North Dakota Regional Human Service Center Overview Brad Brown, M.B.A., L.A.C. Regional Director Badlands Human Service Center West Central Human Service Center

Welcome to

Department of Human Services: Structure of the Department Administration of programs for children and families including (but not limited to): Adoption services and licensing of child-placing agencies Foster care services and licensing Child Protective Services Administration of programs for individuals with Developmental Disabilities. Administration of Aging Service programs. Administration of Behavioral Health Division, including: Policy Division Service Delivery Administration of Economic Assistance Programs (temp assistance, SNAP, fuel assistance, etc.) Administration of Medical Service programs (assistance for needy persons, early and periodic screens, etc).

Department of Human Services: Service Delivery Branch of Behavioral Health Includes: NDSH Regional HSC’s Responsible for: providing chronic disease management, regional intervention services, and twenty-four hour crisis services for individuals with behavioral health disorders.

Behavioral Health Refers to both psychological functioning/well-being as well as to choices and actions that can affect wellness such as substance abuse and misuse. (SAMSHA). The planning and implementation of preventive, consultative, diagnostic, treatment, crisis intervention, and rehabilitative services for individuals with mental, emotional, or substance use disorders, and psychiatric conditions.

What you should expect to see within your communities A lot of recent and pending changes: Need to focus in on requirements/most vulnerable Who shapes how and what.

What you should expect to see within your communities Regional Intervention Services: 24 hour Emergency Services Assessments: Open Access (OA), Integrated Assessments (IA) Chronic Disease/Recovery Management: Rehabilitative Services: Fidelity Models/Evidence Based Practices: Dual Diagnosis Capability in Addiction Treatment (DDCAT) Assertive Community Treatment (ACT) Illness Management & Recovery (IMR) Supportive Employment Telehealth Services for youth and transition age adults:

Assessments Open Access: Integrated Driven by wait times, best practice recognition, and prioritizing access based on population needs All regions: though at different places in implementation Has resulted in other changes: Increase emphasis on groups and integration Change in assessment process (reduced paperwork) Integrated Why: High comorbidity Individuals with co-occurring disorders often exhibit more severe symptoms than those caused by either disorder alone The need to develop effective interventions to treat both conditions concurrently is strongly supported by research

Chronic Disease/Recovery Management Chronic disease management (CDM) and Recovery Management (RM) are person-centered models of service delivery that involve the provision of longitudinal care; client education; integrated treatment; Peer recovery evidence-based treatment plans; and expert care availability. These models hold promise for improving care for individuals with severe substance use disorders and/or serious mental illnesses who often receive no care or fragmented ineffective care.

Rehabilitative Services The goal is to enable the client to develop and enhance: Psychiatric stability Social competencies Personal and emotional adjustment Independent living and community skills The services also enable a recipient to retain stability and functioning if the recipient is at risk of losing significant functionality or being admitted to a more restrictive service setting without these services. In addition, the services instruct, assist, and support: Medication education and monitoring Basic social and living skills in mental illness symptom management Household management Employment-related Transitioning to community living

More similarities than differences Needed to examine how we’ve treated individuals who have a Serious Mental Illness (SMI) or chronic/severe substance use disorder. Consider Social Determinants of Health (10-20% of whether people experience change has to do with those typical things we do). Economic Stability Poverty, Employment, Food Security, Housing Stability Education High School Graduation, Enrollment in Higher Education, Language and Literacy, Early Childhood Education and Development Social and Community Context Social Cohesion, Civic Participation, Discrimination, Incarceration Health and Health Care Access to Health Care, Access to Primary Care, Health Literacy Neighborhood and Built Environment Access to Healthy Foods, Quality of Housing, Crime and Violence, Environmental Conditions

EBP’s/Fidelity Models Dual Diagnosis Capability in Addiction Treatment (DDCAT) Assertive Community Treatment (ACT) Illness Management & Recovery (IMR) Supported Employment

Dual Diagnosis Capability in Addiction Treatment (DDCAT) Persons with co-occurring disorders are welcomed by the program or facility Create an environment which displays, distributes, and provides literature and educational materials that address both mental health and substance use disorders. Routinely and systematically screen for both substance use and mental health disorders. Routinely and systematically assess for mental health problems as indicated by a positive screen. Have the capacity to routinely and systematically diagnose both mental health disorders and substance use disorders. The assessment of readiness for change for both disorders is essential to the planning of appropriate services. The treatment plans indicate that both the mental health disorder as well as the substance use disorder will be addressed.

Assertive Community Treatment (ACT) ACT is an evidence-based practice that improves outcomes for people with severe mental illness who are most at-risk of homelessness, psychiatric crisis and hospitalization, and involvement in the criminal justice system. ACT is a multidisciplinary team approach with assertive outreach in the community. Outcomes: People receiving ACT services tend to utilize fewer intensive, high-cost services such as emergency department visits, psychiatric crisis services, and psychiatric hospitalization.

Illness Management & Recovery An Evidence Based Practice for individuals with Schizophrenia, Bipolar Disorder, and Major Depressive Disorder. Principles that define IMR Education about mental illnesses is the foundation of informed decision-making. Clients can learn new strategies for managing their symptoms, coping with stress, and improving their quality of life. The Stress-Vulnerability Model provides a blueprint for illness management. Curriculum consists of 10 topics: Recovery strategies; Practical facts about mental illnesses; Stress-Vulnerability Model and treatment strategies; Building social support; Using medication effectively; Drug and alcohol use; Reducing relapses; Coping with stress; Coping with problems and persistent symptoms; and Getting your needs met by the mental health system.

Supported Employment Supported Employment is intended to provide services that lead to employment for people with the most significant disabilities Supported employment services are authorized through the federal Rehabilitation Act The ultimate goal for the individual is to reduce or eliminate their need for public financial support. At a minimum: The individual should be employed at least 50 hours per month. The cost for the individual to maintain employment should not exceed their earnings at entrance to Extended Services. The individual earns at least minimum wage or a wage commensurate with people without a disability performing the same or similar tasks.

Tele-health Needed to recognize that we are a rural state and resources are limited. So have begun implementing telehealth Western part of the state AOD evaluations and some treatment Some tele-therapy (likely will expand) Telemedicine throughout the state Exploring the option for components of psychological assessment

Partnerships Program Eligibility: Components 18 or younger MH Diagnosis Involvement in two or more agencies Difficulties have listed or are expected to last a year or longer Not doing well in school, home, or community, and difficulties strongly interfere with the life of the child Components Care coordination Wrap-around values: e.g., community based, strength based, child-centered, collaborative, multi-system. Child and Family Teams

Services Are not significantly changing What’s changed is: Individual therapy Group therapy Assessments Crisis interventions Medication management Psychological evaluation Skills training Addiction treatment What’s changed is: For who How the services are provided

Questions?

Thank you