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March 9, 2016

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

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Francine Sinkoff, Editor
[email protected]

Update to OMH Clinical Records System Offers Many Improvements

Version 3.0 of the New York State Clinical Records Initiative (NYSCRI) Operational System is now online.

Developed by the OMH Office of Medical Informatics, this update is designed to help OMH mental health clinics that run adult and child treatment programs (Part 599 Clinics) manage their office resources so that they can focus on caring for clients. It offers access to data based on regulations, standards, and person-centered care.

This new version offers users improved search capabilities, the ability to generate completed forms and takes advantage of advances in clinical thinking from OMH and the Office of Alcoholism and Substance Abuse Services (OASAS). Providers may use NYSCRI to guide the implementation of an Electronic Medical Record. Available through NYSCRI's redesigned web page, the update features a one-stop dashboard that gives users easy access to information that's vital for operations across multiple domains including staffing, billing, clinical input, and documentation.  Click here to access NYSCRI.
Award Announcement: Capital Restructuring Financing Program and Essential Health Care Provider Support Program

Last week, Governor Andrew M. Cuomo announced a total of $1.5 Billion to fund 162 projects statewide through the Capital Restructuring Financing Program and Essential Health Care Provider Support Program. This funding is a commitment made by New York State to help health care providers statewide fund critical capital and infrastructure improvements, as well as integrate and further develop health systems.
The awards are being made through the Capital Restructuring Financing Program and Essential Health Care Provider Support Program. Both were created by Governor Cuomo to support the goals of the Delivery System Reform Incentive Payment (DSRIP) Program.  The awards were spread out across the following regions: New York City, the Mohawk Valley, Long Island, the Mid-Hudson Region, the Southern Tier, Western New York, the Capital Region, Central New York, the Finger Lakes Region, and the North County.
For a list of awardees and award amounts, visit Governor Cuomo's website here,
where you will find the press releases by region.
Funding Available for Suicide Prevention Coalitions in Non-NYC Counties 

The Suicide Prevention Center of NY (SPC-NY) is pleased to announce the availability of funding for calendar year 2016 for New York State Counties in Long Island and north of New York City that either currently have or plan to create a Suicide Prevention Coalition. (Funding for New York City counties/boroughs will be available in calendar year 2017).
The NYS Office of Mental Health (OMH) will soon release its new State-wide Suicide Prevention Plan (2016-17). One of the four strategic directions of the Plan is the creation and support of Caring, Competent and Healthy Communities. An important part of that strategic direction, and strengthening the State's overall suicide prevention efforts, this funding opportunity supports the evolution of existing suicide prevention coalitions and creation of new suicide prevention coalitions where they either don't exist or where they are inactive.
All participating counties in Long Island and north of New York City that agree to participate in this initiative will receive a $3500.00 grant. Click here for the application.

SAVE THE DATE for the 2016 NYS Suicide Prevention Conference & Awards - September 12-13, 2016.  Click here for more information.
Registration Open for Annual Disaster Mental Health Conference

April 15, 2016 - New Palz, NY
Click here to register.

ASAP 1-Day Summit:  Substance Use Among the Aging Population - A System-Wide Response

April 12, 2016 - Eastchester, NY
Click here to register.


Cultural and Linguistic Competence for CCBHCs: Approaches to Meeting New Requirements
March 17, 3 - 4 pm, National Council for Behavioral Health

March 29, 3 - 4 pm, SAMHSA-HRSA

March 31, 1:30 - 2:30 pm, National Council for Behavioral Health

April 6, 3:30 - 5 pm, CMS & Truven Health



MARCH 2016
Children & Families Committee
March 15:  11:30 am - 1 pm

Director's Meeting - In Person
March 22:  10:30 am - 12 pm
41 State St., Ste. 505, Albany

Executive Committee - In Person
March 22:  12:30 - 2 pm
41 State St., Ste. 505, Albany

Developmental Disabilities Meeting
March 30:  11 am - 12 pm
GTM Only

APRIL 2016
Officers & Chairs - Call In
April 6:  8 am

Mental Hygiene Planning 
April 7:  11 am - 2 pm
GTM Only

Children & Families Committee
April 12:  11:30 am - 1 pm

Director's Meeting 
April 19:  9:30 am - 11 am
GTM Only

Executive Committee 
April 19:  11 am - 12:30 pm
GTM Only

Contact CLMHD for all Call In and Go To Meeting information, 518.462.9422 
New Hope for Mental Health Reform at the Federal Level

Senators are quietly negotiating a bipartisan mental health reform bill that they plan to consider in mid-March, even as a parallel effort in the House struggles to move forward.  The hope is that the mental health overhaul can become a rare legislative achievement in an election year, but the window for action is closing. 

Sen. Lamar Alexander (R-Tenn.), the leader of the Senate Health Committee, is drafting a bill with ranking Democrat Sen. Patty Murray (Wash.) and Sens. Chris Murphy (D-Conn.) and Bill Cassidy (R-La.). The Obama administration is also involved in negotiations.  They are working to mold the bill ahead of a committee markup planned for March 16. 

The bill will likely include multiple pieces from a measure introduced last summer by Chris Murphy and Bill Cassidy. The two senators have noted that one in five adults, or roughly 44 million people, experience mental illness per year, which they say points to the need for greater assistance. The number of available psychiatric beds has actually declined by 14 percent in recent years.

The negotiators are still deciding which parts of the original Murphy-Cassidy bill to include in their rewrite.  The first bill would have created a new assistant secretary to oversee mental health and provided grant funding on topics like early intervention for children who demonstrate risk factors for mental illness.

The House is watching the Senate's effort closely.  Read more here.
Westchester County Unveils 10-Point Concussion Plan

Six months ago, a concussion task force, led by Dr. Mark Herceg, Commissioner, Westchester County, was charged with reviewing concussion protocols that are currently in place at some local high schools. Recently, County Executive Rob Astorino unveiled "Safer Sports," his team's 10 "Best Practices" for concussion management in high school and youth sports.

The 10-point plan is at the forefront of Safer Sports, the latest initiative in Astorino's Safer Communities campaign, which was launched three years ago to address health and safety issues in Westchester. No safety issue has been more prominent in sports, and the concussion task force has learned that Westchester schools have wide discrepancies in how they prevent, diagnose and treat head injuries.

Based on data the task force has compiled so far, an average of 10 students per school suffer concussions each year.

"If you put that in 40-plus schools, that's over 400 kids a year," Herceg said. "We want to make sure students at these schools are being properly treated."

The county's program focuses primarily on improving collaboration between school officials to better treat head injuries. That includes ensuring students receive proper medical care based on his or her symptoms and proper support and/or modifications in the classroom if needed. Herceg said the latter part is too often ignored because a student's will lose focus in his or her attempt to return to action.

Even before it was announced Monday, the 10 "Best Practices" had been endorsed by the Brain Injury Association of America and the New York state government, which passed its own concussion law in 2011.

The county will disseminate the Safer Sports booklet to schools across the county and rely on members of the task force and other key members of the community to encourage adoption. The task force already includes athletic directors Mike O'Donnell (Stepinac), Jim Rose (Yonkers) and Artie McCormack (Irvington) and Hackley athletic trainer Douglas Sawyer, as well as others with preexisting connections to schools.

Click here to read the Safer Sports booklet.
Quality Reporting's Toll on Physician Practices in Time and Money

Noting that the 1,500 clinicians in its multispecialty group were worn out by the hundreds of quality measures they have to track, Indiana University Health embarked on a multiyear effort to streamline the measures that front-line providers are expected to worry about. 

The information reported to Medicare
and insurers is intended to help monitor and improve the quality and safety of healthcare. But collecting it also saps resources.

"It's a lot of time and effort spent at the computer documenting things that don't impact patient care," said Dr. Jonathan Gottlieb, the Indianapolis-based system's chief medical executive. Gottlieb also contends it's impossible for an organization to carry out focused improvement efforts when too many measures are tracked at once. 

Researchers at Weill Cornell Medical College in New York City teamed up with the Medical Group Management Association to put a price on the time providers spend to enter the data into the electronic health record, keep track of newly introduced measures and create protocols to track and report them. 

The answer is about $15.4 billion a year, according to their study published Monday in the health policy journal Health Affairs

That's "a large amount of money being wasted on checking this box and that box," said lead study author Dr. Lawrence Casalino, chief of the division of health policy and economics at the Weill Cornell Medical College in New York City. "It's time physicians could spend on not rushing a patient, or thinking about a diagnosis more carefully."  Read more here.
Researchers Offer Framework to Integrate Behavioral Health and Primary Care

Researchers at the University of Colorado School of Medicine, along with experts from across the country, have developed a set of policy recommendations that would improve the quality of behavioral health care patients receive in clinical settings.

The Eugene S. Farley, Jr. Health Policy Center, with support from the Robert Wood Johnson Foundation, released recommendations in a report, "Creating a Culture of Whole Health," that offers practical improvements that would eliminate the artificial separation of "mental health" from "physical health." The report provides recommendations that call for creating a new approach to health care.

"The health care system differentiates physical and behavioral health care, patients don't," said Benjamin Miller, PsyD, director of the Eugene S. Farley, Jr. Health Policy Center and assistant professor of family medicine at the CU School of Medicine. "They seek care in a single setting with providers they trust in clinics that are convenient for them to visit. There should be no 'wrong door' preventing patients from accessing appropriate care."

To improve the quality of care, Miller and the project team make several recommendations. Read more here.
Mental Illness:  Families Cut Out of Care

Chip and Gail Angell would have paid any price to save their son.  They weren't given the chance.

Their 39-year-old son Chris, who suffered from schizophrenia, refused to allow his doctors to talk to his parents, even though they were his primary caregivers.  So the Angells weren't able to correct their son's medical chart, which incorrectly listed the young man as uninsured. They weren't able to plead with doctors not to base their son's treatment on cost.

"Whenever we tried to get Chris into the hospital, we always ran into the fact that doctors wouldn't talk to us," says Chip Angell, of Brooklin, Maine, who says his son's doctor never returned his calls. "Some doctors think they're protecting the privacy rights of the patient. Others simply use privacy as an excuse because they don't want to talk to someone with an idea contrary to their own, or because they can't be bothered to call someone back."

Although a federal law on patient privacy was written to protect patients' rights, the Angells and a growing number of mental health advocates say the law has harmed the care of adults with serious mental illness, who often depend on their families for care, but don't always recognize that they're sick or that they need help.  The federal law, called the Health Insurance Portability and Accountability Act, or HIPAA, forbids health providers from disclosing a patient's medical information without consent.

Unlike patients with physical conditions, people with serious mental illness often need help making decisions and taking care of themselves because their illness impairs their judgement, says Jeffrey Lieberman, chairman of psychiatry at the Columbia University College of Physicians and Surgeons and director of the New York State Psychiatric Institute. In some cases, patients may not even realize they're sick. Excluding families can have a devastating impact on patients like these, Lieberman says.  Read more here.
Obtaining Prior Authorization Causes Delays for Children and Adolescents Requiring Psychiatric Hospitalization 

A study published online in American Journal of Emergency Medicine found lengthy waits for severely ill child and adolescent psychiatric patients in need of immediate hospitalization due, in part, to time consuming prior authorizations required by insurance companies. Mental health workers spent, on average, 60 minutes on the telephone obtaining authorization. In one case obtaining authorization took 4.5 hours. Over half of these youth who required hospitalization were suicidal, and a substantial minority were aggressive, assaultive, and or homicidal.

Four million children and adolescents in the US suffer from a serious mental disorder that causes significant functional impairments at home, at school and with peers. In youth, many of these disorders can have life-long deleterious effects. Timely access to care might reduce the harms mental illness imposes on youth, along with their families and communities.

For the present study, over a 5 month period, psychiatric clinicians in the Hasbro Children's Hospital emergency room (ER) in Rhode Island tabulated data each time they contacted an insurance company on behalf of a child deemed in need of psychiatric admission. Patients ranged in age from 4 to 19 years old and the most common reasons for admission included suicidal ideation or a suicide attempt (56%), aggression (22%), and homicidal ideation (10%).  The average time required to obtain authorization from the insurance company from the time of first contact to authorization was 59.8 minutes. The time spent on these calls simply added to the total time these children spent in the ER prior to being admitted to an inpatient unit. Every single request for admission was granted.  Read more 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.