Growing up!: Georgia’s Behavioral Health System of Care ...

Growing up!: Georgia's Behavioral Health System of Care for Older Adults

Georgia Department of Behavioral Health & Developmental Disabilities Judy Fitzgerald, Commissioner

Jill D. Mays, MS, LPC, Director Office of Federal Grants and Cultural and Linguistic Competency

Behavioral Health Disorders in Older Adults: Costly, Disabling, and Deadly

Late-life anxiety is related to increased risk of depression-- both affect memory

Disabling-- symptoms and disorders impact selfcare, e.g. ADLs and IADLs

Reduces quality of life-- sometimes becomes deadly ? Suicide risk ? Risk factor

for serious illnesses (diabetes, hear disease) ? Complicates recovery (stroke, hip fracture, etc.)

Depression and anxiety are costly: ? Higher

healthcare costs (50100%) ? Increased morbidity, mortality, nonadherence, recovery costs

Late-life Suicide: A Major Concern: Every 90 Minutes

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Behavioral Health and Older Adults

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Most common disorders: Depression, Anxiety, Irritability/Lability, Apathy/Indifference (suicide risk); Other conditions: Behavioral and Psychiatric Symptoms Associated with

Dementia, Fear of Falling

Persons aged 25-34 years visited an ED and/or died from an opioid-involved overdose more 2 frequently than persons in other age categories (36 deaths of persons 65 and older in 2016,

compared to 808 deaths of persons 25-64)

Persons aged 65-74 years were most likely to be hospitalized because of an opioid-involved 3 overdose.

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At least 5.6-8 million (14-20%) of US older adult population has one or more mental health disorders; 700,000 are nursing home residents

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By 2030, as Baby Boomers age, the numbers of older adults in Georgia with behavioral health needs will increase by 80% (to 430, 837)

IOM Report: In Whose Hands 2013

Georgia Treatment Utilization Trends

83% Decrease after Age 65

Geriatric Behavioral Health Workforce

? While geriatric BH specialists are critical in caring for older adults with BH issues, the more broadly defined geriatric BH workforce (LPCs, SWs, LMFTs, psychologists, nurses, physicians assistants, etc.) has far greater contact with older adults who have or may be at risk for BH conditions.

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use as related to older adults.

? Training general health care professionals and direct care workers is pivotal to improving the workforce because they are the most likely to have contact with older adults with BH conditions. Also essential to training are skills in cultural competence and interprofessional and interagency collaboration to meet the complex needs of older adults and better coordinate care.

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Geriatric Behavioral Health Workforce

Key Areas for Improvement

? Integrating geriatric behavioral health competencies into education for all

health professionals, as well as family caregivers and Peers

? Training for existing providers

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? Training in Cultural ComCopentteancctsy

On-Call List

Committees

? Interprofessional Cross Training & Functionality

Current Focus of DBHDD/DAS/Emory Fuqua Center/Carter Center

collaboration (Georgia Coalition on Older Adults and Behavioral Health)

? Coordination of Care through Partnerships & Data Sharing

Current Focus of DBHDD/DAS/Emory Fuqua Center/Carter Center

collaboration (Georgia Coalition on Older Adults and Behavioral Health)

Where Can We Go from Here. . .Together?: Recommendations

Data Analysis

Workforce Development

Conduct a systematic and trend analysis of the current and projected behavioral health care needs of older adults. Within the target population, consider the special needs of groups for which health disparities already exist, such as racial/ethnic groups, veterans, deaf/hard of hearing, nursing home residents, homeless persons, older inmates in correctional facilities, persons with chronic disease, etc.

? Based on analysis of the behavioral health needs of older adults, develop strategy for how Georgia should grow and prepare the behavioral health workforce to meet these needs.

? Promote interprofessional and interagency partnerships and data sharing agreements to improve systemic coordination of care.

Wide Array of Community Mental Health Services Available to Older Adults

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Core Services

? Community Service Boards (Comprehensive Community Providers-CCPs) Community mental health services Comprehensive psychosocial, psychiatric and nursing assessment Individual/Family/Group Therapy Medication management Peer support Case Management Psychosocial rehabilitation (skills-building)

Assertive Community Treatment (ACT)

? 22 state-funded teams ? 4 Medicaid reimbursement option (MRO)teams ? Provide community-based, recovery-oriented, ? consumer-driven, multi-disciplinary treatment ? team delivered, high-level service, reduction of ? re-admission, homelessness and incarceration, for ? persons meeting ADA Settlement criteria ? Service delivery includes nursing, psychiatry, ? psychology, social work, substance abuse, ? vocational rehabilitation and peer support ? In-reach to jails and hospitals following referral

Community Support Team (CST) ? 10 DBHDD contracted CST teams ? Located in rural communities ? Smaller team composition ? Community-based, recovery-oriented, consumerdriven, for persons meeting ADA Settlement criteria ? Goals to reduce oHospital re-admission oHomelessness oIncarceration

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Case Management

? 16 state-funded intensive case management teams ? 52 state-funded case management services ? Individual support to increase access to community- based

services, care coordination ? Individual recovery plan implementation ? May be combined with other core services

Supported Employment

? 21 Supported employment providers

? Vocational assessment, rapid job search, competitive job placement, job maintenance support, benefits counseling, rehabilitative support

? Task Oriented Rehabilitation Services (TORS): new Medicaidreimbursable component for vocational rehabilitation support services

Crisis Services

? Crisis Stabilization Units (22 CSUs)

? Provide assessment, crisis stabilization, therapeutic education, referral/linkage to appropriate services

? Blended Mobile Crisis Services (BH/IDD)

? Time-limited, rapid crisis response, assessment, referral/linkage to appropriate services

? Multidisciplinary response team

? 159 counties covered

? Benchmark: regions 1 and 4

?BHL: regions 2,3,5 and 6

? Behavioral Health Crisis Centers (11 BHCCs; 2 more coming by 2020)

? 24/7 access, combines walk-in, crisis assessment and stabilization; referral/linkage to services

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Mental Health Treatment Courts

Seven (7) Accountability Court contractual partnerships that combine judicial supervision and community mental health treatment; many CSBs have direct contracts with the courts

Diversion programs geared towards reducing criminal activity, improving stability

Alternative to incarceration for persons with serious and persistent mental illness, substance use disorders or co-occurring disorders, who consent to treatment

Region The picture can'tbe displayed. 1 3 4

Provider Cobb-Douglas CSB, Highland Rivers Health, Avita BHS City of Atlanta Aspire Behavioral Health and Developmental Disability Services, Georgia Pines Community Service Board, Albany ARC

? Structured activities that are provided for individuals with common issues and needs

? Promote self-directed recovery and support individuals in developing and attaining individualized life, recovery and wellness goals

? Georgia is the first state in the U.S. to be able to bill Medicaid for whole health peer support

? Peer support and wellness centers: programs are led by certified peer specialists

Peer Support

? Forensic peer mentor initiatives; partnership with Department of Corrections (GDC), Department of Community Supervision (DCS), and GA Mental Health Consumer Network

PATH and SOAR

? Projects for Assistance in Transition from Homelessness (PATH)

? 10 PATH teams throughout the state ? Case management ? Housing access ? Outreach and linkage to services for the homeless

? SSI/SSDI Outreach, Access and Recovery (SOAR)

? Provides increased access to Social Security disability benefits for people who are homeless or at risk of homelessness and who have mental health challenges or other co-occurring disorders

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Community Transition Planning

? Transition Coordinators who work to support each state hospital in coordinating transition planning via: Reviewing transition plans Assisting with complex discharges Monitoring planning for persons with inpatient stays of +45 days Collaboratively coordinating care between state hospital and regional field office and community service provider

Supported Housing Initiatives

Crisis Respite Apartments

? Brief periods of crisis respite, support services, linkage to treatment and other community services

? Prevention of CSU, ER re-admission/re-hospitalization, reincarceration

? Transition from a higher level of care into the community ? Does not need extensive supervision; does well with periodic

checks throughout the day

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Community Residential Rehabilitation

? Staff support in residential settings, continuous monitoring and supervision

? Skills training, community integration activities and personal support services/activities to restore and develop skills in functional areas that interfere with the individual's ability to safely live in the community, continue with recovery and increase self-sufficiency o Level 1 - 24-hour/on-site supervised; 5 hours of skills training (awake over night staff) o Level 2 ? 24 hour/on site supervised; 5 hours of skills training (non awake overnight staff) : o Level 3 - 36-hour/on-site supervised; 3 hours of skills training

Georgia Housing Voucher and Bridge Fund

? DBHDD Funding for rental assistance for the target population: ? Tenant ? based ? Linked to a DBHDD Community Mental Health Provider ? Bridge funding: provides initial, one?time move in costs (i.e., deposits, furnishings, household goods) ? Serves as a housing safety net for individuals who do not qualify for other housing assistance

? Currently about 2,600 individuals statewide receiving this assistance

? Served over 4,000+ cumulatively

Team Work Makes the Dream Work

BEHAVIORAL HEALTH

PRIMARY CARE

AGING SERVICES

OLDER ADULTS & THEIR FAMILIES/CAREGIVERS

COMMUNITY SERVICES & SUPPORTS

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