Missouri Initiatives Laine Young-Walker, MD Department of Mental Health Medical Director of Children’s Services

Missouri DMH and Medicaid Close connection exists between Missouri Medicaid (MHN) and the Department of Mental Health (DMH) Historical joint efforts include Health Care Home Initiatives with MHN and Children’s Division (CD) to address psychotropic medications in the CD population Drug Prior Authorization committee Non-Pharmaceutical Drug PA committee

First Episode Psychosis Benefits of early intervention Reduces the duration of untreated psychosis Reduces the severity and/or frequency of psychotic symptoms Allow youth and families to be more familiar with signs/symptoms Lessens potential disruption at school or in the community

First Episode Psychosis (SOC-CESS grant) SOC-CESS (System of Care-Communities for Early Signs and Symptoms) SAMHSA funded Cooperative Agreement $3 million per year for 4 years Awarded in 2016 Partner with Administrative agents (Burrell, COMPASS Health, and Ozark Center) Supports increase capacity to assess and provide treatment to individuals experiencing early s/s of psychosis

First Episode Psychosis (SOC-CESS grant) Interventions/trainings Virtual Reality Exposure Therapy Training Structured Psychotherapy for Adolescents Responding to Chronic Stress (SPARCS) Qualitative EEG Neurofeedback and Biofeedback Group and Family Cognitive Behavioral Therapy (GF-CBT) Comprehensive Assessment of At Risk Mental States (CAARMS) Specialized screening called Prodromal Questionnaire Brief (PQ B) Specialized ACT TAY Team for first episode psychosis

First Episode Psychosis (ACT TAY Team) First team initiated in 2013 Includes multidisciplinary team (members from multiple specialties) Services provided in the community with shared caseloads and individual/family treatment components Funded by (Medicaid, State GR, Block Grant) 9 ACT-TAY teams in MO Team Leader Prescriber Nurse Substance Use Specialist Supported Employment and Education Specialist Mental Health Professional/community Support Specialists Peer Specialist Therapist/Clinician Option of Family Support Provider

First Episode Psychosis (ACT TAY Team) Specialized ACT TAY Team with focus on first episode psychosis Is part of the SOC-CESS grant Team based treatment approach Designed to provide individuals ages 16-25 with comprehensive, flexible, community-based psychiatric treatment, rehabilitation and support. Individuals and families receive early intervention services from a team of specialists sensitive to the unique needs of transitional age youth.

First Episode Psychosis-Goals of Interventions Goal of SOC-CESS grant Early recognition and intervention Outcomes will help with increasing services Use data to secure additional funding

Missouri Efforts--Trauma Adverse Childhood Experiences (ACEs) lead to increase in morbidity from medical illnesses Adverse Childhood Experiences have been linked to risky health behaviors chronic health conditions low life potential early death Number of ACEs increases--risk for these outcomes does as well

Missouri Efforts--Trauma DMH led but with significant partners Trauma Roundtable Key Partnerships (Alive and Well, Trauma Matters KC) Developed definition and MO Model on Trauma Informed Training and/or consultation and coaching multiple systems Children’s Division (child welfare) becoming a trauma informed system Dept. of Corrections/Probation and Parole Division of Youth Services (post-adjudication for delinquents) Early Childhood (Head Start, PAT, home visiting programs) Schools (many becoming trauma informed schools) Domestic Violence Centers MO Model for trauma informed Goes beyond access to trauma specific services but focuses on culture shift within an organization and focus on policies, practices and environments

Missouri Efforts--Trauma DMH has a DBT trainer that has provided training and consultation across the state for years Two years ago funding to DMH to provide training on trauma specific interventions for children who have been abused (TF-CBT, EMDR, PCIT trained so far) Budget to provide an incentive to providers who are using an EBP for trauma with children who have experienced trauma 3rd dotpoint – initially doing a manual payment but working on creating a code to have an incentivized rate for specific providers certified in an EBP and working with children who have been abused.

Missouri Efforts--Trauma DMH is working with MHN in providing the incentive to providers who are using an EBP for trauma with children who have experienced trauma MHN has been working with DMH in order to move this initiative forward.