A8 promoting positive mental health for immigrants and refugees
managed care in mental health
1. Managed Care in Mental Health
Keisha E. Moore
HCA 628: Managed Care & Contractual Services
Instructor: Dr. Audra Gardner
October 13, 2014
2. The Texas Department of State Health Services Medicaid managed
care plan: NorthSTAR
• Contracts with 39 Community Mental Health Centers known as
Local Mental Health Authorities
• Serves 7 counties in the Dallas Medicaid service region
• Provides services to specific geographic areas called local
service areas
• Have specific responsibilities
• Ensure consumer choice
• Ensure best use of public money
• Assemble a network of service providers
• Make recommendations
(DSHS, 2011)
3. Resiliency and Disease Management
Assertive Community Treatment (ACT)
• Self-contained program
• Serves as fixed point of responsibility providing
treatment, rehabilitation, and support services
• Identifies consumers with severe and persistent
mental illnesses
• Uses integrated services approach
• Merges clinical and rehabilitation staff expertise
(DSHS, 2011)
4. Patient and Physician Incentives
• Individualized services for employment
• Individualized services for housing , including
access to transportation, meal preparation, and
budgeting
• Co-occurring Psychiatric and Substance Use
Disorders (COPSD) support
• Funding for mental health professionals to assist
those who are homeless and suffering from
mental illness
• Children’s mental health services
• Substance abuse services
• Gambling problem information
(DSHS, 2011a and AAHD, 2012)
5. Non-Discriminating
• Mental and behavioral disorders do not
discriminate
• They do not give special treatment to the young
or old, man or woman, race, social class, or
educational lever
• 1 in 4 people will develop one or more disorder
in their lifetime
• Create a burden on society and individuals
• Rank in the top 10 illnesses causing disability
(Falvo, 2009, WHO, 2004, and NIMH, 2007)
6. A Disabling Disease
• Begins early in life
• Chronic disease of the young
• Data on prevalence U.S. youth is varied
• It is difficult to understand how many children and teens
are affected
• 1.8 percent of youth have more than one disorder
• Account for 4 of 10 leading causes of disability in the
U.S.
• Over 15 million adults over 18 suffer from serious mental
illness (SMI)
• Less than one have of those with SMI receive treatment
or counseling
(NHSDA, 2002, NIMH, 2005, and NHMI, 2009,)
7. Research Shows
• Individuals with one or more mental or
behavioral disorders are at high risk of having a
second one
• Severity is strongly related to comorbidity
• People with serious mental illness (SMI) die 25
years early than the general population
• Suicide and injury account for 30-40 % of excess
mortality
• 60% of premature deaths of persons with
schizophrenia are due to cardiovascular and
pulmonary conditions and infectious disease
(NIMH, 2005)
8. Socioeconomic Status
• Adverse reactions have a significant impact of development
and onset
• A significant relationship between prevalence of common
mental disorders and low education levels exist
• Depression is 1.5 to 2 time more prevalent for low income
groups
• Poverty is a contributing factor
• Mental disorders contribute to poverty
• 90% of homeless people might be suffering from mental
illness
• Homeless adults are 2.5 times more likely to have a disability
• Individuals with a disability are more likely to be homeless
• 26.2% of sheltered homeless adults had a SMI
• 34.7% had a chronic substance abuse problem
(Lee, 2003, Dennis, Rosenheck, Bassuk, & Salomon, 1999, National Coalition for the
Homeless, 2006, WHO, 2004, and U.S. Department of Housing and Urban Development,
2010)
9. TRR: The Role of Preventing Disease
Vision: “Hope, Resilience, and Recovery for
Everyone”
• Adults, children, and youth that are affected by
mental illness and SED are on a continuum of
mental health
• Natural supports and strengths must be built upon
to foster resilience and recovery
• Promotion, early intervention, and quality mental
health serves provide opportunities for achieving
mental health and individual potential
(DSHS, 2013a)
10. Texas Resiliency and Recovery (TRR)
• Patient –centered approach
• Moves away from historical ‘disease’ focused model
• Reviewed and redesigned from RDM in 2010
• Incorporates fundamental principles of the mental
health system
• Evidence based and promising practices are integral
• Services and supports will result in measurable
outcomes and ultimately the resilience, recovery,
and achievement of mental health for all age groups
(DSHS, 2013a)
11. Case management, facilities, and
quality
• Delegated to a local authority
• Cost-benefit and cost-effectiveness analysis are used to
evaluate best outcomes
• Each local authority develops, updates, and maintains
Local Service Area Plan in compliance with DSHS
Performance Contract
• A Network of Providers meets the local needs and
priorities, allows for consumer choice, improve access to
services, and makes best use of funds available
• Strive to provide effective and efficient services without
sacrificing quality
(Aday, 2001, Bluebonnet Trails Community Health and Mental Retardation
Center, 2008, and DSHS, 2013b)
12. Bluebonnet Trails Community MHMR
Services
• Crisis hotline
• Crisis services
• Screenings
• Pre-Admission assessments
• Case management
• Treatment planning
• Provided by internal or external providers
(Bluebonnet Trails Community MHMR Services, 2007).
14. Future of data use and informatics
• CMBHS is a web-based clinical record keeping
system used with EHR
• Monthly teleconferences
(DSHS, 2011 and DSHS, 2013c,
15. Conclusion
• NorthStar: A Medicaid Manged Care Plan
serving 7 counties in the Dallas Medicaid
regionUses LMHAs to local services areas
• ACT: A self-contained program within
NorthStar providing rehabilitation, support
services, and treatment as well as identifying
consumers with SMI
16. Conclusion continued
• Mental disorders do not discriminate
• 1 in 4 people will develop 1 or more mental or behavioral
disorders
• Prevention is the most effective way to reduce the
burden they create
• Managed Care Programs are needed to focus on
controlling, reducing, preventing the
• They account for 4 of the 10 leading causes of disability
• SMIs are suffered by over 15 million adults over 18
• More than half of those individuals do not receive
treatment or counseling
• Those suffering have the likelihood of dying 25 years
earlier than the general population
17. Conclusion continued
• Promotion of mental health, early intervention services, and
quality mental health services allow providers the opportunity
to support adults, children, and youth so they man achieved
mental health and their individual potential
• TRR: A patient-centered approach using fundamental
principles, evidence-based and promising practices to achieve
measurable outcomes and resilience, recovery, and
achievement
• Bluebonnet Trails: Incorporates cost-benefit and cost-
effectiveness with TRR to meet the local needs and priorities
of those they serve and to allow for more consumer choice,
improve access to services, make the best use of available
funds, and to promote consumer, provider, and caregiver
partnerships
18. References
Aday, L. A. (2001). At risk in America: The health and health care needs of vulnerable populations in the United
States. (2 Ed.). San Francisco, CA: Josey-Bass Inc. Retrieved from
http://online.vitalsource.com/books/9780470932476
Bluebonnet Trails Community MHMR Center (2007). Quality management. Retrieved from
http://www.bluebonnetmhmr.org/assets/documents/QMP.pdf
Bluebonnet Trails Community Health and Mental Retardation Center. (2008). Local Area Network Development
Plan FY 2009-2010. Retrieved from http://www.bbtrails.org/assets/documents/FY910.pdf
American Association of Health & Disability . (AAHD, 2012). Texas: Health & disability programs. Retrieved from
http://www.aahd.us/2012/03/texas-health-disability-programs/
Dennis, D., Rossenheck, R., Bassuk, E. & Salomon, A. (1999). Special populations of homeless Americans. Delmar,
New York. Retrieved from http://aspe.hhs.gov/progsys/homless/symposium/2-Spclpop.htm
Lee, J. Department of Mental Health and Substance Dependence, Noncommunicable Diseases and Mental Health.
(2003). Investing in mental health. (ISBN 92 4 156257 9). Retrieved from World Health Organization website:
http://www.who.int/mental_health/en/investing_in_mnh_final.pdf
Falvo, D. (2009). Medical and psychosocial aspects of chronic illness and disability (4th ed.). Sudbury, MA: Jones
and Bartlett Publishers
19. References continued
National Coalition for the Homeless. (2006, June). Mental illness and homelessness. NCH Fact Sheet #5. Retrieved from
National Coalition for the Homeless website: http://www.nationalhomeless.org/publications/facts/Mental_Illness.pdf
National Household Survey on Drug Abuse Substance Abuse and Mental Health Services Administration, Office of Applied
Studies. (2008). The NSHDA report, serious mental illness among adults. Retrieved from U.S. Department of Health and
Human Services website: http://www.samhsa.gov/data/2k2/SMI/SMI.pdf
National Institute of Mental Health. U.S. Department of Health and Human Services, National Institutes of Health (NIH).
(2005). Mental illness exacts heavy toll, beginning in youth. Retrieved from U.S. Government Printing website:
http://mentalhealth.gov/science-news/2005/mental-illness-exacts-heavy-toll-beginning-in-youth.shtml
National Institute of Mental Health. U.S. Department of Health and Human Services, National Institutes of Health (NIH).
(2007). Global survey reveals significant gap in meeting world's mental health care needs. Retrieved from U.S. Government
Printing website: http://mentalhealth.gov/science-news/2007/global-survey-reveals-significant-gap-in-meeting-worlds-
mental-health-care-needs.shtml
National Institute of Mental Health. U.S. Department of Health and Human Services, National Institutes of Health (NIH).
(2009). National survey tracks rates of common mental disorder among American youth. Retrieved from U.S. Government
Printing website: http://mental-health.gov/science-news/2009/national-survey-tracks-rates-of-common-mental-disorder-
among-american-youth.shtml
The Texas Department of State Health Services (DSHS, 2011a). Mental health services for adults. Retrieved from
http://www.dshs.state.tx.us/mhsa/mh-adult-services/
20. References continued
The Texas Department of State Health Services. (DSHS, 2013a). Texas resilience recovery (formerly RDM)
: The mental health system redesigned. Retrieved from http://www.dshs.state.tx.us/mhsa/trr/
The Texas Department of State Health Services. (DSHS, 2013b). TRR local authority functions. Retrieved
from http://www.dshs.state.tx.us/mhsa/trr/lmha/
The Texas Department of State Health Services. (DSHS, 2013c). Clinical management for behavioral
health services. Retrieved from http://www.dshs.state.tx.us/cmbhs/
U.S. Department of Housing and Urban Development, Office of Community Planning and Development.
(2010). The 2010 annual homeless assessment report to Congress. Retrieved from U.S. Government
Printing website: http://www.hudhre.info/documents/2010HomelessAssesstmentReport.pdf
World Health Organization (WHO). (2004). Prevention of mental disorders: Effective interventions and
policy options summary report. (ISBN 92 4 159215 X). Geneva, Switzerland: WHO Library Cataloguing-in-
Publication Data. Retrieved from
http://www.who.int/mental_health/evidence/en/prevention_of_mental_disorders_sr.pdf
Editor's Notes
Managed Care in Mental Health
Keisha E. Moore
The Texas Department of State Health Services (DSHS) contracts with thirty-nine Community Mental Health Centers and NorthSTAR in order to deliver mental health services in communities across Texas (DSHS, 2011a). According to DSHS (2011a) “NorthSTAR is a Medicaid managed care plan that serves seven counties in the Dallas Medicaid service region” (Para. 1). The community mental health centers are referred to as Local Mental Health Authorities (LMHA’s) and they provide services to specific geographic areas of the state which are called local service areas (DSHS, 2011a). The LMHA’s additionally have specific responsibilities and DSHS requires each authority to plan, develop policy, coordinate and allocate resources, as well as develop resources for mental health services in the local service areas according to DSHS (2011a). Each LMHA is required to consider public input, ultimate cost-benefit, and client care issues in order to ensure consumer choice and the best use of public money in assembling a network of service providers as well as to determine they become a provider of service or to contract that service to another organization (DSHS, 2011a). Finally according to DSHS (2011a), they make recommendations relating to the most appropriate and available treatment alternatives for individuals in need of mental health or mental retardation services.
Resiliency and Disease Management Assertive Community Treatment (ACT) “is a self-contained program that serves as the fixed point of responsibility for providing treatment, rehabilitation and support services to identify consumers with severe and persistent mental illnesses” (Texas Department of State Health Services, 2011a). According to Texas Department of State Health Services (2011a) they use an integrated services approach, and the ACT team merges clinical and rehabilitation staff expertise, e.g., psychiatric, substance abuse, employment, and housing within one mobile service delivery system.
In addition the Texas Department of State Health Services (DSHS) additionally provides supported employment that are individualized meant to assist individuals in choosing, getting, and keeping employment; supported housing to assist individuals in choosing getting, and keeping a home along with access to transportation, meal preparation, and budgeting; Co-occurring Psychiatric and Substance Use Disorders (COPSD) support to help identify, develop, and implement effective and efficient methods of engagement, assessment, and treatment models for persons with co-occurring substance use and mental illness disorders; and funding for mental health professionals in thirteen Texas communities in order to assist individuals who are homeless that are experiencing mental illness by providing outreach to the streets, shelters, or wherever these individuals may be found (DSHS, 2011a). According to the American Association of Health and Disability (AAHD, 2012) the Texas Department of State Health Services additionally provides children’s mental health services including a twenty-four hour Crisis hotline, screening and assessment, case/service coordination, treatment planning, skills training, respite services, medication-related services, intensive crisis residential services, impatient services, wraparound planning, counseling, family skills training, school-based services, rehabilitative day treatment, acute day treatment for children, flexible community supports, in-home crisis intervention, and therapeutic foster care. Finally, the provide substance abuse services which include treatment that consists of outreach, screening and referral, and prevention, as well as a substance offender education program and the provision of information on problem gambling (AAHD, 2012).
Diagnosis of mental conditions is as much an art as a science which requires skill and experience (Falvo, 2009, p. 239). Falvo further explains that “the term psychiatric disability encompasses a broad range of conditions with a wide variety of manifestations and varying degrees of disability” (Falvo, 2009, p. 222). Mental and behavioral disorders do not discriminate nor do they give special treatment to the young or old, man or woman, race, social class, or even educational level. In fact, they affect people of all ages, ethnicity, socioeconomic status, gender, and cultures. According to the World Health Organization’s World Health Report 2001, one in four people will develop one or more mental or behavioral disorders in their lifetime (WHO, 2004, p. 15, Para. 1). WHO further states: “prevention of mental, neurological and substance abuse disorders are obviously one of the most effective ways to reduce the burden they create” (2004, p. 3, Para. 1). “Mental disorders are inextricably linked to human rights issues” and “the stigma, discrimination, and human rights violations that individuals and families affected by mental disorders suffer are intense and pervasive” (WHO, 2004, p. 3, Para. 2). “Mental disorders rank among the top ten illnesses causing disability, more than 37 percent worldwide, with depression being the leading cause of disability among people ages 15 and older, according to the Global Burden of Disease and Risk Factors published in 2006” (National Institutes of Mental Health, NIMH, 2007). In a survey of 17 countries conducted as part of the World Health Organization's (WHO) World Mental Health Survey Initiative, it was found that middle-aged people were more likely to receive services than those younger or older; people with more education were more likely to seek out services for mental problems; and married people were less likely to use mental health services than unmarried people, and people in the United States sought and used services more yet most did not receive adequate care (NIMH, 2007).
Mental illness in a disabling disease which begins early in life, with half of all lifetime cases beginning by age 14 and three quarters have begun by age 24 (National Institute of Mental Health, 2005). “Thus, mental disorders are really the chronic diseases of the young” according to the National Institute of Mental Health (NIMH, 2005). According to the NIMH (2005), the risk of mental disorders is substantially lower among people who have matured out of the high-risk age range. Prevalence increases from the youngest group, ages eighteen to twenty-nine, to the next oldest age group, ages thirty to forty-four, and then declines, sometimes substantially, in the oldest group, ages sixty and up. The most recent results were published online in the journal of Pediatrics on December 14, 2009 and were from a survey conducted from 2001 to 2004 which had 3,042 participants. These results include data from children and adolescents ages eight to fifteen. NIMH Director Thomas R. Insel, said, "Data on the prevalence of mental disorders among U.S. youth have been varied, making it difficult to truly understand how many children and teens are affected", he added “these data from the NHANES survey can serve as an important baseline as we follow trends of mental disorders in children" (NIMH, 2009). Six mental disorders were tracked by researchers. Thirteen percent of the respondents met criteria for having at least one of the six mental disorders with about 1.8 percent having more than one disorder. ADHD and conduct disorder was the usual combination (NHMI, 2009). The results were as follows: 8.6 percent had ADHD, with males more likely than females to have the disorder; 3.7 percent had depression, with females more likely than males to have the disorder; 2.1 percent had conduct disorder; 0.7 percent had anxiety disorder or panic disorder; and 0.1 percent had an eating disorder (NHMI, 2009).
According to the National Household Survey on Drug Abuse (NHSDA) report (2002), mental disorders’ account for four of the ten leading causes of disability in the United States. The 2001 NSHDA included questions for adults aged eighteen or older to assess serious mental illness (SMI) during the year prior to the survey interview. It was found that over fifteen million adults over the age of eighteen suffered from SMI with less than one-half receiving treatment or counseling. Approximately 12 percent were age 18 to 25, almost 8 percent were age 26 to 49, and roughly 5 percent were age 50 or older. Females were more likely than males to have past year SMI and females were more likely than males to seek treatment or counseling. Whites were more likely than African Americans or Hispanics to seek treatment or counseling. SMI rates among races tallied in at 14.4 percent for Native Americans and Alaska Natives; 7.5 percent for African Americans and Whites; 6.5 percent for Hispanics; and 4.4 percent for Asians (NSHDA, 2002).
Researchers say individuals with one mental disorder are at a high risk for also having a second one. Forty-five percent of those with one mental disorder met criteria for two or more disorders, with severity strongly related to comorbidity (NIMH, 2005). According to the Oregon Department of Human Services (2008) on average, people with serious mental illness die twenty-five years earlier than the general population. Suicide and injury account for about 30-40 percent of excess mortality, 60 percent of premature deaths in persons with schizophrenia are due to medical conditions such as cardiovascular, pulmonary, and infectious diseases (p. 1).
According to WHO (2004) “adverse conditions such as child abuse, violence, war, discrimination, poverty and lack of access to education have a significant impact on the development of mental ill-health and the onset of mental disorders”, so the “actions and policies that improve the protection of basic human rights represent a powerful preventive strategy for mental disorders” according to (p. 14, Para. 5). Patel and Kleinman relate that studies have shown a significant relationship between the prevalence of common mental disorders and low educational levels (Lee, 2003, p. 25). Low educational levels prevent access to most professional jobs, increases vulnerability and insecurity, and contributes to a persistently low social capital. Lee (2003) states, “illiteracy and illness therefore lock in poverty” (p. 25). Scientific evidence has shown that depression is 1.5 to 2 times more prevalent among the low income groups of a population, therefore poverty could be considered a significant contributor to mental disorders, just as mental disorders could be considered a significant contributor to poverty in addition to those who are unemployed which are more likely to suffer from depression (Lee, 2003, p. 25). Dennis, Rosenheck, Bassuk, and Salomon (1999) state that “the prevalence of psychiatric and addictive disorders among homeless people has probably been studied more intensively and more rigorously than any other problem” and there are as many as 90 percent of homeless people who might be suffering from mental illnesses. Studies done in the mid-1980s that were funded by the National Institutes of Mental Health demonstrated that 20-25 percent of homeless single adults had lifetime histories of serious mental illness; about half had histories of alcohol abuse or dependence; and about one-third had histories of drug abuse or dependence (Dennis, Rosenheck, Bassuk, & Salomon, 1999). According to National Coalition for the Homeless (2006), the National Resource and Training Center on Homelessness and Mental Illness reported in 2003 that twenty to twenty-five percent of the single adult homeless population suffers from some form of severe and persistent mental illness (p. 1). They also stated that in 2005 the National Institute of Mental Health reported that “while 22% of the American population suffers from a mental illness, a small percentage of the 44 million people who have a serious mental illness are homeless at any given point in time (National Coalition for the Homeless, 2006, p. 1). The U.S. Department of Housing and Urban Development’s (2010) AHAR to Congress reported that “nearly four in ten sheltered adults (36.8 percent) have a disability, compared to 24.6 percent of the poverty population and 15.3 percent of the total U.S. population (p. 17, Para. 5). Thus, a homeless adult is nearly 2.5 times more likely to have a disability than an adult in the U.S. population as a whole” according to the Department of Housing and Urban Development (2010, p. 17, Para. 5). In addition they state “persons with a disability are at higher risk of homelessness because a disability, particularly one relating to substance abuse or mental health, can make it difficult to work and earn enough to afford housing” (U.S. Department of Housing and Urban Development, 2010, p. 17, Para. 5). It is finally reported by the U.S. Department of Housing and Urban Development that “from the January 2010 Point-in-Time counts, CoCs reported that 26.2 percent of sheltered homeless adults had a severe mental illness and 34.7 percent had a chronic substance abuse problem” (2010, p. 18, Para. 1).
DSHS (2013a) states that “Hope, Resilience, and Recovery for Everyone” is the vision statement of the MHSA Division of the DSHS (Para. 1). They have aligned this vision with the national movement to incorporate resilience and recovery-oriented services, supports, practices, and beliefs into publicly funded mental health service delivery systems (DSHS, 2013). According to DSHS (2013a) it is acknowledged by the Mental Health and Substance Abuse Division (MHSA) that adults, children, and youth that are “affected by mental illness and severe emotional disturbance (SED) are on a continuum of mental health and have natural supports and strengths which should be built upon to foster resilience and recovery” (Para. 2). By promoting mental health, early intervention, and providing quality mental health services, providers are given the opportunity to support adults, children, and youth to achieve mental health and their individual potential (DSHS, 2013a).
Texas Resiliency and Recovery (TRR ), formerly Resiliency and Disease Management (RDM) “is a patient-centered approach that moves away from the historical ‘disease’ focused model” (DSHS, 2013a, Para. 2). RDM was implemented in 2004 the reviewed by the MHSA Division in 2010 (DSHS, 2013a). According to DSHS (2013a) “this review included feedback and input from frontline staff/providers and a review of research on best practices in serving adults, children, and youth with mental health needs” and “In response to this review, the mental health system has been re-designed” (Para. 3). They state that “resilience and recovery are fundamental principles of the mental health system” and they have incorporated these throughout the new design and have been considered in the selection of available services (DSHS, 2013, Para. 3). “Evidence based and promising practices are an integral part of TRR” according to DSHS (2013a, Para. 3). Therefore the believe that “through the use of these practices, the services and supports provided within the mental health system will result in measurable outcomes and ultimately the resilience, recovery, and achievement of mental health of adults, children, and youth” (DSHS, 2013a, Para. 3).
“Pursuant to the Texas Health and Safety Code, §533.035(a), when appropriate and feasible the DSHS Council may delegate to a local authority its authority and responsibility for any, all, or portions of planning, policy development, coordination, resource development and allocation, and oversight of the delivery of mental health and mental retardation services in a local service area” (DSHS, 2013b, Para. 1). According to DSHS (2013b) “local authority functions include the business operations/processes by which a local authority will manage system operations; ensure the clinically and economically efficient use of resources; address consumer concerns and ensure satisfaction; ensure the competency and capacity of the provider network and ensure accountability. Although development of standardized business processes and tools began as a result of House Bill 2377, until resiliency & disease management, standardized definitions had not been provided by the state authority (Para. 2).
According to Aday (2001), “Cost-benefit and cost-effectiveness analyses are used to evaluate which programs yield the best outcomes relative to what they cost. In cost-benefit analysis, both costs and benefits are expressed in dollar terms; in cost-effectiveness analysis, benefits are expressed in nonmonetary units, such as days of hospitalization, numbers of physician visits, level of functioning, or quality-adjusted life-years” (p. 200).
As a local authority through the DSHS program Bluebonnet Trails Community Health and Mental Retardation Center uses both cost-benefit and cost-effectiveness analyses to evaluate their programs. Bluebonnet Trails (2008); “is responsible for developing, updating and maintaining a Local Service Area Plan in compliance with the Department of State Health Services (DSHS) Performance Contract. The Plan is designed to develop a Network of Providers that will meet the local needs and priorities, allow for more consumer choice, improve access to services, make best use of available funds and promote consumer, provider, and caregiver partnerships” (p. 7). According to Bluebonnet Trails:
The Local Plan serves to address the Center’s political, clinical, and financial status in an integrated fashion through the utilization of information and data. Information is assimilated from community leaders, advocates, family members, clients, and staff. This is used to identify perceived, potential, and/or actual strengths and weaknesses of, opportunities for, and threats to the organization and the Mission of the Center. Available resources and the most appropriate allocation or deployment of those resources is considered in order to meet anticipated challenges and work towards desired outcomes. Finally, outcomes and progress toward goals are monitored in order that the plan may be adjusted in an ongoing, dynamic process. (Bluebonnet Trails Community Health and Mental Retardation Center, 2008, p. 7)
Cost, as opposed to revenues, is utilized because of the direct relationship with the services delivered. The Center strives to provide the most effective and efficient services possible without sacrificing quality (Bluebonnet Trails Community Health and Mental Retardation Center, 2008, p. 7). A variety of data and reports give Bluebonnet Trails the tools to determine how to structure their organization to provide best value to their consumers: the right service, to the right person, at the right time, in the most cost–effective manner. This data is used to guide them in decision‐making regarding staffing, organization and cost effectiveness (Bluebonnet Trails Community Health and Mental Retardation Center, 2008, p. 55).
Bluebonnet Trails provides a crisis hotline, crisis services, screenings, pre-admission assessments, case management, and treatment planning for adults and children with mental illnesses. They assure these services are provided by either internal or external providers: respite, medication administration, medication monitoring, pharmacological management, provision of medication, individual and group training such as medication training and supports and skills training and development, rehabilitative counseling, psychosocial rehabilitative services, supported employment, supported housing, inpatient services and intensive crisis residential services, counseling, family support groups, and family partner support.. Outreach, screening, assessment and referral for Substance Abuse (OSAR) services, and Jail Diversion are also provided. Bluebonnet Trails provides the following required services: eligibility determination and Service Coordination, which includes basic Service Coordination, Texas Home Living Case Management, continuity of services for state facilities, continuity of services for Medicaid programs and, service authorization and monitoring for persons who are mentally retarded. They assure these services are provided by either internal or external providers: HCS case management; respite; supported employment, which includes employment assistance and individualized competitive employment; day training services; supported home living and residential services. They additionally provide telepsychiatry services in order to increase care services for those living in underserved areas (Bluebonnet Trails Community MHMR Services, 2007).
As these programs are state and government funded and supported through Medicaid therefore prescriptions are generally provided at no cost to the consumer.
Using the health information exchange across a “network of networks” and includes locally-controlled and state-managed information systems facilitates coordination of care, improves administrative processes, and simplifies program oversight activities (DSHS, 2011). “Clinical Management for Behavioral Health Services (CMBHS) is a web-based clinical record keeping system for state-contracted community mental health and substance abuse service providers” (DSHS, 2013c). The CMBHS is used as a clinical tool and includes diagnostic and treatment plan capabilities to support data exchange across contracted substance abuse service providers and between DSHS and other state agencies to coordinate care (DSHS, 2013c). CMBHS provides a
single system for DSHS behavioral health contractors to provide and receive data about clients who receive, or have received, DSHS-sponsored behavioral health services. CMBHS is a key resource to support continuity of care across organizations including, but not limited to, DSHS-contracted providers, state hospitals, private health entities, and other state and local agencies (DSHS, 2011). Finally those who are partnered in the CMBHS-supported behavioral health information exchange network will utilize national data standards where practical and collaborate on establishing and adopting best practices to facilitate health information exchange (DSHS, 2011)
http://www.dshs.state.tx.us/cmbhs/default.shtm both dates
DSHS contracts with 39 Community Mental Health Centers and NorthSTAR, which is a Medicaid managed care plan to serve 7 counties in the Dallas Medicaid region. These centers are referred to as LMHAs and provide services to specific geographic areas of the state called local services areas and they are required to fulfill specific responsibilities. ACT is a self-contained program within these services that provides rehabilitation and support services and treatment to and helps to identify consumers with severe and persistent mental illnesses using and integrated services approach. DSHS provides a plethora of support and services to those who suffer from mental disorders and substance abuse disorders.
Mental disorders do not discriminate and therefore affect people of all ages, social class, race, culture, and gender. One in four people will develop one or more mental or behavioral disorders in their lifetime. Prevention of mental, neurological and substance abuse disorders are one of the most effective ways to reduce the burden they create. Therefore managed care programs focusing on controlling, preventing, and preventing mental and substance abuse disorders are necessary because they begin early in life for most individuals and most individuals with a mental disorder are very likely to suffer from multiple disorders. They account for four of the ten leading causes of disability in the United States with over 15 million adults over the age of eighteen suffering from SMI and less than one-half of those individuals receive treatment or counseling as well as the average individual suffering from an SMI having the likelihood of dying 25 years earlier than the general population.
Promoting mental health, early intervention, and providing quality mental health services allows providers the opportunity to support adults, children, and youth to achieve mental health and their individual potential. TRR is a patient-centered approach with hold the fundamental principles of resilience and recovery of the mental health system by using evidence-based and promising practices as an integral part of their work in order to provide the mental health system with measurable outcomes and resilience, recovery, and achievement of mental health of adults, children, and youth. Bluebonnet Trails Community Health and Mental Retardation Center additionally Center uses both cost-benefit and cost-effectiveness analyses to evaluate their programs in order to meet the local needs and priorities, allow for more consumer choice, improve access to services, make best use of available funds and promote consumer, provider, and caregiver partnerships.
