Minutes for 1/14/16 Advisory Board

Minutes for 1/14/16 Advisory Board

Oregon Center of Excellence for Assertive Community Treatment

Minutes for 1/14/16 Advisory Board

In attendance: 12 attendees on site and 17 on phone.

Jason Morrow (Marion County Peer), Jack Hacak (Advocate), Megan Chaloupka(Central City Concern), Sara Dotson (Polk County), Wendy Chavez (Health Systems Division), Tracy Beimler (Advocate, Peer), Hillary Morris (Yamhill County), Raina Wickham (Benton County) Erica Stockdale (Wallowa County, ph),Barbara Day (Collective Medical Technology, Premanage , ph), Justin Keller (OHA Analyst, EDIE/Premanage, ph), Tawnya Moore (Jackson County, ph), Karen Nielsen (Curry County, ph),Gina McCrea (Lincoln County, ph),Kathy Franz (NARA, ph), Debra Girnt, Shannon Hamlin & Ross Aker (Coos County, ph), Kimberly Wilcox & Don Hepler (Sequoia), Rachel Anthony (Clackamas County Peer, ph), Dena McMillian (Linn County, ph), Allison Deputy (Baker County, ph), Cherie Barnstable (Union County, ph), GOBHI Admin (GoToMeeting logged); OCEACT staff: Jeff Krolick, Heidi Herinckx, Emily Reynolds, Ann Delmar

Ann Delmar opened meeting. All attendees sharedname, location in the state, and aword, phrase or sentence that best described most noteworthy ACT related work accomplished during the week.

Minutes Reviewed from 10/8/15 – No changes. Jack motioned to approve, seconded by Jason.

Agenda Reviewed – Role of Older Adult Behavioral Specialist overview from NirmalaDhar was moved to April meeting.

OCEACT Updates

OCEACT Advisory Board Purpose:

  • Based on her review of 2014 and 2015 Advisory Board agendas, Ann stated it seemed that the Board was: 1) a forum to discuss challenges and opportunities related to statewide ACT model implementation; 2) a forum for stakeholders to present salient issues pertinent to ACT team development, 3)a forum for ACT providers and other community representatives to discuss best practices; 4) a forumto celebrate what is going well; and, 5) a forum for providers to support and learn from one another. Participants were asked what else should be added to the list and/or to name what would engage their participation. Comments:
  • Jack stated that he wouldlike to hear morediscussions about ethical practice perspectives.
  • Raina suggested that we focus on advocacy issues, in particular, how to address housing crisis. Jeff suggested it might be helpful if there was acompiled list of advocacy connections that each team has developed in their local communities regarding housing as well as other topics.
  • Jason recommended weuse time to remember the individuals we serve and how we serve them.
  • Reviewed a list of 2014/2015 OCEACT Advisory Board Meeting discussion topics. These included presentations and discussions on theACT Model and Fidelity, Conference Planning, Olmstead and ACT Connection, Update on ACT Programs, Traditional Healthcare Workers Registry, Premanage, and OSH Discharge Planning. Ann requested topics that need to be slated for 2016. Wendy said the state is creating a Universal ACT Referral Form anda screening tool related to ACT admission standards. Wendy will be eliciting feedback on these. Once they are completed changes will be defined in OARs. She clarified that the state is interested in tracking referrals and denials to ACT services and is looking to identify the barriers to getting into ACT programs. It is believed setting some universal standards will help with this. Additionally there will be forms used to track outcomes for the DOJ. Wendy has not yet seen these forms. Some data is already tracked during program reviews and other data is being collected on a form that counties are submitting for ACT participants who are funded by means other than Medicaid. These topics will be the primary focus of April Advisory Board Meeting. Wendy will communicate more information by email.

IMR Training:

OCEACT sent the announcement for the March IMR training scheduled for March 9 & 10 at Chemeketa Community College. Heidi sent out IMR Training Applications to ACT team leaders on 12/28. Applications are due by January 22nd.Top priority will be given to qualified program applicants who did not receivethe 2014 E-IMR training. All ACT teams, those provisionally qualified and those who do not yet have official status, were encouraged to submit applications since there may be slots available. By January 25th or 26th,Heidi will announce which programs were selected after review of all submitted applications.

Conference Planning:

Reviewed list of conference keynote speakers from 2014 and 2015 and announced 2016 keynote speakers.

  • Stacy Smithis a certified by MINT (Motivational Interviewing Network of Trainers). She has 25 years’ experience in NC MH services and worked as a Team Leader for two large ACT teams.
  • Ellis Amdur, Author of Grace Under Fire, will focus on staff and participant safety. He has been training ACT teams and law enforcement personnel for many years on best safety practices while serving individuals who live with psychiatric or substance use related illnesses.
  • The third invited keynote (not yet confirmed), is Eric Granholm. Dr. Granholm’s recent research has primarily focused on clinical trials of interventions to improve functioning and recovery outcomes in schizophrenia. He developed an intervention called Cognitive Behavioral Social Skills Training (CBSST), which combines two evidence-based psychotherapy interventions, cognitive behavior therapy and social skills training.

The conference format this year was revised to include 3 hourworkshops providing ACT staff an opportunity to build skills in areas discussed by keynote speakers and local professional. For example, in addition to a keynote address about the evidence based practice motivational interviewing, Stacy Smith will offera 3 hour hands on workshop applying MI within ACT specific services. All three keynote speakers will provide 3 hour training workshops.There will be a panel discussion focusing on engagement and community integration,in particular, on reclaiming valued social roles for ACT participants. Heidi described the format for a planned group discussion session. Sometimes called popcorn, the group discussion begins with 8 people in a circle in the center of the room discussinga key topic of ACT team interest. All attendees who are interested in adding to topic are invited to participate by replacing someone in the original group. The format will allow Oregon’s teams to share best local practice ideas.

Ann closed conference planning discussion stating that conference topics do come from ACT team recommendations and invited attendees to send additional topic ideas for 90 minute breakout sessions.

Oregon Health Authority Report

Wendy Chavez reported on new ACT funding. About half of the funding will be used for infrastructure. An RFGP, is scheduled to be announced in April. Announcement will be sent to CCOs communicating additional funds available for developing new teams, supporting teams not meeting fidelityand for teams expanding capacity. The funding will not be maintenance funding for existing teams. The language for expansion RFGP has been developed and willprovide CCOs with the most and best information available about realistic expectations to provide ACT services in their area. Wendy has been advocating that some of the additional ACT funding money be provided to CMHPs directly so ACT teams can serve participants who are currently not being served. The second piece relates to what we've been discussing concerning barriers to getting some Oregonians enrolled in ACT services. Sometimes this may be CCO's not authorizing payment or it may be AMHI determining the person is not a good fit. For AMHI there is a general inability to fund individuals in aid and assist. We want these individuals to have access to the program.Wendy will use reports submitted from ACT programs to get estimates of who needs ACT services that are not being approved. The only way we can do this is through CMHP contract amendments. The funding will go through the CMHP and the contract language will be developed that this must be for direct services to client from provider. As one example Wendy stated, we want to make sure there is money for individuals who are not covered by OHP. Wendy is working on a strategy to make this money stretch as far as possible, reach as many as possible, and be as fair as possible. RFGP for CCOs will go out first. Current draft is going through contracts and DOJ then will be available. Once announced, Wendy estimates a 30 day turnaround on proposals. Questions:

  • Raina wanted to know more about program expansion - if we want to expand key positions, i.e. SA and employment, could we apply?Wendy said yes so long as it is to expand the ACT program. She further explained that there will be reporting requirements associated with RFGP. For example, programs who apply for expansion will be expected, by the end of the contract period, to reach expanded level.
  • Jack wanted to know mechanism for CCOs to ask questions about finances. They could contact OCEACT for technical assistance. Heidi stated that OCEACT is always happy to answer questions from providers or CCOs.

Presentations

Justin Keller, OHA Lead Analyst, Office of Health IT presented from the attachedPowerPoint. In addition to providing this overview of EDIE and Premanage systems for new teams, Justin said he really wanted to spend time today getting feedback from ACT teams involved inPremanage pilot study. The two early ACT adopters, Central City Concern and Sequoia Mental Health, therefore had been asked to describe their use and share challenges and value added to havingPremanage. Justin assured all ACT teams currently contracted to participate inPremangepilot would not experience any interruptions or added costs. He stated that all ACT teams will receive continued support through Collective Medical beyond the pilot date. New ACT teams were encouraged to sign on. Justin was happy to report that the applications forms had been simplified. He thanked participants for undergoing the old process which he acknowledgedwas burdensome.

Premanage Comments: Don from Sequoia shared that Premanage was very useful and added tremendous value to their team service delivery. In particular it was invaluable for participants who were homeless and/or had no cell phones. Sequoia’s ACT team, which is on call 24/7, would instantly receive notifications by text. We could immediately work with ER staff about how to best serve individual until staff member arrived.Team also received alerts for transfer from one department to another within the hospital. Don said if alerts concerned a participant who was not engaged with ACT services, we could go to ER to build engagement. During the morning meeting, we would know who went to hospital and immediately determine best actions to take. It is great having this information at finger tips during meeting. We have a participant member that has dual diagnosis and seeks prescription medications that we could better serve. Don said if someone ends up in jail we are not always notified. It really helps us track hard to find individuals and alert us to physical and mental health care concerns allowing our team to coordinate ACT participant care. Don said he liked having this as another data source to update assessments and TX plans and described how the Sequoia team’s Admin Assistant provided data at team meeting and for updating participant EHR. Megan from CCC added that Premangeprovides their team with access to information we didn’t have before. For example, local CCO will alert us but can take from 1-48 hours. These alerts are only for mental health admissions and for participants with OHP coverage. Premanage includes all ER visits whether for physical health, mental health and for non-OHP clients as well as for transfers within the hospital. The staff members can put salient information into alerts to check on our thinkingtoo. Because of this emergency staff know how best to serve ACT clients. The system allows teams to communicate directly through return text. In addition, each week the IT department sends flat file of client list so team members can update care alerts and state when someone is at high risk of going to hospital. NOTE: Care Alerts will be called care recommendations in the future.

Discussion: Raina asked about uploading information and who is authorized to access it. Megan stated that atCCC their IT department sends themreports weekly and then individual clinicians can go into system to update care recommendations. Jack wondered if the client understands who has access to their data.Megan reports access is tracked and at any time they can find out who accessed data from Collective Medical Tech. She also stated these records are not continuously available. Tthey are available only during a crisis. Hilary reports this has been a barrier to them embracing PreManage fully. She said in September CCO clients were uploaded, the rest have not been. Teams discussed informed consent models, forms, tools, etc. for PreManage or EMRs. Group said they would love to collect information and examples. Erica said they would share forms once they finalize them in their new EHR. Barb said Collective Medical has a document that outlines how to create Care Guidelines and what should not be included. See will send out once completed. Cascadia FACT is using a template and we can ask if they will share their example.Heidi is interested in knowing the extent to which care recommendations are utilized at the EDs.

Community Support and Integration Raina from Benton County ACT was asked to share some of their strategies for working to built support in the local community. Raina said we celebrate executive support. Our Benton County MH Director has been a trail blazer for ACT. The county commissioners now seek to learn about and educate the community about ACT services. The county public relations office set up opportunities for ACT clients to share recovery stories. The local Gazette Times has published articles. One ACT participant was interviewed by local TV crew and his story was broadcast. We are able to share ACT participant successes at Benton County’s All Staff Meetings. We are always working to develop positive relationships with local landlords, pharmacies, etc. The support of Commissioner’s and local public relations supports these advocacy efforts. Jack askedRaina is she had ever encountered any individuals that were resistant or worried that ACT was coercive. Raina spoke about the extentof the ACT engagement phase to clarify that there is no coercion however every attempt to provide ACT services to those who quality is made. Additionally, the ACT team works in collaboration with county MH team to see if another service would better support any ACT participants.

Peer Service Specialist Collaborative Jason reported that the January 11 PSS collaborative call included about 20 participants. He was the facilitator for the first call. He talked about how he uses the 8 Dimensions of Wellness and the IMR goal setting handouts to help participants name their personally identified goals and to develop steps toward achieving these goals.

OCEACT Advisory Board Meeting Minutes 10/8/2015Page 1