1. Reach Up’s Substance Abuse and Mental Health Program
An Emerging and Best Practice Model: Adding SA/MH Case Managers and Clinicians to Reach Up’s Teaming Model

2. Reach Up Recipients: Substance Abuse and Mental Health Statistics
About one in five TANF recipients abuses drugs or alcohol. (1)
Approximately one-third of welfare recipients have a mental health condition that may interfere with employment. (2)
Nationally, approximately fifty percent of people with a substance abuse condition have a co-occurring mental health condition. (3)
1. Center on Addiction and Substance Abuse, 2000
2. Mathematica Policy Research Inc., 2000
3. Substance Abuse and Mental Health Services Administration, 2004

3. Our Purpose
To provide integrated substance abuse and mental health services for people on Reach Up.
This was done by increasing access to treatment and case management through the Designated Agency system.

4. Background This is an AHS interdepartmental program.
The departments directly involved with this grant include ESD, DMH and VDH-ADAP.
The role out of this program happened in two phases.

5. Phasing in the Program
The Phase 1 districts included: Rutland, Barre, Burlington and St. Albans.
The contracts for these 4 districts began in November 1, 2013.
In Phase 2 we brought up our remaining 8 districts, and those grants began July 1,

6. Who Are Our New Partners?
St. Albans – 1 clinician from NCSS and 1 clinician (2 days/week) and 1 case manager from Howard Center
Burlington – 1 clinician (3 days/week shared with ADO) and 2 case managers from Howard Center
Hartford – 1 clinical case manager from Clara Martin Center and .5 case manager and .5 clinician from HCRS
St. Johnsbury and Newport – 1 clinician and 1 case manager per district from NKHS
Brattleboro and Springfield - 1 clinician and 1 case manager per district from HCRS
Barre – 1 clinician (also receives supervision from CVSAS) and 1 case manager from WCMH
Rutland – 1 clinician and 1 case manager from RCMH
Bennington - 1 clinician and 1 case manager from UCS
Morrisville – 1 clinician from CHSLV and 1 case manager from LCMH
Middlebury – 1 clinician and 1 case manager from CSAC

7. Important Details
Each case manager and clinician are expected to be working with 35 participants
Services provided have to be billable under the Medicaid Fee schedule
Participants that are not willing to engage cannot remain with these case managers and clinicians indefinitely because there have to have billable hours to sustain this program

8. Case Management Services Provided Under this Program
All functions that an ESD case manager must perform and:
Administer specialized screening and refer to inter- agency resources for assessments for substance abuse, mental health, and trauma
Facilitate and monitor treatment plans
Facilitate and coordinate treatment team meetings
Coordinate closely the Hub and Spoke program
Provide integrated service planning and coordination and specialized community supports as outlined in the State of Vermont Fee for Service Medicaid Manual

9. Clinical Services Provided Under this Program
Access to evidence based programs such as Seeking Safety and Rocking Horse  
Diagnosis and Evaluation
Emergency Services
Individual Therapy
Family Therapy
Group Therapy
Intensive Outpatient Treatment
Medication Management
Residential Substance Abuse Treatment
Medication Assisted Therapy (MAT) 
Case reviews for each case manager.  
Case consultation to Reach Up teams on a regular basis

10. Challenges Filling the positions - compensation
Navigating two separate systems of care (Preferred Providers versus Designated Agencies)
Connecting to Hubs
Funding – the grantees receive a very small grant, the bulk of revenue is from Medicaid billing

11. The Role of Central Office in this Program
Coordinate face to face Community of Practice meetings
3 meetings have been held to date
Coordinate management team meetings in every district
Phase 1 districts have all had meetings and we are working on setting up meetings with all Phase 2 districts
Working to find ways to collaborate with FSD and the new screeners they have in 6 districts