Overview of Youth Behavioral Health Data Findings

This overview presents data from the State Epidemiological Outcomes Workgroup at the University of Delaware Center for Drug and Health Studies regarding youth behavioral health outcomes, funding sources, goals, and support initiatives. The data includes information on school surveys, youth risk behavior assessments, and specific statistics on feelings of sadness or hopelessness among high school students in Sussex County, Delaware.

• Behavioral Health
• Data Analysis
• Youth
• Epidemiology
• Delaware

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1. NC Department of Health and Human Services State-funded Adult Mental Health Service Array Stacy A. Smith, LCHMC-S, LCAS, NCC Adult Mental Health Team Lead June 2020 1 NCDHHS, Division | Presentation Title | Presentation Date

2. State-funded Adult Mental Health Services Objective Review existing State-funded AMH services Identify intended outcomes of current AMH services Identify potential areas of growth for the AMH service array 2 NCDHHS, Division | Presentation Title | Presentation Date

3. 3 NCDHHS, Division | Presentation Title | Presentation Date

4. Assertive Community Treatment (ACT) ACT is a multi-disciplinary team and currently the highest level of community based care for adults with severe and persistent mental illness in NC Staffing includes: Team Lead (licensed clinician) Psychiatrist Nursing staff (at minimum 1 RN) Substance Use Specialist Vocational Specialist Peer Support Specialist Case Managers (Associate Professionals, Qualified Professionals) Program Assistant Services are community based, including psychiatry and nursing functions 4 NCDHHS, Division | Presentation Title | Presentation Date

5. Assertive Community Treatment (ACT) Intended outcomes include a. Beneficiary satisfaction; b. Increased adherence to treatment/service plan; c. Vocational/educational gains; d. Increased length of stay in community residence; e. Increased use of natural supports; f. Reduced utilization of inpatient level of support; g. Improved physical health; h. Increased use of wellness self-management and recovery tools; and i. Increased use of community living settings and supports. We have roughly 80 teams in NC, with all areas of the state covered except for the north-east section of the state 5 NCDHHS, Division | Presentation Title | Presentation Date

6. Integrated Dual Disorders Treatment (IDDT) Not a stand alone EBP in NC An EBP for working with individuals with SPMI and Substance Use ACT Substance Use Specialists and the team as a whole are expected to use this practice when working with individuals with co-occurring MH and SU IDDT uses stages of change and stage wise treatment, motivational interviewing, cognitive behavioral therapy, and harm reduction 6 NCDHHS, Division | Presentation Title | Presentation Date

7. Community Support Team (CST) Community Support Team (CST) services consist of community-based mental health and substance abuse rehabilitation services with a strong focus on housing first practices and principles provided through a team approach to assist adults in achieving rehabilitative and recovery goals Not as clinically intensive as ACT services Team consists of a licensed team lead, a substance use specialist (CCS, LCAS or CADC) and two additional QP/AP/paraprofessional or a certified peer support specialist 7 NCDHHS, Division | Presentation Title | Presentation Date

8. Community Support Team (CST) Expected outcomes include but are not limited to the following: increased ability to function in the major life domains (emotional, social, safety, housing, medical or health, educational, vocational, and legal) as identified in the PCP; reduced symptomatology; decreased frequency or intensity of crisis episodes; increased ability to function as demonstrated by community participation (time spent working, going to school, or engaging in social activities); increased ability to live as independently as possible, with natural and social supports; engagement in the recovery process; increased identification and self-management of triggers, cues, and symptoms; increased ability to function in the community and access financial entitlements, housing, work, and social opportunities; increased coping skills and social skills that mitigate life stresses resulting from the beneficiary s diagnostic and clinical needs; increased ability to use strategies and supportive interventions to maintain a stable living arrangement; or decreased criminal justice involvement related to the beneficiary s mental health or substance use disorder diagnosis 8 NCDHHS, Division | Presentation Title | Presentation Date

9. Critical Time Intervention (CTI) Critical Time Intervention (CTI) is an intensive 9 month case management model designed to assist adults age 18 years and older with mental illness who are going through critical transitions, and who have functional impairments which preclude them from managing their transitional need adequately This service definition defines a critical transition as occurring within no more than 45 days from the start of service. Service is community based A CTI team includes: A Fieldwork Coordinator/Clinical Supervisor that is a full-time, dedicated licensed mental health professional A minimum of 2 FTE staff that can be: licensed professionals, QPs, APs, paraprofessionals, or NC CPSS (inclusion of an CPSS is strongly preferred) Team size cannot exceed one Fieldwork Coordinator/Clinical Supervisor and 3.0 FTE staff 9 NCDHHS, Division | Presentation Title | Presentation Date

10. Critical Time Intervention (CTI) The expected outcomes for this service are specific to the goals identified in the individual s CTI Service Plan, and may include, but are not necessarily limited to, the following: The individual will identify and engage in a stable housing plan The individual will re-engage with providers and other support systems The individuals utilization of community-based services will increase The individuals hospital admissions will be reduced The individuals hospital bed utilization will be reduced The individuals admissions to emergency departments and other crisis care will be reduced The individuals rate of incarceration will be reduced 10 NCDHHS, Division | Presentation Title | Presentation Date

11. Individual Placement Support- Supported Employment (IPS-SE) Individual Placement and Support-Supported Employment (IPS-SE) is a person- centered, behavioral health service with a focus on employment, that provides assistance in choosing, acquiring, and maintaining competitive paid employment in the community An IPS-SE team consists of: a Team Lead Employment Support Professionals an Employment Peer Mentor Services are community based, with the expectation that staff spends roughly 75% of their scheduled work time in the community 11 NCDHHS, Division | Presentation Title | Presentation Date

12. Individual Placement Support- Supported Employment (IPS-SE) Expected clinical outcomes include, but are not limited to the following: The individual finds and maintains competitive employment The individual enrolls in/completes credits towards an educational program that can then be leveraged to find employment The individual increases the average number of hours worked a week The individual increases their average pay We have roughly 34 teams across the state, with some areas of the state currently not having access to IPS-SE services 12 NCDHHS, Division | Presentation Title | Presentation Date

13. Transition Management Services (TMS) Transition Management Services(TMS) is a service provided to individuals participating in the Transition to Community Living Initiative (TCLI).TMS is a rehabilitation service intended to increase and restore an individual s ability to live successfully in the community by maintaining tenancy. Focus is on the following life domains: emotional, social, safety, housing, medical/health, educational, vocational, legal 13 NCDHHS, Division | Presentation Title | Presentation Date

14. Transition Management Services (TMS) A TMS team consists of no more than six staff, including: One full time dedicated QP team lead, AND One full time dedicated QP or AP, AND One FTE NC Certified Peer Support Specialist (role may be filled by no more than 2 NC CPSS), AND An additional FTE NCCPSS (may be filled by two part-time individuals) or one full-time Paraprofessional Expected outcomes include, but are not limited to, the following: Achieved recovery goals identified in the PCP; Continued community tenure; Improved personal, social, and community living skills; Increased access to necessary services in all life domains; Improved functioning in community roles; Re-established or restored network of healthy natural supports and community contacts; Re-established or restored independent living abilities 14 NCDHHS, Division | Presentation Title | Presentation Date

15. Peer Support Services (PSS) PSS services are directly provided by Certified Peer Support Specialists (CPSS) who have self-identified as a person(s) in recovery from a mental health or substance use disorder. PSS provides structured, scheduled services that promote recovery, self-determination, self- advocacy, engagement in self-care and wellness and enhancement of community living skills of beneficiaries. PSS can be provided in combination with some approved mental health or substance use services or as an independent service. 15 NCDHHS, Division | Presentation Title | Presentation Date

16. PSS Expected Outcomes a.increased engagement in self-directed recovery process; b.increased natural and social support networks; c.increased ability to engage in community activities; d.increased ability to live independently as possible and use recovery skills to maintain a stable living arrangement; e.higher levels of empowerment and hopefulness in recovery; f.improved emotional, behavioral and physical health; g.improved quality of life; h.improved vocational skills; i.decreased substance use; j.decreased frequency or intensity of crisis episodes; or k.decreased use of crisis services or hospitalizations 16 NCDHHS, Division | Presentation Title | Presentation Date

17. Psychosocial Rehabilitation (PSR) A Psychosocial Rehabilitation (PSR) service is designed to help adults with psychiatric disabilities increase their functioning so that they can be successful and satisfied in the environments of their choice with the least amount of ongoing professional intervention. PSR focuses on skill and resource development related to life in the community and to increasing the participant s ability to live as independently as possible, to manage their illness and their lives with as little professional intervention as possible, and to participate in community opportunities related to functional, social, educational and vocational goals. This is an office based service, where individuals travel to the location, and attend a variety of groups throughout the day Staffing requirements: PSR Director must be a MH QP PSR staff can be QPs, APs, and paraprofessionals 17 NCDHHS, Division | Presentation Title | Presentation Date

18. Psychosocial Rehabilitation (PSR) Service Outcomes: This service includes interventions that address the functional problems associated with complex or complicated conditions related to mental illness. These interventions are strength-based and focused on promoting recovery, symptom stability, increased coping skills and achievement of the highest level of functioning in the community. The focus of interventions is the individualized goals related to addressing the beneficiary s daily living, financial management and personal development; developing strategies and supportive interventions that will maintain stability; assisting beneficiaries to increase social support skills that ameliorate life stresses resulting from the beneficiary s mental illness 18 NCDHHS, Division | Presentation Title | Presentation Date

19. 19 NCDHHS, Division | Presentation Title | Presentation Date

20. Mobile Crisis Management (MCM) Mobile Crisis Management involves all support, services and treatments necessary to provide integrated crisis response, crisis stabilization interventions, and crisis prevention activities. Mobile Crisis Management services are available at all times, 24-hours-a-day, 7-days-a-week, 365-days-a-year. Crisis response provides an immediate evaluation, triage and access to acute mental health, intellectual/developmental disabilities, or substance abuse services, treatment, and supports to effect symptom reduction, harm reduction, or to safely transition persons in acute crises to appropriate crisis stabilization and detoxification supports or services. MCM is not available to individuals receiving ACT or CST, as those services require the provision of 24/7/365 crisis supports Staffing requirements: QP that is either a nurse, clinical social worker, or psychologist One team member must be a CCS/LCAS/CSAC Must have 24/7/365 access to a board certified or eligible psychiatrist (face to face or phone) A QP or AP with I/DD experience 20 NCDHHS, Division | Presentation Title | Presentation Date

21. Mobile Crisis Management (MCM) Service Outcomes: This service includes a broad array of crisis prevention and intervention strategies which assist the beneficiary in managing, stabilizing or minimizing clinical crisis or situations. This service is designed to rapidly assess crisis situations and a beneficiary s clinical condition, to triage the severity of the crisis, and to provide immediate, focused crisis intervention services which are mobilized based on the type and severity of crisis 21 NCDHHS, Division | Presentation Title | Presentation Date

22. Facility Based Crisis (FBC) This service provides an alternative to hospitalization for adults who have a mental illness or substance use disorder. This is a 24-hour residential facility with 16 beds or less that provides support and crisis services in a community setting. This can be provided in a non- hospital setting for beneficiaries in crisis who need short-term intensive evaluation, treatment intervention or behavioral management to stabilize acute or crisis situations. 22 NCDHHS, Division | Presentation Title | Presentation Date

23. Behavioral Health Urgent Care (BHUC) Behavioral Health Urgent Care (BHUC) is a designated service for individuals four (4) years or older experiencing a behavioral health crisis related to a substance use disorder, mental health disorder, and/or I/DD diagnosis or any combination of the above. A BHUC is designed to provide triage, crisis risk assessment, evaluation and intervention to individuals whose crisis response needs are deemed to be urgent or emergent. A BHUC is an alternative, but not a replacement, to a community hospital Emergency Department (ED). Individuals receiving this service will be evaluated, then stabilized and/or referred to the most appropriate level of care. A Behavioral Health Urgent Care can either be identified as a Tier III or a Tier IV. A Tier III BHUC has operational hours of at least 12 hours per day 7 days a week, 365 days a year. At least 6 operational hours must occur after 4:00 PM each day. A Tier IV BHUC is open 24 hours a day, 7 days a week, 365 days a year. 23 NCDHHS, Division | Presentation Title | Presentation Date

24. Behavioral Health Urgent Care (BHUC) Both Tier III and Tier IV BHUC settings must be able to provide at a minimum the following: Involuntary Commitment First Evaluations capable (IVC) Crisis/Risk Assessment Physical Health Screening/Medical Screenings Clinical Evaluation Psychiatric services Referrals and case management Disposition & discharge planning Inclusion of family or natural supports (as available, with consent). 24 NCDHHS, Division | Presentation Title | Presentation Date

25. 25 NCDHHS, Division | Presentation Title | Presentation Date

26. Family Living- Low and Moderate Provides family style supervision and monitoring of daily activities, professional staff provide support and education to both the individual and the staff Covers costs related to the placement only- rent, subsidy to the family, etc. 26 NCDHHS, Division | Presentation Title | Presentation Date

27. Group Living- Low, Moderate and High Individuals live in a home-like environment, five or more individuals Supervision/therapeutic intervention limited to sleeping time, home living skills and leisure time activities 24 hr. service, includes room and board Designed to support individuals live in the community vs. an institutional setting 27 NCDHHS, Division | Presentation Title | Presentation Date

28. 28 NCDHHS, Division | Presentation Title | Presentation Date

29. Resource Intensive Comprehensive Case Management (RICCM) An innovative partnership between Vaya, RHA, and Mission Hospital Has been continuously operating since July 2, 2017 and has submitted 10 quarters of data 29 NCDHHS, Division | Presentation Title | Presentation Date

30. Resource Intensive Comprehensive Case Management (RICCM) 30 NCDHHS, Division | Presentation Title | Presentation Date

31. RICCM 31 NCDHHS, Division | Presentation Title | Presentation Date

32. Peer Operated Respite (PORS) 32 NCDHHS, Division | Presentation Title | Presentation Date

33. PORS Peer Operated Respite Services: Provide temporary services (typically three to four days) to support persons served in emotional distress and/or urgent or emergent crisis. Employ Certified Peer Specialists who are able to use their lived experiences to assist individuals. Utilize a recognized and emerging best practice model, such as the Intentional Peer Support Model or other compatible model that assists persons served through mutual problem solving. Are provided in a short term community based living arrangement. Are provided by an award recipient that is a Consumer-Run-Organization. 33 NCDHHS, Division | Presentation Title | Presentation Date

34. Promoting Integration of Primary and Behavioral Healthcare (PIPBHC) The North Carolina State Medicaid Agency, known as the Division of Health Benefits, (DHB), and the State Mental Health Agency (SMHA) and the Single State Agency for Substance Use (SSA) of the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services (DMHDDSAS) propose to implement a project that will promote the integration of primary and behavioral care services in high need communities. Community health programs will partner with community health centers so that primary care services can be integrated in behavioral health settings to improve the overall wellness and physical and behavioral health of adults with serious mental illness (SMI), children with serious emotional disturbance (SED), and adults and children with substance use disorders (SUD) and/or co-occurring disorders (COD). 34 NCDHHS, Division | Presentation Title | Presentation Date

35. PIPBHC The goals of the proposed project are the following: Goal 1. To support prevention and wellness activities. Goal 2. To provide integrated and behavioral healthcare and retain participants in treatment. Goal 3. To provide recovery and support services. Goal 4. To establish a continuous quality improvement system that will assess project performance. Goal 5. To sustain the project. The proposed project will serve at least 150 in Year 1 and 500 in each succeeding year for a total of 2,150 individuals served over the grant funding period. 35 NCDHHS, Division | Presentation Title | Presentation Date

36. Questions? Stacy A. Smith Stacy.smith@dhhs.nc.gov 919-715-2368 Jimmy Treires Jimmy.treires@dhhs.nc.gov 919-715-2227 36 NCDHHS, Division | Presentation Title | Presentation Date