June-August 2019

ZIA NEWS – June-August 2019


There has been continuing activity on both old and new projects and a very busy summer!

Interdepartmental Serious Mental Illness Coordinating Committee:

Dr. Minkoff and the other non-federal members of ISMICC attended the in-person meeting of ISMICC at SAMHSA on July 2. There has as yet been no response to the report provided in May by the non-federal members of ISMICC outlining progress and suggested next steps for the federal ISMICC agencies to make further progress on implementation of the ISMICC recommendations. The ISMICC report provides an important road map for addressing many issues of significant concern to the nation regarding people of all ages with serious behavioral health needs, such as providing appropriate crisis response to help prevent suicide and violence, as well as the development of an integrated recovery-oriented continuum of care.

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.   The 155-page Draft Report, entitled: Getting to the Ideal Behavioral Health Crisis System: Essential Elements, Measurable Standards, and Best Practices, has been circulated for pre-release review. At its November meeting, the Committee will be utilizing the feedback from this pre-release review, which includes a wide array of informants ranging from consumer leaders to foundations to crisis providers to NASMHPD, to develop the first official version of the report to be released late 2019 or early 2020.

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 and Dr. Cline are preparing presentations on Ideal Crisis Systems and Implementation of Welcoming, Integrated Systems of Care for Individuals with Co-occurring Mental Health and Substance Use Disorders for the NATCON conference in Austin in April 2020. These are extensions of the successful presentations at the 2019 NATCON event in Nashville.

American Association of Community Psychiatry (AACP):

Dr. Minkoff is an emeritus Board Member, and Dr. Cline 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 as a national standard for measurement of 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 (in contrast to the proprietary instruments used by the managed care organization). A LOCUS advisory committee is being 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.   The next AACP Board meeting will be held at the Institute of Psychiatric Services in NYC, October 2-3, 2019.

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.    CBHL has used its summer Board retreat and a late 2019 membership convening to identify specific strategies for moving in the direction of this new vision, and for attracting funding partners to support this direction. Dr. Minkoff will be participating on the Collective Impact subcommittee of the Board to help this direction.

National Association of State Mental Health Program Directors (NASMHPD)/International Initiative for Mental Health Leadership (IIMHL) – 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 has co-authored this paper with Nancy Covell, PhD of the Center for Practice Improvement at Columbia. The paper has been completed and will be released this fall. Dr. Minkoff presented an overview of the key policy recommendations in this paper to an international audience at the IIMHL/NASMHPD conference in Washington DC on September 13.

Meadows Mental Health Policy Institute:   ZiaPartners has continued active involvement in multiple projects and activities conducted by MMHPI, as follows:

  • Coordinating with the Local Systems team regarding how to best support progress in a variety of local system consultations
  • Working with Dr. Seema Shah and members of the Temple Foundation East Texas project team to discuss statewide efforts to improve primary health/behavioral health integration for children, and to develop statewide academic partnerships regarding research and services. Visited primary care pediatric practices in East Texas, June 14.
  • 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 Technical Assistance team to work with the American Academy of Addiction Psychiatry on statewide Technical Assistance for MAT, as part of the national STR-TA initiative. Dr. Minkoff has been providing TA to an Federally Qualified Health Center in Amarillo
  • Working on the development of materials for the next phase of Okay to Say: (Okay to Share; Okay to Care).
  • Planning for an on-site presentation on integrated care for the Panhandle Behavioral Health Alliance in Amarillo on September 24.
  • Attending MMHPI Staff Meeting in Galveston, June 12-13
  • Attending the fourth annual Engage and Excel Conference in Austin, September 25-27. ZiaPartners were the original developers of the Engage and Excel concept for bringing state and local system leaders together for collaborative learning and facilitated the first E&E conference.

Follow MMHPI at www.texastateofmind.org

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. The development of this product is also aligned with one of the recommendations in the ISMICC report. This project is coordinated by the Equitas Project and has had a series of teleconferences through the summer. There will be a full-day in-person meeting of this group in Denver on November 21.

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 (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 greatest impact over time.   The team was awarded the project, which began in August, with the first on-site meeting in St. Louis on September 4. The team is now working with the Foundations to plan further visits to Missouri in October and December to meet with a developing Advisory Committee for the project, as well as to identify and interview a wide range of key informants, and to plan and organize consumer listening sessions. The project will involve not only state-level meetings but will also include deeper analysis of six major regions within the state.

Illinois Department of Human Services: ZiaPartners has continued its 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 involves a 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. ZiaPartners provided a very successful specialized training on integrated services for the most seriously disabled individuals with co-occurring Substance Use Disorders, for over 200 attendees, in Chicago on June 7. This training was attended by a wide range of providers, ranging from those very experienced working with individuals with very serious mental illnesses and Substance Use Disorders, as well as from Substance Use Disorders or Mental Health providers who were just beginning to improve their ability to provide integrated services. Based on this conference, ZiaPartners provided a set of next step recommendations to DMH and SUPR that will inform continuing efforts in FY 2020.

All Health Network: On July 9-10, ZiaPartners conducted a very successful two-day continuation of a division-wide improvement project for co-occurring capability development, as well as specific consultation and technical assistance to the agency’s Substance Use Disorder IOP and MAT services. The organization has formed a change agent team, to support the improvement of welcoming, integrated services in partnership with leadership. ZiaPartners continues with teleconsultation, with the next on-site visit on October 7-8.

Tennessee Co-occurring Strategic Initiative: Dr. Minkoff provided a full day videotaped webinar training in Nashville on June 25, for the purpose of providing more detailed information about stage-matched interventions for individuals with co-occurring disorders, and to link that information to the improvement of co-occurring capability. The training was attended by representatives of each of the regional learning communities, who can now use the videotaped material to bring the information back to their own organizations and their regional partners. ZiaPartners will be continuing to work with TAMHO in the coming year to provide further support to this statewide initiative.

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 will be providing a two-day on-site consultation visit on September 30-October 1.

Genesee County, MI: Dr. Minkoff contracted to provide six days of co-occurring disorder implementation training to Genesee County Behavioral Health. These trainings were provided on April 23-24, June 4-5, and September 10-11. An important focus of the last training was the development of sustainable improvements at the program and provider agency level. Genesee County leadership has started an ongoing expectation of self-assessment (using tools such as the COMPASS-EZ) and improvement planning for each county Mental Health program as well as their contracted provider partners. ZiaPartners is available to provide continued consultation as needed.

Hope Network, Grand Rapids, MI: Dr. Minkoff contracted to provide ongoing consultation and training to help Hope Network transition its current Crisis Residential Units (operated in two locations in West Michigan, and one location in the Upper Peninsula) to be able to provide crisis services to individuals with active co-occurring substance use.   Dr. Minkoff will be providing a one-day training for all Hope Network crisis providers, in Grand Rapids, on October 9.

Kent County Crisis System Project: ZiaPartners, TriWest Group, and Common Ground partnered to submit a successful proposal to Kent County (Grand Rapids, MI) for assistance with developing an excellent behavioral health crisis system. This project will involve an intensive engagement with community leaders and on-site visits with current providers to develop specific recommendations and implementation strategies. The project is expected to launch in the next few months.

Arnold Ventures (John and Laura Arnold Foundation) Reimagining Crisis Services Project:   ZiaPartners, TriWest Group, Connections Health Solutions (Margie Balfour, MD, Tucson AZ), and the Council on State Governments Justice Center (CSGJC) have partnered to provide a project proposal to Arnold to advance the development of measurable criteria for Behavioral Health crisis systems, the identification of model crisis system communities, and subsequent development of a variety of products to expand implementation of excellent crisis systems nationally. This proposal has been selected for consideration and is currently under review. Implementation may proceed as early as this fall.

Mid-Hudson (NY) Region Co-occurring Initiative: Dr. Minkoff was invited by Association of Community Living for Hudson Region (ACLAIMH) to provide a conference on co-occurring disorders on June 25-June 26. There has been continuing progress in counties across the region on the initiative, and this was an opportunity to engage residential providers in the conversation.   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, particularly Michael Orth of Westchester County. Dr. Minkoff, Dr. Cline will be joining these three individuals in a presentation at the Institute of Psychiatric Services in NYC. The presentation is scheduled for Sunday, October 6, from 8-9:30 AM.

Equine Assisted Therapies and Activities:   ZiaPartners facilitated a weekend retreat in Denver on July 20-22 attended by leadership of major organizations providing various types of therapeutic services (both physical health and behavioral health services) incorporating horses, for the purpose of developing a common terminology for the field. This very exciting project resulted in ZiaPartners collating the discussion into a draft document that has been endorsed by the participants and is now in the process of being disseminated and discussed more widely.

Spokane County Behavioral Health: Dr. Minkoff provided a two-day training event on integrated services and systems for individuals with co-occurring Mental Health and Substance Use Disorders on June 17-18 in Spokane. There were approximately 60 attendees representing a wide variety of Mental Health and Substance Use Disorders providers at the very successful event.

Alameda County Healthcare Services Agency and Alameda County Behavioral Health: Based on successful work performed by ZiaPartners with ACBH (2007-11) on improving co-occurring capability in the county behavioral health system, ZiaPartners has been asked to provide some ideas for how Alameda can advance its more recent efforts to improve integrated health, behavioral health and human services for individuals with complex needs, particularly those who are experiencing homelessness.   This project is termed Care Connect and is a key component of the Alameda County Whole Person Care effort.   ZiaPartners has engaged in some planning calls and will be providing an introductory videoconference slide presentation on September 25 to key leaders within the county.

Los Angeles County Transformation: Los Angeles County Department of Mental Health leadership has been engaged in multiple efforts to create transformative change in the county system, including a 5-year MHSA innovation project to pilot the Trieste model for individuals with serious mental illness in Hollywood. The County District Attorney’s office has also been leading Stepping Up initiatives to address the dramatic challenges of people with mental illness in the justice system, with the initiation of community-based restoration centers to divert individuals with complex needs. The Department of Public Health Division of Substance Abuse Prevention and Control (SAPC) has initiated an Organized Delivery System transformation under the California SA MediCal waiver. Dr. Minkoff has been asked by a leading advocate in the system to present a videoconference to leadership from all three arenas on September 23 on how to conceptualize and implement a more integrated transformational approach across all three departments, countywide.

Training Events in September and October 2019

September 10-11: Dr. Minkoff – Co-occurring Disorders –Genesee County, Flint, MI

September 13: Dr. Minkoff – Integrated Systems for Co-occurring MH/SUD – NASMHPD/IIMHL Conference, Washington DC

September 23: Dr. Minkoff – Integrated System Transformation webinar – Los Angeles County

September 24: Dr. Minkoff: PHBH Integration – Panhandle BH Alliance, Amarillo, TX 

September 25: Dr. Minkoff & Dr. Cline – Integrated System Transformation and Complexity Capability webinar – Alameda County, CA

September 25-27: Dr. Minkoff & Dr. Cline: Engage & Excel, Meadows MH Policy Institute, Austin, TX

October 3-6: Dr. Minkoff & Dr. Cline: Multiple presentations at APA Institute for Psychiatric Services, NYC

October 9: Dr. Minkoff: Welcoming Crisis Services for Individuals with Co-occurring MH/SUD – Hope Network, Grand Rapids, MI

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