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Policy and Practice in Children’s Behavioral Health: The CT Children’s Behavioral Health Plan 28 th Annual Research & Policy Conference on Child, Adolescent, and Young Adult Behavioral Health March 2015 Jeffrey J. Vanderploeg, Ph.D. Tim Marshall, L.C.S.W.

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Page 1: Policy and Practice in Children’s Behavioral Health: …cmhconference.com/files/presentations/28th/s52-1.pdf · Children’s Behavioral Health: The CT Children’s Behavioral

Policy and Practice in

Children’s Behavioral Health:

The CT Children’s Behavioral

Health Plan

28th Annual Research & Policy

Conference on Child, Adolescent, and

Young Adult Behavioral Health

March 2015

Jeffrey J. Vanderploeg, Ph.D.

Tim Marshall, L.C.S.W.

Page 2: Policy and Practice in Children’s Behavioral Health: …cmhconference.com/files/presentations/28th/s52-1.pdf · Children’s Behavioral Health: The CT Children’s Behavioral

Policy and Practice in

Children’s Behavioral Health:

The CT Children’s Behavioral

Health Plan

28th Annual Research & Policy

Conference on Child, Adolescent, and

Young Adult Behavioral Health

March 2015

Jeffrey J. Vanderploeg, Ph.D.

Tim Marshall, L.C.S.W.

Page 3: Policy and Practice in Children’s Behavioral Health: …cmhconference.com/files/presentations/28th/s52-1.pdf · Children’s Behavioral Health: The CT Children’s Behavioral

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Background/Context

PA 13-178 was one of the CT legislature’s responses to the

shootings in Newtown

• Sponsored by Sen. Dante Bartolomeo and Rep. Diana Urban (co-chairs,

Children’s Committee)

History of fragmentation in CT’s behavioral health system

• Access based on insurance type, system involvement, geographic location,

race/ethnicity

• Approximately 40% Medicaid; 28% commercially insured; 28% employee-sponsored plans

• DCF, DSS, DMHAS, DPH, SDE, CSSD, DDS, DRS, OEC

Growing recognition of the impact of trauma

Importance of full service array, including promotion, prevention

Page 4: Policy and Practice in Children’s Behavioral Health: …cmhconference.com/files/presentations/28th/s52-1.pdf · Children’s Behavioral Health: The CT Children’s Behavioral

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Big Issues in Connecticut Ensure access for all children

Reduce fragmentation

• Insurance type, system, geography

Address concerns with commercial insurance coverage

• Coverage for services; coverage for conditions; medical necessity criteria and utilization management; adequacy of provider networks; perceived cost shifting to state

Meaningful family engagement

Full service array

Sufficient administrative infrastructure and support

Robust and integrated data collection and quality improvement

Fully supported provider network

Address ED crisis

Promote community-based treatment as service utilization changes

(e.g., reduced congregate care utilization)

Expand the workforce

Page 5: Policy and Practice in Children’s Behavioral Health: …cmhconference.com/files/presentations/28th/s52-1.pdf · Children’s Behavioral Health: The CT Children’s Behavioral

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Overarching Framework

PA 13-178 calls for the Plan to be:

Comprehensive in scope

Integrated across public and private systems

Inclusive of system-involved and non-system-involved youth

Built on existing system strengths

Legislation calls for an initial Plan, followed by a five year

implementation timeframe

Page 6: Policy and Practice in Children’s Behavioral Health: …cmhconference.com/files/presentations/28th/s52-1.pdf · Children’s Behavioral Health: The CT Children’s Behavioral

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Overarching Framework

PA 13-178 calls for the Plan to be:

Focused on key principles identified in PA 13-178 that support

an effective system of mental health care

• Prevention, early identification, early intervention

• Developmentally-appropriate services

• Comprehensive care through an array of services

• Engaging communities, families, and youth

• Sensitive to diversity

• Monitored through Results Based Accountability

• Data-informed quality assurance strategies

• Improve integration of school- and community-based services

• Enhance consumer input, public education, accountability

Page 7: Policy and Practice in Children’s Behavioral Health: …cmhconference.com/files/presentations/28th/s52-1.pdf · Children’s Behavioral Health: The CT Children’s Behavioral

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Summary of Information Gathering Process

13-178 directed Department of Children and Families

(DCF) to develop the Plan:

• In collaboration with other state agencies/systems

• DCF to own the process and product but engage partners in

ongoing implementation

• Limited internal capacity to produce the Plan

DCF contracted with CHDI to facilitate input gathering

process and Plan development

• January 2014 to September 2014 (9 months)

• Balancing scope of work with time/resources

Page 8: Policy and Practice in Children’s Behavioral Health: …cmhconference.com/files/presentations/28th/s52-1.pdf · Children’s Behavioral Health: The CT Children’s Behavioral

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Summary of Information Gathering Process

The Child Health and

Development Institute

• Independent, non-profit organization

• Children’s Fund and CHDI

• Mission: “A catalyst for improving the

health, mental health and early care

systems for children in Connecticut.”

• Policy, systems, and practice

• www.chdi.org

• www.plan4children.org

Page 9: Policy and Practice in Children’s Behavioral Health: …cmhconference.com/files/presentations/28th/s52-1.pdf · Children’s Behavioral Health: The CT Children’s Behavioral

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Summary of Information Gathering Process

Twelve Facilitated Discussions (220 participants)

Six Open Forums (232 participants)

26 Community Conversations (339 adults, 94 youth)

Public Input through website (www.plan4children.org)

• 60 input forms; 115 report draft review forms

Key Document/Data Review

Advisory Committee Meetings

Page 10: Policy and Practice in Children’s Behavioral Health: …cmhconference.com/files/presentations/28th/s52-1.pdf · Children’s Behavioral Health: The CT Children’s Behavioral

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Thematic Areas

1. System Organization, Financing and Accountability

2. Health Promotion, Prevention, and Early Identification

3. Access to a Comprehensive Array of Services and

Supports

4. Pediatric Primary Care and Behavioral Health Care

Integration

5. Disparities in Access to Culturally Appropriate Care

6. Family and Youth Engagement

7. Workforce

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Key Recommendations

A. System Organization, Financing and Accountability

A.1. Redesign publicly financed system

A.2. Create a Care Management Entity

A.3. Develop plan to address major areas of concern with

commercial insurance coverage

A.4. Integrated behavioral health data infrastructure

B. Health Promotion, Prevention, Early Identification

B.1. Implement evidence-based promotion/prevention

B.2. Periodic standardized screening

B.3. Competency in social and emotional development

B.4. Develop suicide-prevention programs

Page 12: Policy and Practice in Children’s Behavioral Health: …cmhconference.com/files/presentations/28th/s52-1.pdf · Children’s Behavioral Health: The CT Children’s Behavioral

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Key Recommendations C. Access to a Comprehensive Array of Services and Supports

C.1. Build full array of services and supports

C.2. Expand crisis-oriented behavioral health services

C.3. Strengthen role of school based mental health

C.4. Integrate suicide prevention activities across array

D. Pediatric Primary Care and Behavioral Health Care Integration

D.1. Strengthen connections pediatric PCP and BH providers

E. Disparities in Access to Culturally Appropriate Care

E.1. Develop, implement, and sustain standards of culturally and

linguistically appropriate care

E.2. Enhance availability of CLAS services

Page 13: Policy and Practice in Children’s Behavioral Health: …cmhconference.com/files/presentations/28th/s52-1.pdf · Children’s Behavioral Health: The CT Children’s Behavioral

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Key Recommendations F. Family and Youth Engagement

F.1. Include family members and youth in governance and oversight of

behavioral health system

G. Workforce

Goals and strategies throughout document

Includes establishing a workforce committee in the overall

governance and structure of the system of care (Section A)

Other Report Sections

Implementation

Timeline, Priorities, Approximate Costs

Bibliography of Major Documents Reviewed

Behavioral Health Utilization and Quality Measures

Endnotes

Page 14: Policy and Practice in Children’s Behavioral Health: …cmhconference.com/files/presentations/28th/s52-1.pdf · Children’s Behavioral Health: The CT Children’s Behavioral

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Page 15: Policy and Practice in Children’s Behavioral Health: …cmhconference.com/files/presentations/28th/s52-1.pdf · Children’s Behavioral Health: The CT Children’s Behavioral

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Related Initiatives/Reports

Behavioral Health Task Force for Youth (report released April 2014)

Sandy Hook Advisory Commission (report submitted 03/06/15)

State Innovation Model (CT awarded funding @ $45MM)

Medicaid’s Person Centered Medical Home

CONNECT Grant

ACCESS MH CT

DPH Regional Care Coordination Collaboratives

Home Visiting System Development

ECCS – Developmental Screening

Project LAUNCH

CT Suicide Advisory Board

Behavioral Health Partnership

Page 16: Policy and Practice in Children’s Behavioral Health: …cmhconference.com/files/presentations/28th/s52-1.pdf · Children’s Behavioral Health: The CT Children’s Behavioral

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Implementation Updates

Form Children’s BH Implementation Team

Complete fiscal analysis

Network of care analysis

Systems Integration (BH and schools; BH and JJ)

Develop MOAs between EMPS-mobile crisis and schools

System data analysis (e.g., system of care expansion grant, EMPS and ED integration)

Page 17: Policy and Practice in Children’s Behavioral Health: …cmhconference.com/files/presentations/28th/s52-1.pdf · Children’s Behavioral Health: The CT Children’s Behavioral

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Next Steps

Develop detailed work plan and timeline

Develop web based tools and dashboards for reporting progress Short Term Legislative & Budgetary Actions to address immediate s gaps

Expand EMPS and crisis services

Initiate processes for further planning and analysis (e.g., workforce, commercial insurance, CME, clearinghouse, etc.)

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Wrap Up

Comments and Questions