The state plans to move a program to identify and treat children and young adults in the earliest stages of serious mental illness in-house next month, a move that officials say will allow them to better leverage Medicaid dollars to pay for mental health services.
The decision represents not only a change of course for the program but also the state, which, in the last few years, has often opted to rely on the private sector to provide mental health services to decrease the demand and need for state resources. But state officials say that the move will allow them to provide coordinated speciality care with providers across disciplines to treat people in the early stages of mental illness.
Administrator Kelly Woolridge said that the Division of Child and Family Services is forming teams of clinicians and case managers, reaching out to partner with federally qualified health centers and integrating services into the state’s mobile crisis response team. She said the state will focus funds previously granted to the private sector — specifically, the Enliven program run by the Children’s Cabinet, a nonprofit community organization — on boosting the ability of state clinicians to provide services to the uninsured and those who go back and forth between being uninsured and not and ensuring services are reimbursed through Medicaid as needed.
“One of the primary goals of identifying individuals with early onset serious mental illness is really we’re supporting recovery as much as possible and helping individuals to maintain their highest level of functioning without having to go years without adequate treatment,” Woolridge said.
Funding for the so-called first-psychotic episode program comes from a federal mental health block grant, which mandates that 10 percent of the total block grant funds be set aside for early treatment of serious mental illnesses, or $432,945 for the current fiscal year. The goal of the program, which started in 2015, is to catch serious mental illnesses early and treat children and young adults before they reach a crisis situation.
“A lot of research has identified that between the initial onset of a psychotic episode, especially for schizophrenia, and when an accurate diagnosis took place, it took 10 years,” said Dr. Stephanie Woodard, a clinical psychologist with the Division of Public and Behavioral Health. “Those 10 years are incredibly important and vital to pay attention to.”
The federal Substance Abuse and Mental Health Services Administration has now required states to expand from treating not only first episode psychosis but all early serious mental illnesses. Woodard said that the grant funds will be used to build specialty coordinated care teams where there are none, pay for the treatment of uninsured individuals and build training and technical assistance across the behavioral health field to increase knowledge about early onset of serious mental illness and the best practices and standards of care for managing those individuals.
“We have workforce shortage across the state,” Woodard said. “We will be working to develop these teams, even if they’re geographically separate from where these individuals need the coordinated care.”
For instance, the state’s licensed clinical social workers already offer consultation services via telemedicine to hospitals in rural areas where the nearest mental health provider is a couple hundred miles away to help determine the best course of treatment for a patient. Woodard said that the state could “exponentially” expand access to those services.
The Children’s Cabinet’s Enliven program has been operating under a model known as RAISE, or Recovery After an Initial Schizophrenia Episode, which focuses on delivering coordinated speciality care in community practice settings, since it launched in 2015. Former first lady Kathleen Sandoval was one of the driving forces behind starting the program.
In the past two years, Enliven assessed 97 people in Northern Nevada and 41 became clients, including 17 who enrolled in school, 20 who obtained jobs, 29 who participated in medication management and 12 who obtained insurance through Medicaid or their employer. In the South, the program assessed 67 people, including 15 who were accepted to the program and active in the program.
“As the program term came to an end, our organization did submit to continue to the program, but funding changed at the state level and they have made changes to how the program format will move forward,” said Children’s Cabinet spokeswoman Amy Riley in an email. “The Children’s Cabinet remains strong partners with the state and we will continue to work closely with them to develop programs that serve youth and families. It is our hope as an organization that it will be a seamless transition for our current clients as the program changes to the state format and that the state continues funding and early intervention programs for psychosis and mental health.”
Wooldridge said that the state will continue to provide all the services that Children’s Cabinet was — initial assessment, cognitive behavioral therapy and then wraparound case management and care coordination — as well as specialty medical care if needed.
The state plans to transition care for current patients — about 30 people in the north and south, according to Children’s Cabinet — from the nonprofit over to the state’s clinicians by the end of April, although Woolridge said the process could take a little longer to make sure the current clients are comfortable with the transition. Wooldridge said there were “no issues” with Children’s Cabinet and that the decision was “really the direction from (the federal government) over the two year period of getting it started.”
“We did issue a (request for proposals) in January, and we continued to have just some internal discussions about better use of the grant money in terms of making sure we can get Medicaid, making sure we are using Medicaid for these reimbursable services rather than using the money to fund positions,” Woolridge said.
The state ultimately decided to cancel the request for proposals, part of the grant-awarding process, on March 14, Woolridge said.
Mike Willden, chief of staff for Gov. Brian Sandoval, said that the governor’s office has been discussing with Department of Health and Human Services Director Richard Whitley the best way forward for the program as part of regular, ongoing discussions with the department.
“Our belief is it should be one that’s integrated between Nevada Medicaid and probably the federally qualified health centers,” Willden said. “We’ve been asking questions, and it’s my understanding that Director Whitley made a decision to stop the (request for proposals) process. He’s planning to reevaluate how to implement the first episode psychosis break program in a broader fashion.”
Separately, the state also has certified community behavioral health clinics, including two in the rurals, that provide assistance to children with serious emotional disturbances and adults with serious mental illness. Woodard said those clinics, which are funded through a demonstration grant from the federal Centers for Medicare and Medicaid services, are also focused on providing coordinated care and working to expand access to individuals experiencing an early onset of serious mental illness.
Officials said that there are ongoing conversations between the state and the federally qualified health centers (FQHCs) and that they are going to be developing a plan to push out training and technical assistance to the larger behavioral health and medical field to help them identify early signs of serious mental illness.
“One of the primary reasons why FQHCs have been identified as key partners in this is, again, because they’re able to provide that whole health care and behavioral health care,” Woodard said. “They truly are the safety net providers.”
This article reprinted with permission from The Nevada Independent. Those interested can email firstname.lastname@example.org