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January 13, 2016

Advancing Public Policies for People with Mental Illness, Chemical Dependency or Developmental Disabilities   

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Francine Sinkoff, Editor
fs@clmhd.org


NYS Mental Health Services Agencies to Host Integrated Services Webinar - January 26

The three New York State agencies of Department of Health, Office of Mental Health and Office of Alcohol and Substance Abuse Services will be hosting an Integrated Services webinar on Tuesday, January 26th from 2:30 pm - 4:30 pm. The purpose of this webinar is to review the Integrated Services requirements, and the regulations and policies surrounding them.

A "Frequently Asked Questions" (FAQs) will be distributed within the week prior to the webinar.  There will be a presentation, followed by time for Q&A where webinar participants will be able to type in questions during the interactive period.   The session will be recorded and once the recording is available, the link will be provided so interested parties will be able to access it.
 
Click here to register for the webinar.
DOH Releases December 2015 Medicaid Managed Care Enrollment Data for NYSOH

The Department of Health (DOH) released its monthly statewide Medicaid managed care enrollment report, which includes Medicaid enrollment through the New York State of Health (NYSOH).  According to the December 2015 report, a total of 4,625,927
individuals are enrolled in mainstream Medicaid managed care.  Of that number, 1,857,153 enrolled in Medicaid through NYSOH.  Enrollment through the state marketplace represents roughly 40% of the total enrollment in mainstream Medicaid managed care.  

Click here for the most recent report, which shows detailed enrollment data for Medicaid managed care, Child Health Plus, Managed Long-Term Care, Medicaid Advantage, Medicare Advantage, and Fully-Integrated Duals Advantage (FIDA) by county and plan.
DSRIP Timeline Updated

The DSRIP Year 1 Timeline has been updated. A new DSRIP Year 2 Timeline, which begins April 1, 2016, has also been released.  

Click here to review the timeline for Year 1 and here to review the timeline for Year 2.
New York Becomes 32nd State to Enact ABLE

Governor Andrew Cuomo has signed 
ABLE legislation that will allow families the opportunity to set up tax-free 529A savings accounts for disability-related expenses. The New York State Assembly and Senate passed the legislation in June.

The bill follows upon enactment by the federal government of the Stephen Beck, Jr., Achieving a Better Life Experience Act of 2014. Modeled after college savings accounts, ABLE accounts will enable people with autism and their families to save for housing, education, transportation, medical and other expenses if related to their disability. Assets in ABLE accounts will be exempt from a $2,000 cap on conventional savings accounts; exceeding that cap voids eligibility for Medicaid and Supplemental Security Income (SSI) benefits.  Read more here.

Click here to read the Senate bill.
In Drug Epidemic, Resistance to Medication Costs Lives

Dr. Marvin Seppala wrote a book on conquering drug addiction with counseling and group therapy.  The spiritual, abstinence-based strategy pioneered by Alcoholics Anonymous helped him overcome his own alcohol and cocaine addiction when he was 19. As medical director of Minnesota's fabled Hazelden clinic, he watched it work for patients.

He believed in it - and then he changed his mind.  In 2007, Seppala began working at Beyond Addictions, a now defunct treatment center in Beaverton, Oregon. Instead of relying solely on counseling, the center gave its patients a relatively new medication, buprenorphine, to relieve their drug cravings.  Back in Minnesota, his patients had been bailing out of treatment to use illicit drugs again. In Oregon his patients on buprenorphine weren't relapsing or overdosing - they reported feeling "normal" again. 

Nearly a decade later, doctors and brain researchers agree that medications such as buprenorphine, methadone and naltrexone are the most effective anti-addiction weapons available. Nevertheless, more than two-thirds of U.S. clinics and treatment centers still do not offer the medicines. Many refuse to admit people who are taking them.   

The result is that hundreds, perhaps thousands, of Americans are dying unnecessarily, victims of an epidemic that killed more than 28,000 people in 2014 - more than auto accidents, homicides or suicides.

The research is unassailable: Staying in recovery and avoiding relapse for at least a year is more than twice as likely with medications as without them. Medications also lower the risk of a fatal overdose. 

Addicts who quit drugs under an abstinence-based program are at a high risk of fatally overdosing if they relapse. Within days, the abstinent body's tolerance for opioids plummets and even a small dose of the drugs can shut down the lungs.
And yet as the country's opioid epidemic worsens - every day, more than 70 Americans die from overdoses, and the numbers are climbing - only about a fifth of the people who would benefit from the medications are getting them, according to a new study by the Johns Hopkins Bloomberg School of Public Health.  Read more here.
Can Technology Help Prevent Drug Overdoses?

On a recent morning in November, my local newspaper reported that an unusually pure form of heroin was circulating throughout our small Massachusetts community, triggering numerous overdoses. Ultimately, three young people died within a 24-hour period. Just a week earlier, the U.S. Drug Enforcement Administration had revealed that deaths from drug overdoses had surpassed deaths from car crashes and from firearms each year since 2008.

The rapid increase in overdose deaths has been relentless, and public health officials have scrambled for some kind of response to the problem. Among the best-known solutions are the prescription drug monitoring systems that virtually every state has set up to reduce drug abuse. These systems collect, monitor and analyze electronic prescriptions submitted by pharmacies and doctors, and can flag individuals who might be misusing or abusing painkiller medications.

Overall, these systems have been very effective. Missouri's Medicaid program, MO HealthNet, for example, saw Vicodin use drop more than 30% between January 2012 and January 2015. Other states have reported dramatic drops in the number of patients who "doctor-shop" for more prescription painkillers as well.

But prescription monitoring systems have their limits. For one, they can't track illicit drug use. For another, to be effective, the systems depend on electronic prescriptions for monitoring, but more than 40% of prescriptions are still written on paper. Furthermore, the information the systems provide about overutilization can be late in reaching the doctors who prescribe painkillers.

That's where analytics come in. The Massachusetts Department of Public Health (DPH) has begun using analytics -- basically software algorithms -- to sift through sets of data to spot patterns and to devise an early warning system about hotspots in the state where possible overdoses and deaths might occur.  Read more here.







UPCOMING TRAININGS

January 15, 2 - 3:30 pm, National Reentry Resource Center.


 
CALENDAR OF EVENTS

JANUARY 2016
CLMHD Directors Meeting
January 19:  9:30 am - 11 am
GTM Only

CLMHD Executive Committee Meeting
January 19:  11 am - 12:30 pm
GTM Only

CLMHD Mentoring Workshop
January 26:  11:30 am - 12:30 pm
GTM

Developmental Disabilities Committee Meeting
January 27:  11 am - 12:00 pm
GTM Only


FEBRUARY 2016
Mental Hygiene Planning Committee 
February 4:  11 am - 1 pm
GTM

CLMHD Executive Committee Meeting
February 4:  11 am - 12:00 pm
TBD

Officers & Chairs - Call in
February 10:  8 am

CLMHD Office Closed - Lincoln's & Washington's Birthdays
February 12 & 15

Children & Families Committee
February 16:  11:30 am - 1 pm
TBD

OMH Agency Meeting
February 22:  10 am - 12 pm
44 Holland Ave., 8th Fl, Albany

OASAS Agency Meeting
February 22:  1 pm - 3 pm
1450 Western Ave., 4th Fl, Albany

Contact CLMHD for all Call In and Go To Meeting information, 518.462.9422 
OPWDD Releases Transformation Panel Report

Last week, the Office for People with Developmental Disabilities (OPWDD) released its Transformation Panel Report, a document which lays out the process, vision and recommendations of the Transformation Panel, a diverse group of people brought together by Acting Commissioner Kerry A. Delaney to re-imagine the OPWDD system. This collaborative document takes into account the voices of individuals and their family members, which were heard through a series of public forums held by the panel and Acting Commissioner Delaney.
 
Now, OPWDD is asking its valued stakeholders - people with developmental disabilities, their family members and caregivers, provider agency representatives and government partners - to share their opinions. After reading the Transformation Panel's draft report, please send your comments on it to transformation.panel@opwdd.ny.gov.

After the public comment period has ended, revisions will be made to the report based on the feedback received and a final draft will be ready by mid-February. Work on implementing some of the recommendations has already begun, and will proceed to accomplish both short- and long-term goals.
Accountable Care Organization Initiatives Announced to Improve Health System Care Delivery

This week, the Centers for Medicare & Medicaid Services (CMS) announced 121 new participants in Medicare Accountable Care Organization (ACO) initiatives designed to improve the care patients receive in the health care system and lower costs. With this announcement, ACOs now represent 49 states and the District of Columbia.

ACOs are delivering better care, and they continue to show promising results on cost savings. In 2014, they had a combined total net program savings of $411 million for 333 Medicare Shared Savings Program (Shared Savings Program) ACOs and 20 Pioneer ACOs. Based on 2014 quality and financial performance results for Shared Savings Program ACOs who started the program in 2012, 2013, and 2014, those that reported in both 2013 and 2014 improved on 27 of the 33 quality measures, including patients' ratings of clinicians' communication, beneficiaries' rating of their doctors, screening for tobacco use and cessation, screening for high blood pressure, and Electronic Health Record use. Shared Savings Program ACOs also outperformed group practices reporting quality on 18 out of 22 measures.

CMS also announced that providers and hospitals have signed up to join new types of ACOs, which in addition to being paid for positive patient outcomes will also receive penalties for negative ones. With new participants in the Shared Savings Program (SSP), the Next Generation ACO Model, Pioneer ACO Model, and the Comprehensive ESRD Care Model, there will now be:
  • Nearly 8.9 million beneficiaries served
  • A total of 477 ACOs across SSP, Pioneer ACO Model, Next Generation ACO Model, and Comprehensive ESRD Care Model
  • 64 ACOs are in a risk-bearing track including SSP, Pioneer ACO Model, Next Generation ACO Model , and Comprehensive ESRD Care Model
More information can be found by visiting the Next Generation ACO, Pioneer ACO, Comprehensive ESRD Care Models web pages. 
New York Takes Steps to Make the Use of Solitary Confinement More Humane

New York has joined several other states in 
promising to scale back solitary confinement, the institutionalized torture to which prisons across the country subject thousands of inmates every day. The excuse for extreme prisoner isolation is that it maintains order. The reality is that the punishment is wildly overused, and the conditions are often of the sort you'd expect to read about in a human rights report on a Third World dictatorship, a system seemingly designed to break people down, encourage mental illness and inflict deep misery and emotional desperation.

New York has some 4,000 prisoners in solitary confinement, according to the New York Civil Liberties Union, which has been pressing a lawsuit against the state. Under a settlement the NYCLU struck with the state, about a quarter of those prisoners will move out of traditional solitary confinement. This group will include people who were isolated as punishment for minor offenses, prisoners who require intensive behavioral therapy, inmates who need drug treatment, people who are developmentally disabled, minors and prisoners who are set to be released directly from isolation back into their communities. Those who violate prison drug restrictions one time and those who break minor rules will also be ineligible for isolation. Solitary confinement is obviously inappropriate for all of these groups.

New York will also reduce solitary confinement terms. The NYCLU says thatthe average stay in isolation is roughly five months. Now, the maximum term will be three months, except in a few circumstances. The most stringent term for most inmates in solitary for their first time will be 30 days. Officers will also have to explain in writing why they put a prisoner in solitary.  Read more here.
Parents' Drug Abuse Strains Child-Welfare Agencies

Steve and Fawn Kippenberg said they hit many lows in their decade-long battle with pain-pill and heroin addiction. The Ohio couple was evicted from multiple homes. Both contracted hepatitis C from injecting drugs with dirty needles.

But nothing compares to the day that child-protective-services workers knocked on their door and took three of their children into custody because of safety concerns. The children were away for several months while the couple worked to get clean. "My whole world dropped right there," said Mr. Kippenberg, 42 years old. "That was my rock bottom."

Abuse of opioids like heroin and prescription painkillers is straining child-welfare agencies across the U.S. and sending more children into foster care, officials say. Addiction treatment for opioids only occasionally succeeds, relapse is common and children often languish for years in the system.

The number of children in foster care nationwide as of September 2014 rose 3.5% from a year earlier to 415,129, according to the latest data collected by the Administration for Children and Families, part of the U.S. Department of Health and Human Services.

The national data don't specifically measure how many children land in foster care as a result of their parents' drug use, but some state and local officials say opioid addiction is likely contributing to the increase. The epidemic is being fueled by the overprescribing of pain pills coupled with a cheap and abundant supply of heroin, drug experts say.  Read more here.
Anatomy Of Addiction: How Heroin And Opioids Hijack The Brain

When Jack O'Connor was 19, he was so desperate to beat his addictions to alcohol and opioids that he took a really rash step. He joined the Marines.

"This will fix me," O'Connor thought as he went to boot camp. "It better fix me or I'm screwed."

After 13 weeks of sobriety and exercise and discipline, O'Connor completed basic training, but he started using again immediately.

"Same thing," he says. "Percocet, like, off the street. Pills."

Percocet is the brand name for acetaminophen and oxycodone. Oxycodone is a powerful opioid. It's one of the most commonly prescribed painkillers, and is a key factor in one of the country's most pressing public health problems - an opioid addiction epidemic. It is a crisis that started, in part, from the over-prescription of painkillers, like Percocet, and then shifted to heroin, as people addicted to prescription drugs looked for a cheaper high.

O'Connor is one of an estimated 2.5 million Americans addicted to opioids and heroin, according to the National Institute on Drug Abuse. Over three years, he detoxed from prescription painkillers - and heroin - more than 20 times. Each time, he started using again. So why is it so hard for opioid addicts to quit? You can boil it down to two crucial bits of science: the powerful nature of opioids and the neuroscience behind how addiction hijacks the brain.

"The first recording of opioid use was 5,000 years ago," says Dr. Seddon Savage, an addiction and pain specialist at Dartmouth College. It was "a picture of the opium poppy and the words 'the joy plant.' "

'It Ruined Me That Time. But I Loved It.'

Jack O'Connor says he ended his freshman year of college as an alcoholic. He went home that summer desperate to replace alcohol with something else. And it was not hard to do. In 2012, 259 million opioid pain medication prescriptions were written - that's enough painkillers for every American to have a bottle of the pills. O'Connor got his hands on some 30-milligram Percocet.
"I ended up sniffing a whole one, and I blacked out, puking everywhere," says O'Connor. "I don't remember anything. It ruined me that time. But I loved it."

Opioids got him higher faster than any drug he had tried. And even though different drugs produce different highs, they all include the same pathway in the brain.  Read more here.
Research Confirms Racial Inequities in Mental Health Treatments

Millions of Americans suffer from mental illness. Many seek therapy, but racial background influences availability and quality of treatment. In 1999 and 2001, the U.S. Surgeon General's Office issued reports highlighting racial inequities: Racial minorities have less access to 
mental health services than Whites.

A new summary of research representing over 4.7 million individuals has provided data on the severity of the racial inequities: Asian Americans were less than half as likely as Whites to use mental health services, Hispanic/Latino(a) Americans were 25% less likely, and African Americans were 21% less likely. In a finding that is particularly troubling, African Americans suffering from mental illness were found in mental health services less often when they most needed help.

Joseph E. Trimble, research co-author and Distinguished University Professor of Psychology at Western Washington University stated, "We felt grateful that the racial inequities were actually smaller than we imagined them to be. Except for Asian Americans, race accounts for relatively smaller differences in mental health service utilization."

The racial inequities remained after accounting for alternative explanatory factors such as socioeconomic status. However, public assistance for mental health services eliminated racial inequities for African Americans and other clients of color.

"Access to mental health treatment is a major public health issue," said researcher Timothy B. Smith of Brigham Young University. "Conditions such as depression and anxiety have been increasing in recent decades. Making mental health treatments accessible for all populations will benefit society through associated decreases in suicide, substance abuse, and physical illness." Beyond the psychological benefits, financial savings from equitable access to mental healthcare services include decreased medical and insurance costs and fewer missed work days.  Read more here.
CPI Releases Two New Mini-modules for Consumers and Family Members

CPI has developed two new mini-modules - "infomercials" which provide information and uplifting messages about important topics.  Both include video clips of consumers talking about their experiences and encourage the viewer to consider next steps. 
 
"Dual Recovery" is a 5 minute module that focuses on co-occurring mental health and substance use problems.  It explains integrated treatment and makes the point that dual recovery is possible.  You can view this module by clicking on the photo below: 
"Considering Work" is a 4 minute module that focuses on competitive employment.  It makes it clear that individuals diagnosed with mental illness can and do work at jobs that meet their interests.  It introduces the Individual Placement and Support (IPS) supported employment approach and CPI's Employment Resource Book.  You can view this module by clicking on the photo below:

Consumers and family members can view these modules on their own or with practitioners.  These modules can be used to engage individuals in discussions about these important topics, their personal relevance, and possible next steps in pursuing services. 
 

More information can be found by visiting CPI's website here

The Conference of Local Mental Hygiene Directors advances public policies and awareness for people with mental illness, chemical dependency and developmental disabilities.  We are a statewide membership organization that consists of the Commissioner/ Director of each of the state's 57 county mental hygiene departments and the mental hygiene department of the City of New York.

Affiliated