Assessing and planning for behavioral health transformation
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Assessing and Planning for Behavioral Health Transformation. Texas Mental Health Transformation Grant An Overview of the Assessment and Comprehensive Plan Dave Wanser Ph.D., Deputy Commissioner Texas Department of State Health Services.

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Assessing and Planning for Behavioral Health Transformation

Texas Mental Health Transformation Grant

An Overview of the

Assessment and Comprehensive Plan

Dave Wanser Ph.D., Deputy Commissioner

Texas Department of State Health Services


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Transformation Drivers:Assessment of Texas BH indicators

  • Prevalence of behavioral health disorders: 2,578,424

    • SMI and SED in the population: ~1,552,543 (57% adults)

    • Substance Abusers who would seek treatment: ~ 1,025,881

      (2005)

    • 2,149 Texans committed suicide (2002)

    • 9,992 Texas were hospitalized for attempting (2002)

  • Economic Cost to Texas of Behavioral Health Problems:

  • Mental Illness: $16.6 billion(2003)

  • Alcohol and Drug Abuse: $25.9 billion(2002)


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Transformation Drivers:Assessment of Agency BH indicators

HHSC:

  • 1/3 of all Texas children were enrolled in Medicaid in 2005 (~2.1 million).

  • Mental health needs are the most frequent reason children and youth are referred to local CRCG interagency planning teams.

    DFPS:

  • 38,522 investigative cases were confirmed abuse and/or neglect.

  • Parental substance abuse contributes to an estimated 1/3 – 2/3 of cases.

    DADS:

  • 22% of older adults have mental disorder that is not part of the normal aging process

  • ~17% of older adults abuse alcohol or drugs.

  • Older adults have the highest suicide rates.

    DARS:

  • Percentage of people served in Vocational Rehabilitation with disabilities that interfered with their employment: 19% mental/emotional; 16% cognitive; and 7% substance abuse.


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    Transformation Drivers:Assessment of Agency BH indicators

    DSHS:

    • Current system able to serve ~10% of those in need.

    • State Mental Hospitals have had a 55% increase in admissions since 1996, with shorter lengths of stay. Forensic commitments are increasing.

    • 25% in MH and 20% in SA services had a Co-occurring Disorder.

      TJPC/TYC:

    • 26.5% of juveniles supervised by probation departments were mentally ill..

    • High risk youth comprise 43% of TYC population (4% chemically dependent; 48% serious emotional disturbances; 11% were sex offenders; 17% capital and serious violent offenders; 1% mental retardation)

      TDCJ/TCOOMI:

    • Typical adult offender is 36.3 years old; has IQ of 90.7 (normal = 100); a history of academic failure; an average schooling of 10th grade but tests at grade 7.6; low self-esteem including no confidence about finding employment; no vision for a productive future; has compulsive behavior; is defensive or has a negative attitude; has difficulty with relationships and difficulty controlling anger; and, escapes from reality through drug or alcohol abuse before and after incarceration.


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    Transformation Drivers:Assessment of Agency BH indicators

    TEA:

    • Annual student drop out rates for African-American were 5.4%, Hispanic were 6.1%, and White were 2.5%.

    • In high school, more than 1 in 5 African-American (21.9%) and Hispanic (23.5%) students in 9th grade did not advance to 10th grade.

    • In elementary school, African-American and Hispanic students were almost twice as likely to be retained in a grade level as White students.

      TWC:

    • 15,013 adults and 190 youth were served by the Project Re-integration of Offenders work program.

      ORCA:

    • Hispanic population doubling in nonmetropolitan/rural areas by 2040.

    • More aged 65 and older in rural vs. urban counties (15.5% to 9%).

    • Higher poverty rates and lower income levels in rural vs. urban counties.

    • Health care professional shortages in rural areas.


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    Transformation Drivers:Assessment of Agency BH indicators

    TDHCA

    • 25% of homeless individuals suffer from a serious mental illness.

    • More than 65,000 persons with disabilities did not have predictable means of shelter in 1999.

    • An SSI recipient would have to pay 98.3% ($536) of his/her $545 monthly payment to rent a one-bedroom apartment in Texas.

      VHA

    • 27,000 Texas Reservists have fought in Iraq or Afghanistan.

    • In 2005, 1,667,370 veterans resided in Texas, 22.49% had accessed VHA services.

    • If trends continue, half of all returning vets will have a brain injury.

    • About 25% of returning veterans asked for help for mental health disorders.

    • 485,092 patients in the VA health system had substance use disorder (2002).

    • Veterans with substance use disorders accounted for approximately 12% of VA patients and about 25% of total expenditures - $4.2 billion.


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    Driving Transformation:Client Matching

    • Agency collaboration has allowed investigation into shared clients.

      • TDCJ and DSHS

        • Matches TDCJ data to Mental Health CARE System

      • Co-Occurring Children’s Policy Academy

        • Matched children in HHSC (Medicaid), Mental Health, Texas Youth Commission, Texas Juvenile Probation Commission.

        • Matched children in the Department of Family and Protective Services and the Texas Education Agency.


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    TDCJ and Mental Health Matching

    These numbers reflect offenders who have received services in the public mental health system and does not include those not diagnosed or who have not received care in the public system. A recent study indicates 40% of offenders have a mental health disorder.


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    Children’s Policy AcademyHHSC, MH, TYC, and TJPC Matching

    Reflects the number of shared clients among the four agencies.

    Of 213,427 total children in the agencies, at least 12% are served by two agencies, 2% by three agencies, and about 1% by all four agencies.

    It is entirely possible that any or all of those 165 children are each a $1 million dollar child.


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    A Greater Percentage of Victims of Child Abuse/Neglect with Juvenile Justice Contact had Criminal History in their Family, had a Behavior Problem, and/or had a Substance Abuse Issue

    >

    >

    >

    Source: DFPS Child Protective Services and TYC client databases, from Ruggiero, K.M., and Mason, M. (2006). The role of behavioral health services among

    youth in Texas at risk for juvenile justice involvement: Multi-agency data-matching project for the Policy Academy on Co-Occurring Substance Abuse and Mental Health Disorders. Austin, TX.


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    But Less Than Half Received Behavioral Health Services Funded by the State

    Source: DFPS Child Protective Services, DSHS Mental Health and Substance Abuse, HHSC Child Medicaid, and TYC client databases, from Ruggiero, K.M., and Mason, M. (2006). The role of behavioral health services among youth in Texas at risk for juvenile justice involvement: Multi-agency data-matching project for the Policy Academy on Co-Occurring Substance Abuse and Mental Health Disorders. Austin, TX.


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    A Greater Percentage of Victims of Child Abuse/Neglect with a Behavior Problem had an Earlier Disciplinary Problem Identified by TEA - Mostly Student Misconduct

    Source: FY2003 DFPS-TEA Data-Match, TEA, October 2006.


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    Driving Transformation a Behavior Problem had an Earlier Disciplinary Problem Identified by TEA - Mostly Student Misconductin the Current System: Challenges

    Stigma

    Lack of Public Understanding

    Lack of Provider Understanding

    Employment and Housing

    Education and Training Needed

    Veterans and Families

    Large numbers in Texas

    BH problems high after return

    Need for PTSD services/training

    Coordinated approach for families

    Rural Needs

    Access to Care Difficulty

    Workforce Shortages

    Housing Shortages

    Transportation Issues

    Older Population

    Increasing

    More Rural

    Complex Medical Needs

    Undiagnosed Mental Disorders

    Substance Use Increasing

    Allow to Age at Home

    Family Involvement in Care

    Children and Youth

    Increasing

    Changing Demographics

    Justice and Protective Services

    Medicaid Increases

    Dropouts

    Need Systems of Care

    Family Involvement in Care

    Demographic Shifts

    Hispanic Majority by 2040

    Culturally Appropriate Services

    School Dropout Rates

    Less Education = Less Income

    More Un- and Underinsured

    Multilingual Workforce


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    Driving Transformation a Behavior Problem had an Earlier Disciplinary Problem Identified by TEA - Mostly Student Misconductin the Current System: Needs

    Under-funded System

    47th in per capita Funding

    Need exceeds Service Supply

    Operating Costs Increasing

    Transportation Cost

    Medicaid Reimbursement

    Lack of Service Coordination

    Crisis Services Redesign

    Improve Jail Diversion

    Evidence Based Practice Use?

    Coordinate Services in the State

    Earlier Identification of Need

    Workforce Issues

    Training Needed

    Recruit to rural areas

    College/University collaboration

    New service delivery models

    Multilingual workers needed

    Fewer Entering the Field

    Ability to Screen, Assess, Refer

    Consumer Oriented

    Define Consumer Driven

    Different Agency Rules

    System Difficult to Navigate

    Support for Peer Models

    System that works for Youth

    Use of Technology

    Agencies Share Clients

    Data Sharing/Integration

    Expand Current Use

    Use of EHRs

    HIPAA translation


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    Transformation Objectives a Behavior Problem had an Earlier Disciplinary Problem Identified by TEA - Mostly Student Misconduct

    Current System

    Transformed System

    Population-based;

    early intervention

    Persons receiving services

    Coordinated care;

    “no wrong door”

    Agency “silos”

    Piecemeal, fragmented

    training

    Well-defined workforce

    development / training

    infrastructure

    Data Compartments

    Data – sharing and

    coordination

    Consumer and family

    member involvement

    Consumer and family

    driven - system

    Persons falling through

    agency “cracks”

    Seamless continuity

    of care


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    Recognizing that Transformation … a Behavior Problem had an Earlier Disciplinary Problem Identified by TEA - Mostly Student Misconduct

    • is an evolving process which takes time

    • will focus on pivotal issues and opportunities

    • will be based on a learning process, requiring adjustments and refinement

    • requires major shifts in organizational “cultures”

    • will be based on partnerships - consumers, family members, providers and local, state, federal levels of government


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    New Freedom Goals - Texas a Behavior Problem had an Earlier Disciplinary Problem Identified by TEA - Mostly Student Misconduct

    Goal 1

    Mental Health is Essential to Health

    Goal 4

    Early Screening, Assessment, Referral

    Goal 2

    Care is Consumer and Family Driven

    Goal 5

    Excellent Care is Delivered

    Goal 3

    Eliminate Disparities in Services

    Goal 6

    Increase Use of Technology


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    NFC Goals and Strategies a Behavior Problem had an Earlier Disciplinary Problem Identified by TEA - Mostly Student Misconduct


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    NFC Goals and Strategies a Behavior Problem had an Earlier Disciplinary Problem Identified by TEA - Mostly Student Misconduct


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    NFC Goals and Strategies a Behavior Problem had an Earlier Disciplinary Problem Identified by TEA - Mostly Student Misconduct


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    NFC Goals and Strategies a Behavior Problem had an Earlier Disciplinary Problem Identified by TEA - Mostly Student Misconduct


    Nfc goals and strategies22 l.jpg
    NFC Goals and Strategies a Behavior Problem had an Earlier Disciplinary Problem Identified by TEA - Mostly Student Misconduct


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    What’s Next? a Behavior Problem had an Earlier Disciplinary Problem Identified by TEA - Mostly Student Misconduct

    • Continue Dialogue and Inclusion of Voices

    • Four Initial Workgroups Developed:

      Adults, Youth, Technology, Workforce

    • Leverage Immediate Opportunities

    • Research and Evaluate Longer Term Activities

    • Prioritize Efforts


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    The Present System a Behavior Problem had an Earlier Disciplinary Problem Identified by TEA - Mostly Student Misconduct

    Fragmented, confusing to navigate, inadequate services that frustrate recovery….

    A Transformed System

    Consumer-driven, coordinated ‘no wrong door’ quality services supporting recovery …


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