1. Texas Council Conference State and National Perspectives Panel
Sonja Gaines
Associate Commissioner Texas Health and Human Services
June 29, 2017

2. Zara Avery Willis

3. Cameron and Zara

4. Statewide Behavioral Health Coordinating Council Conference Committee Funding Initiatives
Above/Below FY Base

5. Major Behavioral Health Impacts of the 85th Legislature
Inpatient Services
State Hospitals
Community Hospitals
DFPS parental relinquishment RTC beds
Outpatient Services
Peer services investment
LMHA waitlist avoidance
LMHA “10% withhold” reformed
Clubhouses maintained
HCBS waiver maintained
YES waiver maintained
Community Collaboratives
Senate Bill 292
House Bill 13
Texas Veterans + Family Alliance
Healthy Community Collaboratives
Veterans
Texas Veterans + Family Alliance continued
Texas Military Department counseling investment
Military Veteran Peer Network strengthened
Veteran PTSD study funded
Veteran suicide prevention action plan
Justice
SB 292
SB 1326
State Hospital forensic bed capacity increased
IDD
Crisis Services maintained
Additional HCS waiver slots
Study to evaluate training and employment opportunities
Youth
Texas System of Care
RTC beds
TCM and psych rehab for high needs foster care youth
Mental health screenings under Texas Health Steps
Outcome Stats:
13 bills for IDD-BH to implement (plus 4 with heavy coordination with other areas)
About $112.7M tied specifically to these bills
25 riders for IDD-BH to implement
Legislative Themes:
Forensic Legislative Initiatives:
Jail Diversion
Jail-Based Competency Restoration
Outpatient Competency Restoration
Forensic Grants for community collaboratives with local match
Mental health grants to fund local projects to community collaboratives with local match
Peer Support and Recovery Coaches
Wait List Funding
Intellectual and Developmental Disabilities
$102.5M total for fiscal year 2018 LIDDA contracts (number subject to change)
$6M for IDD crisis services and $47.1M for 735 new HCS waiver slots over the biennium
Peer Support and Recovery Coaches:
Addressing workforce shortages especially in rural and Healthcare Professional Shortage Areas
Increasing engagement and adherence to outpatient treatment which can effect more expensive services such as crisis service utilization
State Hospitals
New construction
Deferred maintenance
Maintain cost increases
Expand forensic capacity
Community Hospitals
Expand capacity
Increase contract rates
DFPS parental relinquishment RTC beds
Expanded capacity

6. Statewide Behavioral Health Strategic Plan
Goal 1: Program & Service Coordination
Goal 2: Program & Service Delivery
Goal 3: Prevention & Early Intervention Services
Goal 4: Financial Alignment
Goal 5: Statewide Data Collaboration
Vision:
To ensure that Texas has a unified approach to the delivery of behavioral health services that allows Texans to have access to care at the right time and place.

7. Bridging Local Efforts to BH Services
Statewide Behavioral Health Coordinating Council 20 Collaborating Agencies
Outpatient
SBHCC
Bridging Local Efforts to BH Services
HHSC
TJJD
TCCO
GOV
TVC
DFPS
TEA
TDHCA
TDCJ
TMD
UTHSC-Tyler
TCJS
UTHSC-Houston
Texas Tech HSC
CCA
HPC Agencies
TWC
TIDC
Inpatient
IDD
Justice
Youth
Veterans
Community
Collaboration

8. Statewide Behavioral Health Coordinating Council Members
The Council, includes the Texas Education Agency as a voluntary member, as well as representation from the following agencies:
The Office of the Governor
Texas Veterans Commission
Health and Human Services Commission
Department of Aging and Disability Services
Department of Family and Protective Services
Department of State Health Services
Texas Civil Commitment Office
The University of Texas Health Science Center at Houston
The University of Texas Health Science Center at Tyler
Department of Criminal Justice
Texas Juvenile Justice Department
Texas Military Department
Health Professions Council has one seat representing the Texas Medical Board, Texas Board of Pharmacy, Texas Board of Dental Examiners, Texas Board of Nursing, Texas Optometry Board, and Texas Board of Veterinary Medical Examiners

9. Behavioral Health Gaps in Services
Gap 1: Access to Appropriate Behavioral Health Services
Gap 2: Behavioral Health Needs of Public School Students
Gap 3: Coordination across State Agencies
Gap 4: Veteran and Military Service Members Supports
Gap 5: Continuity of Care for Individuals Exiting County and Local Jails
Gap 6: Access to Timely Treatment Services
Gap 7: Implementation of Evidence-based Practices
Gap 8: Use of Peer Services
Gap 9: Behavioral Health Services for Individuals with Intellectual Disabilities
Gap 10: Consumer Transportation and Access to Treatment
Gap 11: Prevention and Early Intervention Services
Gap 12: Access to Housing
Gap 13: Behavioral Health Workforce Shortage
Gap 14: Services for Special Populations
Gap 15: Shared and Usable Data

10. IDD-Behavioral Health Stakeholders and Workgroups
Joint Committee on Access and Forensic Services
Meadows Mental Health Policy Institute
Promoting Independence Advisory Committee
Behavioral Health Advisory Council
Statewide Behavioral Health Coordinating Council
IDD System Redesign Advisory Committee
Cross-agency Mental Health Awareness Workgroup
United Services for All Children
Association of Substance Abuse Programs
Texas Council of Community Centers
Community Resource Coordination Groups State Workgroup
Cross-agency Mental Health Liaison Workgroup
University of Texas Psychiatric Department Chairs Group
Hogg Foundation for Mental Health
Key:
External
State External/State

11. Behavioral Health Services

12. Texas Veterans + Family Alliance Grant
Pilot - $1M state awards, $1.1M match; 5 projects; 1,450 to be served
Phase II-A - $6M state awards, $6M match; 13 projects; 7,500 to be served
Phase II-B (executing contracts*) - $10M state awards, $10M match; 20 projects; proposed 9,400 to be served
Community Center grantees:
Texas Panhandle Centers
Emergence Health Network
Tropical Texas Behavioral Health (2 projects)
Heart of Texas Regional MHMR
Dallas Metrocare Services (4 projects)
StarCare Specialty Health System
Andrews Center
Bluebonnet Trails Community Services*
MHMR Services for the Concho Valley*
Senate Bill 55, 84th Legislative Session, 2015, directed HHSC to create grant program to award mental health grants to community collaboratives to be matched on a dollar-for-dollar basis
Seeks to improve the quality of life of Texas veterans and families by supporting local communities to expand the availability of, increase access to, and enhance delivery of mental health treatment and services.
Supports a wide range of clinical mental health and non-clinical support services including, but not limited to:
Evidence-based therapies and treatment
Individual, group, and family/couples counseling and peer support services
Suicide prevention initiatives
Support services essential to the provision of mental health services such as child care, emergency financial support, transportation, and child care assistance
Navigation services such as case management and referral services
Through the Pilot and Phases II-A and II-B*, there are 9 centers with grant funding supporting projects across the state. There is approximately $5.3 million in state funds awarded to Centers being matched dollar-for-dollar in private and local match.  Centers’ projects estimate serving approximately 7,630 veterans and family members.
*Phase II-B contracts are currently being executed so these figures include proposed information that is being finalized.

13. Texas Targeted Opioid Response Grant
On May 1, 2017, SAMHSA awarded HHSC a five-year grant aimed to address the opioid crisis in Texas by:
Increasing access to treatment
Reducing unmet treatment need
Reducing opioid overdose related deaths through the provision of prevention, treatment, and recovery activities for opioid use disorder (including prescription opioids as well as illicit drugs such as heroin)
$27.3 million per year for grant activities including:
Prevention
Training and Outreach
Treatment and Recovery
Implementation will primarily be through contract amendments to existing providers and new contracts to university partners in order to maximize the existing infrastructure, rapidly implement services and decrease duplication of efforts
TTOR activities include:
Prevention: The TTOR program will address substance abuse prevention by leveraging existing resources to enhance statewide strategic planning efforts and to distribute prevention training materials. TTOR program activities include strategic planning, expansion of primary prevention programming, and focused media campaign.
Training and Outreach: The TTOR program will address suicide and overdose prevention through a three-part strategy: enhanced crisis response, increased suicide prevention training, and targeted overdose prevention. In addition, funds will be used to provide training to various groups on Opioid 101, Prescription Drug Monitoring Program, Substance Use Disorder Peer Re-entry, Individual Placement and Support/Supported Employment, and Medication Assisted Recovery Services.
Treatment and Recovery: The TTOR program will expand access to opioid treatment at existing and new treatment sites, including parts of Texas which are currently underserved. Stabilization of this provider network will be achieved through a rate adjustment. In addition, TTOR program activities will enhance the array of services available to this population including recovery services/supports such as employment, housing, and peer support.

14. Texas Targeted Opioid Response Grant Continued
HHSC proposes four program opportunities to receive funds through the submission of Needs and Capacity Assessments:
Behavioral Health Mobile Crisis Outreach Team, one LCDC into existing MCOT Teams:
Bluebonnet Trails Community Services, Community Healthcore, Denton County MHMR Center, Gulf Coast Center, and NTBHA
High Fidelity Supported Employment Pilot
Tropical Texas Behavioral Health Center
Job Development – Supported Employment Services:
Center for Health Care Services, Central Counties, Community Healthcore, Emergence, and Heart of Texas Region MHMR Center
Office Based Opioid Treatment:
Emergence, Heart of Texas Region MHMR Center, ATCIC, LifePath, MHMR of Tarrant County, Permian Basin Community Centers, Texoma Community Center, and Tropical Texas Behavioral Health

15. NorthSTAR Transition
North Texas Behavioral Health Authority and LifePath Systems
84th Legislature directed the transition of the NorthSTAR service delivery model to an updated model
New model is a recovery-oriented system of behavioral health care for eligible indigent consumers and transitioning Medicaid eligible consumers to Medicaid managed care organization and local primary care providers.
About 40,000 people affected in Dallas, Ellis, Collin, Hunt, Navarro, Rockwall, and Kaufman counties
Two readiness reviews conducted by HHSC staff
Transition plans include:
Building a mental health and substance use disorder provider network
Developing information technology infrastructure
Securing additional funds to supplement state dollars
Ensuring that stakeholders are kept informed of transition plans
Former NorthSTAR clients who ‘transitioned’ on January 1, 2017 (the transition date) and received subsequent services from NTBHA or Collin County.  The technological effort went amazingly well.
NTBHA = 30,459
Lifepath (Collin County) = 3,335

16. Texas System of Care Texas SOC Federal Grant
Substance Abuse and Mental Health Services Administration awarded a 4-year, $11 million system of care grant to HHSC for
Focusing on sustainability, key projects in the new grant include:
Expansion of SOC to 4 new communities to join current 15 SOC communities
Expansion of wraparound care coordination to children and youth in the juvenile justice system, foster care, and residential treatment centers (RTCs)
Travel funding for wraparound facilitators and family members will be provided through the grant to encourage in-person wraparound team meetings.
Youth peer support services, including training for providers and supervisors
Expansion of family partner services for young adults years old
Expansion of Building Bridges Initiative best practices to additional Texas RTCs
Outreach and education for child-serving agencies on the identification and treatment of first episode psychosis
Texas System of Care (SOC) Initiative
A system of care is a spectrum of effective, community-based services and supports that is organized into a coordinated network (Stroul, Blau, and Friedman, 2010)
Grounded in a well-defined philosophy to guide the way services and supports are provided to children and families
Core values: community-based, family-driven, youth-guided, culturally and linguistically competent
Senate Bill 1021, 85th Legislature, 2017, directed HHSC to implement an SOC framework and enter memoranda of understanding with DSHS, DFPS, TEA, TJJD, and TCOOMI to specify the roles and responsibilities of each agency in implementing the SOC framework.
Initial two expansion communities will be Burke and LifePath Systems. Additional two communities will be selected through a needs assessment in year two of the grant to begin service provision in year three of the grant.

17. Certified Community Behavioral Health Clinics (CCBHC)
Model serves as a stepping stone to integration of behavioral health and primary care
Focuses on care coordination, improved client outcomes
Emphasizes efficiencies, building on relationships, minimizing waitlists
Aligns with multiple HHSC program areas: Intellectual and Development Disability and Behavioral Health Services and Medicaid initiatives
Texas was not selected as a national site, but is focused on implementing a state run pilot
All pilot CCBHCs continue to have interest in the model
HHSC is exploring funding strategies including shared savings, monthly payments, or value-based payments
Updated CCBHC website focuses on pilot sites and resources for supporting the model
Promoting Integration of Primary and Behavioral Health Care
New SAMHSA grant opportunity
Full service integration focus between a community health clinic and a federally qualified health center
Provides up to $2 million per year for 5 years with 90 percent required go to community services
Texas approach builds on the CCBHC model
Incorporates three CCBHC sites – StarCare, MHMR Tarrant County, Bluebonnet Trails
Reinforces CCBHC outcome measures
Offers fuller service integration
Peer services component required
Continues to align with HHSC focus on behavioral health integration

18. Mental Health Adult Waitlists for May 2017
Adult Waiting List: 2,135
14,168 additional average number of adults served up from 5,468 in September 2016
Source: Client Assignment Registration (CARE) system, 06/27/2017
Notes: Average monthly number of adults served per LBB performance measures. Adult Waiting List is number of adults waiting for all services in last month of quarter.
Numbers reported to the LBB for FY14 and FY15 included correction for target calculation for the biennium and will be different than shown here.

19. Mental Health Children’s Waitlists for May 2017
Children’s Waiting List: 134
5,341 additional average number of children served up from 1,211 in September 2016
Source: Client Assignment Registration (CARE) system, 06/27/2017
Notes: Average monthly number of children served per LBB performance measures. Child Waiting List is number of children waiting for all services in last month of quarter.
Numbers reported to the LBB for FY14 and FY15 include correction for target calculation for the biennium and will be different than shown here.

20. Mental Health First Aid
Fiscal year 2016 trainings:
7,162 educators
4,792 non-educators

21. Healthy Community Collaboratives
HHSC awarded this grant to five sites: City of Dallas; Coalition for the Homeless in Houston; Haven for Hope in San Antonio (CHCS); Integral Care; and My Health My Resources (MHMR) of Tarrant County in Fort Worth
Trends in Key Measures: Number of people housed increased from 1, 345 in fiscal years to 2,204 in fiscal year 2016 (64 percent)
Center-related Outcomes:
ATCIC saw decrease in incidences of arrests by 41 percent for and a decrease of incarceration by 29 percent after HCC enrollment.
ATCIC saw a decrease by 26 percent in ER utilization after HCC enrollment.
Tarrant MHMR saw an increase of 230 percent in the number of people receiving case management services from fiscal year 2016 Q1 to fiscal year 2017 Q2.
Haven for Hope
Saw an increase in people receiving substance use disorder services by 12 percent from fiscal year 2016 Q1 to fiscal year 2017 Q2.
People who received job and education services increased by 20 percent from fiscal year 2016 Q1 to fiscal year 2017 Q2

22. Accomplishments: YES Waiver
Two or more specialized therapies is an indicator of a healthy provider network and can sometimes be an indicator of client’s having real choice of services meeting their specific needs.
2 or More Specialized Therapies is an indicator of a healthy provider network and can sometimes be an indicator of client’s having real choice of services that meet their specific needs.

23. Accomplishments: YES Waiver Continued
* “Percent of children receiving YES services” means the percentage of children enrolled in YES waiver who have received a YES waiver service.

24. Intellectual and Developmental Disability Services

25. Funded using 1115 waiver dollars Provides:
START Program
Funded using 1115 waiver dollars
Provides:
24-hour, 7 day-a-week crisis response capability
Psychological/behavioral support services
In-home mobile supports
Intensive service coordination
START was:
Developed in 1988 by Joan Beasley, Ph.D.
Designed to serve individuals with co-occurring IDD & BH needs
Strengthen communication & collaboration with existing systems
START Model
KEY: Enrich the system (avoid strain)
Resources allocated to:
Promote linkages (i.e. the use of a linkage "team")
Fill in service gaps
Services provided across systems and needs (bio-psycho-social)
Expertise, training, mentoring improves capacity
Outreach is key
Positive psychology/strength based approach
Develop a common language
The START Team will be presenting at Behavioral Health Institute on Integrated Community-based Crisis Intervention Teams for People with Intellectual and Developmental Disabilities (IDD) and Behavioral Health Needs

26. Crisis Intervention and Respite Services
Quarters 1 and 2 of fiscal year 2017:
1,786 individuals referred to Crisis Intervention and Respite:
IDD Services: 756
MH Services: 221
Medical Services: 39
IDD & MH Services: 644
IDD & MH & Medical Services: 43
IDD & Medical Services: 64
MH & Medical Services: 19
Individuals who received In Home Respite: 250
Individuals who received Out of Home Respite: 241
Individuals who avoided a hospital or jail: 1,388
H.B. 1, 84th Legislature, 2015, provided $18 million for IDD crisis respite and intervention supports.
Allows individuals with IDD in crisis statewide access to temporary stabilization resources while looking for long-term services supports and alleviate the use of law enforcement as the primary responder to individuals in crisis.

27. Texas PASRR Conference