OMHSAS

1
OMHSAS

• Advisory Committee Update
• May 3, 2007

2
OMHSAS Updates

• Reorganization Highlights
• Staff Changes
• Retirement Challenges

3
Commonwealth of Pennsylvania - Department of
Public Welfare Office of Mental Health
Substance Abuse Services (OMHSAS) ORGANIZATION
CHART
Deputy Secretary
Bureau of Financial Management Administration
Office of the Medical Director
Bureau of Planning Program Development
Bureau of Community Hospital Operations
Bureau of Childrens Behavioral Health
Division of Childrens Policy Program
Development
Quality Management
Division of Behavioral Health Policy
Division of Medicaid Finance
Division of Eastern Operations
Utilization Management
Division of Western Operations
Division of Substance Abuse Services
Division of Budget Administration
Division of Service Delivery
Division of Planning Program Development
Division of Hospital Operations
Division of Hospital Operations
Info Systems
4
Supporting our Journey Aging Forums Evidence of
Progress

• Two recent Aging and Behavioral Health Forums
  Held
• Good representation at each Forum of Aging and MH
• Profiled Aging and DA issues
• Profiled successful collaborations
• Lessons Learned from Case Reviews Highlighted

5
Continuing our Journey School Based Behavioral
Health Setting the Stage

• Secretary of Department of Welfare and Secretary
  of Pennsylvania Department of Education regular
  meetings to address the education and the
  behavioral health needs of students using an
  integrated approach
• Deputy Secretaries and key policy personnel from
  DPW and PDE attend
• Identification of issues and priorities
  established

6
Core Principles

• The best education for a child is in the least
  restrictive environment inclusive setting in her
  or his home school
• Students who must be placed out of their home
  school environments should experience such
  placements for as brief a time as possible
• Operations and policy changes must address the
  set of incentives and disincentives that result
  in keep children out of their home schools
• PDE and DPW must jointly support the program and
  fiscal design of school based behavioral health
  services

7
Priority Projects

• Partial Hospitalization
• Education Law Center, PCPA, and advocacy
  community raised issue regarding access to
  education for children and adolescents receiving
  mental health partial hospitalization services
  during the school day
• DPW and PDE agreed to develop policies and
  practice standards regarding access to intensive
  behavioral health services including partial
  hospitalization

8
Priority Projects ( cont)

• Partial Hospitalization
• DPW Bulletins PDE School Code Change
• DPW Bulletins
• Partial Hospitalization as short term
  stabilization
• Family Driven Youth Guided IEP and ISPT
  occurring at same time when able
• Interagency team meeting/notice requirements to
  home school
• Interagency team meeting/discharge
  planning/notice to home school

9
Supporting our Journey Housing

• 1. Summary Of a CRRS Conversion Process in
  Cumberland County. Total Dollar amount
  converted 505,812
• In an effort to provide maximum opportunity for
  persons with mental illness to choose their
  preferred housing and successfully maintain the
  residence of their choice, the provider agency
  New Visions will, in collaboration with the
  County MH Program, will reduce the number of CRRS
  beds from 16 to ten, provide case management
  support services to 18 additional persons in
  community apartments, and support 9 persons in
  two Fairweather Lodges. A Consumer-Run Drop-In
  Center will be developed in Shippensburg.
• The changes in numbers of persons served
• CRRS beds are reduced from 16 to10,
• Thirty-one persons will receive Supported Living
  services in community apartments an increase of
  18 individuals.
• Two Lodges will provide for another 9 consumers.
• This represents a change from 29 to 50 total
  consumers supported twenty-one additional
  persons supported in housing.
• 15-20 persons will chose to participate in the
  Drop-In Center.
• In addition, the Cumberland County Housing
  Authority will offer Section 8 rental v ouchers
  to all persons leaving a CRRS , beginning in July
  2007.
• The Redevelopment Authority has donated a
  building for use as the second Fairweather lodge.

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Supporting our Journey Housing

• 2. In the last three years of Fairweather Lodge
  operation in Erie County, 50 separate individuals
  served in Lodges have moved to successful
  employment.
• 3. In March 2007, 45 of 48 County MH Programs
  were represented at an all day Conference in
  Harrisburg devoted to Training on how to start
  and manage a Local Housing Options Team, a
  requirement for all MH Programs for the current
  County Plan. It is anticipated that the number
  of LHOTs that are fully operational will reach 35
  by the end of the 2007 calendar year.
• 4. Huntingdon, Juniata and Mifflin County MH
  Program is currently converting a CRRS, to begin
  operation later in the 07/08 year. The total
  budget for the CRRS is 322,000, and the
  conversion will include conversion of that site
  to a Lodge and the development of a new community
  based supportive living counselor/program, which,
  will serve at least 20 new persons living
  independently in the community.

11
Continuing our Journey Peer Supports

• Fundamental element of Transformation Consumer
  Directed Consumer Operated Services Supports
  Choice in Peer Supports
• Variety of Opportunities for Peer Work and
  Support
• Mutual Support Groups
• Community Support Programs
• Recovery Specialists
• Consumer Satisfaction Teams
• Consumer- Run/Operated Services
• Warm-lines
• Drop-In Centers
• Clubhouses
• PatientsRights Advocates
• Certified Peer Specialists

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Certified Peer Specialists

• Five States and Washington DC have successfully
  developed Medicaid funded peer supports (Georgia,
  South Carolina, Hawaii, Arizona, and Iowa)
• Pennsylvania submitted a State Plan Amendment to
  Center for Medicaid /Medicare Services (CMS)
  which was approved on February 22, 2007
• Will provide for certified peer specialists to
  bill for specific services to peers with mental
  illness
• Finalizing
• Service Description Review Approval Process
• Licensing Process
• Enrollment Billing
• Planning of Statewide Technical Assistance Days

13
Certified Peer Specialists

• Certified Peer Specialist Bulletin will be issued
  May, 2007
• Three Options
• Existing MH Licensed Agency
• Subcontract to MH Licensed Agency
• Independent Peer Agency
• Additional training and technical assistance (
  Southeast Mental Health Association current
  approved trainer) may be available Recovery
  Innovations Incl., formerly META Services
• Initiated discussion with OVR regarding funding
  of peer specialist training and certification
• Over 200 certified peers trained billing will
  begin July 2007.
• An array of peer supports and other consumer
  operated and directed services to be maintained!

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OMHSAS Guiding Principles

• The Mental Health and Substance Abuse Service
  system will provide quality services that
• Facilitate recovery for adults and resiliency for
  children
• Are responsive to individuals unique strengths
  and needs throughout their lives
• Focus on prevention and early intervention
• Recognize, respect, and accommodate differences
  as they relate to culture/ethnicity/race,
  religion, gender identity and sexual orientation
• Ensure individual human rights and eliminate
  discrimination and stigma
• Are provided in a comprehensive array by unifying
  programs and funding building on natural and
  community supports unique to each individual and
  family
• Are developed, monitored and evaluated in
  partnership with consumers, families and
  advocates
• Represent true collaboration with other agencies
  service systems

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OMHSAS Objectives

• Transform the childrens behavioral health system
  to a system that is family driven and youth
  guided.
• Policy implementation of a Call for Change to
  support recovery and resiliency in the Adult
  Behavioral Health System
• Assure that behavioral health services and
  supports recognize and accommodate the unique
  needs of older adults.

16
Childrens Objective

• Transform the childrens behavioral health system
  to a system that is family driven and youth
  guided.

17
Some Guiding Principles

• Trauma informed culture should serve as the
  background for all services to children and
  adolescents
• CASSP principles are assumed to be part of the
  childrens Objective and Supporting Projects
• Youth and Family Teams will lead to a
  transformation of the childrens behavioral
  health system.

18
Childrens Supporting Projects and Actions

• Establishment of Child-Family Teams to support
  Transformation
• Establish an Institute to provide training,
  support and monitoring of Youth and Family Teams
• Develop mechanism for Medicaid payment of Youth
  and Family Team process

19
Childrens Supporting Projects and Actions

• Create Home and Community Based Alternatives to
  Residential Treatment
• Develop a White Paper addressing current
  environment, needs and recommendations for
  creating alternatives to the current residential
  treatment system
• Change existing rules to permit small group homes
  and therapeutic housing
• Enroll Multi Dimensional Treatment Foster Care as
  a Medicaid funded service
• Maintain data base on RTF utilization

20
Childrens Supporting Projects and Actions

• Partner with Education to support the development
  of effective school based supports and
  interventions
• Have OMHSAS Childrens Advisory develop White
  Paper on school based behavioral health services
• Engage youth to get their perspective on school
  based behavioral health services
• Review and update the existing Memorandum of
  Understanding with DOE, DOH, and DPW to detail
  responsibilities for SBBH
• Continue to build the relationship with DOE and
  collaborate on projects such as SBBH
  Demonstration Grants, Positive Behavioral
  Interventions and Supports, etc.
• Reduce admission to segregated programs
• Identify efforts underway with BHMCOs on
  collaborative efforts with schools
• Enhance letters of agreement between Counties,
  BHMCOs and Schools

21
Childrens Supporting Projects and Actions

• Partner with Education to support the development
  of effective school based supports and
  interventions
• Have OMHSAS Childrens Advisory develop White
  Paper on school based behavioral health services
• Engage youth to get their perspective on school
  based behavioral health services
• Review and update the existing Memorandum of
  Understanding with DOE, DOH, and DPW to detail
  responsibilities for SBBH
• Continue to build the relationship with DOE and
  collaborate on projects such as SBBH
  Demonstration Grants, Positive Behavioral
  Interventions and Supports, etc.
• Reduce admission to segregated programs
• Identify efforts underway with BHMCOs on
  collaborative efforts with schools
• Enhance letters of agreement between Counties,
  BHMCOs and Schools

22
Childrens Supporting Projects and Actions

• Create Behavioral Health competency to honor the
  strengths and address the unique individualized
  needs of children and adolescents
• In the child welfare system
• In, or at risk of entering, the Juvenile Justice
  system
• In the drug and alcohol system
• With Fetal Alcohol Syndrome Disorder
• That are Deaf or Hard of Hearing
• With Traumatic Brain Injury
• With Autism Spectrum disorder or other Pervasive
  Developmental Disorder
• With Physical Disabilities
• And infants and young children

23
Childrens Supporting Projects and Actions

• Develop a process for identifying and
  implementing evidence based practices promising
  practices and culturally relevant practices
• Utilize the SAMHSA National Registry of Evidence
  Based Practice, the NASMHPD Research Institute,
  the National Blue Print initiative and other
  sources to identify evidence based and promising
  practices
• Document the expansion of Multi Systemic Therapy,
  Functional Family Therapy and other evidence
  based practices in current practice
• Develop the Youth and Family Team process as the
  practice model for childrens behavioral health
  to support evidence based practice

24
Childrens Supporting Projects and Actions

• Develop strategies to address the needs of
  Transitional Youth
• Support Youth involvement in the OMHSAS Advisory
  Council
• Obtain Youth input in identifying needs,
  developing plans, implementing and monitoring
  service development for Transition Youth
• Summarize OMHSAS Transition Pilot projects
• Identify existing initiatives in other agencies
• Work with OMHSAS housing plan

25
Adult Objective

• Policy implementation of services to support
  recovery and resiliency in the Adult Behavioral
  Health System

26
Adult Supporting Projects and Actions

• Define and expand the range of and financial
  commitment to consumer-run services, supports and
  trainers
• New Freedom Initiative Project
• Gain baseline understanding of existing
  consumer-run services, supports and trainers
  statewide
• Develop Centers of Innovation around
  Evidence-based and Promising Practices
• Review national models and define the
  Pennsylvania model

27
Adult Supporting Projects and Actions

• Support community re-integration of individuals
  who have been in state hospitals over 2 years
• Close at least 2 state hospitals by 2010 by
• Development and implementation of individual
  community support plans
• Development of community infrastructure

28
Adult Supporting Projects and Actions

• Implement an integrated system of services and
  support for co-occurring mental health/drug and
  alcohol recovery
• Identify how to increase co-occurring and
  substance abuse awareness and activities within
  OMHSAS
• Develop joint licensing standards
• Issue guidelines around DA confidentiality
• Develop practice standards for co-occurring
  screening and service provision

29
Adult Supporting Projects and Actions

• Implement the recommendations of the Housing
  Workgroup
• Assure that every county/joinder have develop a
  housing plan using the OMHSAS Housing Plan
  template
• Implement and evaluate the Allegheny SSI
  Supplement Demonstration project and develop plan
  for statewide implementation
• Develop strategies and convert at least 1 mil in
  CRR beds to supported housing
• Policy development regarding use of public mental
  health funds in Personal Care Boarding Homes

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Adult Supporting Projects and Actions

• Implement, monitor and expand peer specialist
  services
• Enroll providers statewide, assuring availability
  of at least 2 programs offering peer specialists
  in each county/joinder
• Assure availability of peer specialist
  certification training
• Assure formalized peer support structures are
  available for peer specialists
• Develop the capacity for certified peer
  specialists to serve specific populations older
  adults, individuals involved in criminal justice
  system
• Work in collaboration with the Bureau of Drug
  Alcohol Programs to develop use of certified peer
  specialists in the drug and alcohol system
• Examine the use of consumer run peer specialist
  employment agencies
• Identify specific outcome measures for Quality
  Improvement monitoring

31
Adult Supporting Projects and Actions

• Implement recommendations of the Forensic
  Workgroup
• Partner with PMHCA to develop resources to
  support Certified Peer Specialists in serving
  individuals in the Criminal Justice system
• Work with the Governors Office on cross-systems
  task group
• Inventory existing community diversion and
  re-entry services
• Support Allegheny county national conference

32
Adult Supporting Projects and Actions

• Develop plan for expanding Employment
  opportunities to support recovery
• Collaborate on the delivery of trauma informed
  care
• Work with Hospital Association of PA to eliminate
  seclusion and restraint in community hospitals
• Target resources to plan for the expansion of
  trauma-informed care statewide for individuals,
  including
• Transition age youth, returning veterans,
  individuals involved with the criminal justice
  system

33
Adult Supporting Projects and Actions

• Restructure the Medicaid State Plan to support
  recovery and resiliency
• Review current regulations and revise/develop
  regulations supporting recovery/resiliency-oriente
  d services

34
Older Adult Objective

• Assure that behavioral health services and
  supports recognize and accommodate the unique
  needs of older adults.

35
Older Adult Supporting Projects and Actions

• Expand access to services for older adults with
  the flexibility to provide services wherever they
  are
• Ensure that implementation of peer services
  includes training of older adults as providers of
  the service to older adults as well as younger
  adults
• Monitor access of peer specialist and mobile
  mental health services to older adults.

36
Older Adult Supporting Projects and Actions

• Increase awareness of and planning for suicide
  prevention for older adults
• Adopt at least one recommendation of the Suicide
  Prevention Plan for Older Adults.
• Coordinate an annual Suicide Prevention Day in
  Harrisburg

37
Older Adult Supporting Projects and Actions

• Review the impact of dual eligibility on service
  provision
• Compile Medicare and Medicaid inpatient and
  outpatient date for older adults.
• Develop information and resources to help older
  adults better understand services under Medicare
  and Medicaid (OMHSAS/AGING/APPRISE)
• Use regional behavioral health Older Adult forums
  to share information on Medicare/Medicaid
• Increase collaboration with Area Offices of Aging
  

38
Older Adult Supporting Projects and Actions

• Expand access to the interagency planning project
  for older adults with complex needs
• Compile information for case reviews
• Encourage greater county participation through
  access to training and continued collaboration
  with Aging

39
Older Adult Supporting Projects and Actions

• Increase awareness of needs of older adults for
  substance abuse treatment and programs structured
  to accommodate those needs in a culturally
  competent manner
• Identify facilities appropriate to serve older
  adults
• Define type of services older adults are likely
  to use by getting their feedback

40
Older Adult Supporting Projects and Actions

• Ensure community consumer involvement by
  providing support to individuals transitioning
  from South Mountain Restoration Center into
  communities where they live.
• Ensure consumer participation in discharge
  planning teams.
• Ensure consumer resources are identified and
  utilized in community where they return

41
Older Adult Supporting Projects and Actions

• Continue to assure appropriate mental health
  services are available to older adults
  experiencing dementia who have behavioral health
  problems
• Continue to monitor complaints or concerns
  regarding access to care.
• Engage in educational efforts with public and
  managed care partners.

42
Older Adult Supporting Projects and Actions

• Develop a collaboration with physical health
  partners (Home Health, Visiting Nurses Assn,
  etc.) to promote behavioral health screenings for
  older adults
• Assess willingness of MCOs/providers to partner
  on provision of screenings

43
Older Adult Supporting Projects and Actions

• Ensure an active role for the Older Adult
  Advisory Committee in the Money Follows the
  Person (MFP) project
• Older Adult Committee will identify
  representatives to serve on the MFP Advisory Work
  Group anticipating receipt of grant award.

44
Older Adult Supporting Projects and Actions

• Support efforts to promote a study of Older
  Adults through the Legislative Budget and Finance
  Committee (LBFC)
• When presented with a request for legislative
  analysis, respond with positive support and
  background research on the bill soon to be
  introduced.
• Advisory Committee members may advocate for
  support, either as individuals or members of
  their respective organizations

45
What Will It Take to Support Our Change?

• Culture Change
• Consumer and family voice is central to design,
  implementation and oversight of system change
• Opportunities must be made available for
  consumers, families and advocates to challenge,
  question, confirm assumptions of what is
  meaningful to them.
• A variety of options must be made available, to
  include education, supported employment,
  competitive employment
• Stakeholder investment
• Common Vision
• Providers must be provided opportunity to change
  practice
• Hard Work

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Recovery

• Recovery
• Recovery is remembering who you are through the
  darkness and using your strengths to become all
  that you were meant to be
• Support the Journey

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Transition from the past to the future.
Drawing by Brenda Wagner
There are two ways to look at your life. One is
as though nothing is a miracle the other is as
though everything is. Albert Einstein