Behavioral Health Advisory Committee

DRAFTMeeting #8 Minutes

Friday, October 27, 2017

9:00 a.m.

Health and Human Services Commission

Brown-Heatly Building

Public Hearing Room

4900 North Lamar Boulevard

Austin, Texas 78751

Agenda Item 1:Welcome, Opening Remarks and Introductions

The Behavioral Health Advisory Committee(BHAC) meeting commenced at 9:07 a.m. with Wayne Youngpresiding as chair. Mr. Young welcomed committee members and members of the public. Mr. Young informed committee and public members that agenda item #5 “First episode psychosis” would be rescheduled for the next quarterly meeting in January of 2018. Ms. Trina Ita, Assistant Commissioner of the Office of Mental Coordination, Health and Human Services Commission (HHSC)welcomed everyone to the meeting.

Mr. John Chacón, HHSC Stakeholder Relations Office, announced the meeting was being conducted in accordance with the Texas Open Meetings Act and noted that a quorum was present for the meeting.

Table 1: The Behavioral Health Advisory Committee member attendance at the Friday, October 27, 2017 meeting.

MEMBER NAME / YES / NO / MEMBER NAME / YES / NO
Afejuku, Ayo MD / X / Johnson, Windy / X
Aylor, Candace / X / Leon, Carlos / X
Castañeda, Elizabeth / X / Osadchey, Lidya / X
Feehery, Matthew / X / Richardson, Andrea / X
Holcomb, Valerie / P / Scott, Nakia MD / P
Horton, Colleen / X / Wolff, Matthew / P
Howell, Jason / X / Young, Wayne / X
Humphrey, Cynthia / X
Johnson, Celeste / X

Yes: Indicates attended the meetingNo: Indicates did not attend the meeting

P: Indicated attended the meeting by phone

Agenda Item 3 b, c, d, e, & f: Intellectual Developmental Disabilities and Behavioral Health Services Update

Block grant subcommittee restructure was presented after the Subcommittee and committee reports updates. Trina Ita, HHSC Mental Health Coordination Director provided an update on the public awareness campaign and appointments update.

Mary Sowder, Behavioral Health Services provided an update on the First Responders - Comprehensive Addiction Grant and Disaster response and referred to handout entitled “CARA Summary”. Robert Dole, Senior Advisor, Karissa Sanchez, Committee Liaison, and Suling Homsy, Senior Policy Advisor provided the Peer and Parity Work group update.

Highlights of the public awareness campaign and appointments update and the First Responders - Comprehensive Addiction Grant and Disaster response updateand member discussion included:

  • Ms. Trina Ita stated that the “Speak Your Mind” Campaign targets youth and young adults and is conducted at the local community level, informing the community about behavioral health issues, addressing stigma. The campaign will continue but a subcommittee will be developed to look at enhancing the campaign.
  • Regarding appointments for the BHAC committee, Ms. Ita stated there have been some outstanding appointments for the BHAC and appointments have been put forward, but no decision has been made about the vacant representatives. HHSC had hoped to have the appointments approved for this meeting but will have them for the next meeting. She indicated that two year appointments end August 31, 2018 and three year terms end August 31, 2019.
  • Ms. Mary Sowder commented on the first responders grant and stated that this is an opioid grant for $800,000 a year and Bexar County was chosen to train traditional and non-traditional providers to provide naloxone to the community to address overdoses. Bexar County has a major opioid initiative already so this grant will work with them and that also includes a prevention component as well. Recovery support coaches will also be enhanced in Bexar County.
  • Ms. Sowder stated that Tarrant County LMHA also was awarded a grant for $400,000 a year doing similar work with a similar approach. She stated that this could be a pilot that can be replicated in other areas. HHSC had set up group meetings with public health, DFPS and criminal justice to explore other grant opportunities.
  • Committee member made a comment that all eyes are on this program, but it was based on the number of people in treatment and rural areas don’t have access to treatment, making their numbers lower. Committee member asked how is the above stated information being shared and Ms. Sowder stated that HHSC looked at not just people in treatment programs but also number of people going into detox and residential treatment. Medication must be done in conjunction with counseling and that the 1115 waiver also provides some of these services. The Office-Based Treatment (OBOT) using Vivitrol is office based outpatient treatment and clients were not eligible for the open enrollment but dollars were set aside for the expansion of those services. Private physicians want to do this but they will only be funded if they are connected to a licensed outpatient clinic.
  • Committee member made a comment that overdoses are always undercounted by the state and was happy a peer support is being used because it is more than giving medication. Committee member stated that there are other funding streams that can be accessed. Ms. Sowder stated that the death record is the key piece for data collection. She also stated that many additional entities are looking to have this treatment in their service array as well who are non-traditional service entities.
  • Ms. Sowder stated a red ribbon campaign will be kicked off at the capitol and in communities this coming week.
  • Ms. Sowder stated that the Drug Take Back Day is occurring this Saturday and that the use of anonymous drop boxes makes the program successful. She stated that this event happens twice a year, sponsored by DEA.
  • Regarding the Disaster response, Ms. Mary Sowder stated that Wayne Stewart and Lauren Lacefield-Lewis were deployed with the joint field office (JFO) in the impacted flood areas. There are six teams to cover the additional counties in the impacted areas that have not been seen yet by the federal team. The teams only go to sites and not individual homes. The behavioral health staff are looking at impact on children at day care centers and other entities that serve people to identify behavioral health needs. The response was larger than Katrina in Texas. 24 hospitals were evacuated, 780,000 Texans evacuated their homes and as of October 16, 2017 FEMA received 875,141 registrations for assistance. 14 mental health authorities were included in the disaster proclamation and there was a behavioral health desk staffed at the command center with 24 hour a day staffing.
  • Ms. Sowder stated that crisis counseling services were provided through the Immediate Service Program (ISP) and longer-term services were provided. There were numerous LMHAs with staff who had a house lost or a car lost in the storm and aftermath.
  • Question was asked by a committee member on how the state was addressing behavioral health needs in the Schools and Ms. Sowder responded that many LMHAs have good relationships with schools and many services are provided in the schools. The Rainbow Days curriculum has been proven effective (out of Dallas) and helped children and now HHSC is looking at how to help the principals, counselors and staff.
  • Ms. Sowder stated that the Texas Education Agency (TEA) is holding a symposium on the week of October 30, 2017 to open up discussion of looking at mental health in schools.
  • Question was asked by a committee member if the shelters had access to medication and Ms. Sowder responded that they did but not methadone nor Naloxone.
  • Ms. Sowder stated that with the ISP grant HHSC was able to hire 15 people with the $2.4 million. The new initiative with TEA is very productive and builds a collaboration for the future. There were over 250 ISDs impacted by the storm and this is on top of 9,000 people who are homeless and attending the same ISDs from Katrina.
  • Committee member made a comment that we are going to have more hurricanes in Texas and the hope is that local, state, and federal resources can come together, talk about lessons learned and then develop plans for the next time. Ms. Sowder stated that there are plans but each time one will learn something new and plans have to be developed on an ongoing basis.
  • Committee member made a comment that as the state moves to the education summit, one has to address trauma and needs of children with IDD and there is a curriculum through the National Child Traumatic Stress Network addressing child stress and there are people who have been trained to use the tool kit. It was noted that Michelle Schwartz at Safe Place is the program coordinator for this.

Highlights of the Peer and Parity Work group update and member discussion included:

  • Mr. Robert Dole provided an update on HB1486 regarding the Peer Support Work Group and stated that the last update had a very assertive timeline but because of Hurricane Harvey, resources were diverted and the timeline was pushed back. HHSC will hold a stakeholder workgroup meeting on November 30th. There will be public forums statewide as well and the workgroup will access the needed expertise. One piece is the hope for draft rules by February but may take additional time to ensure the best output. The rules will not be adopted by September 1, 2018 as required due to Hurricane Harvey.
  • Question was asked by a committee member if there was a list of work group members and when will website launch and Mr. Dole responded that there is a list but it is not ready for posting. He stated that media services is working on the website and a notice will be sent out once it is live.
  • Question was asked by a committee member regarding if there will be acknowledgement of how substance abuse and mental health are different and Mr. Dole responded that HHSC is trying to set up one set of rules that applies to both and that HHSC is aware of the challenges.
  • Committee member made a comment that this may be HHSCs only chance to do this right and it would be imperative to know that there is enormous support to implement this as a service.
  • Regarding the Parity Work Group, Karissa Sanchez commented on HB 10 and stated that the Parity work group is required and is charged with increasing compliance with state and federal laws, strengthening enforcement and oversight, improving the complaint process, investigate violations, and increasing public education of the laws. She indicated that a report is required and a strategic plan is the focus of the group. She indicated that specific representatives are required that include experts, providers, sub-providers, advocates and health plans. 14 members had been recommended to the Executive Commissioner and the first meeting has been set for the Monday after Thanksgiving.
  • Ms. Sanchez stated that the new Behavioral Health Office of the Ombudsman is also created by HB10 and that two positions are to be provided by the rider.
  • Ms. Suling Homsy stated that there are sections in HB10 related to Medicaid and CHIP. A study is required that will collect and compare data in four required areas. The goal is to have comparable reports for the two disciplines so there can be comparisons made. She stated that HHSC and the Texas Department of Insurance (TDI) have been coordinating.
  • Question was asked by a committee member that if the data set to be collected would be done electronically and if there are technological issues and Ms. Homsy responded that the discussion on Monday will look at this and that TDI will determine the scope of the data set.
  • Question was asked by a committee member if there was a plan for addressing rights under the parity laws and Ms. Homsy responded that on December 2, 2017 the website will go live and there will be links that educate about parity. She indicated that links to complaint filing will also be provided.
  • Committee member made a comment that in the past Medicaid recipients would receive fliers about notices and that perhaps members can receive information from health plans and other providers. HHSC stated that they will discuss that internally.

Agenda Item 2: Approval of Minutes

Mr. Young called for a motion to review and approve the minutes of the August 18, 2017 meeting.

Motion:

MatthewFeehery moved to approve the minutes from the August18, 2017 meeting as written. Jason Howell seconded the motion. The Committee members unanimously approved the minutes by voice vote, with no nays and no abstentions.

Agenda Item 4: State Hospital Plan

Stephanie Muth, Deputy Executive Commissioner and Tim Bray, associate Commissioner provided an overview of the State Hospital Plan and referred to handout entitled “State Hospital Plan”.

Highlights of the overview regarding the State Hospital Planand member discussion included:

  • Ms. Stephanie Muth stated that the Texas Health and Human Services (HHS) is embarking on a multiyear project to expand, renovate and transform the state hospital system. State hospitals provide in-patient psychiatric care for adults, adolescents and children. She stated that in 2017, the Texas Legislature appropriated funds to the project and that in fiscal year 2018, HHS will begin the first phase of construction and other changes designed to:
  • Enhance the safety, quality of care and access to treatment for Texans with mental health issues
  • Expand capacity and reduce waiting lists for inpatient psychiatric treatment, particularly for maximum security units
  • Increase collaboration with potential partners, particularly higher education and health-related institutions
  • Committee member made a comment about the need for a recovery focused approach but it has been mentioned that recovery focus has not been key to state hospital services and that employees of the hospitals should be included in what service delivery means and a strong focus is kept on person centered services and recovery focused. Commissioner Muth stated that HHSC has set recovery focused services as a priority. She stated that there has been conversations within the governance structure about recovery focus. A committee member stated that it has to be reflected in the measures being used.
  • Committee member made a comment regarding community-based with the state hospital as the anchor is a key element that communities share resources with the state hospitals and that those connections have to be kept strong. Commissioner Muth stated that this is not a cookie cutter approach and it is important that the entire continuum of care works together. She stated it is an opportunity to work together.
  • Committee member made a comment that the additional services that are offered at the community have to be on the agenda as well.
  • Committee member made a comment that it is difficult to get people who can address the needs of the medically complex and was glad that it will be addressed. Committee member stated that there is an opportunity through the Hogg Foundation Grants to transition from the medical model to the recovery model and that the focus should be shifted from the hospital as the anchor to the community being the anchor.

Agenda Item 9a:Subcommittee/Committee Reports

  1. Children and Youth Behavioral Subcommittee Update
  • Ms. Molly Lopez provided the update and referred to handout entitled “Children and Youth Behavioral Health Subcommittee - Legislative Recommendations”. She stated that the subcommittee met on October 11, 2017 and developed recommendations to the BHAC committee. Several evaluation studies were presented and among the topics was residential services and First Psychosis. School mental health reports was covered as well which was impacted by Harvey. Current SAMHSA grants are finishing up to expand access to services, and having family driven systems of care.
  • Question was asked by a committee member regarding what was covered on residential care and Ms. Lopez responded that it addressed relinquishment to DFPS.
  • A committee member stated the subcommittee agreed to move forward and pass along the recommendations for consideration by the BHAC committee at today’s meeting.
  • Recommendation 1 discussion:
  • Question was asked by a committee member regarding whether regulatory changes would be needed for recommendation #1 and Ms. Lopez responded that to be a licensed substance abuse provider it has to be tied to the facility and it does not allow the services to be provided in the School District.
  • Question was asked by a committee member regarding if the schools will be contracting with providers and Ms. Lopez responded that not necessarily as many community centers have direct relationships with schools and it would operate as a satellite office connected to the center.
  • Question was asked by a committee member regarding if this would create a liability for the schools and Ms. Mary Sowder responded that this would close the liability gap, because if something is identified then services have to be provided. She stated that this is motivated from the services provided already and this would be outpatient related services; groups and individual counseling.
  • Question was asked by a committee member regarding whether this would require only rule change or legislative direction and Ms. Sowder responded it would only require a rule change. She stated that there has been guidance provided by regulatory at HHSC, but there has notbeen a public comment period yet.
  • A committee member made a comment that this issue comes up often with schools and churches with the square foot requirements and other requirements for facilities where services are provided. Opening to any community setting raises a concern but this would also create more access and the positives outweigh the negatives.
  • Ms. Mary Sowder stated that on the substance abuse side facilities and providers have to be licensed; for mental health a license is not required.
  • Acommittee member made a comment that it seems clear that getting services to children in schools makes sense. It raises some issues apparently related to the community at large and perhaps just the schools be addressed and then have a separate discussion about the community at large like recovery homes and community based settings.
  • Comment was made by a committee member that only schools and children should be addressed.
  • Ms. Lopez stated that there was an interest to address barriers by going into people’s homes as well and not just schools.
  • A committee member stated that recommendation #1 includes only ages 12 to 17.
  • Committee members discussed whether recommendation should include community and family settings but was decided to leave language as presented.
  • There was no member discussion on recommendations #2 and #3.

MOTION: Ms. Andrea Richardson moved that recommendation #1 be accepted as presented and moving it forward. Mr. Matthew Feehery seconded the motion. The Committee members accepted recommendation #1 by voice vote, with eleven yea’s, no nays and one abstention from Mr. Jason Howell.