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Blog

Highlights from 22nd annual Kaiser/红领巾瓜报 50-state Medicaid Director survey

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This week, our聽In Focus聽section reviews highlights and shares key takeaways from the 22nd聽annual Medicaid Budget Survey conducted by The Kaiser Family Foundation (KFF) and 红领巾瓜报 (红领巾瓜报). Survey results were released on October 25, 2022, in two new reports:聽How the Pandemic Continues to Shape Medicaid Priorities: Results from an Annual Medicaid Budget Survey for State Fiscal Years 2022 and 2023聽补苍诲听Medicaid Enrollment & Spending Growth: FY 2022 & 2023.聽The report was prepared by Elizabeth Hinton, Madeline Guth, Jada Raphael, Sweta Haldar, and Robin Rudowitz from the Kaiser Family Foundation and by聽Kathleen Giff颅ord,聽Aimee Lashbrook, 补苍诲听Matt Wimmer聽from 红领巾瓜报; and Mike Nardone. The survey was conducted in collaboration with the National Association of Medicaid Directors (NAMD).

This survey reports on policies in place or planned for FY 2022 and FY 2023, including state experiences with policies adopted in response to the COVID-19 pandemic. The conclusions are based on information provided by the nation鈥檚 state Medicaid Directors.

Key Report Highlights

In the following sections, we highlight a few of the major findings from the reports. This is a fraction of what is covered in the 50-state survey reports, which include significant detail and findings on policy changes and initiatives related to delivery systems, health equity, benefits, telehealth, provider rates and taxes, and pharmacy. The reports also look at the opportunities, challenges, and priorities facing Medicaid programs.

Medicaid Enrollment and Spending Growth

The COVID-19 pandemic created significant implications for Medicaid. During this time, Medicaid enrollment has reached record highs due to the Families First Coronavirus Response Act (FFCRA), enacted in March 2020, which authorized a 6.2 percentage point increase in the federal match rate, or Federal Medical Assistance Percentage (FMAP), retroactive to January 1, 2020, and until the Public Health Emergency (PHE) ends. The increase was available to states that meet certain 鈥渕aintenance of eligibility鈥� (MOE) requirements. Since the survey, the PHE was extended to mid-January 2023, somewhat delaying the anticipated effects described in survey.

Medicaid enrollment growth slowed to 8.4 percent in FY 2022, after a sharp increase in FY 2021 (11.2 percent). Almost all responding states reported that the MOE continuous enrollment requirement was the most significant factor driving FY 2022 enrollment growth. Responding states expect Medicaid enrollment growth to decline (-0.4 percent) in FY 2023, based largely on the assumption that the PHE and the related MOE requirements would end by mid-FY 2023. States anticipate larger declines as Medicaid redeterminations and renewals resume.

In FY 2022, total Medicaid spending is expected to reach a peak growth of 12.5 percent, with enrollment growth as the primary driver. For FY 2023, total spending growth is expected to slow to 4.2 percent, assuming slower enrollment growth after the unwinding of the PHE. State Medicaid spending grew by 9.9 percent in FY 2022 and is projected to increase by 16.3 percent in FY 2023 once enhanced federal fiscal relief expires. If the PHE is extended, state spending increases and enrollment decreases that states anticipated for FY 2023 could occur later.

Figure 1 鈥� Percent Change in Medicaid Spending and Enrollment, FY 1998-23

SOURCE: FY 2022-2023 spending data and FY 2023 enrollment data are derived from the KFF survey of Medicaid officials in 50 states and DC conducted by 红领巾瓜报, October 2022. 49 states submitted survey responses by Oct. 2022; state response rates varied across questions. Historic data reflects growth across all 50 states and DC and comes from various sources.

Delivery Systems

  • Capitated managed care remains the predominant delivery system for Medicaid in most states. Forty-six states operated some form of Medicaid managed care (managed care organizations (MCOs) and/or primary care case management (PCCM)). Forty-one states contracted with risk-based MCOs. Of these, only Colorado and Nevada did not offer MCOs statewide. Only five states 鈥� Alaska, Connecticut, Maine, Vermont, and Wyoming 鈥� lacked a comprehensive Medicaid managed care model.
    • Thirty-four states, including Distrct of Columbia, operate MCOs only, five states operate PCCM programs only, and seven states operate both MCOs and a PCCM program.
    • Twenty-seven states contracted with one or more PHPs to provide Medicaid benefits, including behavioral health care, dental care, vision care, non-emergency medical transportation (NEMT), and long-term services and supports (LTSS).
  • Of the forty-one states that contracted with MCOs, 35 reported that 75 percent or more of their Medicaid beneficiaries were enrolled in MCOs as of July 1, 2022.

Figure 2 鈥� MCO Managed Care Penetration Rates for Select Groups of Medicaid Beneficiaries as of July 1, 2022

SOURCE: KFF survey of Medicaid officials in 50 states and DC conducted by 红领巾瓜报, October 2022.

Medicaid Managed Care and Delivery System Changes

  • California, Missouri, Nevada, New Jersey, and New York reported expanding mandatory MCO enrollment for targeted populations.
  • Missouri and Ohio reported introducing specialized managed care programs for children with complex needs.
  • California, Nevada, and Tennessee indicated that they were carving in certain long-term services and supports (LTSS) into their managed care programs.
  • California and Ohio reported carving out pharmacy services in FY 2022 or FY 2023, respectively. The District of Columbia carved out emergency medical transportation from its MCO contracts in FY 2022.
  • Maine, North Carolina, Oregon, and Washington reported changes to their PCCM programs.
  • Virginia plans to implement Cardinal Care in FY 2023, merging the state鈥檚 two existing managed care programs: Medallion 4.0 (serving children, pregnant individuals, and adults) and Commonwealth Coordinated Care Plus (CCC Plus) (serving seniors, children and adults with disabilities, and individuals who require LTSS).
  • Forty-one states reported at least one specified delivery system and payment reform initiative (e.g. Patient-Centered Medical Home (PCMH), ACA Health Homes, Accountable Care Organization (ACO), Episode of Care Initiatives, All-Payer Claims Database (APCD)).

Health Equity

  • Twenty-five states reported using at least one specified strategy to improve race, ethnicity, and language (REL) data completeness. Of the 45 responding states, 16 states reported requiring MCOs and other applicable contractors to collect REL data, 12 states reported that eligibility, renewal materials, and/or applications explain how REL data will be used and/or why reporting these data are important, nine states reported linking Medicaid enrollment data with public health department vital records data, and eight states reported partnering with one or more health information exchanges (HIEs) to obtain additional REL data for Medicaid enrollees.
  • Twelve of 44 responding states reported at least one financial incentive tied to health equity in place in FY 2022. The vast majority of these incentives were in place in managed care arrangements (11 of 13). Within managed care arrangements, states most commonly reported linking or planning to link capitation withholds, pay for performance incentives, and/or state-directed provider payments to health equity-related quality measures. Only two states (Connecticut and Minnesota), reported a FFS financial incentive in FY 2022. Five additional states report plans to implement financial incentives linked to health equity in FY 2023.
  • Sixteen of 37 responding MCO states reported at least one specified health equity MCO requirement in place in FY 2022. The number of MCO states with at least one specified health equity MCO requirement in place is expected to grow significantly in FY 2023, from 16 to 25 states. Examples of MCO requirements to address health equity include having a health equity plan, designating a Health Equity Officer, and staff training on health equity and/or implicit bias.

Figure 3 鈥� MCO Requirements to Address Health Equity, FYs 2022-23

SOURCE: KFF survey of Medicaid officials conducted by 红领巾瓜报, October 2022; n=37 states.

Benefits

  • Thirty-three states reported new or enhanced benefits in FY 2022 and 34 states are adding or enhancing benefits in FY 2023. Two states reported benefit cuts or limitations in FY 2022 and no states reported cuts or limitations in FY 2023.

Figure 4 鈥� Select Categories of Benefit Enhancements or Additions, FYs 2022-23

SOURCE: KFF survey of Medicaid officials conducted by 红领巾瓜报, October 2022; Arkansas and Georgia did not respond.

  • Behavioral Health Services. States reported service expansions across the behavioral health care continuum, including institutional, intensive, outpatient, home and community-based, and crisis services. States reported addressing SUD outcomes, including coverage of opioid treatment programs, peer supports, and enhanced care management. At least ten states are expanding coverage of crisis services, which aim to connect Medicaid enrollees experiencing behavioral health crises to appropriate community-based care, including mobile crisis response services and crisis stabilization centers.
  • Pregnancy and Postpartum Services. In April 2022, a temporary option under ARPA to extend Medicaid postpartum coverage from 60 days to 12 months took effect. In addition to the states that took advantage of this eligibility change, some states are enhancing coverage of pregnancy and post-partum services. Nine states (California, District of Columbia, Illinois, Maryland, Michigan, New Mexico, Nevada, Rhode Island, and Virginia) are adding coverage of services provided by doulas and seven states (Alabama, Delaware, Illinois, Maryland, Ohio, Oregon, and Vermont) are investing in the implementation or expansion of home visiting programs.
  • Preventive Services. Sixteen states reported expansions of preventive care in FY 2022 or FY 2023. For example, seven states are expanding services to prevent and/or manage diabetes, such as continuous glucose monitoring. Other reported preventive benefit enhancements relate to asthma services, vaccinations, and genetic testing and/or counseling.
  • Services Targeting Social Determinants of Health. Many states reported new and expanded benefits targeting social determinants of health. Twelve states reported new or expanded housing-related supports, as well as other services and programs tailored for individuals experiencing homelessness or at risk of being homeless.
  • Dental Services. Nine states are adding comprehensive adult dental coverage, while additional states report expanding specific dental services for adults.

Telehealth

  • Most states have or plan to adopt permanent Medicaid FFS telehealth expansions that will remain in place even after the pandemic, though some are considering guardrails on such policies. Nearly all responding states that contract MCOs reported that changes to FFS telehealth policies would also apply to MCOs.

Figure 5 鈥� Changes to FFS Medicaid Telehealth Policy, FY 2022 or FY 2023

SOURCE: KFF survey of Medicaid officials conducted by 红领巾瓜报, October 2022; n=48 states.

  • Nearly all responding states added or expanded audio-only telehealth coverage in Medicaid in response to the COVID-19 pandemic. Twenty-eight states reported that they newly added audio-only coverage while 19 states expanded existing coverage. Nearly all states reported audio-only coverage of mental health and substance use disorder (SUD) services. States least frequently reported audio-only coverage of home and community-based services (HCBS) and dental services. Two states (Mississippi and Wyoming) reported no coverage of audio-only telehealth for the services in question.
  • Telehealth utilization by Medicaid enrollees has been high during the pandemic but has decreased and/or leveled off more recently. States noted that telehealth utilization trends over time correspond to COVID-19 outbreaks, with higher utilization during COVID-19 surges and lower utilization when case counts are lower. In general, states reported that telehealth utilization was projected to continue at higher levels than before the pandemic, at least for some service categories.
  • Thirty-seven states (out of 47 responding) reported that behavioral health services were among those with the highest utilization. Additionally, a majority of states reported high utilization of evaluation and management (E/M) services and/or other physician/qualified health care professional office/outpatient services, including primary care.
  • States reported ACA expansion adults as one of the groups most likely to use telehealth (about one-third of responding states), followed by children and individuals with disabilities (each identified by about one-sixth of responding states).
  • Concerns regarding services delivered via telehealth included the quality of diagnoses, whether audio-only telehealth may be less effective, and inadequate access.
  • Key issues that may influence future Medicaid telehealth policy decisions include analysis of data, state legislation and federal guidance, and cost concerns.

Provider Rates and Taxes

  • In FY 2022, all 49 responding states reported implementing rate increases for at least one category of provider and 19 states reported implementing rate restrictions. In FY 2023, 48 states reported at least one planned rate increase and the number of states planning to restrict rates increased to 25 states.
  • States reported rate increases for nursing facilities and home and community-based services (HCBS) providers more often than other provider categories. The survey also found an increased focus on dental rates with about half of reporting states (20 in FY 2022 and 25 in FY 2023) reporting implementing or plans to implement a dental rate increase

Figure 6 鈥� FFS Provider Rate Changes Implemented in FY 2022 and Adopted for FY 2023

SOURCE: KFF survey of Medicaid officials in 50 states and DC conducted by 红领巾瓜报, October 2022.

  • States continue to rely on provider taxes and fees to fund a portion of the non-federal share of Medicaid costs. All states but Alaska have at least one provider tax or fee in place. Thirty-eight states had three or more provider taxes in place in FY 2022 and eight other states had two provider taxes in place.
  • The most common Medicaid provider taxes in place in FY 2022 were taxes on nursing facilities (46 states), followed by taxes on hospitals (44 states), intermediate care facilities for individuals with intellectual disabilities (33 states), and MCOs (18 states).
  • Three states (Alabama, Mississippi, and Wyoming) reported plans to add new ambulance taxes in FY 2023.

Pharmacy

  • Most states that contract with MCOs report that the pharmacy benefit is carved into managed care (34 out of 41 states that contract with MCOs). Six states (California, Missouri, North Dakota, Tennessee, Wisconsin, and West Virginia) report that pharmacy benefits are carved out of MCO contracts as of July 1, 2022. California was the latest to carve out pharmacy benefits as of January 1, 2022. Two states (New York and Ohio) report plans to carve out pharmacy from MCO contracts in state FY 2023 or later.
  • In FY 2022, Kentucky began contracting with a single PBM for the managed care population. Louisiana and Mississippi report that they will require MCOs to contract with a single PBM designated by the state in FY 2023 and FY 2024, respectively.
  • Seven states (Alabama, Arizona, Colorado, Massachusetts, Michigan, Oklahoma, and Washington) have value-based arrangements (VBAs) in place with one or more drug manufacturers.
  • More than half of responding states reported newly implementing or expanding at least one initiative to contain prescription drug costs in FY 2022 or FY 2023.
  • Six states (Florida, Kentucky, Massachusetts, Maryland, Nebraska, Nevada) reported recently implemented or planned policies to prohibit spread pricing or require pass through pricing in MCO contracts with PBMs.

Key Opportunities, Challenges, and Priorities in FY 2023 and Beyond

When asked to identify the top challenges for FY 2023 and beyond, Medicaid directors listed the following:

  • The unwinding of PHE emergency measures and the resumption of redeterminations.
  • Expiration of emergency authorities.
  • Lasting focus on COVID-19, including vaccinations, long-COVID, decreased utilization of preventive care services, and future emergency preparedness.

Medicaid directors stated that future priorities shaped by COVID-19 include:

  • Health equity.
  • Specific populations and service categories, including behavioral health, long-term services and supports, and maternal and child health.
  • Health care workforce challenges.
  • Payment and delivery system initiatives and operations.
  • IT system modernization.
  • Social determinants of health.

Medicaid directors note that COVID-19 has presented both new opportunities and challenges and has also shifted and shaped ongoing Medicaid priorities.

Links to Kaiser/红领巾瓜报 50-State Survey Reports

Brief & Report

System integration across child welfare, behavioral health, and Medicaid

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Children and families involved in the behavioral health and child welfare systems are often the most vulnerable and in need of intensive supports. Fragmented systems of care across child welfare, behavioral health, and Medicaid often cause families 鈥渢o fall through the cracks,鈥� leading to increased use of high-cost services that separate families and results in poorer outcomes.聽 These siloed approaches perpetuate and exacerbate trauma to children and families. In the second in a series of briefs focused on enhancing the youth behavioral health system, the 红领巾瓜报 team of Uma Ahluwalia, Caitlin Thomas-Henkel, Roxanne Kennedy, and Courtney Thompson propose four core design elements 鈥� and related KPIs 鈥� for establishing a high-functioning integrated system of care for children, youth, and their families, child welfare, Medicaid, and behavioral health systems.

Blog

SAMHSA releases CCBHC planning grants opportunity for states

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Today, the Substance Abuse and Mental Health Services Administration (SAMHSA) released the highly anticipated Cooperative Agreements for Certified Community Behavioral Health Clinic (CCBHC) Planning Grants Notice of Funding Opportunity (NOFO). .

The CCBHC model provides integrated and coordinated community-based care for individuals across the lifespan with and at risk for behavioral health conditions, with a focus on adults with serious mental illness, those with any mental illness, children with serious emotional disturbance, and those with substance use disorders. The model is designed to increase access to behavioral health services; provide a comprehensive range of services, including crisis services, that respond to local needs; incorporate evidence-based practices; and establish care coordination as a linchpin for service delivery. To date, CCBHCs have demonstrated[1]:

  • Significant reductions in client hospitalizations
  • Increased access to high quality community-based care, including services like Medication Assisted Treatment and care coordination
  • Reduced impact of the mental health and substance use care workforce shortage
  • Innovative and strengthened partnerships with cross-system partners, including law enforcement, schools, and hospitals

About the Planning Grants

These CCBHC Planning Grants are established to support states to develop and implement certification systems for CCBHCs, establish Prospective Payment Systems (PPS) for Medicaid reimbursable services, and prepare an application to participate in a four-year CCBHC Demonstration program. Through this opportunity, SAMHSA anticipates making 15 Planning Grant awards of up to $1 million per award. Awarded states will have 12 months to use their Planning Grant dollars to accomplish the following:

  • Solicit input for the development of a state CCBHC Demonstration program from consumers (including youth), family members, providers, tribes, and other key stakeholders.
  • Create and finalize application processes and review procedures for clinics to be certified as CCBHCs.
  • Assist clinics with meeting certification standards by:
    • facilitating access to training and technical assistance;
    • providing workforce supports, including assisting CCBHCs to improve the cultural diversity and competence of their workforce; and
    • facilitating cultural, procedural, and organizational changes to CCBHCs that will result in the delivery of high quality, comprehensive, person-centered, and evidence-based services that are accessible to the population(s) of focus.
  • Certify an initial set of clinics as CCBHCs, including those that represent diverse geographic areas, including rural and underserved areas. As an option, states can also develop a process for bringing additional clinics into the State CCBHC Demonstration program to reach the desired geographic spread by the end of the four-year CCBHC Demonstration.
  • Establish a PPS for behavioral health services furnished by a CCBHC in accordance with the original PPS Methodology Guidelines developed by CMS. A statement indicating that the State agrees to pay for services at the rate established under the PPS during the CCBHC. Demonstration program must be attached with the application.
  • Develop or enhance statewide data collection and reporting capacity.
  • Submit a proposal to participate in the CCBHC Demonstration Program no later than March 20, 2024.

The Planning Grant project period is anticipated to begin on March 30, 2023. As a Cooperative Agreement, SAMHSA anticipates having substantial federal programmatic participation, including providing input to selected states in the planning, implementation, and evaluation of the program.

These planning grants are the first phase of a two-phase process of the expansion of the CCBHC Demonstration, authorized by the Bipartisan Safer Communities Act.[2] Beginning July 1, 2024, and every two years thereafter, 10 states that have completed planning grants and submitted successful applications to participate in the CCBHC Demonstration will be eligible to join the program for a four-year period.

Eligibility to Apply

Eligibility for this Planning Grant opportunity is limited to the State Mental Health Authorities, Single State Agencies, or State Medicaid Agencies that are located in the 41 states, including the District of Columbia, that were not previously selected to participate in the CCBHC Demonstration Program. Regardless of which state entity ultimately serves as the applicant, each application must include a signed Memorandum of Agreement between the Director of the State Mental Health Authority, the Director of the Single State Agency, and the Director of the State Medicaid Agency demonstrating a partnership to fulfill the requirements of the award.

Updates to CCBHC Certification Criteria and PPS Guidance Expected but Not Before Application Deadline

Updates are expected to both the CCBHC Certification Criteria and PPS Guidance in the coming months, but the NOFO is clear that these updates will not be available during the application period for these Planning Grants. Specifically:

  • SAMHSA is in the process of updating the CCBHC Certification Criteria through a process which will include a significant opportunity for public comment. SAMHSA intends to keep the existing framework for the criteria, which is included in the authorizing statute. SAMHSA does not intend to make major changes to the scope and shape of the Certification Criteria.
  • CMS is also working to update the CCBHC PPS guidance. Any PPS changes will be made available prior to the planning grant execution period and included as part of technical assistance provided to states during the planning grant execution period.

Because neither of these updates will be released prior to the application submission deadline, applicants will use the existing and to inform their applications.

Next Steps for Interested State Stakeholders

Applications for this opportunity are due December 19, 2022 at 11:59 pm. Each application will be scored on their 30-page narrative submission, which includes significant emphasis on each applicant鈥檚 approach to CCBHC planning (including both certifying CCBHCs and establishing the PPS rates) and the state鈥檚 experience with the model to date (including the steps already taken to develop a CCBHC program in their state).

红领巾瓜报 and the National Council for Mental Wellbeing will host a joint webinar about this NOFO on Monday, November 7, 2022 at 1-2 pm ET.

In addition, in anticipation to the NOFO鈥檚 release, 红领巾瓜报 and the National Council hosted a webinar on October 6, 2022, on 鈥淒eveloping a Strategy for the CCBHC State Demonstration RFP.鈥� During this webinar, we engaged representatives from New York and Michigan to share information about their Demonstration program implementation to date.

[1]

[2]

Webinar

Webinar replay: state strategies for the certified community behavioral health clinic demonstration planning grant opportunity

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This webinar was held on November 7, 2022.

The Bipartisan Safer Communities Act offers new funding for states to develop a Certified Community Behavioral Health Clinic (CCBHC) Demonstration program. A new (NOFO) for states has just been released with a deadline of Monday December 19, 2022. During this webinar 鈥� a follow up to our October 6 webinar 鈥� experts from 红领巾瓜报 and the National Council for Mental Wellbeing provided an overview of the CCBHC Demonstration program NOFO, offered strategies for using CCBHC as a strategic transformational opportunity for systems improvement, reviewed the NOFO requirements and key changes from previous opportunities, and outline strategies for developing a successful response.

Learning Objectives

  • Review requirements of the new CCBHC Demonstration Planning NOFO for states and how it varies from previous efforts.
  • Understand the importance of aligning the CCBHC model within a larger state behavioral health and integrated care strategy.
  • Learn key considerations for states in responding to the opportunity and steps to improve the quality of a response.

Speakers

Kristan McIntosh, Principal,聽红领巾瓜报

Heidi Arthur,听笔谤颈苍肠颈辫补濒,听贬惭础

Josh Rubin,听笔谤颈苍肠颈辫补濒,听贬惭础

,聽Senior Advisor, Public Policy and Special Initiatives,聽National Council for Mental Wellbeing

 

Did You Miss Part 1 of our CCBHC Planning Grant Webinar Series?

In case you missed it, experts from 红领巾瓜报 and the National Council for Mental Wellbeing were joined by state leaders from New York and Michigan (two current CCBHC Demonstration states) for a pre-NOFO release discussion on October 6, 2022. During this prior webinar, we shared lessons learned and strategies states have used to successfully plan for the CCBHC Demonstration Program and leverage the CCBHC initiative as a transformation opportunity that can help behavioral health care systems achieve their broader health quality and access goals. The recording, slide deck, and an associated Q&A document from that previous session can be found here.

Webinar

Webinar replay: equity-centered approaches to supporting community prevention and treatment

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This webinar was held on November 15, 2022.聽

Deeply rooted structures, systems, and beliefs have perpetuated racial inequities within substance use and mental health treatment and recovery settings. Racism and associated traumas add to these injustices and may influence how people of color experience and seek help for behavioral health needs. During this webinar, hear from community-based practitioners, who are leveraging evidence-based practices centered in equity, to provide support to our most vulnerable through harm reduction, overdose prevention and linkage to community treatment services.

Learning Objectives

  • Learn about the importance of centering your approaches in equity.
  • Obtain concrete examples of specific equity practices for harm reduction and overdose prevention.
  • Develop an understanding of national efforts that can support prevention in communities, driven by communities.

Speakers

, MD, Attending Physician, Behavioral Health, Department of Family and Community Medicine and Center for Health Equity and Innovation, Cook County Health
Rashad Saafir, PhD, President, CEO, Bobby E Wright Comprehensive Behavioral Health Center

Moderators

Michelle Ford, Principal, 红领巾瓜报
Leticia Reyes-Nash, Principal, 红领巾瓜报

Webinar

Webinar replay: collaborating with faith-based organizations on reducing overdose deaths and addressing stigma

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This webinar was held on November 8, 2022.

Substance and opioid use disorders (S/OUD) affect people from all walks of life, including those active in faith communities. Yet many faith leaders do not know how to effectively support members of their congregations and their families who are struggling with these diseases. Faith groups and faith leaders from all denominations can be critical allies in addressing the stigma of S/OUD and building safe, compassionate spaces for individuals to get spiritual support along with the physical, mental, and emotional help they need to recover from S/OUD.

Presenters led participants through the myths and facts about S/OUD most relevant to faith communities and how to create faith-based prevention initiatives that can work in collaboration with other state S/OUD prevention and harm reduction strategies.

Learning Objectives

  • Find out how Faith-based Organizations (FBOs) can play an important role in helping individuals and families affected by S/OUD.
  • Learn how to encourage collaboration between faith communities and systems of care.
  • Understand key myths and facts related to S/OUD to share with FBOs.
  • Learn how to help FBO start prevention and harm reduction strategies in their communities.
  • Find out how to leverage FBOs to expand education about SUD and reduce stigma.

Speakers
, West Tennessee Faith-Based Community Coordinator with the Tennessee Department of Mental Health & Substance Abuse Services
Ana Bueno, Senior Associate, 红领巾瓜报
Stephanie Denning, Principal, 红领巾瓜报

Related Video

Webinar

Webinar replay: industry-specific outreach and education for reducing overdose deaths

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This webinar was held on October 25, 2022.聽

Industry stakeholders are non-traditional partners who can be effective in supporting and expanding opioid overdose prevention efforts. During this webinar, attendees heard about one state鈥檚 experience using data to identify and target stakeholders in high-risk industries, including construction and food services. We shared a framework for industry-specific prevention efforts鈥攊ncluding use of data; identification of key partners; engagement strategies, and education; stigma reduction, and harm reduction activities鈥攖hat other locales can adapt and integrate into their overall opioid prevention and response strategies. In addition, we identified possible funding opportunities to support this type of effort.

Learning Objectives

  • Learn about effective ways to build non-traditional, industry-specific partnerships to support communities to reduce overdose deaths.
  • Understand how data can help target and engage stakeholders in outreach, education, stigma reduction, and harm reduction.
  • Obtain concrete examples of industry-specific engagement and education activities that have been impactful in the restaurant and construction industries.

Speakers

, Director, Office of Health Crisis Response, Delaware Department of Health and Social Services Division of Public Health
Mayur Chandriani, Associate, 红领巾瓜报
Kristan McIntosh, Principal, 红领巾瓜报

Blog

Funding and strategies to address the youth behavioral health crisis

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Communities across the country are seeing elevated numbers of adolescents in the Emergency Department due to suicide attempts, self-harm, anxiety, depression, substance use disorder (SUD), and overdose. While this youth mental health crisis predates COVID, it has been greatly exacerbated by the pandemic. According to the Centers for Disease Control and Prevention (CDC), in 2019, 13% of adolescents reported having a major depressive episode, a 60% increase from 2007, and suicide rates rose nearly 60% for youth ages 10 to 24 by 2018[1]. Then it got worse. Last December, the U.S. surgeon general issued a as emergency room visits due to suicide attempts rose 51% for adolescent girls in early 2021, compared to the same period in 2019. For boys, the increase was 4%[2].

The surgeon general recommends a 鈥渨hole-of-society effort,鈥� including a focus on mental health education and prevention, early identification, and access to high-quality mental healthcare.[3] School-based intervention is ideal because only 20% of students in need of more intensive services typically receive needed care when referred to external providers.[4]

The Bipartisan Safer Communities Act has committed $1.7 billion for mental health support in schools and communities via an array of methods including grant programs. The following programs are currently available for a wide array of eligible entities, including states, cities/counties, Local Education Agencies (LEAs), Indian tribes or tribal organizations, health facilities, and nonprofit entities:

  • .  This grant program provides up to $1.8 million per year for up to 4 years to develop a sustainable infrastructure for school-based mental health programs and services. Grant recipients are expected to build collaborative partnerships with the State Education Agency (SEA), LEA), Tribal Education Agency (TEA), the State Mental Health Agency (SMHA), community-based providers of behavioral health care services, school personnel, community organizations, families, and school-aged youth. Grant recipients will leverage their partnerships to implement mental health-related promotion, awareness, prevention, intervention, and resilience activities to ensure that students have access to and are connected to appropriate and effective behavioral health services.  Applications are due October 13th.
  • (ReCAST). This program provides up to $1,000,000 a year for up to 4 years to promote resilience, trauma-informed approaches, and equity in communities that have recently faced civil unrest, community violence, and/or collective trauma within the past 24 months; and to assist high-risk youth and families through the implementation of evidence-based violence prevention, and community youth engagement programs. SAMHSA expects ReCAST to be guided by a community-based coalition of residents, non-profit organizations, and other entities (e.g., health and human service providers, schools, institutions of higher education, faith-based organizations, businesses, state and local government, law enforcement, and employment, housing, and transportation services agencies). Applications are due October 17th. 

In addition to these two grants, there will be an expansion of the Certified Community Behavioral Health Center (CCBHC) Demonstration for States that is expected to be released later this month. The Excellence in Mental Health Act[5] established a federal definition and criteria for CCBHCs. These centers are a provider type that delivers a comprehensive range of mental health and SUD services to vulnerable individuals. They meet people where they are, which can include school-based services, and act as a critical partner in ensuring people have access to quality, affordable, and accessible mental health care.

School-based Mental Health Services

School-based mental health services, delivered within a Multi-Tiered System of Supports (MTSS) framework, can be supported by the aforementioned funding opportunities. The MTSS framework is currently used in public schools to target services and supports to students. As shown below, MTSS addresses universal prevention and progressively targeted support for students and families. It also aligns well with partnerships with community providers to establish an authentic community response that addresses the continuum of mental health needs.

Multi-Tiered System of Supports (MTSS) framework

The key to a successfully implemented MTSS framework is a strong partnership between the school staff, parents/guardians, children, and community partners. This partnership works well when anchored to an evidence-based socio-emotional curriculum that is reinforced across all Tiers and familiar to all parties.

Suicide and Self Harm Prevention

Dialectical Behavioral Therapy (DBT) was recently identified by the New York Times as because it is one of the only interventions found to reduce self-harm and suicidal ideation, its effects are maintained at one-year follow-up[6], and it successfully engages young people[7].

Curriculum developers Drs. Lizz Dexter-Mazza and James Mazza worked with Marsha Linehan, the DBT treatment developer, to adapt DBT Skills into a universal school-based social emotional learning curriculum, called . This approach is designed to help schools intervene and support well-being and resiliency before kids are suicidal or self-harming. It trains existing school personnel to integrate skill-building into the school program, universally or as a stand-alone option for youth in 6-12th grade (an elementary version is in development). As such, it is a viable approach, despite the current shortage of mental health care professionals in school-based settings.

In addition, DBT provides a shared language and strategies across all three MTSS tiers so that everyone (students, school staff, teachers, providers, and parents/guardians) can benefit. Because DBT is also commonly provided in inpatient, outpatient, and residential behavioral health programs, the value of extending this approach into school settings is further magnified for youth who transition from the highest levels of care.

A DBT STEPS-A program taught at the universal level provides the broadest application within school-based settings, supports uptake that leads to peer-to-peer coaching and support, along with shifting the school environment and culture to promote mental wellbeing and reinforce the skills via a shared language and common strategies. In Tier 2, students are supported to practice skills and decision-making strategies in smaller group or individual psychotherapy sessions as needed. The third tier is more intensive support for students experiencing ongoing emotional and behavioral difficulties for whom Tier 2鈥搇evel support is not sufficient. It is designed to supplement individual psychotherapy for those in need of a higher level of care. Parent/guardian skills-training seminars are recommended, so they can learn about the skills their child is acquiring and how best to support them while they are practicing. Engaging parents/guardians proactively helps to increase adaption of the skills across both home and school contexts.

A matched sample of adolescents who received the DBT STEPS-A curriculum demonstrated lower scores on the BASC-2 Emotion Symptom Index and on the BASC-2 Internalizing Problems, indicating fewer mental health difficulties, compared to peers who did not receive the curriculum (Cohen鈥檚 F squared equal to 0.65 and 0.83, respectively[8].

The DBT curriculum is accessible via a . All handouts for kids are available in English and Spanish and can be printed from a web-based link for free. An are available to support rapid school-based service delivery.

To learn more about current and upcoming funding for enhanced school and community-based mental health care or DBT-STEPS-A, contact our experts below.

You can also contact DBT in Schools, LLC for information about DBT-STEPS-A [email protected].

[1] National Vital Statistics reports – Centers for Disease Control and … (n.d.). Retrieved from https://www.cdc.gov/nchs/data/nvsr/nvsr69/nvsr-69-11-508.pdf

[2] Richtel, M. (2021, December 7). Surgeon general warns of Youth Mental Health Crisis. The New York Times. Retrieved from https://www.nytimes.com/2021/12/07/science/pandemic-adolescents-depression-anxiety.html

[3] Protecting youth mental health – hhs.gov. (n.d.). Retrieved from https://www.hhs.gov/sites/default/files/surgeon-general-youth-mental-health-advisory.pdf

[4] Sheryl H. Kataoka, M.D., M.S.H.S., Lily Zhang, M.S., and Kenneth B. Wells, M.D., M.P.H. (2002). Unmet Need for Mental Health Care Among U.S. Children: Variation by Ethnicity and Insurance Status.

[5] Excellence in Mental Health Act. (2013, February 7). http://www.congress.gov/

[6] McCauley E, Berk MS, Asarnow JR, et al. JAMA Psychiatry. 2018;75(8):777鈥�785. doi:10.1001/jamapsychiatry.2018.1109

[7] Rathus, Jill H. ( 2014). DBT skills manual for adolescents. New York :The Guilford Press,

[8] Elizabeth T. Dexter-Mazza, James J. Mazza, Alec L. Miller, Kelly Graling, Elizabeth Courtney-Seidler, and Dawn Cattuchi (2022). Application of DBT in a School-Based Setting. Pending publication

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Webinar replay: community response teams- reducing overdose deaths and addressing stigma

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This webinar was held on October 18, 2022.聽

Community Response Teams are vital cross-sector, data driven, community-based collective action initiatives that address the local opioid crisis through harm reduction education, Naloxone distribution, and data. During this webinar, 红领巾瓜报 speakers addressed the rationale, framework, funding, and implementation of successful initiatives that serve as models for other states, including case studies from California and Delaware.

Learning Objectives

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John O鈥機onnor, Managing Director

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Don鈥檛 miss other webinars in this series, which will address:

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  • The CCBHC Demonstration opportunity and what the evidence for the model demonstrates
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Join us to:

  • Garner strategies and approaches for successfully winning grant dollars
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