Transcript Mental Health and Substance Abuse Services Mimi Martinez McKay

Mental Health and
Substance Abuse Services
Mimi Martinez McKay, M.A., M.L.I.S.
Chief of Staff/Information Services
Director
[email protected]
Scope of Duties
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Legislative Liaison
Stakeholder Communications
Web Services Administrator
Information Services Director
DDRAC Coordinator
PDFT Contract Administrator
NASADAD Liaison
Other duties as assigned!
Overview
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DSHS/MHSA overview
System Improvement
DSHS Legislative Update
Drug Demand Reduction Advisory
Committee
• Partnership for a Drug Free Texas
DSHS Overview
Texas Department of State Health Services (DSHS)
became operational on September 1, 2004 in accordance
with HB2292.
Health Department
Mental Health Agency
Substance Abuse Agency
DSHS Overview
• Mission
• To improve health and well-being in Texas
• Fiscal Year 2008 Budget
• $2,750,231,703
• Full-Time Positions
• 12,206
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DSHS Organizational Structure
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MHSA Overview
• Mission
• Provide statewide leadership, direction and oversight for services to
help Texans prevent mental health or substance abuse problems,
build resiliency and facilitate recovery in their home or community.
• Fiscal Year 2008 Budget (total funding)
• Community Mental Health Services: $482,316,409
• Mental Health Hospital Services: $373,730,280
• Substance Abuse Services: $164,575,118
• Division includes 11 state hospitals, and has service
contracts with 39 mental health centers, and 270
substance abuse providers.
• Full-Time Positions
• 7,734
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Division Summary
• Substance Abuse Prevention, Intervention, and Treatment
Services
• Inpatient Psychiatric Services (State Hospitals)
• Community-Based Mental Health Services
• Projects for Assistance in Transition from Homelessness
(PATH)
• NorthSTAR – Community-Based Mental Health, Substance
Abuse and Co-Occurring Services
• South Texas Health Care System
• Texas Center for Infectious Disease (TCID)
Economic Impact of
Substance Abuse in Texas
Estimated Economic Costs of Substance Abuse, 2007
by Cost Category (Total: $33.4 Billion)
11%
Other
43%
Work Lost
27%
Crime
19%
Premature Death
Source: Decision Support Unit, MH & SA, DSHS.
Need Met for Substance Abuse
Treatment in Texas
ADJUSTING FOR POVERTY
2008
Texas Population
(age 12+)
19,844,757
2008
Estimated Number
with Chemical
Dependency
1,855,364
Who Are
Also Poor
892,882
SFY2008
Number Served in DSHSFunded Substance Abuse
Treatment Programs (including
NorthSTAR)
52,129
(5.8%)
Source: Decision Support Unit, MH & SA, DSHS.
Substance Abuse Prevention and
Early Intervention Services
• Primary Prevention
• HIV Early Intervention and Outreach
• Outreach, Screening, Assessment and Referral Services
(OSAR)
• Tobacco Prevention and Control
• Pregnant and Post-partum Intervention for Women (PPI)
PREVENTION OUTCOMES
Outcomes Positive among Youth in DSHS-Funded
Substance Abuse Prevention Over Time
Percent of Youth Completing SA Prevention
100%
85%
88%
Number of Schools Participating in SA Prevention
88%
2,500
2,087
75%
2,000
1,875
1,699
1,500
50%
1,000
25%
500
0%
FY2005
FY2006
FY2007
0
FY2005
Source: DSHS Behavioral Health Integrated Provider System (BHIPS).
FY2006
FY2007
PREVENTION OUTCOMES
Percentage of Texas Youth Who Used Substances
in the Past Month Decreasing Over Time
50%
2002
Percentage
40%
2004
2006
35%
33%32%
30%
18%17%
15%
20%
16%
14%13%
14%13%
11%
7% 7% 6%
10%
0%
Alcohol
Tobacco
Any Illicit
Drug
Marijuana
Source: Texas School Survey of Substance Use, DSHS.
Inhalants
Substance Abuse Treatment
Services
• Detoxification
• Intensive and Supportive Residential (adult and youth)
• Outpatient (adult and youth)
• Opioid Replacement Therapy
• Co-Occurring Psychiatric and Substance Abuse
Disorders (COPSD) Services
• Specialized Female Services
TREAMTMENT OUTCOMES
Clinical Outcomes Positive among Adults
Completing DSHS-Funded Substance Abuse
Treatment Over Time
FY2005
0%
Percentage Completing
Treatment
25%
FY2006
FY2007
50%
75%
66%
62%
63%
83%
85%
87%
Percentage Reporting
Abstinence at Follow-Up
Percentage Gaining
Employment at Follow-Up
100%
61%
60%
63%
98%
98%
98%
Percentage Not ReArrested at Follow-Up
Source: DSHS Behavioral Health Integrated Provider System (BHIPS).
TREATMENT OUTCOMES
Clinical Outcomes Positive among Youth
Completing DSHS-Funded Substance Abuse
Treatment Over Time
FY2005
0%
Percentage Completing
Treatment
25%
FY2006
FY2007
50%
75%
100%
60%
57%
59%
84%
84%
88%
Percentage Reporting
Abstinence at Follow-Up
94%
94%
95%
Percentage with Positive
School Status at Follow-Up
97%
97%
96%
Percentage Not ReArrested at Follow-Up
Source: DSHS Behavioral Health Integrated Provider System (BHIPS).
Current and Emerging
Challenges
• Changing trends in drug use patterns
• Cost pressures on treatment providers
• Workforce development
• Availability of specialized services
• Ensuring a continuum of care
Trends In Substance Abuse
• Alcohol is the primary drug of abuse in Texas
• Of particular concern is heavy consumption of
alcohol, or binge drinking, which is defined as
drinking five or more drinks at one time. In 2008, 12
percent of all secondary students said that when they
drank, they usually drank five or more beers at one
time, and 13 percent reported binge drinking of liquor
• In 2008, 27 percent of all clients admitted to publicly
funded treatment programs had a primary problem
with alcohol
Trends In Substance
Abuse
• Increase in inhaling heroin—not just “Cheese”
(heroin+Tylenol PM) but use of other
diphenhydramine products such as Benedryl to
produce powder from the Tar.
• Problems with inhaled heroin continue to increase,
especially among youths and young adults.
• Suboxone (buprenorphine + naloxone) as treatment
option for young heroin clients.
• Proportion of Black crack users continues to
decrease.
• Decreased availability and increased price due to late
2008 gang moratorium and Colombians not fronting
cocaine on consignment to Mexican traffickers.
Trends in Substance Abuse
(Con’t)
• Methamphetamine availability down and
price up.
• Mexican limits on importation of
pseudoephedrine have dropped from 140
tons in 2005 to 12 tons in 2007
• Small meth labs starting up again
TX-Mexico Border concerns
• magnitude of the substance abuse and mental health
problem on the Border is of serious concern.
• Concern that people in need of substance abuse and
mental health services will become more “closeted”
and afraid to ask for help due to repercussions
related to the safety of their families and/or
immigration issues.
• Increasing numbers of youth involved in drug
trafficking and fewer options for them. Choosing
whether or not to become involved in drugs and
gangs is less a “choice” and instead a decision based
on threats and fear.
Data Source
• Jane Maxwell, Ph.D.
• Center for Excellence in Drug Epidemiology
• Gulf Coast Addiction Technology Transfer
Center
• http://www.utexas.edu/research/cswr/gcattc/d
ocuments/Texas2009_002.pdf
• E-Mail: [email protected]
System Improvement
• Clinical Management Behavioral Health System (CMBHS)
• Access to Recovery (ATR)
• Texas Recovery Initiative (TRI)
• Licensure
Clinical Management Behavioral
Health System (CMBHS)
• CMBHS will:
• Integrate clinical management tool for
Substance Abuse and Mental Health service
providers
• Capture demographic, service and clinical data
for Substance Abuse and Mental Health clients
• Track service utilization and client progress
• Facilitate State and Federal reporting
requirements
Who Can Use CMBHS?
• All Mental Health & Substance Abuse
Treatment providers contracted with DSHS’
Mental Health and Substance Abuse division.
• CMBHS will serve as a connection point to
other publicly-funded behavioral health
service systems and related programs.
• Clients will not currently have direct access to
information in CMBHS. A future expansion
may provide this service.
Substance Abuse Treatment
Providers and CMBHS
• CMBHS will replace BHIPS, DSHS’ legacy
system for managing substance abuse
treatment.
• CMBHS is web-based. Providers need only a
computer with Internet access to use the
system.
• Training began earlier this month, with rollout
to providers by region.
• Helpdesk services will be available to all
CMBHS users.
CMBHS Provider Benefits
• Efficient, seamless administrative and clinical
processes for gathering, updating, and
sharing client information.
• Convenient and accessible from any
computer that has a browser and Internet
connection, allowing access from almost any
location.
• Free of charge to community Mental Health
and Substance Abuse treatment providers
who provide services under contract to
DSHS.
CMBHS Client Benefits
• A person seeking services will experience more
streamlined intake, admission, assessment, diagnosis,
treatment plan development, treatment and discharge
processes by:
• Reducing time for staff to perform administrative tasks
and gather basic client information
• Using a single process that assesses a person’s need
for mental health and/or substance abuse treatment
• Creating a single client record that can be shared,
eliminating need to create and maintain multiple client
records
• Allowing access to previous health records that can
help identify what types of treatment have been most
effective in the past and facilitate current treatment
plans.
When Will CMBHS Be Ready For
Use?
• CMBHS will begin an incremental rollout to
Substance Abuse and NorthSTAR providers
beginning in August.
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Region 7 Substance Abuse Providers, 08/10/09
Region 6 Substance Abuse Providers, 09/08/09
NorthSTAR Substance Abuse Providers, 10/05/09
Region 3 Substance Abuse Providers, 11/02/09
Region 5 Substance Abuse Providers, 12/01/09
When Will CMBHS Be Ready For
Use?
• (CMBHS Release One Deployment Continued)
• Region 4 Substance Abuse Treatment Providers, January
2010
• Region 2 Substance Abuse Treatment Providers, February
2010
• Region 11 Substance Abuse Treatment Providers, March
2010
• Region 9 Substance Abuse Treatment Providers, April 2010
• Region 10 Substance Abuse Treatment Providers, May 2010
• Region 8 Substance Abuse Treatment Providers, June 2010
• Region 1 Substance Abuse Treatment Provider, July 2010
Connecting CHMBHS to Other
Systems
Access to Recovery
(ATR)
• Federal SAMHSA Grant awarded 2004
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$22.8 million for three years
Federal target 8,928 clients; served 15,000
Voucher issued to client rather than contract with provider
30 participating drug courts in 13 counties
• Second ATR Meth Grant awarded 2007
• $13.5 million for three years
• Federal target 6,038 clients
• Focus on methamphetamine use
• Partnership with Governor’s Office/Criminal Justice
Division
Substance Abuse Services
Performance Improvement
• The Texas Recovery Initiative (TRI)
• Partnership between DSHS and the substance
abuse treatment and recovery communities
• Identify opportunities and methods for improving
the quality and effectiveness of services provided
to adult population
• Process to date has included a series of
community meetings, creation of a task force and
the presentation of a set of summary findings for
service improvement and recommendations
Texas Recovery Institute’s
Next Steps
• Emphasize integration in all efforts.
• Make public health messages readily available to
individuals seeking recovery.
• Expand existing infrastructure through peer case
management at the treatment level, community
recovery services at the OSAR level and seek
additional funding for additional wrap-around
ancillary services to support recovery.
Proposed Facility Licensure Rules
Revision
• Chemical Dependency Treatment Facility
Licensure Rules, TX Administrative Code,
Chapter 448 are under review for revision
• A stakeholder meeting for input and feedback on
the preliminary revised Chapter 448 draft was
held in Austin on July10th
• Input from that meeting is being used to revise
the rules draft
Proposed Facility Licensure Rules
Revision
• The subsequent revised Ch. 448 rules draft
is expected to be available today (7/31):
http://www.dshs.state.tx.us/hfp/hottopics.shtm
• Current Ch. 448 rules are available here:
http://www.dshs.state.tx.us/hfp/rules.shtm#substa
nce
Proposed Facility Licensure Rules
Revision
• Another stakeholder meting on the draft
rules will be held on Friday, Aug. 7
from 9:00 a.m. to 4:00 p.m.
UT Austin JJ Pickle Research Center Campus
PRC Commons Center
Building 137, Room 1.102 (Big Tex)
10100 Burnet Rd.
Austin, TX 78753
Proposed Facility Licensure Rules
Revision (con’t)
Stakeholder meeting #3
• Date: September 11, 2009
• Time: 9:00 am – 4:00 pm
• Location: UT Commons Center – J.J. Pickle
Campus
Proposed Facility Licensure Rules
Revision
• Contact for questions on the proposed rules
revisions:
Jack Montague
Manager, Substance Abuse Compliance Group
Regulatory Division
TX Dept. of State Health Services
(512) 834-6700, ext. 2126
[email protected]
Counselor Licensure Rules
• A joint meeting between TAAP, ASAP, TDCJ,
DSHS/MHSA and DSHS/Regulatory will
convene this fall
• Contact: Cynthia Humphrey, ASAP Executive
Director, [email protected]
Contact Information for LCDC
Programs
• Licensed Chemical Dependency Counselor Program
800/832-9623, option 5
• 512/834-6677 FAX
• [email protected]
• http://www.dshs.state.tx.us/lcdc
• Mailing address:
• Stewart Myrick, Team Lead, LCDC Program
Texas Department of State Health Services
P.O. Box 149347 (MC-1982)
Austin, TX 78714-9347
• 512-834-4565
• [email protected]
2009 Legislative Update
Exceptional Items
Community Mental Health Services
Total Request
Amount Requested:
$85,536,497
Amount Received: $56,200,000
• Includes funding for:
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Crisis Expansion - $0
Transitional Services - $25,698,282
Intensive Ongoing Services - $29,301,718
Veterans Mental Health Training and Coordination –
$1,200,000
Cognitive Processing Training for LPHAs - $500,000
Web-based eligibility – $500,000
Regional Conferences with Partners Across Texas – $200,000
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Exceptional Items
Community MH Services – Maintenance of
Critical Services
Total Request
Amount Requested:
Amount Received:
$26,800,000
$7,977,486
• Includes funding for:
Cost increases for medications, salaries, fuel, vehicles,
lab, increase in healthcare costs, utilities, etc
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Exceptional Items
Mental Health Hospital Services:
Total Request
Amount Requested:
$85,308,524
Amount Received:
$63,078,000
• Includes funding for:
• Maintain Current Service Level - $35,000,000
• Stipends for Psychiatry - $850,000
• Building & Equipment Repair & Replacement
$27,228,000
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Exceptional Items
MHSA
Information Technology Total Request
Amount Requested:
$16,316,153
Amount Received: $0
• Includes funding for:
• Clinical Management System for Behavioral Health
Care Services (CMBHS)
• Increase Information Technology Support at Hospitals
• Increase electronic client record system capacity and
bandwidth
• Automated medicated dispensing system
Exceptional Items
Substance Abuse Services
Total Request
Amount Requested:
$81,669,715
Amount Received:
$0
• Includes funding for:
Treatment Rate Increase
• Increase Prevention Services
• Expand Detoxification Services
• Enhance Medicaid Benefits
• Recovery Support and Service Coordination Services
• OSAR Expansion
• Services for Persons with Co-occurring Mental Illness
• Medication Assisted Treatment
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Substance Abuse Adult Medicaid
Benefit
Article IX, Sec. 17.15 of SB 1
• Sec. 17.15. Medicaid Substance Abuse Treatment. Out of funds
appropriated above in Goal B, Medicaid, the Health and Human
Services Commission shall, beginning January 1, 2010, provide
coverage for comprehensive substance abuse treatment services
under Medicaid to persons who are at least 21 years of age, have a
substance abuse disorder, and otherwise qualify for Medicaid. The
commission may delay implementation pending federal approval.
The commission shall analyze data relating to the provision of
those treatment services and provide the data to the Legislative
Budget Board in a format and at times requested by the Legislative
Budget Board. The commission may not provide those treatment
services if the Legislative Budget Board determines that the
treatment services have resulted in an increase in overall Medicaid
spending.
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Who is Eligible for SA Medicaid
Benefit and its Potential Array of
Benefits
• All Medicaid recipients in Texas
• Traditional fee for service delivery system
and managed care
• Clinical assessment, residential levels of
care, ambulatory detox, case mgt, outpatient,
medication assisted treatment are being
reviewed by HHSC and DSHS
• Benefits must be approved by CMS prior to
implementation
Details about SA Medicaid Benefit
and Implementation Plan
• The rider may allow some greater flexibility in terms of
benefit array, timeliness for cost effectiveness study.
• HHSC (lead agency) and DSHS are co-managing roll
out. There are standing workgroups to address the
implementation issues, which include:
• decisions of IT systems, service delivery system (fee for
service vs. managed care), benefit design/medical policy
and CMS approval of benefits, utilization management,
provider education, recruitment and enrollment in Medicaid,
recipient education, staffing/oversight, how it will relate with
and the effect on the SAPT block grant and DSHS provider
contracts, and cost effectiveness evaluation component.
SA Medicaid Benefit
Implementation Plan (cont.)
• HHSC and DSHS have been meeting regarding
questions on IT systems, benefit design and
provider network.
• Tentative implementation date:
• Around April-May 2010
• Detailed project plan:
• There are many moving parts and
interdependencies in this plan. There will be
frequent updates to the provider community to
keep all apprised.
Relevant Bills
• HB 1232 - The Department of State Health Services shall
establish a local behavioral health intervention pilot project for
children in Bexar County.
• HB 2196 - The executive commissioner of the Health and
Human Services Commission shall establish a workgroup to
recommend best practices in policy, training, and service
delivery to promote the integration of health and behavioral
health services in this state.
• SB 1325 - relating to the creation of a mental health intervention
program for military veterans.
• HB 1233 - relating to the court-ordered administration of
psychoactive medication to certain criminal defendants.
Partnerships and
Stakeholder Engagement
• Texas Education Agency (TEA)
• Education Service Centers (ESC) - expanding role
of School Health Specialist to include MH promotion
and substance abuse prevention efforts
• Legislative direction to implement tobacco education
program in schools
• Drug Demand Reduction Advisory Committee
(DDRAC)
Drug Demand Reduction
Advisory Committee
(DDRAC)
Texas Drug Demand Reduction
Advisory Committee
• The DDRAC was legislatively mandated to
develop a comprehensive statewide strategy
with recommendations to reduce drug
demand in Texas.
• 16 state agencies must participate in effort,
as well as 5 at-large members from different
geographical areas within the state.
• 3 Subcommittees: Workforce, Continuity of SA
Services/ Data Sharing & Media/Communications
Recommendations of the
DDRAC
• Remove exclusion clause for medical expenses
from Uniform Individual Accident and Sickness
Policy Provision Law
• Statewide public smoking ban
• Prescription Drug Monitoring
• Mandate comprehensive alcohol and other drug
reduction strategies targeting college students
• Support the recruitment and retention of quality
service providers in the field of substance abuse
prevention and treatment
Workforce Subcommittee
Recommendations
• To develop a strong workforce and provide a
holistic approach to substance abuse and mental
health service delivery:
• Shift the focus from the number of people receiving
services to the specific services urgently needed to
reduce drug demand in Texas.
• Recruit and train a professional workforce to fully meet
the service needs and provide appropriate training and
tools.
Agencies Represented on the
Workforce Subcommittee
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Association of Substance Abuse Programs
Texas Workforce Commission
Texas Youth Commission
Department of Family Protective Services
Southwest Center for the Application of
Prevention Technologies
• DSHS
Recruitment and Retention of
Service Professionals
• Rationale:
• Texas has an urgent need for qualified and wellsupported behavioral health professionals across
disciplines.
• The reported annual staff turnover for Texas
substance abuse programs was 42% and program
directors report ongoing difficulty filling their open
positions.
• Quality service providers in the field of substance
abuse prevention and treatment specializing in
criminal justice populations are also decreasing and
difficult to recruit.
Action Items: July 15, 2009
Workforce Meeting
• Increase the number of substance abuse
programs in higher education institutions
• Stimulus funding for health care should include
behavioral health
• Establish an internship program with local
institutions of higher education
• Make LCDC training a part of the TRI
• Target veterans to receive assistance to be
trained as substance abuse professionals
DDRAC Border Symposium
• DSHS, Aug 4th ,1-5pm
• http://www.dshs.state.tx.us/sa/ddrac/symposi
um.shtm
• Unique opportunity for attendees to gain a
greater understanding of the unique
challenges facing the border region because
of the demand for drugs in the United States
• As of today, there have been 9,903 drug war
related deaths at the US/Mexico Border
Source: UC San Diego Transborder Institute
DDRAC Border Symposium (con’t)
Speakers include:
• Jane Maxwell, Ph.D., UT Addiction Technology Transfer Ctr.
• Chilo Madrid, Ph.D., Aliviane NO-AD, Inc.
• Luis Flores, SCAN, Inc.
• Michael Hanson, Border Patrol, Operation Detour
• Guillermo Valenzuela, Director of International and Border
Affairs for U.S. Congressman Silvestre Reyes, Chairman of the
House Select Committee on Intelligence
• Sergio Nogueira, CEO of Mexican Association of Rehabilitation
of Alcoholics and Addicts
• Simon F. Sotelo, Executive Director, Quad Counties Council on
Alcohol and Drug Abuse
Partnership for a Drug Free
Texas
Partnership for a Drug Free
Texas
• Mission: To reduce youth drug use in
Texas by distributing research-based media
messages created by the Partnership for a
Drug-Free America and supplementary
marketing materials developed specifically for
Texas.
PDFT Projects
• Alliance Support
• 1-877-9-NO-DRUG Hotline
• Red Ribbon Rally (October 15!)
Looking Forward: 2009
• Children’s Activity Book
• Currently producing bilingual activity book for ages
5-7
• PSA Distribution Changes
• Moving towards digital PSA distribution
• New Drug-Free Texas Website
• Working with Partnership National to syndicate
content
• Will allow for daily updates by DSHS and PDFT
Recovery Month
• 2009 marks the 20th Anniversary of Recovery Month,
which aims to:
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highlight societal benefits of substance abuse treatment
laud the contributions of treatment providers
promote the message that recovery is possible
encourage citizens to help expand and improve availability of
effective treatment
• educate public on substance abuse, addiction is a treatable
disease and recovery possible
• reduce and eventually eliminate public stigma associated
with substance abuse and recovery
Recovery Month Events
• Rallies will be hosted in:
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San Antonio
Dallas
Houston
El Paso
• More much more information on Recovery
Month can be found at:
• http://www.recoverymonth.gov
On behalf of the citizens of
Texas, thank you for all of
the work you do!