1. PCPA Outpatient Summit Joan Erney, J.D. Office of Mental Health & Substance Abuse Services December 2, 2009

2. Environmental Scan National Beginning of new administration Rescinding of Proposed MA changes Increased attention to F&A Unclear CMS/SAMSHA Direction HealthCare Reform Expanded population to serve Medical Home, PH/BH co-ordination MH/D&A Parity IT capability Economic Realities Attention to Evidence Based Practices Support High Outcome, Low Cost Practices State End of current administration Economic Challenges Transformational Agenda Unified Systems

3. Outpatient Clinic Services MA State Plan: Clinic Option Chapter 5200 Regulations; 1981 Modifications to Outpatient Co-occurring Option to support MH/SA Mobile Mental Health Treatment (Rehab)

4. Outpatient Clinic Services Outpatient Clinic Services (current) Psychiatric Supervision Medication Management Master’s level Therapists Individual and Group Therapy Physical Evaluation, Treatment Planning Linkages with mental health service system

5. Outpatient Services Office of Mental Health & Substance Abuse Services Environmental changes/impact on outpatient clinic services- just to name a few… Inability to attract, adequately pay and retain psychiatrists, master’s level clinicians Clinic limitations, site based Current regulatory limitations, staffing ratios as example Community Mental Health Centers role in delivery system, consumer choice, elimination of catchment areas BHRS; behavioral interventions not attached to clinical home Team delivered, alternative treatment options “Medical Model” presumed at clinics Personal consumer preference, peer delivered preference Managed Care ( Commercial ) Medicare BH HealthChoices

6. Outpatient Services and yet… Office of Mental Health & Substance Abuse Services Priority remains for persons with Serious Mental Illness and children with serious emotional disturbances; however…. Expanded demand; birth to death Prevention/mental health supports Maternal depression and early childhood needs Expanded children’s need; children who have experienced trauma, or involvement with children and youth or juvenile justice system Young adult, aging out or transition age youth Individuals with co-occurring drug and alcohol problems Expanded role to support Veterans Adults, Older Adults involved in the Criminal Justice System Physical Health; depression associated with heart disease, chronic illnesses Older Adults, persons with serious mental illness, newly diagnosed persons experiencing psychiatric symptoms, organic brain diseases

7. Outpatient : Changing the paradigm Recovery and Resiliency Orientation Targeted specialties, by age, condition Individuals practitioners acting within scope of practice Anticipate consumer choice of location, clinician or support person, service option Provide Flexible business hours Provide consultative support; lead clinical home

8. Outpatient : Changing the paradigm for persons with serious mental illness Instead of treating as “chronic care” treat as long term investment to support an individual’s recovery Instead of “case management”, consider partnership with individual or family to stay connected to treatment and personal supports; (navigator, case manager, peer) Clinical Home instead of MH treatment clinic; partner is available and connected when and where needed

9. Outpatient: What are the possibilities Reconsidering outpatient and ambulatory options for individuals Rehab option vs. Clinic Option Individual choice of clinic, clinician service options Recovery Orientation, inclusive of peers in service delivery Licensed practitioners acting within Scope of Practice Team Delivered Services Strong Clinical Accountability Restructure Financial model

10. Where do we go from here Prioritize for New Administration Pilot outpatient models in HealthChoices, build evidence base; Propose financial models; think sustainability Check in and consult with individuals and families using your services early and often!