placement criteria for implementation

of Intensive Outpatient Services (IOP) for

adolescents)

Pilot an Intensive Outpatient Program for youth ages

18-21 who are leaving the juvenile justice

system which includes transitional living and

independent skill development

Schools examine and revise, as needed,

comprehensive Safe School Plans and wellness

policies that address substance abuse and

violence prevention

Promote the integration of special education and IEPs

with behavioral health plans and services



Work with tribal communities to identify needs to

build and balance service arrays including

increasing prevention, wellness, and community

supports

Mid-Range

Initiate shifts in the Children’s Purchasing Plan as

outlined below. These shifts will prioritize services

that are outcome-driven, use evidence-informed

practices, are culturally competent, and can be

developed in tribal, rural, and frontier communities.

Expand access to services across the array through

the investment of Children Youth and Families

Department (CYFD) funds (e.g., care

coordination using a wraparound approach,

respite services, infant mental health services,

and transitional living services)

Expand early detection and intervention services for

youth experiencing their first episode of

psychosis in order to decrease movement to

more seriousness

Based on the youth Intensive Outpatient Program

pilot project, develop a comprehensive clinical

model that utilizes a system of care philosophy;

and, include an evaluation component to

examine the model’s effectiveness

Youth with serious mental illnesses (SMI) will be

transitioned from the youth system to the adult

system in a seamless fashion. Incentives for the

providers will be developed to better ensure

participation

Develop a “ road map” for employment opportunities

for transitioning youth; partner with public

education, vocational rehabilitation, and

workforce solutions agencies; educate youth,

families & stakeholders in its use

Increase screening and assessment in school based

health centers



Create a model for prevention and early intervention

systems within school based health centers

Expand school-based early intervention strategies in

school-community collaborations

Develop a consistent risk and protection approach to

a range of prevention issues, including

substance use (e.g., underage and binge

drinking), suicide, mental health, violence, teen

pregnancy, school dropout and delinquency

Expand community based prevention and wellness as

resources become available

Long Term (3 Years)

Continue shifts in the Children’s Purchasing Plan as

outlined below. These shifts will prioritize services

that are outcome-driven, use evidence-based

practices, are culturally competent, and can be

developed in tribal, rural, and frontier communities.

Seek funding to expand the evaluated youth

Intensive Outpatient Program (IOP) model for

regional access

Implement a standardized substance abuse

assessment for youth

Create full time capacity in school based health

centers to provide mental health and substance

abuse prevention, assessment, crisis

intervention, and early intervention services

Implement comprehensive school based plans that

address prevention and wellness especially as

related to substance abuse and violence



Expand the full service community school model

statewide

Develop strategies to support movement towards a

full continuum of promotion and prevention

services within communities for universal,

selected, and indicated populations

Develop a coordinated effort linking primary care and

BH across communities, including tribal

communities, to address prevention and

wellness, including positive youth development

strategies

Incorporate expenditures in State facilities currently

not under the auspices of the Children’s

Purchasing Plan.



New Priorities for Next Plan – Children’s Array of Services Section

Actionable in 2015:

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Mid-Range:

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Long-term (3 years):

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Other Comments:

2011-2014 NM BH Strategic Plan Review – Adult’s Array of Services Section


Comments By: __________________________

ADULT’S SERVICES No

Progress

Being Worked On BY

Completed Comments

Actionable in 2011

Solicit input from the BH Planning Council and

its Subcommittees, consumers, family

members, and providers, on criteria and

strategies to expand and guide the sizing

of the Adult Purchasing Plan – the

services needed to build out the array

and the targets for shifting to more


Work with NM Health Care Reform

Leadership Team and other groups

addressing health care reform to ensure

that adult behavioral health is part of

their planning related to prevention,

wellness, health disparities, consumer

protection, education, outreach and

communication, and overall payment

and delivery system reform

Map all prevention, early intervention, and

treatment resources across the state –

Access to Recovery (ATR), Total

Community Approach (TCA), Substance

Abuse Prevention and Treatment (SAPT)

and Community Mental Health Services

(CMHS) Block Grant funds, compulsive

gambling, medication assisted

treatment, supportive housing programs

and resources as well as other General

Fund substance abuse expenditures

Mid-Range

Initiate shifts in the Adult Purchasing

Plan as outlined below. These shifts will

prioritize services that are outcome-

driven, use evidence-based practices,

are culturally competent, and can be

developed in tribal, rural, and frontier

communities.



Increase supportive housing to decrease

transitional living services

Increase consumer-operated services and

bolster improvement of psychosocial

rehabilitation services

Increase comprehensive community support

services and focus on evidenced-

informed outpatient therapies

Fill gaps in the continuum of available services

and ensure substance use residential

services are used only when that level of

care is appropriate

Increasing the utilization of substance abuse

Intensive Outpatient Programs (IOP)

Develop a plan for more access to prevention,

screening and early intervention, and

strategies that promote wellness

Create a comprehensive, evidence-informed

strategy to prevent and reduce

substance abuse, including binge and

chronic drinking by adults, including

adults over 65

Create an IOP model for mental health;

develop a strategy for piloting this model

Educate providers about appropriate services

for elderly and persons with disabilities

who also experience severe and complex

behavioral problems and co-occurring

acute medical issues

Expand community based prevention and

wellness as resources become available



Long Term (3 Years)

Continue shifts in the Adult Purchasing

Plan as outlined below. These shifts will

prioritize services that are outcome-

driven, use evidence-based practices,

are culturally competent, and can be

developed in tribal, rural, and frontier

communities.

Invest Behavioral Health Services Division’s

(BHSD) non-Medicaid funds in services

that will fill gaps in the service array

Implement broad, high risk drinking reduction

strategies using cross agency

coordination efforts to leverage greater

impact

Expand the capacity of community-based

providers that serve people who are

elderly and persons with physical

disabilities with severe and complex

behavioral problems and co-occurring

acute medical issues

Expand the capacity of facilities that serve

people who are elderly and persons with

physical disabilities with severe and

complex behavioral problems and co-

occurring acute medical issues

Incorporate expenditures in State facilities

currently not under the auspices for the

Collaborative, into the Adult Purchasing

Plan.



New Priorities for Next Plan – Adult’s Service Array Section

Actionable in 2015:

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Mid-Range:

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Other Comments:

2011-2014 NM BH Strategic Plan Review – Infrastructure Section


Comments By: __________________________

INFRASTRUCTURE No

Progress

Being Worked On By

Completed Comments

Actionable in 2011 Work with the NM Health Care Reform


addressing health care reform to develop

a vision of integrated primary care and

behavioral health infrastructure

Establish a workgroup among primary care,

Federally Qualified Health Centers

(FQHC’s), 638’s and behavioral health

providers to agree on a practice model

for clinical integration

Develop mechanisms to share successful

implementation strategies across CSAs

Provide CCSS and Wraparound training to

CSAs

Work with CSAs to develop infrastructure for

responding to community suicide crises

Support local sites in SAMHSA grant to

develop logic models, system designs,

and strategic plans for local systems of

care that can be replicated in other

communities

Develop a statewide strategic plan for the use

and expansion of behavioral health

telehealth services that starts with

psychiatric services in FY11, then other

clinical services in FY12, and then non-

clinical services in FY13

Develop funding strategies to

support telehealth

infrastructure in school based

health centers



INFRASTRUCTURE No

Progress

Being Worked On By

Completed Comments

Mid-Range

Develop a training and technical assistance

plan for primary care providers to

incorporate behavioral health services in

primary care settings, including topics

such as: implementing Screening, Brief

Interventions Referral and Treatment

(SBIRT), use of Motivational Interviewing

skills, administration of depression

screening instruments, appropriate

prescribing practices, treating opioid

addiction in families



addressing health care reform to develop

at least one pilot project on clinically

integrated primary care and behavioral

health that incorporates medical homes

and clinical homes

Pilot and evaluate a health home approach in

school based health centers in three to

five sites; document successful

components and outcomes of pilots

incorporating health home operations

within School-based Health Centers

(SBHCs); develop process to expand in

additional SBHCs

Integrate physical health initiatives within the

behavioral health consumer/recovery

population to focus on health

consequences related to major disease

processes such as diabetes, heart

disease, and emphysema

Develop a competency based CSA framework

and training plan with competencies

framed in terms of Quality Services

Review (QSR) principles

Develop a strategy for deployment of staff

from CSAs to screen, assess, and conduct

referrals of the elderly within primary

care clinics and senior centers



INFRASTRUCTURE No

Progress

Being Worked On By

Completed Comments

Expand Local Lead Agency partnerships with

Core Service Agencies to increase access

to supportive housing in local

communities

Provide education, training, and technical

assistance based on lessons learned from

SAMHSA sites to expand local

development of systems of care for

children, youth and their families in

communities throughout the State

Develop a system of care model incorporating

wraparound approaches for adults,

including adults over 65; provide

education, training, and technical

assistance in implementing the model

statewide

Develop systems to use data to identify

emerging trends, e.g., the emergent use

of opioids

Develop strategies and seek grant funds to

initiate transportation services for

persons with BH issues in conjunction

with Department of transportation

(DOT), including the implementation of

consumer-run services and the

expansion of existing services

Long Term (3 Years)



addressing health care reform to

rigorously evaluate a pilot on integrated

primary care and behavioral health and

develop a long term plan for expansion

statewide

Link school based health centers to primary

care practitioners and CSAs and other

community based providers in an

integrated system that includes a

medical home approach



INFRASTRUCTURE No

Progress

Being Worked On By

Completed Comments

Develop an integrated model for services and

supports to elderly persons that

incorporates behavioral health care with

primary care and other services

Develop processes that ensure that

individuals receive screening and early

intervention to minimize severity of

illness, symptoms, and functional

limitations

New Priorities for Next Plan – INFRASTRUCTURE Section

Actionable in 2015:

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Mid-Range:

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→

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Other Comments:

2011-2014 NM BH Strategic Plan Review – Performance & Quality Section


Comments By: __________________________

PERFORMANCE & QUALITY No

Progress Being

Worked On By

Completed Comments

Actionable in 2011 Establish a “Consumer and System

Performance Dashboard” that monitors

gains in a limited set of key measures

addressing: improved functioning,

reduction in problems and achievement

of recovery of resiliency goals in

children and adult consumer lives.

Promote practice improvement through

expanding Quality Services Reviews

with Adult and Children’s Core Services

Agencies (CSA’s) statewide

Implement quality improvement processes

within CSA’s to assure implementation

of core functions and service to eligible

populations

Use results from statewide CCSS adult

provider audits to create ‘next steps’ in

development of a recovery-and

resiliency-based system of care

Provide training and implement functional

assessment (e.g. CAFAS) in Children’s

CSAs

Improve continuity in the services array by

trending services received 7 and 30

days after discharge from Adult

Residential and Psychiatric Inpatient

Improve quality through Fidelity Assessment

and Compliance monitoring:

Implement IOP Fidelity Tool for all

adult IOP providers

Strengthen current ACT Fidelity

Tool utilization by ACT programs

Monitor appropriate access to services for

older consumers with behavioral health

disorders by tracking services and

diagnoses by age

Mid-Range




Progress Being

Worked On By

Completed Comments

Develop standardized functional assessment

tool options for adults and older adults

Standardize functional assessment tool for

children (i.e., Child Adolescent Family

Assessment Scale (CAFAS)

Implement Intensive Outpatient (IOP) Audit

Tool for Medicaid providers of IOP

Improve quality by developing supportive

housing and lead agency fidelity

assessment tools and implementing a

compliance monitoring process

Implement concurrent review for residential

substance abuse services

Modify patient placement criteria for

substance abuse services to incorporate

harm reduction approaches and self-

directed recovery skills

Develop and implement treatment standards

that address appropriate transitions

between levels of care; include

incentive structures to support changes

Long Term (3 Years)

Expand access to functional assessment

information (e.g., CAFAS) to other child

serving systems (e.g., schools)

Implement functional outcomes as the

standard measure of child and youth




Progress Being

Worked On By

Completed Comments

outcomes

Develop strategies to increase access to

community support services for older

adults by designing pilot initiatives

within CSAs to explore access issues

Evaluate core service agency (CSA)

effectiveness in achieving recovery

outcomes, learning opportunities for

improvement, and incorporating

learning into practice.

Conduct a study of comprehensive

community support services (CCSS) to

determine its effectiveness in

supporting recovery-oriented

outcomes.



New Priorities for Next Plan – PERFORMANCE & QUALITY Section

Actionable in 2015:

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Mid-Range:

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Other Comments:

2011-2014 NM BH Strategic Plan Review – Consumer Engagement Section


Comments By: __________________________

CONSUMER ENGAGEMENT No

Progress

Being Worked On By

Completed Comments

Actionable in 2011 Identify strategies that support development of

consumer and youth resiliency in services

and trauma-informed systems of care.

Increase the number of Peer, Family and Youth

Specialists throughout the state and

promote their employment in community

organizations as Community Support

Workers (CSW) or Assertive Community

Treatment (ACT) team members

Provide leadership and advocacy training to

ensure that consumers, youth, and family

members are partners in strategic

planning, policy development, priority

setting, service implementation, resource

allocation, and evaluation

Revitalize LC’s to welcome consumers, youth,

and family members; and to ensure

members are adequately trained in

legislative advocacy, mental health first

aid, etc.

Increase LC’s participation via telehealth and

webinars to ensure that Local

Collaboratives have a voice in decision-

making

Actively distribute timely data to each LC

related to services and populations (i.e.,

persons served by gender, age, ethnicity)



To gather information on specialized behavioral

health needs and engage special

populations in natural settings, such as

older adults in senior centers and people

with disabilities in vocational programming

Develop stakeholder-friendly surveys and

reports on consumer, youth & family

satisfaction; share findings broadly and

identify relevant quality improvement

measures

Mid-Range

Engage consumers, youth and family members

in designing systems of care that capitalize

on their local community resources and

needs

Ensure that LC’s include schools, community

programs, law enforcement, housing,

employment, child welfare, juvenile justice,

local governments, neighborhood assoc.

and others in their systems of care

Evaluate the mechanisms and effectiveness of

consumer engagement for special

populations including Native Americans,

veterans, older adults, and people with

disabilities

Implement Community Wellness and Recovery

Resource Centers as peer-run and peer-

driven pilots tailored to the needs of

communities

Support peer-to-peer school based and Peer

Bridger housing programs such as the

Natural Helpers

Increase public awareness by expanding the

number of mental health focused public

service announcements focused on

recovery and stigma

Implement statewide the New Mexico

Consumer, Youth and Family Involvement

Standards which focus on the role of state

agencies, employment, media and

marketing, and community providers.

Long Term (3 Years)



Expand drop-in centers as resources for

consumers to continue growth and

development in their lives

Engage youth and their families in designing

systems of care including prevention in

their own communities

Recruit and train consumers from special

populations (i.e., Native Americans,

veterans, older adults, and people with

disabilities) to work as peer support

specialists

Increase awareness of early childhood

development and the effectiveness of

early intervention in terms of long-term

health and mental wellbeing for children

and families, including early intervention

for psychosis

Track data on behavioral health system

outcomes (e.g., where referrals for

behavioral health services are made) to

determine greatest needs



New Priorities for Next Plan – CONSUMER AND FAMILY ENGAGEMENT Section

Actionable in 2015:

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Mid-Range:

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Other Comments:

2011-2014 NM BH Strategic Plan Review – Workforce Development Section


Comments By: __________________________

WORKFORCE DEVELOPMENT No

Progress

Being Worked On By

Completed Comments

Actionable in 2011 Augment the existing workforce to include

trained peer and family specialists as part

of the paid workforce by:

Continuing training for Peer and Family

Specialists and assisting with job

placement

Improving the Peer and Family Specialist

curriculum after quarterly reviews

and feedback from participants to

ensure that they are trained to enter

the workforce

Developing an internship process for Peer

and Family Specialists to experience

the workplace

Conducting media campaigns to promote

the benefits of Peer and Family

Specialists as essential parts of the

workforce

Increase readiness of provider agencies to

employ Peer and Family Specialists and

identify funding strategies to support the

work of these individuals

Expand outreach and identify successful efforts

to provide behavioral health services in

areas of limited workforce capacity (e.g.,

rural and tribal communities)

Deliver training in the Matrix Model to assist in

the implementation of Intensive Outpatient

Services (IOP) for adolescents and adults

and aftercare placement in supportive

housing where appropriate

Provide Comprehensive Community Support

Services and Wraparound training to

ensure that the workforce is adequately

trained to work in public and private non-

profit behavioral health settings

Seek support to sustain and expand the

prevention certification program




Progress

Being Worked On By

Completed Comments

Work with Health Care Reform Leadership group

to evaluate funding opportunities for

workforce development. Include the Dept.

of Workforce Solutions in this process

Work with licensing boards to encourage

adoption of the NM developed cultural

competency curriculum as the standard for

all behavioral health continuing and higher

education programs

Expand mental health interpreter training,

including language as well as deaf and hard

of hearing, by offering additional training

opportunities

Mid-Range

Develop new learning models, such as

web-based trainings and web-based

learning collaboratives to ensure that the

workforce has the information to

effectively implement evidence based.

Training examples include:

Specialized training on unique issues of

older adults and persons with

disabilities

Education on the warning signs and

appropriate responses to youth and

adult suicide concerns

Training to school personnel on behavioral

health needs in school settings

Develop and implement a Core Service Agency

Integrated Training curriculum

Develop training methods for Core Service

Agencies workforce to support shared

decision making and shared planning

Provide training to Certified Family Specialists to

serve as care coordinators/wraparound




Progress

Being Worked On By

Completed Comments

facilitators and to provide family support

services

Seek funding and mechanisms for expanding

mental health treatment guardians

Create a specialized curriculum for Veteran Peer

Specialists focusing on trauma spectrum

disorders

Train school staff about behavioral health issues;

signs and symptoms of substance abuse,

depression, suicide, and appropriate

methods of response, referral, etc.

Create incentive strategies and policies to

increase number of Certified Prevention

Specialists

Develop Training Initiatives to engage workforce

outside of Behavioral Health. Training

examples include:

Behavioral health training for nursing

home staff

Mental Health First Aid for first

responders

Training to Primary Care staff on

integrating care (CEUs)

Long Term (3 Years)

Develop and train the workforce in clinically

integrated models to serve the general

population as well as populations with

Serious Emotional Disorders (SED) and

Serious Mental Illness (SMI)

Seek funding and develop mechanisms to

support consumer, family member, and

provider participation in trainings

Develop a Training Academy, in conjunction with

the Collaborative’s Consortium for

Behavioral Health Training and Research,

for long-term statewide training delivery

Develop strategies and incentives to encourage




Progress

Being Worked On By

Completed Comments

cross-agency and cross-system

collaboration

Strengthen licensure, re-licensure, and

certification requirements; develop a

Continuing Medical Education (CME) for

professionals with Geriatric specialty or

developmental disability specialty

Improve recruitment and retention efforts in

rural, frontier and tribal communities by

increasing access to telehealth or

enhancing availability of peer and family

specialists

Pursue education and training grants for

behavioral health service providers as they

become available under health care reform

Work with institutions of higher education to

ensure that issues relevant to public

behavioral health are integrated into

existing non-medical and medical

curriculum

Develop tax or educational incentives to

increase the recruitment of potential BH

students as well as prescribing

professionals practicing in New Mexico

Review the recommendations from the

Annapolis Coalition Workforce

Development report and prioritize steps



New Priorities for Next Plan – WORKFORCE DEVELOPMENT Section

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Other Comments:

2011-2014 NM BH Strategic Plan Review – Financing Section


Comments By: __________________________

FINANCING No

Progress

Being Worked On

BY

Completed Comments

Actionable in 2011 Increase consumer and family involvement in funding allocation discussions

Review the State’s Behavioral Health

Purchasing Plan and develop a

strategic plan for funding that takes

into account the limited dollars

available

Move toward equitable access to services

across the major funding streams (i.e.,

Medicaid, state general funds and

federal block grant funds) through

braided funding strategies

Demonstrate flexible payment strategies

within the Provider Network by

implementing risk-sharing pilots in

three areas of the state with children

and adult Core Services Agencies.

Support implementation of wrap-around

supports in the three anchor sites of

the Systems of Care initiative by

testing case rates.

Use the “Money Follows the Person”

federal planning grant to move elderly

adults from institutional care to


Evaluate providers on performance and

target incentives for improvements in:

Consumer Outcomes

Service System Performance

Conduct a system analysis of the use of

Medicaid reimbursement for school

based BH services (ie. in school-based

health centers, special education, and

other school personnel)

Develop a workgroup with state, provider,

tribal, consumer, youth and family

representation to address expected

Medicaid shortfalls



FINANCING No

Progress

Being Worked On

BY

Completed Comments

Seek new funding streams for community

based prevention programs

Mid-Range

Develop a cost study resulting in

recommendations for expanding

behavioral health services in schools

by school-based health centers,

special education, and other school

personnel

Develop a cost study resulting in

recommendations for expanding

substance abuse services for

adolescents

Develop financial strategies to support

vulnerable services such as: care

coordination/wraparound facilitation,

respite services, transitional living

services, and early childhood/infant

treatment services

Develop financial strategies to establish

uniform crisis mobile outreach services

statewide

Implement pay-for-performance and

shared-risk payment methodologies as

research indicates

Develop financial incentives for CSAs to

develop outreach strategies and

implement integrated models that

reach Native American populations,

the elderly and adults with disabilities

Rigorously evaluate risk sharing pilots and

develop a plan for modification and/or

expansion

Pilot efforts in the use of flexible funds in

wraparound plans in the three anchor

sites of the System of Care initiative



FINANCING No

Progress

Being Worked On

BY

Completed Comments

In accordance with Health Care Reform,

work with Medicaid and managed

care organizations to dedicate funds to

promote the clinical integration of

behavioral health and primary care

when appropriate

Reimburse Intensive Outpatient (IOP)

services based on demonstration of

Co-Occurring Disorder treatment

competencies established through the

Co-Occurring System Improvement

Grant (COSIG)

Long Term (3 Years)

Develop policy and financing

strategies for adult and child

wraparound approaches and other

peer and family support services

Establish Medicaid codes to support

treatment integration across service

sectors (e.g., BH, developmental

disability, primary care) so that

needed services can be provided

efficiently rather than in silos

Actively seek opportunities for

communities and the state increase

funding in New Mexico through

federal grants and other options

Develop incentives to serve populations

who are high-need, high-risk and have

complex needs

Develop models to reimburse services

based upon provider performance

Expand proven risk-sharing methodologies

statewide

Increase availability of flexible funds for

wraparound plans



New Priorities for Next Plan – Financing Section

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Other Comments:

behavioral health services division (bhsd) of the human

Documents