Early Intervention in Behavioral Health National Association of Medicaid Directors Fall Conference Jennifer Vermeer | President and CEO | University of Iowa Health Alliance

Medicaid’s significant role in behavioral health % % Mental Health Spending In 2014, Medicaid funded: Medicaid spend on enrollees with behavioral health conditions % Addiction Spending Average Medicaid spend for those with mental health condition is 4x as much as for other enrollees Challenges such as workforce shortages and access limitations can impede receiving behavioral health services. Medicaid’s Role in Behavioral Health May 05, 2017 https://www.kff.org/infographic/medicaids-role-in-behavioral-health/

Medicaid as an innovator Traditional health coverage and fee-for-service reimbursement have historically created barriers to innovation, coverage and funding. Many states are using ACA options such as: Health Home allows states to provide comprehensive care coordination for members with chronic conditions 1915(i) allows states to provide home and community based services to specific populations Money Follows the Person Grants helps support individuals transitioning from institutions to the community. Medicaid’s Role in Financing Behavioral Health Services for Low-Income Individuals Jun 29, 2017 https://www.kff.org/medicaid/issue-brief/medicaids-role-in-financing-behavioral-health-services-for-low-income-individuals/

Benefits of early intervention One in five children have a mental illness or disorder Of children ages 12 – 17 only one in five receive treatment or counseling When left untreated these disorders can lead to substance abuse, school drop out, involvement with law enforcement, and suicide – lifelong consequences. 70.4% of youth in Juvenile Justice system have been diagnosed mental health disorder High risk youth cost society $1.2-2M each in rehabilitation, incarceration, and costs to victims https://www.aacap.org/App_Themes/AACAP/docs/resource_centers/resources/fact_sheets/Cost_Effectiveness_Fact_Sheet_2011.pdf

Early intervention strategies Trauma Informed Care (TIC): Growing body of research shows that experiencing traumatic events raises risk of long-term physical and behavioral health issues Links between Adverse Childhood Events (ACEs) and lifelong health problems such as chronic lung and heart diseases, liver disease, autoimmune disease, sexually transmitted infections, depression and other mental health conditions Early Intervention in Psychosis – Research indicates treating psychosis as early as possible after symptoms appear increases likelihood of recovery. First five years after onset appears to be a critical period when symptoms are more responsive to treatment. Examples of trauma: Observing or experiencing physical, sexual emotional abuse Childhood neglect Having family member with MH SA disorder Experiencing or witnessing community violence Natural or human made disasters Sudden unexplained separation from loved one War or terrorism Poverty, discrimination, and historical trauma Trauma overwhelms a person’s coping capacity and has long term effects on functioning and well-being. http://www.chcs.org/media/understanding-trauma-fact-sheet_071217.pdf https://www.earlypsychosis.ca/pages/curious/early-intervention

Iowa & Trauma Informed Care (TIC) Iowa Department of Human Services utilizes it’s SAMHSA grant to help support a number of TIC related programming including training targeting suicide risk, co-occurring substance abuse and mental health disorders. Agencies receiving funds include: Judiciary Courts State of Iowa Community Providers Department of Public Health Iowa Medicaid has been working to develop new payment codes including a code to reimburse for TIC provider training. Medicaid’s Role in Behavioral Health May 05, 2017 https://www.kff.org/infographic/medicaids-role-in-behavioral-health/

Iowa & Trauma Informed Care (TIC) Iowa Department of Education has developed trauma informed care training within its Early Access Program for children 0-3. Focused training on trauma and brain development Iowa’s Educational system, and Judicial system, both are exploring additional ways of imbedding mental health trauma informed care within their programs. The majority of youth involved with the juvenile justice system have experienced traumatic events, with at least 75 percent having experienced traumatic victimization (Sprague, 2008). A recent study of youth in detention found that over 90 percent of youth had experienced at least one trauma, 84 percent experienced more than one trauma, and over 55 percent reported being exposed to trauma six or more times (Abram et al., 2013). Medicaid’s Role in Behavioral Health May 05, 2017 https://www.kff.org/infographic/medicaids-role-in-behavioral-health/

Iowa & Trauma Informed Care – Provider Work Resmiye Oral, MD, Pediatrician University of Iowa (UI) Health Care and Director of the Iowa Child Protection Center is leading implementation of TIC at UI Health Care. Dr. Oral is leading efforts to imbed TIC training within specific care clinics that have high rates of patients with adverse childhood experiences (ACES)/trauma ---obesity, burn and diabetes. Dr. Oral has focused her work on the under-diagnosis of children impacted by (ACES)/trauma. Orchard Place, a not-for-profit organization located in Des Moines, IA is leading a group of community partners in The Trauma Informed Care Project The project is providing education/training on current research and practice trends by brining national speakers to Iowa. Local and regional initiatives are also highlighted to demonstrate how organizations can implement trauma informed practices throughout the larger system. Medicaid’s Role in Behavioral Health May 05, 2017 https://www.kff.org/infographic/medicaids-role-in-behavioral-health/

Behavioral Health Panel David Simnitt, Oregon State Medicaid Director Dr. Laine Young-Walker, MD. Psychiatry, Associate Professor of Psychiatry at University of Missouri Health Dr. Susan Azrin, PhD. Clinical Psychology Program Chief at National Institute of Mental Health