Download 10 Huang_Simpson SanAntonio IBHI 1 29 17

Revisiting
“Million Dollar Murray:”
A Better Plan
Larke Nahme Huang, Ph.D.
Director, Office of Behavioral Health Equity
Lead, Trauma and Justice Strategic Initiative
Jennie Simpson, Ph.D.
Staff Lead, Criminal Justice Initiative
Office of Policy, Planning and Innovation
Criminal Justice-Behavioral Health- Partnerships Promoting
Integrated Healthcare
IBHI and CHCS Conference
San Antonio, TX – January 29, 2017
SAMHSA’s Trauma and Justice
Strategic Initiative
2
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Integrating a trauma informed approach throughout
health, behavioral health and related systems in order
to reduce the harmful effects of trauma and violence on
individuals, families and communities.
•
Utilizing innovative strategies to reduce the
involvement of individuals with trauma and behavioral
health issues in the criminal and juvenile justice
systems.
Who is Million Dollar Murray?
What Creates Health?
Determinants of Health
Genes and Biology
Physical
Environment
Clinical
Care
10%
10%
Social and Economic
Factors
40%
10%
Necessary conditions
for health (WHO)
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Health
Behaviors
30%
Determinants of Health Model based on frameworks developed by: Tarlov AR. Ann N Y
Acad Sci 1999; 896: 281-93; and Kindig D, Asada Y, Booske B. JAMA 2008; 299(17):
2081-2083.
World Health Organization. Ottawa charter for health promotion. International Conference on
Health Promotion: The Move Towards a New Public Health, November 17-21, 1986 Ottawa, Ontario,
Canada, 1986. Accessed July 12, 2002 at http://www.who.int/hpr/archive/docs/ottawa.html.
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Shelter
Education
Food
Income
Stable eco-system
Sustainable
resources
Mobility
Health Care
Social justice
and equity
Trauma
Reduction
Key Data Points
(Bureau of Justice Statistics, 2006)
Criminal justice involvement among noninstitutionalized
adults with and without serious mental illness
Alene Kennedy-Hendricks et al. Health Affairs 2016;35:1076-1083
Substance Abuse and Mental Health Services Administration National
Survey of Drug Use and Health
Ten medical conditions with the
highest estimated spending in 2013
Charles Roehrig Health Aff 2016;35:1130-1135
©2016 by Project HOPE - The People-to-People Health Foundation, Inc.
Combined spending by private insurance, Medicaid, and Medicare
as a share of all spending for mental health and substance use
disorder treatment
Tami L. Mark et al. Health Aff 2016;35:958-965
Trends in substance use disorder and criminal justice involvement
Brendan Saloner et al. Health Aff 2016;35:1058-1066
Substance Abuse and Mental Health Services Administration National Survey of Drug Use and Data
Selected Federal and National Initiatives
Policy Initiatives
Grant Programs
Partnerships
• 21st Century Cures
Act
• Affordable Care Act
• HIPAA
• MAT
• Health Homes
• Public Health 3.0
• Criminal Justice
Programs
• Certified Behavioral
Health Clinics
• Opioid State Grants
• ReCAST
•
•
•
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Data Driven Justice
Stepping Up
One Mind
SPARK
21st Century Cures Act and Mental
Health Reform Bill- Selected Provisions
Title 9, Promoting Access to Mental Health and
Substance Use Disorder Care –
• Authorizes programs for Adult Suicide Prevention,
Assertive Community Treatment, Crisis response, Jail
Diversion, Assisted Outpatient Tx
Title 12, Medicaid Mental Health Coverage:
• Clarifies that Medicaid does not prohibit same day
payment for mental health and primary care services
Sec 1003, Account for State Response to Opioid Abuses
Crisis: $1B over 2 years to address treatment gap for
States
Title XIV, Mental Health and Safe Communities
• Increases for Law Enforcement Training on crisis
response; Amends COPS-crisis training; court-ordered
AOT; Forensic ACT, Law Enforcement-School MH
Crisis Intervention Team
Affordable Care Act:
Benefits and Medicaid Expansion
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•
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Essential Benefits Package
Medicaid expansion – 31 states and D.C.
People recently incarcerated
– ~ 10% of Medicaid expansion
population
Before ACA
– 80% of people recently released from
prison were uninsured.
~ 80% CJ-involved may qualify for Medicaid
in expansion states
New Medicaid guidance (April 2016)
–
–
Clarifies that individuals who are currently on
probation, parole or in home confinement are not
considered inmates of a public institution.
Extends coverage to Medicaid-eligible individuals
living in community halfway houses where they
have freedom of movement
Disparities in Coverage: Example African Americans
(Snowden, 2016)
13
Medicaid Non-Expansion States
States with Highest Proportion of African Americans
ACA: Aligning New Service Delivery and
Payment Models
• Health Home Option with Enhanced FMAP
• Improves care coordination and service
linkage for people with chronic conditions
• 19 States and DC (SPA)
• New York:
– Piloting CJ Program in Health Homes
– Established Complex Trauma as Chronic Condition
HIPAA Guidance (2016)
• Clarifies if a covered
entity may collect, use,
and disclose criminal
justice data under
HIPAA
https://www.hhs.gov/hipaa/forprofessionals/faq/2073/may-coveredentity-collect-use-disclose-criminal-dataunder-hipaa.html
Medication Assisted Treatment:
New Buprenorphine Regulation
July 2016: Final rule, “Medication Assisted Treatment
for Opioid Use Disorders.”
– Allows physicians with waiver to prescribe buprenorphine for up to 100
patients for a year or more to obtain a waiver to treat up to 275 patients.
– Early 2017: Nurse practitioners (NPs) and physician assistants (PAs) able to
submit applications to become buprenorphine waived as of early 2017.
Sequential Intercept Model –
Organizing Framework for SAMHSA Grants
Early
Diversion
BH Treatment
Court
Collaboratives
Treatment
Drug Courts
Offender
Reentry
Program
Starting at Intercept 0:
Law Enforcement & Behavioral Health Partnerships for
Early Diversion
• Three grantees:
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Boulder County Sheriff’s Department
The Connecticut Department of Mental
Health and Addiction Services (DMHAS)
Tennessee Department of Mental Health
and Substance Abuse Services (TDMHSAS)
Best practices in police response–
combines craft knowledge, training,
and community policing
EB treatment – combines best clinical
judgment and science
Warm hand-offs
Community services: behavioral
health, social and human services
 gains for public health and public
safety
Intercept 2 and 3:
Treatment Courts
• Use of MAT
– SAMHSA Treatment Drug
Court grantees are
encouraged to use up to
20%
grant award for MAT
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Behavioral Health
Treatment Court
Collaboratives
Adult Treatment Courts
Adult Tribal Healing to
Wellness
Juvenile Treatment Drug
Court
• Trauma Informed
Approaches with
Justice-Involved
Individuals
Mental Health Indicators among Adults Aged 18 or Older, by
Lifetime Trauma Exposure: MHSS Clinical Study,
2008-2012 (n = 5,653)
25
23.2
Lifetime Trauma Exposure
No Lifetime Trauma Exposure
Percent
20
15
17.8
14.4
14.3
10.4
10.1
10
8.1
6.1
4.3
5
4.4
3.1
2.4
0
Any Mental
Illness
Serious
Mental
Illness
Serious
Psychological
Distress
CBHSQ Data Review, April 2016
Major
Depressive
Episode
Suicidal
Thoughts
Received Mental
Health Treatment/
Counseling
Intercept 4:
Offender Reentry Program
• Substance use treatment
services & recovery
supports for individuals
reintegrating into
communities
• Includes funding for MAT &
Trauma Informed
Approaches with JusticeInvolved Individuals
State Targeted Response to the
Opioid Crisis Grants
• Announced on December 21, 2016
• For: All 50 states and territories
• Purpose: Address the opioid crisis by:
– increasing access to treatment,
– reducing unmet treatment need, and
– reducing opioid overdose related deaths through the provision of
prevention, treatment and recovery activities for opioid use disorder
• Goal: Expand prevention, treatment, and recovery services as
well as expand efforts to reduce deaths from opioid-related
causes.
Certified Community
Behavioral Health Centers
• Protecting Access to Medicare Act of 2014
– Section 223: Establishes a national demonstration program that provides an opportunity
for states to improve and pay for the behavioral health of their residents by improving
access to high quality community-based mental and substance use disorder treatment
through CCBHCs.
– Twenty-five states were awarded planning grants to prepare for the demonstration
program.
• Eight demonstration states: Minnesota, Missouri, New York,
New Jersey, Nevada, Oklahoma, Oregon and Pennsylvania
ReCAST Grant: Resiliency in Communities
After Stress and Trauma
• For: Communities experiencing
civil unrest
• Purpose:
– Assist high-risk youth and families
– Promote resilience and equity in communities
– Use violence prevention/community youth
engagement programs
– Link with trauma-informed services
• Goal: local community entities and
government (law enforcement, education,
etc.) agencies to work together to improve
behavioral health, empower community
residents and reduce trauma
•
http://www.samhsa.gov/grants/grantannouncements/sm-16-012
Emerging Framework for Service
Delivery and Payment Models
Karen DeSalvo, MD, MPH; Assistant Secretary for Health, DHHS
Public Health 3.0 Components
“emphasizes cross- sector environmental, policy- and
systems- level actions that directly affect the SDOH.”
FLEXIBLE &
SUSTAINABLE
FUNDING
DATA,
ANALYTICS &
METRICS
LEADERSHIP &
WORKFORCE
ESSENTIAL
INFRASTRUCTURE
STRATEGIC
PARTNERSHIPS
CMS: Center for Medicare and Medicaid
Innovation- Accountable Health Communities
• Based on emerging evidence that
addressing health-related social
needs through enhanced clinicalcommunity linkages can improve
health outcomes and reduce
costs.
• Model promotes clinicalcommunity collaboration
through:
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Screening to identify certain unmet healthrelated social needs;
Referral to community social services;
Provision of navigation services
Alignment between clinical and
community services
What if we consider the social determinants of
justice involvement- Public Safety 3.0?
Historical and
community trauma
Access to
affordable
housing
Police,
court, and
correction
practices
Health and
Behavioral
Health
Access to
employment
Neighborhood
instability
Partnering with National Initiatives
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Data Drive Justice
Stepping Up
One Mind
Spark - Optum
Resources
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GAINS Center
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Federal Interagency Reentry Council
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US Interagency Council on Homelessness
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National Institute of Corrections