Revisiting “Million Dollar Murray:” - PowerPoint Presentation

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Revisiting “Million Dollar Murray:” A Better Plan

Criminal Justice-Behavioral Health- Partnerships Promoting Integrated HealthcareIBHI and CHCS ConferenceSan Antonio, TX – January 29, 2017

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

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2

SAMHSA’s Trauma and Justice

Strategic

Initiative

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.

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Who is Million Dollar Murray?

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What Creates Health?

N

e

c

e

ss

a

r

y

c

ond

iti

on

s for health (WHO)

ShelterEducationFoodIncomeStable eco-systemSustainable resourcesMobilityHealth CareSocial justice and equityTrauma Reduction

Dete

rm

i

n

a

n

ts

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.

Determinants of Health

Genes and Biology Physical

Environment

ClinicalCare

Health Behaviors

Social and Economic Factors

10%10%

10%

30%

40%

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Key Data Points

(Bureau of Justice Statistics, 2006)

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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

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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.

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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

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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

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Partnerships

Data Driven Justice

Stepping Up

One Mind

SPARK

Grant Programs

Criminal Justice Programs

Certified Behavioral Health Clinics

Opioid State Grants

ReCAST

Policy Initiatives

21

st

Century Cures Act

Affordable Care Act

HIPAAMATHealth HomesPublic Health 3.0Selected Federal and National Initiatives

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21st Century Cures Act and Mental Health Reform Bill- Selected ProvisionsTitle 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 servicesSec 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 CommunitiesIncreases for Law Enforcement Training on crisis response; Amends COPS-crisis training; court-ordered AOT; Forensic ACT, Law Enforcement-School MH Crisis Intervention Team

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Affordable Care Act:Benefits and Medicaid Expansion 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 statesNew Medicaid guidance (April 2016)

C

larifies

that individuals who are currently on probation, parole or in home confinement are not considered inmates of a public institution.

E

xtends

coverage to Medicaid-eligible individuals living in community halfway houses where they have freedom of

movement

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13

States with Highest Proportion of African

Americans

Medicaid Non-Expansion States

Disparities in Coverage: Example African Americans

(Snowden, 2016)

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ACA: Aligning New Service Delivery and Payment ModelsHealth Home Option with Enhanced FMAPImproves care coordination and service linkage for people with chronic conditions19 States and DC (SPA)New York:Piloting CJ Program in Health HomesEstablished Complex Trauma as Chronic

Condition

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HIPAA Guidance (2016)Clarifies if a covered entity may collect, use, and disclose criminal justice data under HIPAA

https://www.hhs.gov/hipaa/for-professionals/faq/2073/may-covered-entity-collect-use-disclose-criminal-data-under-hipaa.html

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Medication Assisted Treatment: New Buprenorphine RegulationJuly 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.

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Sequential Intercept Model – Organizing Framework for SAMHSA Grants

Early Diversion

Treatment

Drug Courts

Offender Reentry Program

BH Treatment Court

Collaboratives

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Starting at Intercept 0: Law Enforcement & Behavioral Health Partnerships for Early DiversionThree grantees: Boulder County Sheriff’s

DepartmentThe 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 policingEB 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

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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

Trauma

Informed Approaches with Justice-Involved

Individuals

Behavioral Health Treatment Court

Collaboratives

Adult Treatment Courts

Adult Tribal Healing to Wellness

Juvenile Treatment Drug Court

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Mental Health Indicators among Adults Aged 18 or Older, by Lifetime Trauma Exposure: MHSS Clinical Study,

2008-2012 (

n

= 5,653)

CBHSQ Data Review, April 2016

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Intercept 4:Offender Reentry ProgramSubstance use treatment services & recovery supports for individuals reintegrating into communities

Includes funding for MAT &Trauma Informed Approaches with Justice-Involved Individuals

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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.

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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

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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/grant-announcements/sm-16-012

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Emerging Framework for Service Delivery and Payment Models

Karen DeSalvo, MD, MPH; Assistant Secretary for Health, DHHS

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L

E

A

D

ERSHIP

&

W

O

R

K

F

O

R

CE

DATA, ANALYTICS & METRICSESSENTIAL INFRASTRUCTUREFLEXIBLE & SUSTAINABLE FUNDINGSTRATEGIC PARTNERSHIPSPublic Health 3.0 Components“emphasizes cross-

sector environmenta

l, policy- and systems

- level actions that di

rectly affect the SDOH.”

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CMS: Center for Medicare and Medicaid Innovation- Accountable Health Communities

Based on

emerging evidence that addressing health-related social needs through enhanced clinical-community linkages can improve health outcomes and reduce costs.

Model promotes clinical-community

collaboration through:

Screening

to

identify certain unmet health-related social needs;

Referral

to community social services

;

Provision of navigation

services

A

lignment

between clinical and community services

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What if we consider the social determinants of justice involvement- Public Safety 3.0?

Health and

Behavioral Health

Historical and community trauma

Neighborhood instability

Access to affordable housing

Access to employment

Police, court, and correction practices

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Partnering with National InitiativesData Drive JusticeStepping UpOne MindSpark - Optum

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ResourcesGAINS CenterFederal Interagency Reentry CouncilUS Interagency Council on Homelessness

National Institute of Corrections