Transforming Mental Health in America Sybil Goldman, M.S.W.

1. Transforming Mental Health in America Sybil Goldman, M.S.W. Special Assistant for ChildrenOffice of the Administrator Gary M. Blau, Ph.D. Chief, Child, Adolescent & Family Branch Center for Mental Health Services Substance Abuse, Mental Health Services Administration

2. “Imagination is the beginning of creation. You imagine what you desire, you will what you imagine and at last you create what you will.” ~ George Bernard Shaw ~

3. The President’s New Freedom Commission on Mental Health Achieving the Promise:Transforming Mental Health Care in America

4. Transforming Mental Health Carein America “We envision a future when everyone with a mental illness will recover, a future when mental illnesses can be prevented or cured, a future when mental illnesses are detected early, and a future when everyone with a mental illness at any stage of life has access to effective treatment and supports - essentials for living, working, learning, and participating fully in the community.” ~ Presidents New Freedom Commission on Mental Health – Achieving the Promise: Transforming Mental Health Care in America ~ 4

5. President’s New FreedomCommission on Mental Health The Goals of a Transformed System Goal 1Americans Understand that Mental Health Is Essential to Overall Health Goal 2Mental Health Care Is Consumer and Family Driven Goal 3Disparities in Mental Health Services Are Eliminated * Includes 19 Key Recommendations

6. President’s New FreedomCommission on Mental Health The Goals of a Transformed System Goal 4Early Mental Health Screening, Assessment, and Referral to Services Are Common Practice Goal 5Excellent Mental Health Care Is Delivered and Research Is Accelerated Goal 6Technology Is Used to Access Mental Health Care and Information * Includes 19 Key Recommendations

7. Defining Transformation: A continuous and complex process New behaviors, new competencies New sources of power New partners Profound changes in structure, culture, policy and programs Will not happen over night 7

8. The process of Transformation includes three distinct types of activities: • Continuous smallsteps • A series of exploratory mediumjumps, and • A few big jumps 8

9. Goal 1: Americans Understand That Mental Health Is Essential to Overall Health Recommendations 1.1 Advance and implement a national campaign to reduce the stigma of seeking care and a national strategy for suicide prevention 1.2 Address mental health with the same urgency as physical health

10. Goal 2:Mental Health Care Is Consumer and Family Driven Recommendations 2.1 Develop an individualized plan of care for every adult with a serious mental illness and every child with a serious emotional disturbance 2.2 Address mental health with the same urgency as physical health

11. Goal 2:Mental Health Care Is Consumer and Family Driven Recommendations 2.3 Align relevant Federal programs to improve access and accountability for mental health services 2.4 Create a Comprehensive State Mental Health Plan 2.5 Protect and enhance the rights of people with mental illnesses

12. Goal 3:Disparities in Mental Health Services Are Eliminated Recommendations 3.1—Improve access to quality care that is culturally competent 3.2—Improve access to quality care in rural and geographically remote areas

13. Goal 4: Early Mental Health Screening, Assessment, and Referral to Services Are Common Practice Recommendations 4.1—Promote the mental health of young children 4.2—Schools should have the ability to play a larger role in mental health care for children

14. Goal 4: Early Mental Health Screening, Assessment, and Referral to Services Are Common Practice Recommendations 4.3—Screen for co-occurring mental and substance abuse disorders and link with integrated treatment strategies 4.4—Screen for mental disorders in primary health care, across the lifespan, and connect to treatment and support

15. Goal 5:Excellent Mental Health Care Is Delivered and Research Is Accelerated Recommendations 5.1—Accelerate research to promote recovery and resilience and, ultimately, to cure and prevent mental illnesses 5.2—Advance evidence-based practices (EBPs) using dissemination and demonstration projects and create a public-private partnership to guide their implementation

16. Goal 5:Excellent Mental Health Care Is Delivered and Research Is Accelerated Recommendations 5.3 Improve and expand the workforce providing evidence-based mental health services and supports 5.4 Develop the knowledge base for… • Eliminating mental health disparities • Assessing long-term effects of medications • Reducing impact of trauma • Improving acute care

17. Goal 6:Technology Is Used To Access Mental Health Care and Information Recommendations 6.1 Use health technology and telehealth to improve access and coordination of mental health care, especially for Americans in remote areas or in underserved populations 6.2 Develop and implement integrated electronic health record and personal health information systems

18. Federal Partners for Transformation Other Partners Dept. of Education Dept. of Housing and Urban Development Dept. of Justice Dept. of Labor Social Security Adm. Dept. of Veterans Affairs White House Office of Faith-Based Community Initiatives U.S. Department of Health & Human Services AoA NIH/NIDA ACF NIH/NIMH AHRQ HHS/OS - ASPE CDC - OCR CMS - OD - OPHS HRSA SAMHSA IHS 18

19. ACCOUNTABILITY CAPACITY EFFECTIVENESS Measure and report program performance Increase service availability Improve service quality Vision:A Life in the Community for Everyone Mission:Building Resilience and Facilitating Recovery for people with or at risk for mental or substance use disorders SAMHSA “One SAMHSA” 19

20. Each strand is individual and unique. Woven together they transform into a strong and mighty cloth.

22. Implementing the Strategic Prevention Framework • Building Substance Abuse Treatment Capacity: Access to Recovery • Addressing Needs of Youth and Adults with Co-occurring Mental and Substance Use Disorders • Transforming the Mental Health System Major SAMHSA Initiatives 22

23. Membership: • Key policy and program leadership for children across three Centers & OA: CMHS, CSAP & CSAT • Purpose: • Align SAMHSA vision, goals and activities to improve the quality and availability of a comprehensive,integrated continuum of services and supports — that includes prevention, early intervention, and treatment —for children, with or at risk for mental and/or substance use disorders, and their families. SAMHSA’s Children and Families Workgroup • Action Plan 23

24. More grows in the garden than the gardener sows. ~ Spanish Proverb ~

25. Children and Families • Strategic Prevention Framework • Mental Health Transformation • Co-occurring Disorders SAMHSA Matrix Action Plans Action Plans available online: www.samhsa.gov 25

26. Resource/toolkit on SA and MH screening for use in multiple settings • TA document to help States use standardized screening tools • Resource document on primary care/behavioral health interface: MH/SA screens of children 0 to 3 and their caregivers, and facilitated referrals Children and Families two-year Action Plan – Selected TA Strategies 26

27. Pilot project, “Transforming, Linking and Caring (TLC),” links regional CMHS child-focused grantees to develop continuum of care • Financing guide on strategies for integrating funding streams for SA and MH services and supports • Prototype of individualized plan of care for children and their families Children and Families two-year Action Plan – Selected TA Strategies 27

28. Create and award Child and Adolescent State Infrastructure Grants (SIG) • Create new State Mental Health Transformation Grants (to include children and families, and build on Child and Adolescent SIG) • Develop prototype grants to fund a State adolescent SA treatment coordinator to build State infrastructure and capacity for services integration Children and Families two-year Action Plan –Selected Grant Opportunities 28

29. Collaborate with Dept. of Education to expand school-based MH programs • Collaborate with ASPE, ACF, CMS and Depts. of Education and Justice on eliminating practice of parents giving up custody for treatment • National Child Traumatic Stress Initiative (increase outreach to build new collaborative partnerships) Children and Families two-year Action Plan –Selected Collaborations 29

30. Services Grants – provide funding toexpand and strengthen effective, culturally competent mental health and substance abuse services • InfrastructureGrants– support identification and implementation of systems/structures, but not designed to fund services • Best Practices Planning & Implementation Grants–help communities and providers identify practices to effectively meet local needs, develop strategic plans for implementing/adapting those practices, and pilot-test practices prior to full-scale implementation • Service-to-Science Grants – provide funds to document and evaluate innovative—but not yet proven effective–practices that address service gaps SAMHSA’s 4 Standard Grant Announcements Note: Some funding opportunities do not fit standard announcements; separate stand-alone grant announcements will be published in those instances 30

31. “Frisbeetarianism is the belief that when you die, your soul goes up on the roof and gets stuck..” ~ George Carlin ~

32. T = (V + B + A)  (CQI)2

33. The Transformation Equation Transformation  (VisionBeliefAction)  ( Continuous Quality Improvement )2 • The primary strategy of the Child, Adolescent & Family Branch for transforming mental health involves helping states, local communities & tribal organizations build strong systems of care. Key elements of this strategy include: • Visionthat provides direction for the work we do • Beliefthat guides the work we do • Actionthat is taken to make our vision and beliefs a reality; and • Continuous Quality Improvementwhich helps ensure that our actions reflect the wishes and needs of the community being served

34. Center for Mental Health ServicesChild, Adolescent and Family Branch Vision • All children and their families live, learn, work, and participate fully in communities where they experience joy, health, love, and hope. Mission • Through investment and partnerships in home and community-based systems of care, the Child, Adolescent and Family Branch promotes potential and the well-being of children and youth who have, or are at risk of having, a serious emotional or behavioral disturbance, and their families. Accomplished by… • Embracing families and their cultures, • Eliminating disparities and fostering cultural and linguistic competence, • Establishing effective service delivery models, • Collaborating with other public and private child-serving systems and organizations, and • Ultimately transforming children’s mental health care across America.

35. Context • CASSP Program begins in 1993 A budget of 4.9 million in when the CASSP program was initiated.

36. Context Children’s ProgramFederal Funding Fiscal Year (FY) 2004 budget: $102,353,000

37. System-of-Care Communities of the Comprehensive Community Mental Health Services Program for Children and Their Families Northwoods Alliance, WI Milwaukee, WI Willmar, MN Lyons, Riverside, & Proviso, IL Lancaster County, NE Illinois (Chicago area) Nebraska (22 counties) Lake County, IN Bismarck, Fargo, & Minot, ND Sault Ste. Marie Tribe, MI Sacred Child Project, ND Marion County, IN Oglalla Sioux Tribe, SD Detroit, MI Passamaquoddy Tribe, ME Northern Arapaho Tribe, WY Cuyahoga County, OH Maine (4 counties) u Southern Consortium & Stark County, OH Vermont 1 (statewide) King County, WA u Vermont 2 (statewide) New Hampshire (3 regions) Allegheny County, PA Clark County, WA u u Montana Worcester, MA u Four Counties, OR u Rhode Island 1 (statewide) u Clackamas County, OR Rhode Island 2 (statewide) u u Lane County, OR Connecticut (statewide) Idaho Mott Haven, NY u New York, NY United Indian Health Service, CA Westchester County, NY u Iowa Burlington County, NJ u South Philadelphia, PA Glenn County, CA Delaware (statewide) Sacramento County, CA u u Baltimore, MD Napa & Sonoma Counties, CA Montgomery County, MD Contra Costa County, CA u Washington, DC u u Oakland, CA Alexandria, VA San Francisco, CA Charleston, WV u Monterey County, CA Edgecombe, Nash, & Pitt Counties, NC u California 5 (Santa Cruz, San Mateo, Riverside Ventura, & Solano Counties) Arkansas North Carolina (11 counties) North Carolina (10 counties) Santa Barbara County, CA u 3 counties & Catawba Indian Nation, SC Clark County, NV u Charleston, SC San Diego County, CA Greenwood, SC Rural Frontier, UT Gwinnett & Rockdale Counties, GA Pima County, AZ Navajo Nation Eastern Kentucky u Las Cruces, NM u Hillsborough County, FL El Paso County, TX Birmingham, AL West Palm Beach, FL Colorado (3 counties) Nashville, TN Denver, CO Broward County, FL Yukon Kuskokwim Delta Region, AK Louisiana (5 parishes) Wichita, KS Jackson, MS Oklahoma Fairbanks, AK St. Louis, MO Funded Communities Travis County, TX St. Charles County, MO Ft. Worth, TX Date Number Date Number Missouri Parsons, KS Wai'anae & Leeward, HI Guam 9-1-93 4 2-1-94 7 9-1-94 9 11-1-94 2 9-1-97 9 10-1-98 13 11-1-98 1 9-30-99 20 5-1-00 1 7-1-00 1 10-1-02 18 9-30-03 7 u Choctaw Nation, OK Puerto Rico u u

38. Context:System of Care Development Efforts • Ninety-six systems of care grants and cooperative agreements funded since 1993 • Each community funded for 6 years • Forty-five communities have completed federal funding phase (graduated)

39. Context:System of Care Development Efforts • Forty-eight States impacted by the Children’s Program • 364 counties served by the Program since 1993 • Number of children served: More than 60,000

40. Philosophy of the Program • Driven by the needs and preferences of the child and family; • Addressed through a strength-based approach; • Focus and management of services occurs in multi- agency and community base; • Services, partners and programs are responsive to cultural characteristics of the populations served and: • Families are partners in all phases of the program.

41. Family Involvement Youth Involvement Technical Assistance Research System of Care Transformation Cultural Competence Site Improvement Systems of Care as a Transformation Strategy Beliefs +Actions x(CQI)2 • Moving from family involvement to family driven • Relentless customer focus • Fully embracing youth involvement • Council on Collaboration and Coordination • Integrating technical assistance activities • Opening the data set • Establishing key benchmarks • Family driven • Recovery, resilience, prevention - defining how systems of care contribute • Moving from concept to reality. Tools & strategies • Improving the site visit process

42. Continuous QualityImprovementApproach Integrated & Coordinated Technical Assistance TransformationLeadership FundedCommunities:TransformingSystemsof Care Research Agenda Family Driven Youth Guided Reducing Disparities Council on Coordination & Collaboration Priority Focus Areas

43. Council for Coordination & Collaboration Priority Focus Areas 1. Continuous quality improvement • Ensuring the quality of outputs and outcomes of the sites, the partners and the Council.

44. Council for Coordination & Collaboration Priority Focus Areas • Leadership to transform children’s mental health • Synthesizing “lessons learned” regarding best practices for organizing and implementing mental health services to children and their families with a focus on practical outcomes of care. • Strengthen overall program goals and activities. • Move from “good” to “great.” • Define recovery and resilience for children and families.

45. Council for Coordination & Collaboration Priority Focus Areas 3A. Family Driven • Define “family-driven” • Strengthen roles of families in systems of care • Lessons learned about family involvement • Further develop concept of family choice • Develop concept of youth guided care

46. Council for Coordination & Collaboration Priority Focus Areas 3A. Family Driven • Define “family-driven” • Strengthen roles of families in systems of care • Lessons learned about family involvement • Further develop concept of family choice • Develop concept of youth guided care

47. Council for Coordination & Collaboration Priority Focus Areas 3B. Youth Guided • Develop National Youth Development Board • Protocols and orientation for youth attending local and national meetings

48. Council for Coordination & Collaboration Priority Focus Areas 4.Reduce disparities and enhance cultural and linguistic competence among policy-makers, administrators and service providers • Emphasize essential role of cultural & linguistic competencein achieving the vision & mission of the Branch and the Program. • Enhance organizational capacityfor cultural and linguistic competence.

49. Council for Coordination & Collaboration Priority Focus Areas 4.Reduce disparities and enhance cultural and linguistic competence among policy-makers, administrators and service providers • Increase awareness and knowledge of factors that contribute to disparities. • Develop specific approachesthat contribute to the goal of eliminating disparities.

50. Council for Coordination & Collaboration Priority Focus Areas 4.Reduce disparities and enhance cultural and linguistic competence among policy-makers, administrators and service providers • Support Branch efforts to implement principles and concepts of cultural and linguistic competence.