January – February 2019 Work

ZIA NEWS – January-February 2019

Activities:

There has been continuing activity on both old and new projects as 2019 starts off with a lot going on!

Interdepartmental Serious Mental Illness Coordinating Committee:

Dr. Minkoff and the non-federal members of ISMICC were successful in putting together a draft report outlining progress and suggested next steps for the federal ISMICC agencies to make further progress on implementation of the ISMICC recommendations. The next step is to work with Dr. McKance-Katz and SAMHSA staff to identify the best way for the non-federal members to work collaboratively with the federal members to help everyone be successful. One of the items under consideration is how the report should be utilized, if at all. Currently, the report is in draft form, and further dissemination is on hold, pending discussions in March.

Group for the Advancement of Psychiatry (GAP) – Committee on Psychiatry and the Community: 

Dr. Minkoff is co-chair of the committee, with Dr. Jackie Feldman, working on developing a report outlining the measurable criteria for an “Ideal Crisis System” for any community. Dr. Feldman, Dr. Balfour, and Dr. Minkoff met in Tucson at the end of February to coordinate the contributions from the entire Committee into a first draft. This meeting was highly productive, and it is anticipated that the review draft will be available in March 2019.

National Council for Community Behavioral Healthcare: ZiaPartners is an Affiliate Member of National Council, and Dr. Minkoff is a member of the Medical Director’s Institute. ZiaPartners has committed to two presentations at the NATCON conference in Nashville in March: A pre-conference institute on co-occurring disorder service implementation on March 24, and a presentation on the criteria for designing and implementing an Ideal Crisis System (with Dr. Margaret Balfour from Connections AZ) on March 25.

College for Behavioral Health Leadership – As a Board member, Dr. Minkoff has been contributing to launching a new set of CBHL activities that will allow the organization to operate on a much bigger scale and will attract resources for the development of materials to “make leaders better” across multiple sectors and boundaries within the universe of Behavioral health service delivery. Dr. Minkoff has developed an updated vision and mission draft for the organization that outlines this new direction, which is pending approval at the March Board meeting.   Once this material is disseminated, Dr. Minkoff will be working on helping to seek funding to support the “big new vision” for the organization.

National Association of State Mental Health Program Directors (NASMHPD) – Dr. Minkoff was contracted by NASMHPD to prepare one of its 2019 concept papers (funded by SAMHSA) on developing integrated systems and services for individuals with co-occurring Mental health and substance use disorders. Dr. Minkoff will be working on this project with Nancy Covell of the Center for Practice Improvement at Columbia. The paper’s first draft is nearly completed, and will be due for finalization by June.

American Association of Community Psychiatrists – Drs. Minkoff and Cline worked during December to plan the Winter Board meeting of AACP in Vieques, Puerto Rico. The meeting was held from January 31-February 2 and involved AACP working with the entire community on how to improve mental health services on this tiny island (Population 10,000) that has experienced considerable trauma.   Drs. Minkoff and Cline participated in a community event on mental health, that involved a wide representation of community representatives and a consulting psychiatrist group called Crear Con Salud, one of whose members is an AACP Board Member. AACP is planning continued involvement with this small community, including planning for holding a follow up Board meeting in Vieques next winter.

Meadows Mental Health Policy Institute:   ZiaPartners came to Texas in January to be part of a proposal presentation for system consultation to John Peter Smith, the Tarrant County Hospital District. ZiaPartners has continued active involvement in multiple projects and activities conducted by MMHPI, as follows:

  • Finalizing the Houston Endowment Substance Use Disorders System report following submission of the first draft to the funder.
  • Coordinating with the Local Systems team regarding how to best support progress in a variety of local system consultations
  • Working with Dr. Seema Shah to discuss statewide efforts to improve primary health/behavioral health integration for children, and to develop statewide academic partnerships regarding research and services.
  • Participating with Sam Shore on the HHSC-MMHPI workgroup on substance use disorder services, focusing on data accuracy and policy recommendations for sober living and expansion of opioid use disorder services.
  • Supporting implementation of a Texas TA team to work with the American Academy of Addiction Psychiatry on statewide TA for MAT, as part of the national STR-TA initiative.
  • Working on the development of materials for the next phase of Okay to Say: (Okay to Share; Okay to Care).

Follow MMHPI at www.texastateofmind.org

Iowa East Central Region: ZiaPartners held a very successful two-day crisis training conference in Dubuque, attended by representatives from crisis center development in all three major communities in the region (Dubuque, Iowa City, Cedar Rapids).   The conference covered a range of topics including: characteristics of an ideal crisis system, team-based staffing models, clinical practice development, integrated crisis assessment, integrated level of care assessment, developing data driven quality improvement metrics, and a deep dive conversation on funding and billing within the Iowa Medicaid system, involving representation from two MCOs and from DHS. There was a follow up conversation on implementation steps with Dubuque, and a follow up conference call on developing specific recommendations for how to define various types of service provision and associated reimbursement.

Greater Oregon Behavioral Health, Inc. (GOBHI): ZiaPartners engaged in an onsite planning visit with GOBHI leadership and board members in West Linn, OR on February 13. This involved a presentation on the CCISC model and how it could be applied within the GOBHI system (and the state of Oregon generally) to advance Mental Health/Substance Use Disorders and Psychological Health/Behavioral Health integration, especially within the context of CCO 2.0 re-procurement. The presentation was well-received, and the decision was to go forward with a formal launch at the spring conference in May.

Illinois Department of Human Services: ZiaPartners began a consultation project with the Mental health Division and the Substance Use, Prevention, and Recovery (SUPR) Division to assist the Mental health Division with addressing the needs of individuals with co-occurring Mental Health and Substance Use Disorders who are in institutions (IMDs and Nursing Homes) who are covered by two federal consent decrees requiring progress in deinstitutionalization. The project will involve consultation to the state, engagement with providers, and provision of recommendations, as well as technical assistance, consultation, and training on implementation of recommendations that will help the state meet its targets under the consent decrees.

Massachusetts:   On January 16, Dr. Minkoff participated on a panel for a state leadership conference on integration of Mental Health and Substance Use Disorders in Massachusetts, coordinated by Danna Mauch, Executive Director of Massachusetts Association of Mental Health, in collaboration with National Council (BHECON project). The result of Dr. Minkoff’s presentation was a verbal consensus from participants that Massachusetts should take organized steps to implement an integrated system of care where all programs become co-occurring capable.

St. Clare’s Behavioral Health: On January 18, Dr. Minkoff did a full day training on developing integrated services and systems for individuals with co-occurring mental health/substance use disorders for St. Clare’s Hospital Behavioral Health Services in Denville, NJ. The presentation was very well received and generated some significant energy and excitement for change.

All Health Network: In February, Dr. Minkoff conducted a 2 day on-site assessment of the full array of co-occurring disorder services at this large mental health center serving Arapahoe and Douglas Counties in Colorado (outside of Denver). The assessment generated substantial excitement for organizational change, and to improve the existing co-occurring IOP services as well as to develop co-occurring capability in the current array of serious mental illness recovery services. This will result in an ongoing implementation project that will begin in March, with a formal launch event in April.

All Health Network

Tennessee Co-occurring Strategic Initiative: Dr. Minkoff and Dr. Cline had a teleconference with Patrick Slay and representatives of 7 agencies participating in the Tennessee Co-occurring disorders project, regarding how these agencies can participate as peer mentors to registrants at the Pre-Conference Institute at NATCON in Nashville in March. The participants were delighted to share their positive experiences and learning and indicated that it would be fun for them to be involved in this way.

Vermont Co-operative for Practice Improvement and Innovation (VCPI): Dr. Minkoff continues working with the VCPI leadership team to develop a working leadership and operations structure for VCPI. ZiaPartners is also a subcontractor along with VCPI on a proposal submitted by Vermont Care Partners to Vermont Department of Mental Health to expand co-occurring Mental Health/Substance Use Disorders services, with a focus on adults with Serious Mental Illness and Opioid Use Disorder.

Common Ground: Continued consultation to assist in the development of improved capacity for Common Ground to deliver the highest possible quality comprehensive crisis service array in Oakland County, Michigan, as well as assistance with application for a SAMHSA Grant to develop “air traffic control” capability.

Genesee County, MI: Dr. Minkoff contracted to provide six days of co-occurring disorder implementation training to Genesee County Behavioral Health: 2 days each in April, June, and September.

Network 180, Grand Rapids, MI: Dr. Minkoff contracted to provide one day of training in June on integrated strength-based case formulation and treatment planning for individuals with co-occurring disorders and other complex needs.

CALM:   ZiaPartners met by phone with the individuals who funded our consultation project to report on successful progress to date. CALM has made dramatic progress in the course of our consultation, and the results of their organization’s commitment to healthier organization culture, involving both clinical and business practice, are really taking hold at all levels.

Silver Hill Hospital – ZiaPartners had a teleconference with the new CEO, Andrew Gerber, MD to discuss our observations and recommendations.   ZiaPartners had contracted with Silver Hill (located in New Canaan, CT) to assist with continuing implementation of the transformational recommendations from our April visit, to implement a collaborative culture to facilitate admissions, transitions, and staff engagement. Dr. Gerber will be in touch regarding any requests for continuing help.

Mid-Hudson (NY) Region Co-occurring Initiative: Following the November conference, there has been continuing progress in counties across the region.   ZiaPartners is very appreciative of the amazing work on this project by Marcie Colon of the Mid-Hudson Region (link) and Stephanie Marquesano of The Harris Project, as well as the 7 County BH leaders.

Equine Assisted Therapies and Activities:   ZiaPartners was awarded a competitive bid to help multiple organizations involved with equine assisted therapies and activities to come together to develop a common language for the entire field. This three-day meeting is scheduled for July 2019.

Missouri Foundation for Health: ZiaPartners organized a team (including TriWest, Lynfro Consulting, and Joe Parks, MD from The National Council) to respond to an RFP released by Missouri Foundation For Health for a statewide analysis of the Missouri Behavioral Health System.   This proposal is under review and is one of three finalists. If accepted, the project will begin in summer 2019.

Monterey County, California: ZiaPartners was contacted by Michael Lisman, Director of Adult Services, for possible engagement with implementing an integrated service continuum in Monterey County. ZiaPartners submitted a proposal with multiple levels of possible effort, which is currently under review.

 

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Victorian Dual Diagnosis Initiative

St. Vincent’s Hospital in Melbourne hosted the Victorian Dual Diagnosis Initiative Forum on March 12th.  They have provided video presentations on their website, including an introduction to The Harris Project by our own Dr. Kenneth Minkoff.

VDDI Forum 2019

Introduction by Dr. Minkoff

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November-December Work

Activities:

There has been continuing activity on both old and new projects as the year draws to a close!

Interdepartmental Serious Mental Illness Coordinating Committee:

Dr. Minkoff worked with the non-federal members of ISMICC to help organize several activities to support the implementation of the ISMICC recommendations, including planning for the second full ISMICC meeting of 2018, which was held at SAMHSA on December 11. The meeting was very successful and provided an opportunity for ISMICC members to interact with the interdepartmental workgroups which are making progress on implementation of the ISMICC recommendations (ISMICC report). Assistant Secretary McKance-Katz has proposed further engagement of ISMICC members with the workgroups during 2019, having both two quarterly teleconference meetings in addition to the two in-person meetings.   The non-federal ISMICC members are working on a report on the progress of ISMICC implementation which is intended to be completed in early 2019.

Group for the Advancement of Psychiatry (GAP) – Committee on Psychiatry and the Community:

Dr. Minkoff is co-chair of the committee, with Dr. Jackie Feldman. At the fall GAP meeting (Nov 8-10), the Committee made considerable progress on its report on the criteria for an ideal crisis system.   A plan was developed for putting together an initial draft for review by stakeholders, with Dr. Feldman, Dr. Balfour, and Dr. Minkoff meeting in Tucson at the end of February to coordinate the contributions from the entire Committee. It is anticipated that the review draft will be available in March, 2019.

National Council for Community Behavioral Healthcare: ZiaPartners is an Affiliate Member of National Council, and Dr. Minkoff is a member of the Medical Director’s Institute. ZiaPartners has committed to two presentations at the NATCON conference in Nashville in March: A pre-conference institute on co-occurring disorder service implementation on March 24, and a presentation on the criteria for designing and implementing an Ideal Crisis System (with Dr. Margaret Balfour from Connections AZ) on March 25.

Presentations: 

Institute on Co-occurring Disorder Service Implementation

Defining the Ideal Crisis System

College for Behavioral Health Leadership – As a Board member, Dr. Minkoff has been contributing to launching a new set of CBHL activities that will allow the organization to operate on a much bigger scale and will attract resources for the development of materials to “make leaders better” across multiple sectors and boundaries within the universe of Behavioral Health service delivery. Dr. Minkoff will be working on helping to seek funding to support the “big new vision” for the organization.

National Association of State Mental Health Program Directors (NASMHPD) – Dr. Minkoff was contracted by NASMHPD to prepare one of its 2019 concept papers (funded by SAMHSA) on developing integrated systems and services for individuals with co-occurring Mental Health and Substance Use Disorders. Dr. Minkoff will be working on this project with Nancy Covell of the Center for Practice Improvement at Columbia. The paper is due to be completed by June.

American Association of Community PsychiatristsDrs. Minkoff and Cline worked during December to plan the Winter Board meeting of AACP in Vieques, Puerto Rico. The meeting will be held from January 31-February 2 and will involve AACP working with the entire community on how to improve Mental Health services on this tiny island (Population 10,000) that has experienced considerable trauma.   Planning for the event has involved a series of meeting with community representatives and a consulting psychiatrist group called Crear Con Salud, one of whose members is an AACP Board Member.

Meadows Mental Health Policy Institute:   Dr. Cline and Dr. Minkoff attended the MMHPI full staff meeting in Austin on December 5-6, and did a presentation, with Dr. Seema Shah, on the experiences of individuals with serious mental illnesses to help non-clinical staff have a better understanding of the impact of Mental Health policies. ZiaPartners also continued active involvement in multiple projects and activities conducted by MMHPI, as follows:

  • Finalizing the Houston Endowment Substance Use Disorder System report following submission of the first draft to the funder.
  • Coordinating with the Local Systems team regarding how to best support progress in a variety of local system consultations
  • Working with Dr. Seema Shah to discuss statewide efforts to improve primary health/behavioral health integration for children, and to develop statewide academic partnerships regarding research and services.
  • Participating with Sam Shore on the HHSC-MMHPI workgroup on Substance Use Disorder services, focusing on data accuracy and policy recommendations for sober living and expansion of Opioid Use Disorder services.
  • Supporting implementation of a Texas TA team to work with the American Academy of Addiction Psychiatry on statewide TA for MAT, as part of the national STR-TA initiative.
  • Working on the development of materials for the next phase of Okay to Say: (Okay to Share; Okay to Care).

Follow MMHPI at www.texastateofmind.org

While visiting Texas, ZiaPartners also met with Sonja Gaines, Deputy Commissioner for Behavioral Health at the Texas Health and Human Services Commission, to discuss support for HHSC efforts at interdepartmental coordination as well as the implementation of integrated MH/SUD/DD/BI services.

Mid-Hudson (NY) Region Co-occurring Initiative: There was a very successful conference on November 13 for co-occurring capability implementation teams from all seven counties in the region, with approximately 150 people in attendance. Each County was able to develop an implementation plan for continued progress with using the COMPASS-EZ across county services to improve co-occurring capability. Individual county meetings with Westchester and Putnam County leadership and providers on November 14 resulted in a much more granular discussion on how EACH agency could identify and address its own improvement opportunities across multiple programs based on its experience with the COMPASS-EZ, as well as developing a framework for how the county co-occurring coordinators and steering committees could support that continuing progress in an organized fashion.   ZiaPartners is very appreciative of the amazing work on this project by Marcie Colon of the Mid-Hudson Region and Stephanie Marquesano of The Harris Project, as well as the 7 County Behavioral Health leaders.

Iowa East Central Region: ZiaPartners initiated a consultation activity with the MHDS East Central Region (including 9 counties with three regional hubs in Cedar Rapids, Iowa City, and Dubuque). This has involved a specific focus on working with the Dubuque hub to plan their network of Access Center services, and then to engage the Access Center planning groups in Johnson County (Iowa City) and Linn County (Cedar Rapids). During November and December, Dr. Cline and Dr. Minkoff had a series of teleconferences to meet the main participants in the Access Center planning process in order to develop a framework for how to support the development of successful crisis services in Iowa.

Greater Oregon Behavioral Health, Inc. (GOBHI): ZiaPartners began a consultation project with GOBHI to implement co-occurring services and assist with Substance Use Disorders system redesign in the regions for which GOBHI is a Coordinated Care Organization (CCO) under the Oregon Health Authority (three counties in NW Oregon as well as most of Eastern Oregon). The opening phases of this project involve reviewing a comprehensive set of materials that define GOBHI’s functioning as a CCO, video conferencing with GOBHI leadership to understand their challenges and opportunities, understanding the current landscape regarding CCO re-contracting in Oregon, and preparing for an onsite planning visit with GOBHI leadership in The Dalles on February 13. This will permit detailed planning for an implementation launch at the GOBHI annual provider conference in May.

Equine Assisted Therapies and Activities:   ZiaPartners was awarded a competitive bid to help multiple organizations involved with equine assisted therapies and activities to come together to develop a common language for the entire field. This three-day meeting is scheduled for July 2019.

CALM:   Following our final on-site consultation visit in Santa Barbara on October 29-30, ZiaPartners has worked with CALM leadership on a continuing support plan for the remaining resources in our consultation contract to extend through 2019. CALM has made dramatic progress in the course of our consultation, and the results of their organization’s commitment to healthier organization culture, involving both clinical and business practice, are really taking hold at all levels.

Tennessee Co-occurring Strategic Initiative: Dr. Minkoff presented a series of three webinars to engage new participants in the statewide co-occurring capability development process, particularly Substance Use Disorder programs working with criminal justice.

Vermont Co-operative for Practice Improvement and Innovation (VCPI): Dr. Minkoff continues working with the VCPI leadership team to develop a working leadership and operations structure for VCPI. ZiaPartners is also a subcontractor along with VCPI on a proposal submitted by Vermont Care Partners to Vermont Department of Mental Health to expand co-occurring Mental Health/Substance Use Disorder services, with a focus on adults with Serious Mental Illness and Opioid Use Disorder.

Common Ground: Continued consultation to assist in the development of improved capacity for Common Ground to deliver the highest possible quality comprehensive crisis service array in Oakland County, Michigan.

Silver Hill Hospital – ZiaPartners has contracted with Silver Hill (located in New Canaan, CT) to assist with continuing implementation of the transformational recommendations from our April visit, to implement a collaborative culture to facilitate admissions, transitions, and staff engagement. Following our on-site visit in September, Silver Hill has engaged a new CEO, and we will be communicating with the new CEO regarding our ongoing involvement.

Missouri Foundation for Health: ZiaPartners organized a team (including TriWest, Lynfro Consulting, and Joe Parks, MD from The National Council) to respond to an RFP released by MFFH for a statewide analysis of the Missouri Behavioral Health System.   This proposal is under review and if accepted, the project will begin in 2019.

 

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September-October Work

ZIA NEWS – September-October, 2018

Fall Activities:

There has been an explosion of activity, including international events, this fall, and more to come!

Interdepartmental Serious Mental Illness Coordinating Committee:

Dr. Minkoff worked with the non-federal members of ISMICC to help organize several activities to support the implementation of the ISMICC recommendations:

  • Monthly phone calls to plan for the December 11 full in person ISMICC meeting, working on promoting involvement of non-federal members in contributing to the implementation workgroups, and planning how to measure and report on overall ISMICC progress.
  • Coordinating linkage between SAMHSA leadership and non-federal ISMICC members, as identified co-lead (with Conni Wells) of the non-federal ISMICC group
  • Working with the Crisis Workgroup on the recommendation to implement LOCUS and CALOCUS as standard tools for level of care assessment nationwide.
  • Recommending inclusion of SMI and SED populations in the surveillance priorities of CDC.

National Council for Community Behavioral Healthcare: ZiaPartners is an Affiliate Member of National Council, and Dr. Minkoff is a member of the Medical Director’s Institute. Dr. Minkoff represented Zia at the National Council fall meeting on October 22. This resulted in a further discussion of how National Council aligns with ISMICC recommendations, as well as how ZiaPartners will participate in the NATCON 2019 conference in Nashville March 24-27.

Institute on Psychiatric Services, Chicago, IL: Oct 3-6. ZiaPartners attended this conference, and provided 4 presentations, attendance at the American Association of Community Psychiatrists Board Meeting, and attendance at the National Council Medical Directors Institute. The presentations included one on ISMICC, one on how to publish in Psychiatric Services (where Dr. Minkoff is a column editor for the High Value Care column), a symposium on the Group for the Advancement of Psychiatry Committee on Psychiatry and the Community publication: People with Mental Illness in the Criminal Justice System, Answering a Cry for Help, Dr. Minkoff is committee co-chair, and a presentation with Dr. Margie Balfour on ideal crisis system development.

Dr. Minkoff is Chair of the Product and Services Plan for AACP. The Plank is working on several Clinical Tips, including Medication Assisted Treatment for opioid use disorder, and a guidance document for Utilization Management.

Meadows Mental Health Policy Institute:   Dr. Cline and Dr. Minkoff continued active involvement in multiple projects and activities conducted by Meadows Mental Health Policy Institute, as follows:

  • Finalizing the Houston Endowment substance use disorder System report following submission of the first draft to the funder.
  • Coordinating with the Local Systems team regarding how to best support progress in a variety of local system consultations
  • Working with Dr. Seema Shah to discuss statewide efforts to improve primary health/behavioral health integration for children, and to develop statewide academic partnerships regarding research and services.
  • Participating with Sam Shore on the HHSC-MMHPI workgroup on substance use disorder services, focusing on data accuracy and policy recommendations for sober living and expansion of opioid use disorder services.
  • Supporting implementation of a Texas TA team to work with the American Academy of Addiction Psychiatry on statewide TA for MAT, as part of the national STR-TA initiative.
  • Working with Coby Chase and Michelle Harper to organize the events related to children, youth, and early intervention services during the Meadows Mental Health Policy Institute’s visit to London for the Global Mental Health Summit in early October (See Below).
  • Planning attendance representing Meadow Mental Health Policy Institute at the One Mind Conference in St. Helena, CA in September (See below)
  • Working with Susan Fordice and Sam Shore to develop the substance use disorder track for the third annual Meadows Mental Health Policy Institute Engage and Excel Conference (Houston, Oct 23-25) (engageandexcel.org). (See below)
  • Working with LDWW on the development of materials for the next phase of Okay to Say: (Okay to Share; Okay to Care).

Follow MMHPI at www.texastateofmind.org

Meadows Mental Health Policy Institute related events:

  • One Mind Conference, Staglin Family Vineyards, Napa, Ca (September 12-15): Dr. Minkoff and Dr. Cline, along with Dr. Andy Keller (MMHPI CEO) represented MMHPI at this series of events. The Staglin Family has raised millions for brain research and other initiatives and this event brings together policy makers and scientists to develop major change efforts. There were events focused on creating an international movement for workplace mental health, as well as an international strategy for brain health research.
    • For more information about One Mind, click here.
  • Global Summit for Mental Health Culture Change, London, England (October 7-11): Minkoff and Dr. Cline were part of the MMHPI leadership team that attended this event, where Dr. Keller was a panelist. They helped to organize visits and events that allowed for collaboration with and learning from expertise in the UK, with particular regard to early intervention services for psychosis.
    • For more information on the Global Summit, click here.
  • Engage and Excel, Houston, TX (October 23-25): Minkoff and Dr. Cline presented and facilitated at this third annual statewide event that they helped to create and design. The event brings together people working on BH systems change from local communities and state entities all over TX to engage in a partnership for how to excel in their systems back home. Dr. Minkoff and Dr. Cline presented with Houston provider leaders on implementing integrated services for individuals with co-occurring mental health/substance use disorders.
    • For more information on Engage and Excel, click here.

CALM:   Planned and implemented the final on site consultation visit on October 29-30. This visit focused on the successes in implementing culture change at CALM, in the direction of trauma-informed organization delivering trauma specific services to youth and families. Focal discussions involved:

  • Strengthening the functional organization chart going forward
  • Implementing a continuous quality improvement culture
  • Helping to launch the CALM Action Team, with participation by staff and leadership
  • Improving the level of support and engagement of Regional Managers and Program Managers
  • Reviewing strategies for improving revenue generation, third party billing, and documentation, that may result in an increase of over $100,000 of collections in this fiscal year.
  • Reviewing methodology for evaluating the performance of various programs for purpose of strategic prioritization
  • Revision of the HR Employee Handbook from the perspective of a trauma-informed organization

Tennessee Co-occurring Strategic Initiative: Begun implementation of a series of webinars to engage new participants in the statewide co-occurring capability development process, particularly SUD programs working with criminal justice.

Vermont Co-operative for Practice Improvement and Innovation (VCPI): Dr. Minkoff continues working with the VCPI leadership team to develop a working leadership and operations structure for VCPI, and will be working with VCPI and partners to expand co-occurring MH/SUD services, with a focus on adults with SMI and Opioid Use Disorder. (Link to vtcpi.org)

Mid-Hudson (NY) Region Co-occurring Initiative: Dr. Minkoff has continued detailed planning, organizing the November events, which so far includes a conference on November 13 for co-occurring capability implementation teams from all seven counties in the region, and individual county meetings with Westchester and Putnam on November 14.

Common Ground: Continued consultation to assist in the development of improved capacity for Common Ground to deliver the highest possible quality comprehensive crisis service array in Oakland County, Michigan. In July the focus of activity was to work with Common Ground on completion of a response to an RFP to develop a comprehensive continuum of crisis services in Detroit-Wayne County, Proposal interview was conducted in September, but unfortunately the RFP was withdrawn in October.

Iowa East Central Region: ZiaPartners initiated a consultation activity with the MHDS East Central Region (including 9 counties with three regional hubs in Cedar Rapids, Iowa City, and Dubuque). This has involved a specific focus on working with the Dubuque hub to plan their network of Access Center services. In addition, ZiaPartners has subcontracted with Brenda Jackson to assist all the regions with how to strategize on their relationship with Iowa Medicaid.

Solano County, CA: Dr. Minkoff gave a very well received presentation on September 20 in Fairfield, CA at the Solano County Recovery Day event to help launch a county initiative on integrating mental health/substance use disorder.

Silver Hill Hospital – ZiaPartners has contracted with Silver Hill (located in New Canaan, CT) to provide assistance with continuing implementation of the transformational recommendations from our April visit, to implement a collaborative culture to facilitate admissions, transitions, and staff engagement. The first on site visit in this phase of the work occurred on September 26-27 and resulted in increased buy in from across the hospital, and specific next step activities to translate the general recommendations into a variety of improvement projects, some of which were launched immediately. Improvement activities focused on creating a more welcoming experience for patients, families, and referents, and involve collaboration between Access, Marketing, and Treatment units.

College for Behavioral Health Leadership – As a Board member, Dr. Minkoff has been contributing to launching a new set of CBHL activities that will allow the organization to operate on a much bigger scale and will attract resources for the development of materials to “make leaders better” across multiple sectors and boundaries within the universe of behavioral health service delivery. Dr. Minkoff participated in the CBHL Board meeting on September 25, at which a new strategy was decided, and will be working on helping to seek funding to support the “big new vision” for the organization.

SAMHSA – Dr. Minkoff was asked by SAMHSA to coordinate a day long panel meeting on Co-occurring Serious Mental Illness and Opioid Use Disorders on August 23. The forum incorporated input from NASMHPD, NACBHDDD, National Council, CCBHCs, CMHCs, and various BH provider disciplines, including peers. The objective was to identify what is known about how to help individuals with serious mental illness/opioid use disorders and how to implement what we know more systematically across the nation.   There was follow up planning in September, and there will be a report prepared on the results of the panel.

 

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July-August 2018

Summer Activities:

Even with vacations (2 weeks in Brazil in July, 2 weeks on Cape Cod in August) it has been a busy summer.

Interdepartmental Serious Mental Illness Coordinating Committee:

Dr. Minkoff worked with the non-federal members of ISMICC to help organize several activities to support the implementation of the ISMICC recommendations:

  • Developing a plan for assigning non-federal ISMICC members to each of the five ISMICC workgroups, as well as to maximize non-federal member and other stakeholder engagement in the process within the limits of the Federal Advisory Committee Act (FACA).
  • Beginning to outline a process for the non-federal members to produce an annual report of progress in December 2018
  • Creating a process for organizing the non-federal members into a regular working team
  • Contributing input to the Data and Quality Workgroup on quality standards, and contributing to the non-federal ISMICC member input into a draft set of standards proposed by the National Quality Forum (NQF).

Meadows Mental Health Policy Institute:   Dr. Cline and Dr. Minkoff continued active involvement in multiple projects and activities conducted by MMHPI, as follows:

  • Finalizing the Houston Endowment Substance Use Disorder System report following submission of the first draft to the funder.
  • Coordinating with the Local Systems team regarding how to best support progress in a variety of local system consultations
  • Working with Dr. Seema Shah to discuss statewide efforts to improve primary health/behavioral health integration for children, and to develop statewide academic partnerships regarding research and services.
  • Participating with Sam Shore on the HHSC-MMHPI workgroup on SUD services, focusing on data accuracy and policy recommendations for sober living and expansion of Opioid Use Disorder services.
  • Supporting implementation of a Texas TA team to work with the American Academy of Addiction Psychiatry on statewide TA for MAT, as part of the national STR-TA initiative.
  • Coordinating with Dr. Meher Karam on STR-TA and the state of treatment for nicotine addiction in Texas
  • Working with Coby Chase and Michelle Harper to organize the events related to children, youth, and early intervention services during the MMHPI visit to London for the Global MH Summit in early October
  • Planning attendance representing MMHPI at the One Mind Conference in St. Helena, CA in September
  • Working with Susan Fordice and Sam Shore to develop the SUD track for the third annual MMHPI Engage and Excel Conference (Houston, Oct 23-25) (engageandexcel.org). Dr. Minkoff and Dr. Cline will be presenting on developing universal co-occurring capability.
  • Working with LDWW on the development of materials for the next phase of Okay to Say: (Okay to Share; Okay to Care).
  • Contributing to an MMHPI Report on Criminal Justice-Behavioral Health Services in Texas
  • Contributing to MMHPI’s public input on HHSC’s redrafted Medicaid policy on SUD treatment.

Follow MMHPI at www.texastateofmind.org

CALM:   Engaged in continuing activities to accomplish the following objectives:

  • Developed a draft supervision plan for CALM
  • Developed a tool for prioritization of the various CALM programs (in accordance with mission alignment, level of success, uniqueness, and financial performance) which will be used by CALM leadership in September
  • Consulted to the intake team on a process for improving welcoming access through the intake process.
  • Discussed the process of conceptualization of CALM programs as a continuum of services based on individual, family, and community need, rather than as distinct service components driven by funding requirements.

Tennessee Co-occurring Strategic Initiative: Begun planning for a series of webinars in the fall to engage new participants in the statewide co-occurring capability development process, particularly Substance Use Disorder programs working with criminal justice. Strategic Initiative

Vermont Co-operative for Practice Improvement and Innovation (VCPI): Dr. Minkoff has been working with the VCPI leadership team to develop a working leadership and operations structure for VCPI.

Follow the Vermont Co-perative at vtcpi.org

Recovery to Practice: On August 6, Dr. Minkoff participated in the final teleconference for the RTP Advisory Committee (Task 4) hosted by Advocates for Human Potential, to discuss project successes and recommendations for continuation of the work following project conclusion in September.

Mid-Hudson (NY) Region Co-occurring Initiative: Dr. Minkoff has been working on organizing the November events, which so far includes a conference on November 13 for co-occurring capability implementation teams from all seven counties in the region, and individual county meetings with Westchester and Putnam on November 14. Other counties may schedule individual meetings as well.

Common Ground: Continued consultation to assist in the development of improved capacity for Common Ground to deliver the highest possible quality comprehensive crisis service array in Oakland County, Michigan. In July the focus of activity was to work with Common Ground on completion of a response to an RFP to develop a comprehensive continuum of crisis services in Detroit-Wayne County, and in August to prepare for a proposal interview.

Iowa East Central Region: ZiaPartners initiated a consultation activity with the MHDS East Central Region (including 9 counties with three regional hubs in Cedar Rapids, Iowa City, and Dubuque). This evolved into a project helping all the MHDS regions in Iowa respond to new proposed rules for required intensive core services based on recent legislation. Dr. Minkoff attended the MHDS Commission hearing regarding those regulations on July 19, and then worked with all the regions and a few other stakeholders to write suggested revisions of the proposed rules and regulations on behalf of the regions. These were submitted to the regions on August 30 and are due to MHDS on September 4. The suggested revisions address in detail the relationship between the state, the MCOs, the regions and the providers, moving toward a collaborative design and away from the implication of an unfunded mandate. There is also detailed language regarding the design of the crisis continuum, including Access Centers, crisis residential programs, continuing crisis intervention services, and so on. Language addressing multi-occurring conditions (MH, SUD, IDD, BI) was modified and improved.

Solano County, CA: ZiaPartners began a conversation with Solano County (in central CA, based in Fairfield) behavioral health services in July about how to help with their movement to developing a systemwide integration of MH and SUD services.   The next step in this process will be a presentation given by Dr. Minkoff on September 20 at the Solano County Recovery Day event.

Silver Hill Hospital – ZiaPartners has contracted with Silver Hill (located in New Canaan, CT) to provide assistance with continuing implementation of the transformational recommendations from our April visit, to implement a collaborative culture to facilitate admissions, transitions, and staff engagement. The first on-site visit in this phase of the work will be September 26-27,

College for Behavioral Health Leadership – As a Board member, Dr. Minkoff has been contributing to launching a new set of CBHL activities that will allow the organization to operate on a much bigger scale and will attract resources for the development of materials to “make leaders better” across multiple sectors and boundaries within the universe of BH service delivery. This initiative will be formally launched at the CBHL Summit in Richmond in September (link to website)

SAMHSA – Dr. Minkoff was asked by SAMHSA to coordinate a day-long panel meeting on Co-occurring Serious Mental Illness and Opioid Use Disorders on August 23. The forum incorporated input from NASMHPD, NACBHDDD, National Council, CCBHCs, CMHCs, and various Behavioral Health provider disciplines, including peers. The objective was to identify what is known about how to help individuals with SMI/OUD and how to implement what we know more systematically across the nation.   There will be a report prepared on the results of the panel, and the content of this report will be referred to the relevant ISMICC workgroup (which is co-chaired by Justine Larson, MD, Medical Director for the Center of Mental Health Services, who was one of the SAMHSA conveners of the panel, along with Tison Thomas, who is one of SAMHSA’s experts on co-occurring disorders and oversees the MH Block Grant.).

 

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“September is Recovery Month”

This was taken from Hon. Peggy Hora of the Justice Speakers Institute

September is Recovery Month

A Time of Celebration and Hope

www.recoverymonth.gov

In Memorium: Christopher Kennedy Lawford, 33 years sober.

While recovery should be celebrated every day, September is the 29thAnnual National Recovery Month to remind us of the importance of this issue in our communities.  We ask local policy makers to sign proclamations to demonstrate a commitment to improving access to treatment programs for mental and/or substance use disorders. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), the “[m]onth celebrates individuals throughout the country who have achieved long-term recovery from mental and substance use disorders and recognizes the contributions of the dedicated men and women who provide treatment and recovery services.”

Approximately 21 million Americans ages 12 and up dealt with a substance use disorder in 2014.

SAMHSAreports that approximately 21 million Americans ages 12 and up dealt with a substance use disorder in 2014, and that was before the opioid epidemic.  SAMSHA also reports “about 44.7 million Americans aged 18 and older experienced a mental disorder. In addition, an estimated 2.6 million adults aged 18 or older had co-occurring serious mental illness and substance use disorder.”

The triple message for Recovery Month is:

    • Prevention works.
    • Treatment is effective.
    • People can and do recover.

     

People in long-term recovery tell their story best.  Greg Williams stopped using alcohol and other drugs when he was only 17-years-old.  You can see his story here.

The Betty Ford Center defines recovery as “[a] voluntarily maintained lifestyle characterized by sobriety, personal health and citizenship.”  Recovery is clearly more than the absence of alcohol or other drugs in one’s life.  Watching people work to complete a drug treatment court or a behavioral health court program reveals how difficult a struggle it is. The road to recovery is seldom a straight path but, rather, one filled with twists and turns, potholes and distractions.

Click on the box to tweet the important message!

Relapse prevention is often part of treatment’s curriculum and for good reason. While using is part of relapse, it is not uncommon for use episodes to occur.  If that happens, it is imperative that corrective action be taken immediately and that the person return to treatment and follow their recovery plan.

Actress Kristen Bell publicly celebrated her husband’s 14 years of recovery on Instagram recently.  She said, “…I know how much you loved using. I know how much it got in your way. And I know, because I saw, how hard you worked to live without it.”    And it is difficult to find a family that is not touched by substance use disorders or mental health issues. When family members are supportive of their loved one’s recovery, outcomes are usually better.   SAMHAS has a free booklet for family members of people with substance use disorders.  Hazelden, a well-known recovery corporation, has developed “Nine Strategies for Families Helping a Loved One in Recovery.”

They are:

    1. Help your loved one follow all treatment recommendations.
    2. Encourage total abstinence from alcohol and other drugs
    3. Help your loved one build good coping skills
    4. Reduce family friction and provide social support
    5. Encourage participation in peer support groups
    6. Help your loved one create a sober peer network
    7. Know the signs of relapse
    8. Support your loved one’s involvement in meaningful, structured activities
    9. Keep hope alive

 

While we celebrate the 23 million+ Americans living in recovery, we must not lose sight of those still struggling with these disorders who are losing their lives every day.  Last year more than 72,000 people died from opiate overdoses.  When you add in deaths caused by alcohol and impaired driving crash statistics, there is much to mourn.  How will you recognize and celebrate Recovery Month?

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Paradigm

Dr. Minkoff had an article published in Illinois Institute for Addiction Recovery’s journal Paradigm.  His article “Twelve Steps to Co-Occurring Competency: Building Competency in the Entire System” can be found on page 14 of the journal.

Here is a copy of this issue of Paradigm.

If you would like to subscribe to Paradigm you can do so for free here.

 

 

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June 2018

Activities in June

Interdepartmental Serious Mental Illness Coordinating Committee:

Dr. Minkoff attended the first official ISMICC meeting of 2018, held in Washington, DC on June 8. (Opening Remarks of the ISMICC meeting) The ISMICC report released in December 2017 is a foundation for much of SAMHSA’s ongoing efforts and has been very successful in engaging not only cooperation but enthusiasm from other federal departments. This meeting included a very supportive introduction from newly appointed Health and Human Services Secretary Alex Azar, and then focused entirely on practical discussions of implementation efforts.   ISMICC members heard reports from each of the five interdepartmental implementation workgroups and were able to provide feedback and input.   In addition, there was a highly engaged discussion about the importance of collecting up to date epidemiologic data about the population of people with serious mental illness/serious emotional disturbance, using updated and consistent definitions, and attending to co-morbidity. Going forward, the non-federal ISMICC members will have the opportunity to participate in continuing activities of the workgroups, as well as in periodic topic meetings, and will also be able to work collaboratively to engage partners in the implementation process at the state/tribe and local level nationwide. These are important steps of progress in a multi-year process that has the potential to transform the national delivery system for adults and children with severe mental health and substance use issues.

Meadows Mental Health Policy Institute:   Dr. Cline and Dr. Minkoff continue active involvement in multiple projects and activities conducted by MMHPI, as follows:

  • Finalizing the Houston Endowment substance use disorders System report that is due in July.
  • Coordinating with the Local Systems team regarding how to best support progress in a variety of local system consultations
  • Working with Dr. Seema Shah to discuss statewide efforts to improve primary health/behavioral health integration for children, and to develop statewide academic partnerships regarding research and services.
  • Participating with Sam Shore on the HHSC-MMHPI workgroup on substance use disorders services, focusing on data accuracy and policy recommendations.
  • Supporting implementation of a Texas TA team to work with the American Academy of Addiction Psychiatry on statewide TA for MAT, as part of the national STR-TA initiative.
  • Participating in Policy Workgroup and Financing Workgroup for the Mental Health Association of Greater Houston Integrated Health Care Initiative
  • Working with Susan Fordice and Sam Shore to develop the substance use disorders track for the third annual MMHPI Engage and Excel Conference (Houston, Oct 23-25) (engageandexcel.org). Dr. Minkoff and Dr. Cline will be presenting on developing universal co-occurring capability.
  • Working with LDWW on the development of materials for the next phase of Okay to Say: (Okay to Share; Okay to Care).

Follow MMHPI at www.texastateofmind.org

CALM:   ZiaPartners (Drs. Cline and Minkoff) provided continuing teleconference support to CALM to help with organizing next steps, with a focus on developing guidance materials to help CALM leadership conceptualize the implementation of a QI Action Team with front line staff partners.

Tennessee Co-occurring Strategic Initiative: On June 6-7, Dr. Minkoff provided the second of three regional 2-day TA sessions, and on June 20-21, the third of those sessions, to support the work of individual provider organizations to make progress toward co-occurring capability in Tennessee. These regional events were held in Memphis and Knoxville, to engage both mental health centers and addiction provider organizations in west and east Tennessee. The agencies that attended each had individual meetings with Dr. Minkoff to focus on the results of their COMPASS-EZ self-assessments and how to utilize those to develop achievable and meaningful action plans to improve co-occurring capability within their current services and resources. (Tennessee Co-Occurring Strategic Initiative). There was a follow-up conversation with leadership of the Substance Abuse Division at the Tennesse Department of Mental Health and Substance Abuse Services to discuss how the division could best engage new providers from the criminal justice system in making progress toward C0-Occurring Disorder Capability, as well as how to support the few remaining community Substance Use Disorder providers who had not yet started to make progress.

Vermont Co-operative for Practice Improvement and Innovation (VCPI): Dr. Minkoff participated with the VCPI Leadership Team in finalizing the transition plan for VCPI to move out from under Southern New Hampshire University to its new “parent” at Northern Vermont University. This change will be effective as of July 1 and is an exciting opportunity for VCPI to have more support for growth and innovation going forward. (For more information vtcpi.org)

Common Ground: Continued consultation to assist in the development of improved capacity for Common Ground to deliver the highest possible quality comprehensive crisis service array in Oakland County, Michigan. In June the focus of activity was to work with Common Ground on the preparation of a response to an RFP to develop a comprehensive continuum of crisis services in Detroit-Wayne County.

Mid-Hudson (NY) Region Co-occurring Initiative: Dr. Minkoff provided a COMPASS-EZ training teleconference on June 19 with representatives of the project teams from the seven counties (Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster, Westchester) participating in this regional project. This project was described in more detail in the May notes. The next on-site activity for this project will be in November 2018.

Michigan Co-occurring College: Dr. Minkoff did a full day plenary event at the Michigan Co-occurring College in Lansing, on June 25. The presentation was a participatory event for the approximately 100 attendees from all over the state, and focused on practicing welcoming, recovery-oriented, integrated, stage-matched treatment planning, and on implementing the 12 steps of co-occurring competency, utilizing the ZiaPartners ILSA Supervision Workbook (2017). This event was met with excitement by both local participants and state level leadership. (For more information about the Michigan co-occurring college)

Iowa East Central Region: ZiaPartners initiated a consultation activity with the MHDS East Central Region (including 9 counties with three regional hubs in Cedar Rapids, Iowa City, and Dubuque). The focus of the consultation, which builds on the relationships developed during ZiaPartners five-year consultation statewide on universal development of multi-occurring capable services within emerging regional systems of care, is to help the region with the implementation of various core services for individuals with complex needs. The earliest challenges involve responding to new regulations about Access Centers and working with the various local hubs about implementation strategies.

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May 2018

Interdepartmental Serious Mental Illness Coordinating Committee:

Dr. Minkoff worked with the non-federal members of ISMICC to contribute input to the agenda and content of the first ISMICC meeting of 2018, to be held on June 8.   This included preparation of a one-page document outlining how the non-federal members could best support the ongoing implementation of the recommendations in the ISMICC report.

Meadows Mental Health Policy Institute:  

Dr. Cline and Dr. Minkoff participated in the MMHPI semiannual staff meeting held at the Horseshoe Bay Resort outside of Austin on May 16-17. This exciting event provided an opportunity for MMHPI staff working on many different projects to come together and share energy and information, and to better coordinate efforts.  Dr. Minkoff and Sam Shore made a presentation to the group on the findings and recommendations from the Houston Endowment funded project to assess the substance use disorder delivery system for Harris County (Houston), and how those recommendations are contributing to MMHPI input to the currently ongoing work of the Texas House Select Committee on substance use disorder.

Follow MMHPI at www.texastateofmind.org

CALM:   ZiaPartners (Drs. Cline and Minkoff) and TriWest had the second two day on-site visit with CALM in Santa Barbara County, CA on May 9-10. This highly successful event provided an opportunity for ZiaPartners to contribute to the implementation of an internal reorganization of the agency that provided the beginning steps to the creation of a structure that reinforces the importance of the provision of clinical supervision and allows for a focus on clinical performance and staff engagement across the agency.   The meeting opened a dialogue between senior administration (Executive Team) and program managers and set the stage for the development of a quality improvement Action Team for the agency that would provide a mechanism for formal staff engagement in problem-solving and improvement activities. Work was done on launching a pilot to eliminate barriers in the intake and engagement process, taking next steps in clarifying the elements of the agency’s supervision plan, and redoing the employee handbook. Next on-site meeting will be held in October.

Texas Association of Addiction Professionals – Houston Chapter: Dr. Minkoff presented on May 4 on Welcoming, Integrated Services for Individuals with Co-occurring Disorders at the TAAP Annual Conference. The presentation was well received and provided a framework for front-line counselors to be able to proceed through the “12 Steps of Co-occurring Competency” (link on our website) to be able to improve their ability to deliver integrated services to their current clients who have a high prevalence of co-occurring mental health issues.

New Jersey Co-occurring Disorders Psychopharmacology Conference: On May 21, Dr. Minkoff presented to over 100 attendees on psychopharmacologic interventions for co-occurring disorders, at Rutgers University in Piscataway, NJ. The conference attendees were very excited about the opportunity to immediately implement some of the information provided in their current efforts to work with individuals with opioid use disorders as well as individuals with serious mental illness and a variety of co-occurring conditions.   The New Jersey state co-occurring technical assistance and training team that sponsored the event indicated an interest in a follow-up consultation to support the implementation of co-occurring services statewide.

Tennessee Co-occurring Strategic Initiative: On May 22-23, Dr. Minkoff provided the first of three regional 2-day TA sessions to support the work of individual provider organizations to make progress toward co-occurring capability in Tennessee. This regional event was held in Nashville, to engage both mental health centers and addiction provider organizations in central Tennessee. The agencies that attended each had individual meetings with Dr. Minkoff to focus on the results of their COMPASS-EZ self-assessments and how to utilize those to develop achievable and meaningful action plans to improve co-occurring capability within their current services and resources.

For more information visit Tennessee Co-occurring Disorders Collaborative

Vermont Co-operative for Practice Improvement and Innovation (VCPI): Dr. Minkoff participated with the VCPI Leadership Team in helping to develop the transition plan for VCPI to move out from under Southern New Hampshire University to its new “parent” at Northern Vermont University. This provides an exciting opportunity for VCPI to have more support for growth and innovation going forward.

For more information visit vtcpi.org

Recovery to Practice: On May 31, Dr. Minkoff participated in a teleconference for the RTP Advisory Committee (Task 4) hosted by Advocates for Human Potential, to discuss accomplishments to date on the preparation of webinars on rrecovery-oriented psychopharmacologic practice and next steps in the project.

Mid-Hudson (NY) Region Co-occurring Initiative: Dr. Minkoff participated in a planning call on May 31 with representatives of the seven counties (Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster, Westchester) participating in this regional project, which was launched in November of 2016.   The counties are at the stage of readiness to implement COMPASS-EZ self-assessments across their mental health and substance use disorders programs in each county and work collaboratively under the guidance of the region (Marcie Colon – regional coordinator; Stephanie Marquesano of the Harris Project providing technical support and overall encouragement), county specific project managers, and county steering committees in each county to prepare to make formal progress. This conference call was a first step to helping each county match its next steps to its level of preparation, and to plan for a conference call to do COMPASS-EZ training in June. The next on-site activity for this project will be in November 2018.

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Current Work

We are always working to spread our ideas for hopeful, strength-based, integrated mental health practice to the many communities that need support.

January 2018

February 2018

March 2018

April 2018

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