1. RBHA Coordination of Care for Justice Involved Members
2017 Justice Court Conference

2. WHAT CAN RBHAs DO?
Presented by Shelley Curran Court Services Administrator Mercy Maricopa Integrated Care

3. What is a RBHA? Regional Behavioral Health Authority
RBHAs manage the mental health and substance abuse services for persons who are eligible for Title XIX benefits through the Arizona Health Care Cost Containment System (AHCCCS). This is the Medicaid program for Arizona.

4. Geographic Service Areas (GSA) as of 10/1/15
CRISIS LINES
Mohave, Coconino, Apache, Navajo, Gila, and Yavapai
Maricopa or
Cochise, Graham, Greenlee,
La Paz, Pima, Pinal, Santa Cruz, and Yuma
Gila River T/RBHA
North – Health Choice Integrated Care
Apache, Coconino, Gila, Mohave, Navajo, and Yavapai
Central – Mercy Maricopa Integrated Care
Maricopa and portion of Pinal
(Apache Junction, San Tan Valley, Queen Creek)
South - Cenpatico
Cochise, Graham, Greenlee, La Paz, Pima, Pinal,
Santa Cruz and Yuma
Facilitator’s notes:
This map shows regional behavioral health authorities based on “geographical service areas.” Mercy Maricopa Integrated Care is the RBHA of GSA 6.
From Arizona Department of Health Services/Division of Behavioral Health Services website about Arizona’s public behavioral health system:
The Arizona Department of Health Services/ Division of Behavioral Health Services (ADHS/ DBHS or Division), per Arizona law, is the permanent authority for publicly-funded behavioral health services in Arizona. In this capacity, the Division has many responsibilities, which are summarized as follows:
  Administering a comprehensive, regionalized, behavioral health system of community-based prevention, intervention, treatment and rehabilitative services for individuals and families.
  The application, execution and oversight of numerous federal grants providing funding for mental health, substance abuse and prevention services, as well as workforce development training initiatives.
 Contracting with the Arizona Health Care Cost Containment System (AHCCCS) to plan, administer, and monitor behavioral health services funded through Medicaid.
Contracting with county and city municipalities to provide necessary services within those communities.
 Providing care to individuals enrolled within other state programs, including the Arizona Long Term Care System for those with Developmental Disabilities (DD-ALTCS), and Child Protective Services.
  Operating the Arizona State Hospital (ASH), accredited by the Joint Commission to provide long -term psychiatric care to the most seriously men- tally ill Arizonans. The hospital campus consists of a civil-commitment facility (116 beds), a forensic facility (143 beds) and a facility for sexually violent persons (current census 82).

5. COURT-ORDERED TREATMENT FOR PERSONS CHARGED WITH OR CONVICTED OF A CRIME
RBHA providers may be responsible for providing evaluation and/or treatment services when an individual has been ordered by a court due to:
Conviction of a domestic violence offense; or
Upon being charged with a crime when it is determined that the individual is court ordered to treatment, or programs, as a result of being charged with a crime and appears to be an “alcoholic.”

6. Domestic Violence Offender Treatment
Domestic violence offender treatment may be ordered by a court when an individual is convicted of a misdemeanor domestic violence offense. Although the order may indicate that the domestic violence (DV) offender treatment is the financial responsibility of the offender under A.R.S. § , the RBHA will cover DV services with Title XIX/XXI funds when the person is Title XIX/XXI eligible and the service is medically necessary. Required prior authorization will need to be obtained if the service is provided by an in-network provider. For Non-TXIX/XXI eligible persons’ court ordered for DV treatment, the individual can be billed for the DV services.

7. Court ordered substance abuse evaluation and treatment
Substance abuse evaluation and/or treatment (i.e., DUI services) ordered by a court under A.R.S. § is the financial responsibility of the county, city, town or charter city whose court issued the order for evaluation and/or treatment. Accordingly, if the RBHA receives a claim for such services, the claim will be denied with instructions to the provider to bill the responsible county, city or town.
If the person is Title XIX/XXI eligible then substance abuse treatment is a covered voluntary service through the RBHA.

8. Court Ordered Treatment Licensing Requirements
Behavioral health providers who are licensed by the Arizona Department of Health Services - Division of Assurance and Licensing Services as a court-ordered treatment agency must adhere to Division of Licensing Services requirements

9. Court Ordered Treatment Licensing Requirements
A list of providers in each county licensed to provide Domestic Violence or DUI services can be found at:

10. RBHA Resources & Services Presented by Beya Thayer Health Choice Integrated Care Justice Liaison

11. Continuum of Care
Crisis Services Prevention Services Integrated Physical & Behavioral Healthcare (AHCCCS SMI) Supported Employment & Residential Services (AHCCCS SMI) Inpatient Behavioral Health Services Outpatient Behavioral Health Treatment Services Substance Abuse Treatment Services Peer & Family Support Services Pharmacy

12. Crisis Services
Crisis Line: Service to provide telephone-based support to persons in crisis; often providing the first place of access to the behavioral health system. Mobile Crisis: Services provided by a mobile team or individual who travels to the place where the person is having the crisis. Crisis Stabilization Unit: 24 hour crisis support for individuals in need of short term monitoring and evaluation. Law enforcement has successfully transported individuals to the unit for behavioral health interventions. These individuals traditionally could have been incarcerated for minor violations.

13. Inpatient Psychiatric Hospitalization & Residential Treatment Centers
Inpatient Psychiatric Hospitalization: provides continuous treatment that includes general psychiatric care, medical detoxification, and/or forensic services. Residential Treatment Centers: Structured treatment setting with 24-hour supervision and counseling or other therapeutic activities for persons who do not require on-site medical services.

14. Integrated Physical & Behavioral Health Care AHCCCS eligible individuals diagnosed with an (SMI)
May enable doctors and nurses to be on the same team as psychiatrists, therapists, caseworkers, and pharmacists Or may provide services separately, but coordinate those services

15. Outpatient Behavioral Health Treatment Services
Support &Rehabilitation Services: individual, group and/or family behavioral health counseling and therapy, skills training and development, medication training and support, ongoing support to maintain employment, home care family, medication monitoring, case management, and self-help/per services. Assertive Community Treatment (“ACT”) teams: is an intensive community based, wrap around treatment modality for individuals who have complex needs. This program has successfully decreased emergency utilization, inpatient admissions and incarceration. Forensic Peer Supports: supports to the transition of individuals from incarceration into the community which has increased the individual's compliance with probation and decreased recidivism.

16. Supported Employment & Residential Services AHCCCS eligible individuals diagnosed with an (SMI)
Employment support in a variety of settings: Part time work; unpaid work experience; meaningful volunteer work Behavioral Health Residential Facility: provide a structured treatment setting with 24 hour supervision, counseling or other therapeutic activities Supported Housing: helps individuals find and stay in independent, safe housing

17. Justice focused services
Reach In: AHCCCS enrolled inmates who have history of behavioral health and have a set release date receive a reach-in visit to encourage an out patient appointment within one week of release SMI Non Title XIX members have a funding source which may assist with services during incarceration Offender Screening Tool completed by probation pre- release or immediately upon release; Probation refers defendants to behavioral health as needed

18. Presented by Sarah Darragh Cenpatico, Director of Justice Systems
Urban vs Rural challenges/differences/solutions in accessing and providing services
Presented by Sarah Darragh
Cenpatico, Director of Justice Systems

19. Urban and Rural Communities Have the Same Mission
Improving Quality of Life
Prevention of Diseases
Increasing Life Expectancy
Promoting Overall Physical and Mental Health

20. Urban Challenges Communication
More people to connect with as systems are larger
Entering systems can be more formal and have greater time delays
Interagency Coordination
Do not have strong relationships or may not have worked with one another
Transportation, you may have it but…
Affordability, proximity to services, time in transit
Cost of living
Employment
Maintaining employment – can’t afford to take time off for appointments
Job availability

21. Rural Challenges
Rural Areas have fewer health professionals per capita then urban areas (College of Public Health UofA)
Less Specialty Providers
Transportation infrastructure - limited
After Hour appointments – fewer health professionals
Members may not feel comfortable being open and honest because they don’t feel their information is confidential, “it’s a small town”
Lower use of practitioners trained in Evidence Based Practitioners
Fewer housing needs for the homeless

22. Differences in Rural vs. Urban
Urban areas may have easier access to public transportation
Urban areas have more healthcare professionals
According to USDA Economic research Service in 2015 poverty rate in rural Arizona is 27.5%, compared to 16.8% in urban areas of Arizona
Same report indicated 20.0% of rural population did not complete high school compared to 13.6% of the urban population lacks a high school diploma

23. Differences in Rural vs. Urban
Rural and Urban Substance Abuse Treatment Admissions
According to the TEDS Report by SAMHSA:
Rural admissions were younger and less ethnically diverse then urban admissions
Rural admissions were more likely than urban admissions to report primary abuse of alcohol (49.5 vs percent) or non-heroin opiates (10.6 vs 4.0 percent);
Urban admissions were more likely then rural admissions to report primary abuse of heroin (21.8 vs. 3.1 percent) or cocaine (11.9 vs. 5.6 percent)
Rural Admissions were more likely than urban admissions to be referred by the criminal justice system and less likely to be self-referred.

24. Rural Solutions Telemedicine can provide services to the rural areas
Recruit doctors or soon to be doctors to stay and serve in their community
Provide Services in the home to reduce the transportation barrier
Work with public transportation to obtain reduce rates or vouchers for members
Train all providers in Evidenced Based Practices
Prevention education to help members know what services are offered to them

25. Urban Solutions Community Navigators Vouchers for Transportation
Partners meeting to have coordinated care for member
Employment Centers
Professional networking

26. Communities Large and Small
Communities are Unique
Communities have Strengths
Building off Strengths allows you to build upon a Foundation
Being creative and knowing your true needs is essential in serving your community
Big or Small your not a National Statistic

27. Tools that Assist with Diversion & Reentry
Jail Data Link
Continuity of Care Calendar
Forensic Peer Support and Crisis Navigators
Administrative Orders
Superior Courts (Pinal and Maricopa)
Tempe
Mesa
Glendale
Phoenix

28. Role of the Adult Court Liaison
Ensure continuity of care for adult RBHA members involved in a criminal court matter. Identifying those with mental health needs and collaboration with court administrations, legal defense council, adult probation department, city court officials, correctional health services (jail mental health providers) and provider network clinics, to ensure treatment and services area available to the members.
As the RBHA Adult Court Liaison our primary role is to ensure continuity of care is being provided to our members that are going through the legal process in a criminal court matter and are receiving SMI services through the management of Mercy Maricopa Integrated Care and the provider network clinics. By identifying those with mental health needs and collaboration with court administrations, legal defense council, adult probation department, city court officials, correctional health services (jail mental health providers) and provider network clinics, to ensure treatment and services area available to the members.

29. Mercy Maricopa Court Services
Adult Court Liaisons Juvenile Court Liaisons Shelley Curran Court Services Administrator Mercy Maricopa Integrated Care

30. Tools to Assist with Diversion & Re-Entry
Data Sharing Initiatives
Co-located Jail Liaisons
AHCCCS Pre-release Application Process
Community Re-Entry
Reach-In
Enhanced Supervision Caseload

31. CENPATICO JUSTICE SERVICES
Sarah Darragh
Director of Justice Services
Cenpatico Integrated Care
Deana Champagne
Vice President of Justice Systems

32. Tools to Assist with diversion & Reentry
Post-Arrest Diversion Assessments during Incarceration: For SMI members and with limited funding for non- SMI members, HCIC provides intakes and assessments based on referrals from the public defender’s office, for incarcerated individuals who are experiencing complex behavioral health needs and whom the court agrees transition to services are more beneficial than incarceration.

33. Health Choice Integrated Care Justice Services
Beya Thayer Justice Liaison

34. THANK YOU
Questions?