As we come to the end of 2021, we want to summarize our activities for the past year and provide a preview of our work during 2022.
Group for the Advancement of Psychiatry (GAP) – Committee on Psychiatry and the Community:
Dr. Minkoff is co-chair of the committee, with Dr. Margie Balfour as chair, working on further dissemination and development of additional products and tools relevant to our recently released report, published by the National Council in April 2021: Roadmap to the Ideal Behavioral Health Crisis System: Essential Elements, Measurable Standards, and Best Practices. Dr. Minkoff and Dr. Balfour have begun a Roadmap Learning Community using the Roadmap’s Report Card, involving five pilot communities: Austin (Travis County), TX; Grand Rapids (Kent County), MI; Iowa City (Johnson County), IA; Lawrence (Douglas County), KS; and Miami (Dade and Monroe Counties), FL.
National Council for Community Behavioral Healthcare: ZiaPartners is an Affiliate Member of the National Council, and Dr. Minkoff is a member of the Medical Director’s Institute. Presentations on Ideal Crisis Systems are scheduled for NATCON 2022 in April in Washington DC. Dr. Minkoff is participating with Drs. Joe Parks (National Council Medical Director), Henry Chung, and Lori Raney, under the auspices of the National Council’s Center of Excellence on Physical Health/Behavioral Health Integration (funded by SAMHSA) as one of four editors for a National Council publication to be released in early 2022 defining a new bidirectional Comprehensive Health Integration (CHI) framework for measuring, implementing, and financing progress in dissemination of Public Health/Behavioral Health integration in all types of settings and systems. ZiaPartners will also be consulting to the new CCBHC Center of Excellence in 2022.
American Association of Community Psychiatry (AACP). Dr. Minkoff is an emeritus Board Member, and Dr. Cline is a past Board member of AACP. Dr. Minkoff is a member of the leadership team, as coordinator of the Products and Services “plank” of the Board. Dr. Minkoff has been helping AACP leadership (Michael Flaum, MD President, and Wesley Sowers, MD, LOCUS lead) work with National Council leadership (Joe Parks, MD, Medical Director) to develop a combined strategy to advance the use of LOCUS (Level of Care Utilization System) and CALOCUS (jointly owned by AACP and American Academy of Child and Adolescent Psychiatry (AACAP) as a national standard for measurement of the level of care determination. This has been enhanced by the recent federal court decision in Wit vs United Behavioral Health, in which the federal court indicated that LOCUS indeed represented such a standard of care. A LOCUS advisory committee has been formed under the auspice of the National Council, for the purpose of continuous improvement of the clinical quality of LOCUS and CALOCUS, developing further research on the effectiveness of LOCUS, and implementing plans for further dissemination. This group will be releasing a white paper on LOCUS as a standard for service intensity assessment in early 2022, for which Dr. Minkoff is a lead editor. AACP and AACAP have formed a “Committee” to oversee joint dissemination of the LOCUS Family of Tools, of which Dr. Minkoff is a member. Further, Dr. Minkoff and Dr. Cline have contributed chapters on Welcoming Culture and Comprehensive Integrated Systems (the latter with Dr. Nancy Covell) to the newest edition of the AACP Textbook on Community Psychiatry, to be released in 2022. AACP SMART Tool: Finally, Dr. Minkoff is co-author, with Drs. Rachel Talley and Sosunmolu Shoyinka of the AACP’s 2021 Self-assessment for Modification of Anti-Racism Tool (SMART) which is being field-tested at several sites nationally.
American Academy of Addiction Psychiatry (SAMHSA’s Serious Mental Illness Training Assistance Center): Dr. Minkoff was contracted by the AAAP to assist with its subcontract to the American Psychiatric Association’s Serious Mental Illness Training Assistance Center to provide materials that focus on improving services nationwide for individuals with co-occurring Serious Mental Illness and Substance Use Disorders. Dr. Minkoff has created implementation guides and fact sheets (with Dr. Miranda Greiner) for use by front-line staff and managers. He also has provided two courses on Integrated Systems and Services for People with Co-occurring Disorders. He serves on the Serious Mental Illness Training Assistance Center’s Advisory Committee. ZiaPartners expects to provide continued consultation in 2022.
College for Behavioral Health Leadership (CBHL) – Dr. Minkoff completed his four years as a CBHL Board member in July. As a Board member, Dr. Minkoff contributed to launching a new set of CBHL activities to “make leaders better” across multiple sectors and boundaries within the universe of Behavioral Health service delivery. This has led to the development and launch of a new leadership fellowship focused on Diversity, Equity, and Inclusion. The SMART Tool may be incorporated into that fellowship program.
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) entitled: Integrated Systems and Services for individuals with co-occurring Mental Health and Substance Use Disorders: What’s Known, What’s New, What Now. Dr. Minkoff has co-authored this paper with Nancy Covell, PhD of the Center for Practice Improvement at Columbia. The paper was released in August 2019), and includes specific recommendations for system leaders, policymakers, and funders. Dr. Minkoff and Dr. Covell have prepared a shorter Open Forum piece – Recommendations for Integrated Systems and Services for People with Co-occurring Mental Health and Substance Use Conditions – which is being published by Psychiatric Services in 2022.
Model Mental Health Commitment Law Working Group: Dr. Minkoff was invited by Judge Steven Leifman (Miami-Dade, Circuit Court Judge, and national leader of criminal justice/Mental Health collaboration) to join a working group of judicial and psychiatric leaders to draft a model civil commitment law for the 21st Century, balancing current scientific knowledge, the need to have more access to civil commitment to help prevent unnecessary arrest and incarceration, and the importance of protecting civil liberties for people with all types of behavioral health challenges. This project is coordinated by the Equitas Project and Mental Health Colorado. The group is developing recommended procedural language for state and local jurisdictions to use to guide emergency intervention, non-emergency civil commitment (to any level of care), and diversion from the criminal system at any point in the sequential intercept. A key product is Pathways to Care: A Roadmap for Coordinating Criminal Justice, Mental Health Care, and Civil Court Systems, which completely reimagines the criminal justice system based on the expectation that most individuals will have behavioral health conditions that require attention to maximize successful public health and public safety outcomes. Dr. Minkoff is on the editorial team for the project.
National Conference of State Courts – National Judicial Task Force to Examine State Court’s Response to Mental Illness. Dr. Minkoff has been invited to join the Education, Partnership, and Implementation Committee of this effort, facilitated by Patti Tobias. He has contributed to a Leading Change guide for state court administrators and chief justices.
Completed Major State and Local Consultation Projects:
Kent County Crisis System Project: ZiaPartners, TriWest Group, and Common Ground partnered to assist Kent County (Grand Rapids, MI) for assistance with developing an excellent behavioral health crisis system. This project involves an intensive engagement with community leaders and included on-site visits in November and February to develop specific recommendations and implementation strategies, to build broad community public and private consensus on a plan, develop a pro forma for various services, and create a set of steps to guide implementation. The project was completed successfully in January 2021, with a hand-off to TBD Solutions to be the local implementation manager. The community recently released a press announcement that Network 180 and Mercy Health Saint Mary’s were partnering to implement a Behavioral Health Crisis Center in the downtown area in 2022, per the recommendations of this consultation.
Missouri Foundation for Health (MFFH): ZiaPartners led a team (including TriWest, Lynfro Consulting, Joe Powell from Association of Persons Affected by Addiction, and Joe Parks, MD from The National Council) to respond to a request for proposal released by MFFH (based in St. Louis and covering the eastern two-thirds of Missouri), in partnership with Health Forward, a similar health access foundation based in Kansas City, for a statewide analysis of the Missouri Behavioral Health System for the purpose of helping the foundations develop an effective “investment strategy” for behavioral health to achieve the greatest impact over time. The team has completed a statewide report and then conducted in-depth community assessments, including listening sessions with people with lived experience, in regions surrounding St. Louis, Kansas City, Springfield, Jefferson City, Columbia, Joplin, Hannibal, Moberly, Cape Girardeau, and Kennett. This led to the preparation of a detailed set of recommended strategic priorities with the participation of a statewide advisory team. The final report is being utilized to guide further strategic efforts in behavioral health by the foundations, as well as legislative advocacy for the newly formed Mental Health Select Committee in the Missouri Legislature. This project was completed in Summer, 2021.
Heritage Behavioral Health Center, Decatur IL: Heritage leadership had participated in statewide training and consultation on integrated treatment for co-occurring Mental Health/Substance Use Disorders provided by ZiaPartners in Illinois during 2019 and 2020 and contracted with ZiaPartners to provide six months of in-depth training and consultation in 2021 to all the services in the Heritage continuum, with particular focus on the most challenging individuals served through the Williams and Colbert class action lawsuits.
San Mateo County (CA) Health and Behavioral Health Integration: Working as a subcontractor to Mostly Medicaid, ZiaPartners provided consultation on clinical program, quality improvement, and utilization management issues to assist San Mateo County’s Behavioral Health and Recovery Services along with the County Health Plan to develop a path forward to meet state expectations of integrated system development. This project concluded in June 2021. Gale Bataille, MSW, former BHRS director in San Mateo was a member of the ZiaPartners team for this project.
Current State and Local Consultation Projects:
Ohio Mental Health and Addiction Services – Crisis System Landscape Analysis: Working as a subcontractor with the Ohio based Healthcare Perspective consultation group, led by Kris Vilamaa and Hilary Hamlin, ZiaPartners began a year-long project in July 2021 to work with OMHAS, Ohio Department of Medicaid, Ohio Association of County Behavioral Health Authorities, Ohio Council of Behavioral Health Providers, Peg’s Foundation, and numerous other stakeholders to conduct a statewide landscape analysis of crisis services, manage the activity of a comprehensive statewide Crisis Task Force with six committees (Connect, Respond, Stabilize/Thrive, Community Crisis Coordination, Performance Metrics and Data, and Financing) to develop a set of specific recommendations for the design of a best practice crisis system for the state of Ohio. The Board survey data has just been received and is being analyzed, and the six committees under the Task Force have just launched. There is a deadline of June 2022 for the project to be completed.
Mid-Hudson (NY) Region Co-occurring Initiative: ZiaPartners is participating in a grant-funded project organized by Stephanie Marquesano of The Harris Project, as well as the 7 County Behavioral Health leaders, to implement co-occurring capable services in the Mid-Hudson region. (Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster, and Westchester). The current project involves 14 days of virtual consultation, training, and technical assistance that has been provided to the Co-occurring System of Care Committees (COSOCC) and individual providers in six of the counties (not Rockland). Columbia University’s Center for Practice Innovation, under the leadership of Nancy Covell, is also partnering on this project, which is continuing into 2022, and expanding attention on sustainability, and inclusion of additional populations, such as individuals with co-occurring behavioral health conditions and intellectual/developmental disabilities, acquired brain injury, and neurodiversity.
Victoria, Australia: Comprehensive Continuous Integrated System of Care Pilot (CCISC). ZiaPartners has been providing training and consultation in integrated Mental Health/Substance Use Disorder service and system change, in alignment with the Royal Victoria Commission’s recommendations for Behavioral Health system restructuring in Victoria. As a result of this consultation, the Ministry of Health have funded a regional integrated system pilot using the CCISC model. This pilot launched this past fall, is led by First Step in St. Kilda, Vic, and includes ten other Mental Health, Alcohol and Other Drugs, and health agencies serving the South East Melbourne region. ZiaPartners is providing regular videoconferencing for consultation, training, and technical assistance, working with Delwyn Maxwell as the Project Manager, and Jen Thompson as the Project Consultant.
Prince William County (VA) Community Services Board (PWC CSB): Integration Training and Consultation: The PWC CSB underwent internal reorganization in the past year to improve their ability to deliver integrated services to individuals and families with co-occurring Mental Health and Substance Use Disorder needs. In order to help advance both the clinical services and the organizational design, PWC contracted with ZiaPartners in 2021 for assistance. ZiaPartners has provided training to all staff, and consultation to each team within the major community behavioral health services division and is now proceeding to assist with further changes in policy, procedure, billing, and service redesign.
Common Ground: Continued consultation to assist in the development of comprehensive redesign of the community crisis services system to result in improved capacity for Common Ground to deliver the highest possible quality comprehensive crisis service array in Oakland County, Michigan. Dr. Minkoff continues to provide teleconference consultation as indicated.
Berryhill Community Mental Health Center: ZiaPartners is being contracted to provide training and consultation to this organization in https://www.unitypoint.org/fortdodge/berryhill-center-of-mental-health.aspxFt. Dodge, IA, which is part of the Unity Point Health System, to assist with their meeting the expectations of their Certified Community Behavioral Health Center grant, including integration of Mental Health and Substance Use Disorder Services. This project began in 2020 and will extend through 2022.
Monterey County (CA) Behavioral Health: CCISC Implementation: ZiaPartners has made an initial presentation to the Monterey County Behavioral Health Leadership Cabinet to initiate CCISC implementation across the county system of care. Contract negotiations for an 18-month project are underway, with an expected time frame from January 2022 to June 2023.