Division of Behavioral Health and Recovery State of Washington Department of Social and Health Services Behavioral Health Services Integration Administration Division of Behavioral Health and Recovery Washington State Department of Social & Health Services

Washington State Department of Social & Health Services Presenters Amie Roberts, CPM, LMHC Mental Health Program Administrator, DBHR Robera@dshs.wa.gov 360-725-3813 Melena Thompson Regional Support Network Oversight Manager, DBHR thompml2@dshs.wa.gov 360-725-3758 Washington State Department of Social & Health Services

What is a Recovery Support Service and How can I provide any of them at my agency? Become a Licensed Behavioral Health Agency http://www.dshs.wa.gov/dbhr/CertLicensing.shtml Washington State Department of Social & Health Services

Behavioral Health Agency Mental Health Services Outpatient Services Crisis Services Recovery Support Services Chemical Dependency Services Problem Gambling Services Washington State Department of Social & Health Services

Mental Health Services Personnel requirements, credentials, training, background checks, job descriptions, etc. Facility and Quality Management requirements. Services are provided by, or under the supervision of a mental health professional. Initial Assessments Individual Service Plans Clinical Record Content and Documentation * See Appendix B Washington State Department of Social & Health Services

BEHAVIORAL HEALTH AGENCY WAC 388-877 Mental Health Services WAC 388-877A Outpatient Services Individual Therapy Brief Therapy Group Therapy Family Therapy Case Management Psychiatric Medication Day Support Less Restrictive Alternative Residential Treatment Washington State Department of Social & Health Services

BEHAVIORAL HEALTH AGENCY WAC 388-877 Mental Health Services WAC 388-877A Crisis Services Crisis Telephone Support Crisis Outreach Crisis Stabilization Crisis Peer Support Emergency Involuntary Detention Washington State Department of Social & Health Services

BEHAVIORAL HEALTH AGENCY WAC 388-877 Mental Health Services WAC 388-877A Recovery Support Services Requiring Program Specific Certification Employment * Peer Support * Wraparound Facilitation Medication Support * Applied Behavior Analysis Washington State Department of Social & Health Services

Washington State Department of Social & Health Services Employment Services * These services assist in training, job search, and placement services in order to help individuals find competitive jobs in their local communities. Vocational assessment Individualized job plan Assist in finding job opportunities Document coaching, outreach and support Educate employer about ADA * See Appendices C and D Washington State Department of Social & Health Services

Peer Support Services * If you become an agency that provides peer counseling, you must ensure the peer counselor: Is qualified (has attended the training and passed the test) Is supervised by a mental health professional Practicing within their scope of training and credential (from Department of Health) Receives annual training relevant to their unique work environment * See Appendices A, E, F, G and H Washington State Department of Social & Health Services

Medication Support Services * When providing medication support services, you must either… Also be certified to provide psychiatric medication services, or Have an agreement with another licensed behavioral health agency who provides psychiatric medication services. Observe and encourage medication compliance Communicate compliance with psych/med agency Can take place at any location (clinically necessary) * See Appendices I, J, K, L, M, and N Washington State Department of Social & Health Services

“Two roads diverged in a yellow wood…” OPTION 1 ONLY provide the recovery support service(s) and have an AGREEMENT with another BHA who provides an outpatient service OPTION 2 Provide a recovery support service(s) AND an outpatient service at your agency Outpatient Services Individual Therapy Brief Therapy Group Therapy Family Therapy Case Management Either way, to provide a Recovery Support Service, your agency MUST BE licensed as a Behavioral Health Agency (WAC 388-877) Washington State Department of Social & Health Services

Washington State Department of Social & Health Services OPTION 1 ONLY provide the recovery support service(s) and have an AGREEMENT with another BHA who provides an outpatient service Option 1 The agreement must specify: The responsibility for initial assessments, The determination of appropriate services, Individual service planning, and The documentation of these requirements. Washington State Department of Social & Health Services

Washington State Department of Social & Health Services Option 1 Con’t When providing any recovery support service requiring program-specific certification, an agency must: Have an assessment process to determine the appropriateness of the agency's services, based on the individual's needs and goals. Refer an individual to a more intensive level of care when appropriate. With the consent of the individual, include the individual's family members, significant others, and other relevant treatment providers, as necessary to provide support to the individual. Washington State Department of Social & Health Services

Washington State Department of Social & Health Services Option 1 Checklist Meet the Behavioral Health Agency requirements in WAC 388-877 Submit an application to DBHR with all required documentation specified on the application Submit policies and procedures to DBHR for WAC 388-877 and the recovery support service(s) for which you seek certification, found in WAC 388-877A-Section 3 Submit the AGREEMENT your agency has with another BHA that specifies: The responsibility for initial assessments, The determination of appropriate services, Individual service planning, and The documentation of these requirements. Washington State Department of Social & Health Services

Washington State Department of Social & Health Services OPTION 2 Provide a recovery support service(s) AND an outpatient service at your agency Option 2 In addition to the Recovery Support Service(s), your agency also provides one or more: Individual Therapy Brief Intervention Treatment Group Therapy Family Therapy Case Management Washington State Department of Social & Health Services

Option 2 Outpatient Treatment Options Individual Treatment Services Brief Intervention Treatment Services Group Therapy Services Family Therapy Services Case Management Services Washington State Department of Social & Health Services

Individual Treatment Services Individual treatment services are services designed to assist an individual in attaining the goals identified in the individual service plan. The treatment services are conducted with the individual and any natural supports as identified by the individual. Washington State Department of Social & Health Services

Option 2 Outpatient Services Individual Therapy Services WAC 388-877A-0138 An agency providing individual treatment services must ensure treatment is provided by a: Mental health professional (MHP) who has documented coursework, continuing education, and/or training that specifically address individual therapy theories and techniques; (2) Person under the supervision of an MHP (the MHP must meet the requirements in (1) of this section); (3) Clinician who is licensed by department of health to practice independently; or (4) Licensure candidate under the supervision of an approved supervisor, as defined in chapter 246-809 WAC, for their respective license. Washington State Department of Social & Health Services

Brief Intervention Treatment Services Brief intervention treatment services are solution-focused and outcome-oriented cognitive and behavioral interventions, intended to resolve situational disturbances. These services do not require long term treatment, and do not include ongoing care, maintenance, or monitoring of the individual’s current level of function or assistance with self-care or life skills training. Washington State Department of Social & Health Services

Option 2 Outpatient Services Brief Intervention Treatment Services WAC 388-877A-0140 An agency providing brief intervention treatment services to individuals must meet the individual service plan requirements in WAC 388-877-0620 and ensure the individual service plan identifies a course of treatment to be completed in six months or less. (2) The additional assessment and individual service plan requirements in WAC 388-877A-0130 and 388-877A-0135 do not apply to brief intervention treatment. (3) An individual may move from brief intervention treatment to longer term outpatient mental health services at any time. Washington State Department of Social & Health Services

Group Therapy Services Group therapy services are provided to an individual in a group setting to assist the individual in attaining the goals described in the individual service plan. Washington State Department of Social & Health Services

Option 2 Outpatient Services WAC 388-877A-0150 Group Therapy Services An agency providing group therapy services must: Have a written description of each group’s purpose. (2) Ensure group services are provided with a staff ratio of one staff member for every twelve individuals. (3) Ensure a group does not contain more than twenty-four individuals. (4) Ensure any nonmental health professional facilitating a group receives supervision by a mental health professional. (5) Ensure any group containing more than twelve individuals has at least one facilitator or co-facilitator that is a mental health professional. (6) Ensure group notes are recorded in each individual’s clinical record before the next group meeting. Washington State Department of Social & Health Services

Family Therapy Services Family therapy services are services provided for the direct benefit of an individual, with family members and/or other relevant persons in attendance. Interventions must identify and build competencies to strengthen family functioning in relationship to the individual’s identified goals. The individual may or may not be present. Washington State Department of Social & Health Services

Option 2 Outpatient Services Family Therapy Services WAC 388-877A-0155 An agency providing family therapy services must: Ensure the services are provided by: A mental health professional who has documented coursework, continuing education and/or training that specifically address family systems theories and techniques in family therapy; or (b) A staff member under the supervision of a mental health professional. The staff member must have documented training in family therapy. (2) With the individual’s written consent, provide information and education about the individual’s illness to family members or other relevant persons in order to assist the individual in managing the mental illness. Washington State Department of Social & Health Services

Case Management Services Case management services are services that meet the ongoing assessment, facilitation, care coordination and advocacy for options and services to meet an individual’s needs through communication and available resources, to promote quality and effective outcomes. Washington State Department of Social & Health Services

Option 2 Outpatient Services Case Management Services WAC 388-877A-0170 An agency must provide case management services that: Assist an individual to achieve the goals stated in the plan; (b) Support consumer employment, education and/or participation in other daily activities appropriate to the individual’s age, gender and culture; and (c) Assist an individual to resolve crises in the least restrictive setting. (2) Rehabilitative case management services include specific rehabilitative services provided to: Assist in an individual’s discharge from an inpatient facility; and (b) Minimize the risk of readmission to an inpatient setting. Washington State Department of Social & Health Services

Washington State Department of Social & Health Services Option 2 Checklist Meet the Behavioral Health Agency requirements in WAC 388-877 Submit an application to DBHR with all required documentation specified on the application Submit policies and procedures to DBHR for WAC 388-877 and the outpatient and recovery support service(s) for which you seek certification, found in WAC 388-877A-Sections 1 and 3 Washington State Department of Social & Health Services

Washington State Department of Social & Health Services You’ve decided… You want to become a Licensed Behavioral Health Agency and provide a Recovery Support Service requiring program specific certification! Washington State Department of Social & Health Services

Application Assistance: To Do List Application to become a BHA Attachments: Policies and procedures Hiring policy Quality Management plan/process Facility check (accessibility barrier checklist) Sample clinical record for each service Personnel list with job descriptions, background checks, and DOH licenses Application fee Master business license Application Assistance: Darrel Streets, Provider Request Manager, DBHR StreeDR@dshs.wa.gov 360.725.3819 Washington State Department of Social & Health Services

Washington State Department of Social & Health Services To Do List Con’t After you apply and pay: Policy and Procedure approval with DBHR Facility and Personnel review with DBHR Receive an initial license for 6 months – 1 year Within 1 year, a clinical record review by DBHR Full licensure/certification DBHR will conduct on-site reviews, usually about once every three years Washington State Department of Social & Health Services

Washington State Department of Social & Health Services WACs Behavioral Health Services Administrative Requirements WAC 388-877 Outpatient Mental Health Services WAC 388-877A-Section 1 Recovery Support Services Requiring Program Specific Certification WAC 388-877A-Section 3 Washington State Department of Social & Health Services

How can I make providing these services a reality? Medicaid Mental Services for people who meet the Access to Care Services are paid for through contracts with the Regional Support Networks. Regional Support Networks are limited by the services allowed under the Medicaid State Plan and cannot pay Room and Board/Rent with these funds Washington State Department of Social & Health Services

Are there other options? DSHS is developing a proposal to add Supported Housing and Support Employment to the Medicaid State Plan. The Legislature in Senate Bill 6312 calls out these recovery support services and will be investing in some pilot sites for supported housing in the future. A licensed as a community mental health agency for other services such as peer support or medication monitoring these services can be provided in a housing program using Medicaid funds. Some RSNs have local funds from tax dollars or county appropriations that they use to contract for housing services. Washington State Department of Social & Health Services

How do I become a contracted provider? Regional Support Networks are required to have network of licensed provider agencies to provide all of the Medicaid State Plan services. RSN’s are not however required to contract with all licensed providers. The best option is to contact your RSN and talk with them about the services you would like to provide. This will help them to give you a realistic idea about what they can purchase and what the rate for the services. Remember that the Medicaid funds can only be used for services and not for rent, room or board. Washington State Department of Social & Health Services

Washington State Department of Social & Health Services QUESTIONS Washington State Department of Social & Health Services

Washington State Department of Social & Health Services Appendices Washington State Department of Social & Health Services

Washington State Department of Social & Health Services WAC 388-865-0107 Peer counselor certification. In order to be certified as a peer counselor, all applicants must meet the following requirements: (a) Be a self-identified consumer of mental health services, as defined; (b) Maintain registration as a counselor under chapter 18.19 RCW; (c) Complete specialized training provided or contracted by the mental health division; and (d) Successfully pass an examination administered by the mental health division or an authorized contractor. The training requirement specified in (2)(c) of this subsection is waived for consumers who were trained prior to October 1, 2004 by trainers approved by the mental health division, provided that all of the other requirements are met by January 31, 2005. A consumer whose request for certification is denied has the right to contest this decision by submitting a written request to the mental health division within twenty-eight calendar days of the date of notification: (a) The request should include the consumer's name, address, and telephone number and a brief explanation of the issue and resolution being requested; (b) The consumer also has the right to use the state administrative hearing process as described in chapter 388-02 WAC; (c) A consumer who completes the administrative hearing process may request reconsideration in accordance with chapter 388-02 WAC but does not have recourse to review by the DSHS board of appeals. Appendix A Washington State Department of Social & Health Services

Washington State Department of Social & Health Services Mental Health Services are provided by, or under the supervision of a Mental Health Professional: (1) A psychiatrist, psychologist, psychiatric nurse or social worker as defined in chapters 71.05 and 71.34 RCW; (2) A person with a masters degree or further advanced degree in counseling or one of the social sciences from an accredited college or university. Such person shall have, in addition, at least two years of experience in direct treatment of persons with mental illness or emotional disturbance, such experience gained under the supervision of a mental health professional; (3) A person who meets the waiver criteria of RCW 71.24.260, which was granted prior to 1986; (4) A person who had an approved waiver to perform the duties of a mental health profession that was requested by the regional support network and granted by the mental health division prior to July 1, 2001; or (5) A person who has been granted a time-limited exception of the minimum requirements of a mental health professional by the mental health division consistent with WAC 388-865-0265. Appendix B Washington State Department of Social & Health Services

Washington State Department of Social & Health Services Employment Services * Appendix C WAC 388-877A-0330 These services assist in training, job search, and placement services in order to help individuals find competitive jobs in their local communities. An agency providing employment services must have knowledge of and provide individuals access to employment and education opportunities by coordinating efforts with one or more entities that provide other rehabilitation and employment services, such as: The department's division of vocational rehabilitation; (b) Community, trade, and technical colleges; (c) The business community; (d) WorkSource, Washington state's official site for online employment services; (e) Washington state department of employment security; and (f) Organizations providing job placement within the community. 1 of 2 Washington State Department of Social & Health Services

Employment Services Con’t* Appendix D (2) An agency providing employment services must: Ensure all staff members providing direct services for employment are knowledgeable and familiar with services provided by the department's division of vocational rehabilitation. (b) Conduct and document a vocational assessment in partnership with the individual that includes work history, skills, training, education, and personal career goals. (c) Assist the individual to create an individualized job and/or career development plan that focuses on the individual's strengths and skills. (d) Assist the individual to locate employment opportunities that are consistent with the individual's skills, goals, and interests. (e) Document any outreach, job coaching, and support at the individual's worksite, when requested by the individual and/or the individual's employer. (f) If the employer makes a request, provide information regarding the requirements of reasonable accommodations, consistent with the Americans with Disabilities Act (ADA) of 1990, and the Washington state anti-discrimination law. 2 of 2 Washington State Department of Social & Health Services

Peer Support Services * Appendix E WAC 388-877A-0340 (2) An agency providing peer support services must ensure peer support counselors; (a) Meet the requirements of WAC 388-865-0107. (b) Provide peer support services: (i) Under the supervision of a mental health professional; and (ii) Within the scope of the peer counselor's training and department of health credential. (c) Receive annual training relevant to their unique working environment. (3) An agency providing peer support services must document the frequency, duration, and expected outcome of all peer support services in the individual service plan. 1 of 1 Washington State Department of Social & Health Services

Washington State Department of Social & Health Services Appendix F Peer Support Washington State's Peer Support Program has trained and qualified mental health consumers as Certified Peer Counselors since 2005. A "consumer" is someone who has applied for, is eligible for, or who has received mental health services. This also includes parents and legal guardians when they have a child under the age of 13, or a child 13 or older and they are involved in their treatment plan (WAC 388-865-0150). Peer Counselors work with their peers, adults and youth, and the parents of children receiving mental health services. Certified Peer Counselors draw upon their experiences to help their peers find hope and make progress toward recovery. Because of their own life experience, they are uniquely equipped to provide support, encouragement and resources to those with mental health challenges. The peer support program is managed by the Office of Consumer Partnerships (OCP). The OCP is guided by adult, youth and family representatives with behavioral health concerns. For more information contact: Bonnie Staples - Peer Support Program Administrator (360) 725-1883 Washington State Department of Social & Health Services

Washington State Department of Social & Health Services What are the requirements to become a Peer Counselor? To qualify, a consumer must submit an application to the Peer Support Program. Once approved, the applicant will be placed on the waiting list for training. After completing the training, each applicant must pass the certification exam. The exam is typically offered three weeks after the training and contains both an oral and written portion. Applicants have three attempts to pass the exam, after which they may request to be re-trained. Additional training is not guaranteed. Once an applicant successfully completes the training and passes the exam they become qualified as a Peer Counselor. Those who work for licensed community mental health centers may be required by their employer to seek a counselor credential from the Washington State Department of Health, as a funding requirement for Medicaid-paid Peer Support. What types of trainings are available and when are they offered? Trainings sponsored by DBHR are typically offered 4-6 times per year. Some Regional Support Networks (RSNs) also offer training. Contact the RSN in your area to find out about their trainings: http://www.dshs.wa.gov/dbhr/rsn.shtml#dbhr. All trainings are 40 hours and uses a state-approved curriculum. There are currently three types of Certified Peer Counseling trainings available: standard training, family and youth training, and Spanish training. All trainings are for the same certification. There is a box on the application form to indicate your preference. Appendix G Washington State Department of Social & Health Services

Washington State Department of Social & Health Services How do I apply for a Peer Counselor training? Please use the following process to submit an application: Print the application form and carefully read and follow all instructions. All questions must be answered completely. Incomplete applications will be returned. All applications are submitted to DBHR, including applications for the Youth and Family training. Applications are read and scored as described in the application instructions. Applicants will receive a letter informing them whether their application has been approved. Once approved, applicants are placed on a waiting list for trainings. Trainings are filled by priority and application date, and invitations are issued about a month before each training. Applicants may not request to be enrolled in specific trainings. Some trainings are offered for people in specific regions, and some are available statewide. It is not possible to predict when a training opportunity will be available. Wait times for training can be a year or longer. Applicants should ensure their contact information remains updated. DBHR can only notify applicants when they are being invited to a training. However, if you have not been invited to a training within a year, please contact Bonnie Staples at (360) 725-1883 to ensure your contact information is correct. Appendix H Washington State Department of Social & Health Services

Medication Support Services * Appendix I WAC 388-877A-0360 (1) Medication support services are certified by the department's division of behavioral health and recovery only when the agency: Is also certified to provide program-specific psychiatric medication services (see WAC 388-877A-0180); or (b) Has an agreement with another behavioral health agency certified to provide psychiatric medication services. The agreement must specify the responsibility for medication support services, and the documentation of the requirements. 1 of 6 Washington State Department of Social & Health Services

Medication Support Con’t * Appendix J (2) Medication support services occur face-to-face and: (a) Include one-on-one cueing, observing, and encouraging an individual to take medication as prescribed. (b) Include reporting any pertinent information related to the individual's adherence to the medication back to the agency that is providing psychiatric medication services. (c) May take place at any location and for as long as it is clinically necessary. 2 of 6 Washington State Department of Social & Health Services

Medication Support Con’t * Appendix K (d) Are provided to any individual who: (i) Has a history of low medication adherence; (ii) Is newly on medication; or (iii) Is new to the specific medication prescribed. (3) An agency providing medication support services must: Ensure services are provided by or under the supervision of a mental health professional. (b) Ensure that the staff positions responsible for providing medication monitoring and/or delivery services are clearly identified in the agency's medication support services policy. 3 of 6 Washington State Department of Social & Health Services

Medication Support Con’t * Appendix L (c) Have appropriate policies and procedures in place when the agency providing medication support services maintains and/or delivers medication to the individual. The policies and procedures must address: The maintenance of a medication log documenting medications that are received, prescribed, and dispensed. (ii) Reasonable precautions that need to be taken when transporting medications to the intended individual and to assure staff safety during the transportation. (iii) The prevention of contamination of medication during delivery, if delivery is provided. 4 of 6 Washington State Department of Social & Health Services

Medication Support Con’t * Appendix M (d) Ensure that all medications kept by staff in the agency are safely and securely stored as follows: Medication must be maintained in locked cabinets within a well-illuminated, locked, and properly ventilated room. (ii) Medication kept for individuals on medication administration or self-administration programs must be clearly labeled and stored separately from medication samples kept on site. (iii) Medication marked "for external use only" must be stored separately from oral or injectable medications. (iv) Refrigerated food or beverages used in the administration of medications must be kept separate from the refrigerated medications by the use of trays or other designated containers (v) Syringes and sharp objects must be properly stored and disposed of safely. (vi) Refrigerated medications must be maintained at the required temperatures. 5 of 6 Washington State Department of Social & Health Services

Medication Support Con’t * Appendix N (e) Ensure that outdated medications are disposed of in accordance with the rules of the state board of pharmacy, and ensure that no outdated medications are retained. (f) Ensure that the individual's clinical record contains: (i) The individual service plan, including (ii) Documentation of observations on the individual's behavior indicating the effects, interactions, and side effects of the prescribed medication, as necessary. (iii) Documentation of regular reviews of the individual's adherence to the medication support plan as reflected in the individual service plan. (iv) Documentation of reports to the prescriber about medication adherence and/or side effects. 6 of 6 Washington State Department of Social & Health Services