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September 17, 2009 Denise Sleeper, Granite State Employment Project

Mental Health and Supported Employment: Opportunities to Provide Incentives for Evidenced Based Supported. September 17, 2009 Denise Sleeper, Granite State Employment Project Sara Kendall, OR Competitive Employment Project. New Hampshire: Granite State Employment Project. Systems Challenge.

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September 17, 2009 Denise Sleeper, Granite State Employment Project

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  1. Mental Health and Supported Employment: Opportunities to Provide Incentives for Evidenced Based Supported September 17, 2009 Denise Sleeper, Granite State Employment Project Sara Kendall, OR Competitive Employment Project

  2. New Hampshire: Granite State Employment Project

  3. Systems Challenge Significant budget cuts and unclear administrative rules around employment practice led to strained relationships between the Bureau of Behavioral Health and Community Mental Health Centers. Employment outcomes have been marginal as a result. A recent State Health Authority Yardstick (SHAY) report identified the challenges and laid out explicit recommendations.

  4. Innovation: Proposed Systems Change • Revise Administrative Rule to promote EBSE & to clearly define: • competitive employment • evidenced based practice supported employment • work preparation • how to bill for EBSE and what it includes • Functional Support Services rate drops on 10/15/2009 , but the EBSE rate stays the same

  5. Role of the MIG • Convener of stakeholders • Conduit to Technical Assistance • Connecting the dots to how the MIG can support existing goals as outlined in a recent SHAY report. • Funding for initiatives • Provider of the higher level perspective (Sometimes you cannot see the forest through the trees)

  6. Key stakeholders, Roles • State agencies NH Vocational Rehabilitation – clear understanding of the EBSE model and how to share funding responsibilities. • Providers Community Mental Health Centers in 10 Regions throughout the state. Identifying who are the early adopters of endorsing EBSE (discrepancy between CEO’s with & without a clinical background). • Individuals Building consumer demand for employment services through outreach with Office of Consumer Affairs, Peer Support Networks, NH NAMI & CMHC’s.

  7. Key stakeholders, Roles NCHSD Barbara Otto worked with the GSEP & BBH to get to the core issues affecting the employment infrastructure within NH’s Mental Health Service delivery system. Developed clear strategies and action steps. Connected NH to relevant information from other states. CMS NH recognized the importance of working collaboratively with CMS from the beginning. Shawn Terrell provided support to find out what NH can and cannot do. Provided excellent advice on CMS policies and how to shape changes to Administrative Rules. Dartmouth-Hitchcock Psychiatric Research Center Collaborated with BBH to create thresholds for Fidelity Review to shift perception from “punitive” to a “quality improvement” process. PRC hired an additional staff person to separate training functions from fidelity review.

  8. Strategies for moving forward • MIG Supported Strategies  Funding  On-going Technical Assistance & Support  Convening meetings to build stakeholder buy-in  Assistance with operationalizing identified goals  Development of the Employment Data System  Development of strategies to pay for the outcomes desired  Intensive review of regional CMHC to identify consumers who are eligible for the Medicaid Buy-In (MEAD)  Outreach & Education on MEAD, Work Incentives & New Ticket to Work  Continually promoting sustainability  On-going development of Employment Professionals Competency Model Training, Technical support, Financial support • Role of key stakeholders in moving forward

  9. Revision of Administrative Rules around employment Development of thresholds for Fidelity Review Creation of an EBP Advisory Council Developing NH’s capacity to provide effective EBSE (Competencies & Trainer’s Bureau) Developed a three Year Plan for Supported Employment Exploring paying for performance Strong collaboration with VR Strategies to Sustain the Innovation

  10. Oregon:Competitive Employment Project – Oregon Supported Employment Center for Excellence

  11. Systems Challenge How to assist people (including those without Medicaid and/or indigent) who are diagnosed with serious mental illness to obtain and maintain meaningful competitive employment.

  12. Innovation: Proposed Systems Change • County mental health providers conversion from day treatment to supported employment using the evidence-based practice Individual Placement and Support (IPS model) and fidelity scale developed by Johnson & Johnson Dartmouth Community Mental Health Program. • Pay providers to cover true cost of the IPS model

  13. Role of the MIG • Partner, Funder, Technical Assistance, Cheerleader • MIG does not provide any direct services. • Built relationships with key players in the systems change including state Mental Health administration, management, Portland State University staff, county mental health providers and peer support groups. • At different times able to step in and move the relationship between Addictions and Mental Health Division and the Oregon Supported Employment Center for Excellence forward. • Participated in hiring panel for Mental Health staff; actively participate on OSECE Advisory Board, individual county mental health and the OSECE quarterly supervisors’ meetings. • Provide funding including SE Peer Support component.

  14. Key stakeholders, Roles • State agencies Office of Vocational Rehabilitation Services (OVRS) and AMHD: Co-planners and funders. AMHD in collaboration with CMS created a payment code for SE for those who reached fidelity as per J & J Dartmouth model. • Providers 17 county mental health providers including the 2 who run the OSECE • Individuals • Rollin Shelton, MH PeerLink America • Individual members of Frontier Leadership Network (Eastern Oregon) • Individual members of MIG Leadership Council

  15. CMS Joe Razes and Effie Shockley worked with the MIG to redefine goals and performance outcomes for the grant, and this helped us identify the areas in which MIG staff could assist the OSECE as well as give them some ideas for expansion of services. And….MIG-RATS helped us to understand the kind of data the OSECE and PSU needed to collect beyond that required by J & J Dartmouth to ensure sustainability.

  16. Strategies for moving forward • MIG Supported Strategies • Funding; • Planning and initial implementation of the OSECE; • Infrastructure planning; • Outreach and education about OSECE; • Reviewing monitoring reports and outcomes and making recommendations for changes; • Providing training opportunities for participating providers in Employment Outcomes Professional model; and • Providing Work Incentives Network staff as participants in fidelity reviews. • Promoting service by MIG Leadership Council members on OSECE Advisory Board.

  17. Discussion • How did community mental health centers respond to the fidelity review process? • How do your states fund other supported employment models or even other employment services for people with psychiatric disabilities? • What kind of time was involved in working with our federal partners – either at the Baltimore or regional level – to get your house in order?

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