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

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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 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.

8. 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

9. 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

10. 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

11. 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.

12. 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.