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Putting Health back into Clinical Mental Health Counseling

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Putting Health back into Clinical Mental Health Counseling Presented by: Jim Messina, Ph.D., NCC, CCMHC At: Utah Mental Health Counselors Association Date:

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1 Putting Health back into Clinical Mental Health Counseling
Presented by: Jim Messina, Ph.D. , NCC, CCMHC At: Utah Mental Health Counselors Association Date: May 10, 2013

2 From Dream to Reality in 1976
On an impulsive whim Nancy and Jim: Coined term “Mental Health Counselor” Coined Association Title: The American Mental Health Counselor’s Association As the process caught fire Established the Profession of Mental Health Counseling Set out to create its “Hallmarks of a Profession”

3 What are the Hallmarks of a Profession?
Professional Membership Organization Code of Ethics Certification and Licensure Accreditation Research into Effectiveness of Service Delivery

4 History Timeline of Creation of Mental Health Counseling Profession
1976 – Coining of term Mental Health Counselor and formation of American Mental Health Counselor’s Association as Division of ACA 1979 – Creation of the National Academy of Certified Clinical Mental Health Counselors 1981 – First State Law to license Mental Health Counselors put into effect in Florida 1985 – AMHCA had over 12,000 members 2011 – AMHCA put out its newest Standards of Practice in Mental Health Counseling-Helping to put Health back into Clinical Mental Health Counseling 2013 – AMHCA has over 7,000 members

5 The National Professional Association of Clinical Mental Health Counselors
American Mental Health Counselors Association Founded in 1976 when term Mental Health Counselor was coined

6 Initial Definition of Scope of CMHC Practice
The 1979’s initial AMHCA’s Journal of Mental Health Counseling included first published definition of mental health counseling as: “an interdisciplinary, multifaceted, holistic process of: Promotion of healthy lifestyles Identification of individual stressors & personal levels of functioning Preservation or restoration of mental health” (Seiler & Messina, 1979)

7 AMHCA’s Revised Scope of Practice in 1986
The 1986 AMHCA Board of Directors adopted: “Clinical mental health counseling is the provision of professional counseling services involving the application of principles of: Psychotherapy Human Development Learning Theory Group Dynamics Etiology of mental illness & dysfunctional behavior to individuals, couples, families and groups, for the purpose of promoting optimal mental health, dealing with normal problems of living and treating psychopathology…

8 1986 Scope of Practice (2) The practice of clinical mental health counseling includes, but is not limited to: Diagnosis & treatment of mental & emotional disorders Psycho‐educational techniques aimed at the prevention of Mental & emotional disorders Consultations to individuals, couples, families, groups, organizations & communities Clinical research into more effective psychotherapeutic treatment modalities.”

9 Regional Chapters of State MHCA’s
State Chapters of AMHCA Regional Chapters of State MHCA’s

10 AMHCA Belongs to American Counseling Association
Was known as APGA-American Personnel and Guidance Association in1976 and in 1983 as AACD American Association of Counseling and Development until 1992 when it changed to ACA

11 CODES OF ETHICS Governing Clinical Mental Health Counselors

12 National Certification

13 NBCC’s National Certifications for Mental Health Counselors
NCC: National Certified Counselor – Over 48,000 CCMHC: Founded Certified Clinical Mental Health Counselor – Today only 1, are CCMHC’s which needs to change if we are to put Health back into the professional identity of Clinical Mental Health Counseling

14 State Licensure for Counselors and Related Fields
In USA 120,429 Licensed Professional Counselors 54, Licensed Marriage & Family Therapists 202,924 Licensed Social Workers All 50 States have Licensed Professional Counselors but only 15 have Mental Health Counseling in their Title (Major way of taking Health out of Clinical Mental Health Counseling!)

15 15 States with MHC’s in Title
Delaware-License Professional Counselor of Mental Health (LPCMH) Florida-Licensed Mental Health Counselor (LMHC) First Licensed 1981 Hawaii-Licensed Mental Health Counselor (LMHC) Indiana-Licensed Mental Health Counselor (LMHC) Iowa-Licensed Mental Health Counselor (LMHC) Massachusetts-Licensed Mental Health Counselor (LMHC) Nebraska-Licensed Independent Mental Health Practitioner (LMHP) New Hampshire- Licensed Clinical Mental Health Counselor (LCMHC) New Mexico-Licensed Mental Health Counselor (LMHC) New York-Licensed Mental Health Counselor (LMHC) Rhode Island-Licensed Clinical Mental Health Counselor (LCMHC) South Dakota-Licensed Professional Counselor-Mental Health (LP-MH) Tennessee-Licensed Professional Counselor-Mental Health Service Provider (LPC/MHSP) Utah-Licensed Clinical Mental Health Counselors (LCMHC) as of 2012 Vermont-Licensed Clinical Mental Health Counselor (LCMHC) Washington-Licensed Mental Health Counselor (LMHC)

16 Major Recommendation to Promote Professional Identity of CMHC’s
Given only 15 out 50 states licensed CMHC’s, it is imperative that we who have LMHC licensure encourage the LPC’s in the other 35 states to gain Certified Clinical Mental Health Counselor (CCMHC) status through the NBCC which would be a clear way of putting HEALTH into Clinical Mental Health Counseling and a way to get counselors in all 50 states enabled to call themselves Clinical Mental Health Counselor

17 AMHCA’s Online Newsletter

18 Research in the field is Reported in AMHCA’s Journal

19 Accreditation: Standards for Training of CMHC
CACREP (The Council for Accreditation of Counseling & Related Educational Programs) 1988 CACREP set out its first Standards for accreditation of CMHC Programs using 60 hour requirement put out in 1979 by AMHCA – But it also had Community Counseling Programs with up to 48 hours – Most went Community Counseling 2009 CACREP adopted standards for CMHC which included 60 hour requirement

20 2009 CACREP Standards for CMHC
Required both core CACREP areas & specialized training in clinical mental health Core CACREP areas include: Professional Orientation and Ethical Practice Social and Cultural Diversity Human Growth and Development across the lifespan Career Development Helping Relationships Group Work Assessment Research and Program Evaluation

21 2009 CACREP Standards for CMHC Specialized CMHC Training:
Ethical, Legal & Practice Foundations of CMHC Prevention & Clinical Intervention Clinical Assessment Diagnosis & Treatment of Mental Disorders Diversity & Advocacy in Clinical Mental Health Counseling Clinical Mental Health Counseling Research & Outcome Evaluation These areas of CMHC preparation address clinical mental health needs across the lifespan (children, adolescents, adults and older adults) & across socially & culturally diverse populations.

22 AMHCA 2011 Standard Additional Requirement for CMHC Training
The 2011 AMHCA standards also recommend these additional areas of training for CMHC Training programs: Biological Bases of Behavior (including psychopathology and psychopharmacology) Specialized Clinical Assessment Trauma Co-Occurring Disorders (mental disorders and substance abuse)

23 Implications of AMHCA’s 2011 Expanded Clinical Standards for Training of CMHC’s
Evidenced-Based Practices Diagnosis and Treatment Planning using EBP’s Diagnosis of Co-Occurring Disorders & Trauma Biological Basis of Behaviors Knowledge of Central Nervous System Lifespan Plasticity of the Brain Psychopharmacology Behavioral Medicine Neurobiology of Thinking, Emotion & Memory Neurobiology of mental health disorders (mood, anxiety, psychosis) over life span Promotion of optimal mental health over the lifespan

24 Accreditation-CACREP in 2009:74 Clinical Mental Health Counseling
In Florida they are: Argosy Sarasota Barry University Florida Atlantic University Florida Gulf Coast University Florida International University Florida State University Rollins College Troy University Southeast Region University of Central Florida University of Florida University of North Florida University of South Florida Online: Cappella University Walden University In Utah: University of Phoenix-Mental Health Counseling NOTE: things will change now that Utah has in 2012 implemented the LCMHC

25 CACREP 2016 Standards for CMHC
1. FOUNDATIONS A. development of mental health counseling B. theories and models related to mental health counseling C. principles of mental health counseling, including prevention, intervention, consultation, education, and advocacy, and networks that promote mental health D. medical foundation and etiology of addiction and co-occurring disorders E. principles, models, and documentation formats of biopsychosocial case conceptualization and treatment planning

2. CONTEXTUAL DIMENSIONS F. etiology, process, nomenclature, treatment, referral, and prevention of mental and emotional disorders G. mental health service delivery modalities such as inpatient, outpatient, partial treatment and aftercare and the mental health counseling services networks H. diagnostic process, including differential diagnosis, and the use of current diagnostic tools, such as the current edition of the (DSM) I. potential for substance use disorders to mimic and/or co-occur with a variety of medical and psychological disorders J. impact of crisis on individuals diagnosed with mental illness K. classifications, indications, and contraindications of commonly prescribed psychopharmacological medications for appropriate medical referral and consultation L. public policy and government relations on local, state, and national level to enhance equity funding and promote programs that affect the practice of mental health counseling M. cultural factors relevant to mental health counseling N. professional organizations, preparation standards, and credentials relevant to the practice of mental health counseling O. legal and ethical considerations specific to mental health counseling P. record keeping, third party reimbursement, and other practice and management issues in mental health counseling

27 Let’s see if this will matter based on future trends.
3. PRACTICE Q. intake interview, mental status evaluation, biopsychosocial history, mental health history, and psychological assessment for treatment planning and caseload management R. strategies for interfacing with the legal system regarding court referred clients S. techniques and interventions related to a broad range of mental health issues What does this tell us? Little change is being recommended for the next round of CACREP Standards & AMHCA’s 2011 Standards have had little impact on what is being proposed at the current time. Let’s see if this will matter based on future trends.

28 The Growth of Mental Health Counseling as a Profession
In 2008, according to US Department of Labor: 120,000 Mental Health Counselors were employed & only 6.7% of them were self-employed By 2018 43,000 jobs will be added (for a for a total of 163,000), representing a 36.3% growth  Median annual wages in 2008 for Mental Health Counselors was $38,150. This is High when compared to other jobs.

29 Parity with the Other Mental Health Professions
The median reimbursable fee for service: Clinical Mental Health Counselors is $63 Psychologists is $75 for psychologists Clinical Social Workers & Marriage and Family Therapists is $60 (January 2006 study by Psychotherapy Finances)

30 SO! What do Mental Health Counselors Currently Do?
Mental Health Counselors offer full range of services: Assessment & diagnosis Treatment planning and utilization review Psychotherapy Brief and solution-focused therapy Alcoholism and substance abuse treatment Psycho-educational & prevention programs Crisis management Trauma Intervention

31 ACA’s 20/20 Commission’s Definition of Counseling
Counseling is a professional relationship that empowers diverse individuals, families and groups to accomplish mental health, wellness, education and career goals They also established: The counseling profession shall establish uniform licensing standards with LPC as an entry-level title for counselor licensure.

The emerging health needs of Americans is changing and as a result the roles and function of mental health practitioners will be changing as well

33 New AMHCA Clinical Standards Help CMHC to Get Ready for Changes in System
The Affordable Care behavioral medicine interventions 1. ACA calls for the coordination and integration of medical services through the primary care provider for a “whole person orientation” to medical treatment - model currently implemented at some level in VA & Federally Qualified Health Centers (FQHC’s) 2. The ACA calls for creation of Affordable Care Organizations (ACO’s) to provide comprehensive services to Medicare recipients with a strong primary care basis 3. The ACA model includes integration of mental & behavioral health services into the Patient-centered medical home (PCMH) which can enhance patient outcomes 4. The ACA model integrates mental, behavioral and medical services under one roof with potential of controlling the costs for patients 5. The ACA integrated behavioral medical approach opens a massive opportunity for clinical mental health counselors 6. To be prepared to fill this evolving behavioral medicine role, it is imperative that clinical mental health counseling training programs establish training for future practitioners in these integrated medical settings.

34 The Affordable Care Act (ACA)
Beginning 2014 ACA increases access to quality health care including coverage for mental health & substance use disorder services All new small group & individual private market plans will be required to cover mental health & substance use disorder services as part of the health care law's “Essential Health Benefits” categories

35 The Affordable Care Act (ACA)
Behavioral health benefits will be covered at parity with medical & surgical benefits Insurers will no longer be able to deny anyone coverage because of a pre-existing behavioral health condition ACA already ensures that new health plans cover recommended preventive benefits without cost sharing, including depression screening for adults & adolescents as well as behavioral assessments for children

36 Results of the Affordable Care Act
Primary care providers receive 10% Medicare bonus payment for primary care services A new Medicaid state option is created to permit certain Medicaid enrollees to designate a provider as a health home & states taking up the option receive 90% federal matching payments for two years for health home-related services. Small employers receive grants for up to five years to establish wellness programs

37 Results of the ACA continued:
The Center for Medicare & Medicaid Innovation launches the Accountable Care Organization (ACO) Model & Advance Payment ACO Model, which offers shared savings & other payment incentives for selected organizations that provide efficient, coordinated, patient-centered care Some States established American Health Benefit Exchanges & Small Business Health Options Program Exchanges to facilitate purchase of insurance by individuals & small employers Teaching Health Centers are established to provide payments for primary care residency programs in community-based ambulatory patient care centers

38 Two Healthcare Organizational Models which are Driving Change
Two New Medicare/Medicaid models are driving a change in healthcare delivery: Patient Centered Medical Homes Accountable Care Organizations (ACO’s)

39 Medical Homes Patient Centered - Empowers them with Information and Understanding Comprehensive - Co-location of care providers in physical and behavioral health Coordinated Care - Through Health Information Technology all providers are kept in touch Accessible – same day appointment & 24/7 availability through technology online Committed to Quality & Safety – Quality Improvement Goals which are tracked

40 Benefits of Medical Homes
Patients seek out the right care which is needed- which is often behavioral vs. physical Less use of ER’s or delays in seeking care Less duplication of tests, labs & procedures Better control of chronic diseases & other illnesses improving health outcomes Focus on wellness & prevention – reduce incidence & severity of chronic disease or illnesses Cost savings less use of ER’s & Hospitals

41 What is moving the Patient Centered Home Health Model
In April 2013 the Patient-Centered Primary Care Collaborative Pointed out on it website these factors driving the Home Health Model Unsustainable cost increases in health care delivery Growing availability of data Vast change in the way we communicate Example: In Denmark, more than 80 percent of health-care encounters & transactions are electronically based & vastly different method of communicating is coming online and it's coming fast, driven by younger generations of patients and physicians.


43 Potential Role of Mental Health Counselors in Medical Homes
Address the stressors which lead folks to seek out medical attention in the first place Assist in increasing compliance of patients with the medical directives given them by primary care staff Wellness educational programming to help ward off chronic or severe illnesses Assisting clients to cope with the medical conditions for which they are receiving medical attention

44 Primary and Behavioral Health Integration Grants based on Medical Home Model in ACA
In Utah: Weber Human Services-Ogden, Utah In Florida: Apalachee Center–Tallahassee Community Rehabilitation Center-Jacksonville LifeStream Behavioral Center-Leesburg Lakeside Behavioral Center–Orlando Coastal Behavioral Health Care-Sarasota Miami Behavioral Health Center-Miami

45 Accountable Care Organizations
Have a look at the CMS video which overviews the ACO model: Now let’s look at the announcement of the Role Out of the ACO rules in 2011 to see what is hoped for in this model: /2011/03/accountablecare a.html

46 Goal of ACO’s The goal of coordinated care is to ensure that patients, especially the chronically ill, get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors.

47 So what are ACO’s ACO assumes financial risk rather than 3rd party payers (government, business or insurance companies) for group of patients assigned to it Consists of more than one hospital & number of primary care clinics with full array of medical & health specialists- who self-refer to their own specialists Control costs by being responsible for full care of patients Integration of mental & behavioral health services into Patient-centered medical homes Enhance patient outcomes through emphasis on prevention, compliance, and immediate 24/7 attention Utilize an integrated behavioral medical approach

48 How will ACO’s Work? The Affordable Care Organizations (ACO’s) is a large local health system It usually includes more than one hospital and a number of primary care clinics. It is this whole system which is in charge of the care of its patients The providers refer to other specialists inside of their own system These ACO’s have their own group of providers (which could include Clinical Mental Health Counselors) & by referring within the system controls costs ACO’s are then responsible not only for their costs but also for the quality of their services to their patients Providers are paid a flat fee that is risk adjusted for the severity of the issues facing the patients The ACO organization assumes the financial risk rather than the government, business or insurance companies Where Clinical Mental Health Counselors work and how they will be paid may change greatly in the future as these ACO’s become reality after full implementation of the ACA in 2014

49 Utah’s Efforts under ACA
Utah is one of 16 states which proposes to design an innovative statewide initiative to facilitate improved physician/patient communication & care coordination Goal of improving health care quality & lowering costs The state will convene a multi-stakeholder group that will address strategies for healthcare transformation in five key areas: Expanded health information technology Adequate healthcare workforce Wellness & healthy lifestyle promotion Payment reform Medical malpractice & dispute resolution.

50 Key Players in Utah working on ACA innovations
Organizations IHC Health Services (Intermountain Health Care) Trustees Of Dartmouth College State of Utah Hospital working on ACA innovation Salt Lake Regional Medical Center Utah’s Innovation Advisors Nancy Murphy MD Victoria Wilkins MPH, MD Sarah Woolsey MD,

51 Accountable Care Organizations
Current Utah ACO’s Health Choice at Healthy U at University of Utah at Molina at /pages/home.aspx SelectHealth at Central Utah Clinic, P.C. (Provo, Utah) IASIS Health Care Org at very open to creation of ACO’s in their hospital localities: IASIS Utah Hospitals Davis Hospital and Medical Center, Layton, UT Jordan Valley Medical Center, West Jordan, UT Pioneer Valley Hospital, West Valley City, UT Salt Lake Regional Medical Center, Salt Lake City, UT Health Choice Utah Accountable Care LLC

52 Prevention Services Mandated by ACA
After September 23, 2010, the following preventive services must be covered without policy holder having to pay copayment or co-insurance or meet deductible but only applies when these services are delivered by a network provider: Alcohol Misuse: screening & counseling Alcohol and Drug Use: assessment for adolescents Behavioral Assessment for children of all ages Depression: screening for adults & adolescents Developmental screening: for children under age 3 & surveillance throughout childhood Diet: counseling for adults at higher risk for chronic disease Obesity: Screening & counseling for adults & children Sexually Transmitted Infection (STI): prevention counseling for adults & adolescents at higher risk who are sexually active Tobacco Use: screening for all male & female adults & cessation interventions for tobacco users & expanded counseling for pregnant tobacco users Domestic & interpersonal violence: screening & counseling for all women Well-woman visits: to obtain recommended preventive services for women under 65

53 Potential Clinical Setting Openings for CMHC’s with ACA Implementation
Clinical Mental Health Counselors will be ideally situated to provide Behavioral Medical Interventions based on their expanded training and implementation of AMHCA’s Clinical Standards. They will then need to promote themselves in the following settings: General Practice: Family Practice & Internal Medicine Clinics Rehabilitation In-patient and out-patient Centers General and Specialized Hospitals Senior Citizen’s Independent housing, Assisted Living & Nursing Homes

54 What are the future prospects for the profession?
Recognized for VA Positions in VA Hospitals and Field Agencies which is good given the OIF and OEF veterans complex health issues AMHCA hopes to soon be recognized for Medicare Services Increased work in Behavioral Medicine in Hospitals, Rehab Centers & Primary Care Physicians’ Offices Increased work in Substance Abuse & Alcohol Treatment Facilities

55 Mental Health Needs of OEF & OIF Vets
The invisible wounds which our OIF and OEF vets return with are staggering PTSD and TBI along with Combat Depression are staggering disorders which are impacting from 1/3 to 2/3’s of these vets. The Mental Health system over the next 5 to 10 years will become overwhelmed in meeting their individual as well as marital and family needs. CMHC’s need to be ready to serve this population

56 Baby Boomer Generation are Aging
The increase in Boomers aging and their impact on the medical and mental health field cannot be ignored or underestimated It is imperative that CMHC’s be armed with Behavioral Medicine techniques to address the needs of this geriatric population to address their chronic health issues, disabilities and cognitive decline needs

57 What Skills Do Mental Health Counselors Need?
Ability to understand dynamics of Human Development to capture good psychosocial history of clients Diagnosis of and treatment for behavioral pathology Evidenced based practices in psychotherapy to provide credible treatment to clients Understanding of basic neuroscience of brain and nervous system to understand roots of emotional responses to life’s stressors Understanding of psychopharmacological treatment of psychopathology

58 SO what’s Up in Utah? Related to all these Changes?
State of Utah, UT (DCFS,DJJS) Diagnostic and/or Rehabilitative Mental Health This multi-step procurement is issued on behalf of the State of Utah, Department of Human Services for the purpose of identifying and contracting with all qualified Offerors interested in providing Diagnostic and/or Rehabilitative Mental Health Services for clients in the custody of DHS, DHS/DCFS, or DHS/DJJS   (Outpatient Mental Health) The initial submission date for Responses is: Monday, May 13, 2013 on or before 3:00pm Submissions end: September 30, :00 pm

59 Some Requirements for Contractors
Use of Evidenced Based Practices with targeted youth Use of SMART Goals: Specific, Measurable, Attainable, Realistic and Timely Responsivity Principle: varying treatment according to the relevant characteristics of Client such as gender, culture, developmental stages, trauma, IQ, motivation, mental disorders, & psychopathy “Telehealth” practice of mental health care delivery through interactive video communications when distance or other hardships create difficulty with consistent access to services. Telehealth occurs in real-time or near real-time. Trauma Informed Care: providers must assess childhood maltreatment & may need to modify treatment based on understanding of neurological, biological, psychological & social effects of trauma.

60 Evidence Based or Evidence-Informed Treatment – Utah Model
1. The treatment regimen shall be individualized based on the Client’s age, diagnosis & circumstances. This includes, but is not limited to, addressing grief, loss, trauma, and criminogenic factors affecting Client. 2. Maintain fidelity of the approved evidence-based or evidence informed treatment program through monitoring effectiveness of program. 3. Maintain documentation of staff training received and/or skills in t evidence based treatment for which Client will be engaged to restore the highest possible level of function.

61 CMHC Tools Needed to Put Health Back into Clinical Mental Health
Evidenced Based Practices Apps that Work Neuroscience Psychopharmacology Behavioral Medicine Military Focus Materials Multicultural Perspective as a Mental Health Counselors Focus on the Military

62 Evidenced-Base Practices
Overview of Evidenced Based Practices Anxiety Disorder Obsessive-Compulsive Disorder (OCD) PTSD Phobias Depressive Disorders Bipolar Disorder Alcohol Dependence Substance Abuse Anorexia Bulimia Autism ADHD Guidebooks for EBPs Resources on Evidenced Based Practices

63 Apps that Work For Clients For Practitioners
Moving the concept of Telehealth to new levels appsthatwork.html

64 Neuroscience
Basics of Neuroscience Stress Response of Humans Lectures on Neuroscience

65 Psychopharmacology
Psychopharmacology Chart Drug Classifications to treat the following conditions: ADHD Alcohol Disorder Schizophrenia and other Psychotic Disorders Depressive Disorders Bipolar Disorder Anxiety Disorders Eating Disorders Dementia Generic names of each drug Commercial names of each drug Time to reach clinical level for each drug Benefits of each drug Side effects of each drug

66 Behavioral Medicine ne.html
Background on Behavioral Medicine Lectures on Behavioral Medicine Behavioral Medicine Introductory Bibliography Internet Resources on Behavioral Medicine

67 Multicultural Competency
html Why the Need for Multicultural Competency? Cultural Immersion Multicultural Self-Assessment Challenging Your Cultural Biases Resources for Multicultural Competencies

68 Focus on the Military &Their Families
Virtual Boot Camp for Civilian Mental Health Practitioners Impact of Deployment on the Military and their Families Psychological First Aid for Returning Military and their Families Building Resilience in Tough Times Addressing Compassion Fatigue in the Family and Workplace Background Resources on the Deployment's Impact Resources for Active and Veteran Military Service Members and their Families

69 So far so Good. So what else does COPING
So far so Good! So what else does COPING.US have which will help CMHC’s put health into CMHC which are Evidence Based Practice oriented so that they can be trusted to meet the needs of both the counselors and their clients?

70 EBP Tools on
Tools for Coping: CBT based Client Workbooks SEA’s: 12 Step Program in Self-Esteem Recovery Laying the Foundation: Tools for overcoming Patterns of Low Self-Esteem Tools for Handling Loss and Grief Tools for Personal Growth Tools for Relationships Tools for Communications Tools for Anger Work-Out Tools for Handling Control Issues Growing Down: Tools for Healing the Inner Child Tools for a Balanced Lifestyle: weight management program

71 How can CMHC use Tools for Coping Series
Clinical mental health counselors can utilize these workbooks with their clients to: Expedite their treatment Encourage their recovery Sustain their well-being Identify triggers for & steps to prevent relapse Tools for Coping Handbooks enable CMHC’s to challenge clients to: Maintain personal growth in between sessions by use of: Exercises Tools for changing behaviors Journal writing These workbooks are cost effective interventions based in clinically sound principles which have an evidenced based support in Cognitive Behavior Therapy for their efficacy & positive results

72 In Summary Today we looked at How to put Health back into Clinical Mental Health by reviewing: The implications of the new Affordable Care Act (ACA) and how available tools can help clinical mental health counselors prepare themselves to be better able to present themselves to the medical community as legitimate partners in the prevention and treatment of mental illness in the next century The new 2011 AMHCA CMHC Clinical Standards and how they put Health into CMHC The need for Counselors to become Behavioral Medicine Specialists armed with understanding of Neuroscience, Psychopharmacology, Evidenced Based Practices and the needs of people who have experienced severe trauma such as the Vets from OIF and OEF.

73 THANK YOU ALL! Any further questions or clarifications you would like at this time?

74 End of Program

75 ACO’s Announced in 2013 in FL
1. Accountable Care Coalition of North Central 2. American Health Alliance 3. BAROMA Health Partners 4. Central Florida Physicians Trust 5. Collaborative Care of Florida 6. Diagnostic Clinic Walgreens Well Network 7. Integral Healthcare 8. MCM Accountable Care Org 9. Nature Coast ACO 10. Northeast Florida Accountable Care 11. Paradigm 12. Physicians Collaborative Trust ACO 13. Primary Care Alliance 14. ProCare Med 15. South Florida ACO 16. Primary Partners 17. ProCare Med

76 Accountable Care Organizations in Florida First announced 2012
Accountable Care Coalition of Northwest Florida-NW Florida Accountable Care Partners – Jacksonville Allcare Options – All Florida Florida Medical Clinics-Hillsborough & Pasco Counties FPG Healthcare – All Florida HealthNet-Dade, Broward & Palm Beach Counties Integrated Care Alliance-North Central Florida Medical Practitioners for Affordable Care-Broward County Meridian Holdings – Florida Palm Beach ACO–Palm Beach/Broward County ProHEALTH Accountable Care Medical Group - Florida Reliance Healthcare Management Solutions-N & C Florida TP-ACO - Florida

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