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Detroit-Wayne County Community Mental Health Agency Three Year Strategic Plan For Integration of Mental Health, Substance Abuse, and Physical Healthcare.

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Detroit-Wayne County Community Mental Health AgencyThree Year Strategic PlanForIntegration of Mental Health, Substance Abuse,and Physical Healthcare

Vision:In 3 years a Detroit Wayne County Community Mental Health Consumer can enter at any door and receive recovery oriented services and supports from health care professionals who are welcoming and trained to deliver integrated health care that meets their mental health, substance use and physical health care needs.

Overall Goal:To facilitate coordinated and integrated mental health, substance abuse, and physical health care for persons with serious mental illness (SMI)/Co-occurring mental illness and substance abuse disorders, developmental disabilities, and serious emotional disturbances (SED).

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Objective I: Facilitate access to an integrated database inclusive of physical health and mental health care information for health care providers in Wayne County.


a) Facilitate discussions with the Michigan Department of Community Health (MDCH) to promote access to both physical health care and mental health care information for health care providers in Wayne County.

b) Promote “Read Only” access to consumer specific mental health care information in the Agency’s information technology (IT) system for Medicaid Health Plans in Wayne County.

c) Established coordination of care agreements to ensure sharing of physical health and mental health care information with Federally Qualified Health Clinics (FQHC).

d) Promote the utilization of internet access to WEB-DENIS (Electronic Inquiry System through Blue Cross/Blue Shield) for all participating providers in Wayne County.

e) Facilitate a process for receiving physical health care information in the Agency’s IT system from Medicaid Health Plans and sharing with contracted mental health providers.

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Objective II: Prepare the Agency’s contracted provider networks for the cultural change to Integrated Mental Health and Physical Health Care.


a) Develop policies and procedures to reflect measurable performance expectations for coordinated and integrated mental health and physical health care.

b) Include Agency expectations in the MCPN contracts.

c) Facilitate notification of Agency expectations and training to consumers, families, providers, Managers of Comprehensive Provider Networks (MCPN), and stakeholders.

d) Provide focused training to Agency staff and stakeholders involved in the Community Planning Council; Consumer and Family Advocacy Council; and Agency Quality Improvement Committees (i.e. Standards of Care, Quality Steering Committee, etc).

e) Ensure the provision of training to all Peer Support Specialist in Wayne County aimed towards promoting recovery, effective systems navigation and consumers involved in care coordination.

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Objective III: Ensure Agency’s policy and procedures facilitate effective access to integrated mental and physical health care for eligible uninsured consumers.


a) Develop and implement Agency’s policies and procedures which specifically require access to coordinated/integrated services for uninsured consumers.

b) Establish coordination of care agreements with FQHC’s specific to integrated models of care for uninsured consumers.

c) Establish collaborative partnership and agreements with Department of Human Services (DHS) to promote timely process of Medicaid applications for eligible uninsured consumers.

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Objective IV: Promote the implementation of Pilots Projects which demonstrate best practice/evidence-based models of Integrated Physical and Mental Health Care.


  • Provide focused training to consumers, stakeholders, MCPN’s and contracted providers, with emphasis on describing current integrated models of care with FQHC’s/MHP’s, at existing community mental health agencies (i.e. Southwest Solutions, New Center, North Central, Northeast Guidance, and Community Care Services).

  • Establish data collection methodology and outcome performance measures.

  • Provide technical assistance to pilot provider agencies as needed to ensure successful implementation.

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Objective V: Collaborate with Medical Directors, Psychiatrist, and Primary Care Physicians to plan and develop integrated health care strategies.

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Objective VI: Promote Standardized Assessment Tools inclusive of both mental and physical health care consumer information.


a) Assess current nursing assessments utilized by community mental health providers.

  • Develop and implement a standard nursing assessment tool which an effective physical health care assessment.

    c) Promote system wide training on the standard assessment tool.

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Objective VII: Eliminate barriers to accessing services for consumers across MCPN’s to ensure “No Wrong Door” for receiving physical health and mental health care services.


a) Facilitate the development and implementation of written agreements and protocols specific to providing services between Gateway and Carelink which promotes access to physical and mental health care services.

b) Ensure monitoring and evaluation of access to services.

c) Provide training to consumers, providers, and stakeholders specific to polices and procedures on assessing community mental health services.

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Objective VIII: Comprehensively evaluate the needs and supports needed to reduce utilization of emergency rooms high utilizes of mental health and physical health care services.


  • Facilitate implementation of sub-committees within the Agency’s Standards of Care Committee for Adults to assess the high utilize population.

  • Promote implementation of effective processes to address the identified needs of high utilizes.

    c) Encourage the utilization of peer support specialist, development of medical homes and consistent community mental health provider agencies for this population.

    d) Ensure reporting of challenges, outcomes, and successes to the Agency’s Quality Steering Committee.

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Objective IX: Facilitate the development and implementation of performance measures to effectively evaluate measurable outcomes.


a) Establish specific performance indicators which reflect integration of physical and mental health care.

b) Establish the type and frequency of data collection and reporting required of provider agencies.

c) Incorporate the physical health and mental health care integration strategic plan into all existing Agency, provider and MCPN Quality Assessment Performance Improvement Plans (QAPIP).

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Objective X: Promote the development and implementation of a Learning Series specific to Physical and Mental Health care integration for consumers and providers.


  • Encourage collaboration with the Agency’s Medical Director and partnership with the Virtual Center of Excellence (VCE) to develop a Training Curriculum for integrated health care.

  • Promote collaborations with MDCH, stakeholders, consumers and their families to develop the Learning Series.

    c) Facilitate the utilization of best practices/evidence-based research in the learning series which is culturally sensitive to the diverse population group served in Wayne County.

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Objective X1: Promote coordination within the provider network for all grant opportunities related to integrating physical and mental health care

Objective XI1: Facilitate the development and dissemination of system wide brochures and informational materials related to physical and mental health care integration.

Objective XII1: Facilitate implementation of a large Learn and Share Conference which focuses on communicating successes, networking, and sharing information to consumers, providers, and stakeholders regarding Detroit-Wayne County Community Mental Health Agency’s story related to physical and mental health care integration

Objective X1V: Facilitate the development of consumer satisfaction focus group, interviews and surveys to assess consumer and family perceptions and satisfaction with integrated physical and mental health care modes of care.