1. Idaho BGTWG Panel Presentation: Response to Key Questions Carol Bianco Advocates for Human Potential, Inc. Albany, NY cbianco@ahpnet.com

2. Panel Questions/Responses What are your thoughts respective to when and how to integrate substance use and mental health from a structural perspective? Structural integration has limited impact without major changes at the agency and program levels. Use the Four Quadrant framework to map each regional system. Develop a plan for routine and standard screening and assessment. Assess Dual Diagnosis capability in all BH programs – use existing tools (COMPASS, CODECAT, DDCAT, DDCMHT). Use results to develop training schedules and learning collaboratives.

3. Panel Questions/Responses  What oversight structure would you recommend to sustain our transformation? Consistency and commitment are key. Members of TWG should have a clear stake (resources or personal) in success, be actively invested in one or more key transformation initiatives. Should have substantial consumer, family, provider, and local representation on the TWG and through committees, work groups, etc. Must have trusted and empowered leader who is supported by experienced and skilled staff. Must provide political cover – transformation requires boldness and risk-taking, and mistakes

4. Panel Questions/Responses What systems and structures must be in place in order to implement an outcome-based/managed care system? Strong state leadership with clear quality and performance standards Locally-driven priorities, plans, and flexible resources to create incentives for innovation. Simplified intake/access structures and processes, information sharing among providers Clear and accessible information for Consumers & families Empowered, independent care managers Real-time consumer feedback on quality of services  See Scott Miller www.talkingcure.com session rating scalewww.talkingcure.com

5. Panel Questions/Responses  What experience can you share/advice can you provide regarding managing for quality assurance and accountability? Measure progress frequently and visibly  track changes,  analyze outliers (good and bad),  communicate lessons learned,  course correct promptly Monitor practice fidelity, incorporate into compliance or credentialing standards Assess System and Program Recovery Orientation  Recovery Oriented System Indicators (ROSI)  Recovery Enhancing Environments (REE)

6. Panel Questions/Responses  What specific recommendations do you have regarding the elements of our draft approach, and what specific steps would you take to implement those recommendations? One person-centered treatment plan should include all services in the network (See Michigan’s PCP model used by county MBHOs) Core service definitions are fairly comprehensive - consider also:  Specialized services for co-occurring disorders, as well as co- occurring capability throughout the system  Psychiatric Rehabilitation  Age Specific services, especially older adults, transition-age youth  Health and Wellness promotion  Personal Assistance Services (Aging and disability model)

7. Panel Questions/Responses Service Recommendations continued  Illness Management and Recovery – adopt EBP Toolkit and implement systematically with fidelity.  Medication Management – incorporate Shared Decision-Making approaches adapted from general medicine. See upcoming SAMHSA Medication Decision Aid or Pat Deegan’s Common Ground web-based shared decision-making software  Peer support – can be Medicaid reimbursable  Include Respite as core service (not optional under early intervention)  Psychotherapy – promote use of evidence based approaches  Supported Housing – use rehab option to fund support and housing retention services. Create bridge subsidy to move people out of group homes. See upcoming SAMHSA toolkit on Supportive Housing  Supported Employment – leverage VR and WIA funds for short term customized employment – Medicaid rehab option for follow-along support

8. Panel Questions/Responses  The underlying goal of all this work is to better and more effectively serve people. How do we assure our collective efforts are moving toward that end? Focus on both process and outcomes - set goals and measure both Identify a few key metrics of successful outcomes  Go beyond “absence of …(symptoms, crises) to measurable quality of life and recovery indicators (eg. employment and income, housing stability, graduation rates, aging in place)  Align incentives with metrics  Use existing data sources whenever possible to reduce reporting burden See WA TSIG evaluation: Measures of Statewide performance created by TWG (Eric Bruns)

9. Parting thoughts  Make the business case for transformation  Show the human face of transformation  Describe, disseminate, replicate and go to scale with successes quickly (before you lose momentum or priorities shift)  Honor the past while building the future