October 2015 | Vol. 5, Issue 4
Greetings from Smoky Mountain!
  
Smoky makes it easy to keep up with what's going on with services for mental health, substance use or intellectual or developmental disability in western North Carolina. Whether you're an individual receiving services, a family member, a provider or a community partner, we're honored to share with you how we're striving to meet local needs in a way that only a public managed care company can. It is our pleasure to share with you information about Smoky news and events.
  
CEO SPOTLIGHT:
Message from Brian Ingraham
The cover of a recent issue of Behavioral Healthcare, a trade journal I receive, said quite simply, and in very bold type face, Everything Changes. It's not as if I need a constant reminder of that, given my work at Smoky, but I saved it and put it up on my door, maybe just as validation.

Speaking of change, with thoughts turned toward Medicaid reform, I'm reminded of how Smoky has changed over the past 15 years. When the Legislature ended area authorities as we knew them, Smoky succeeded in evolving into a highly capable local management entity. When North Carolina instituted the Medicaid waiver, we transformed into a managed care organization. Along the way, we expanded from serving seven to 23 counties, a region bordering three states. We have not only become skilled at reinventing ourselves into something even better - we have thrived as an agile organization and improved the quality of and access to services for tens of thousands of some of our state's most vulnerable residents. 

The General Assembly's legislation to shift Medicaid management to managed care organizations and provider-led entities - while not unexpected - is also not the complete and final word on reform. The legislation outlines broad program goals, but details will come in the development of the state's application for an 1115 Medicaid Waiver, to be submitted for approval to the Centers for Medicare & Medicaid Services by June 2016. The approval of that waiver will give a clearer picture of the trajectory of the state's Medicaid program and what role Smoky will play in it.

That doesn't mean we're sitting idly by. Knowing reform would likely break down the silos of physical verses behavioral healthcare, we've already made tremendous investments in a paradigm that values collaborative, "integrated" care. These include both special projects and daily practices, such as: 
  • Developing and training the regional workforce in whole-person care in partnership with the Mountain Area Health Education Center (MAHEC)
  • Enhancing care coordination to address needs from a whole-person perspective
  • Eliminating barriers to integrated care and creating supports through policy, funding, contracting and advocacy
  • Managing the behavioral health and intellectual/developmental disabilities network to support the evolution toward a whole-person orientation to care
  • Measuring progress of whole-person care and outcomes in partnership with providers 
We'll continue to get better at what we already do, whether it's refining our provider network, increasing staff knowledge and skills, pursuing a comprehensive model of care or analyzing data to improve treatment outcomes.

Western North Carolinians will always need the kind of services we manage. Smoky has expertise not only in the region, but also in managing specialty care services in a system of full financial risk and working with a variety of partners to improve care. Our accomplishments, along with our flexibility and willingness to adapt, will serve us well as the state moves forward with reform.
Medicaid reform: Reading the tea leaves
 
Lanier Cansler
Lanier Cansler
N.C. legislators have returned home following this year's extended "long" session and vote to overhaul the state's Medicaid system. Now, stakeholders throughout the system are determining where and how they fit in under the proposed changes and analyzing how the legislation may be implemented.

Healthcare industry and government leaders shared insights on the Medicaid reform law during a September panel discussion at Smoky's 2015 Provider Summit in Asheville. Two top recommendations for providers and other stakeholders were to embrace innovation and focus on outcomes.

"Innovation is something that has to happen at the local level," said panelist Dave Richard, Deputy Secretary of the Division of Medical Assistance of DHHS. That may mean forming new partnerships, trying different approaches to service delivery and breaking down the "silos" that hinder integrated care.

Smaller providers, in particular, may want to look for partners. These can be other providers, schools or health departments and should increase integration of primary and behavioral health services, said Dr. Jeff Heck, President and CEO of the Mountain Area Health Education Center (MAHEC). 

Organizations that can point to specific, favorable outcomes have the brightest outlook in the future system, multiple panelists said. That may mean investing in prevention and early intervention to improve health and reduce costs, said Marc Malloy, Senior Vice President, Health Plan Solutions of Mission Health. Providers can use data to show improved effectiveness and a concrete return on investment, said Karen McLeod, President and CEO of Benchmarks. McLeod encouraged providers to "take a good, hard look" at themselves, ask what sets them apart from other providers and use that information to better market themselves.

Multiple panelists also said they hoped Medicaid reform would open the door to Medicaid expansion in North Carolina. To date, the state has refused to expand eligibility under the Affordable Care Act to an additional 500,000 residents.

Ingraham said that physical healthcare providers will increasingly focus on integration of physical healthcare services and those for mental health, substance use and developmental disabilities. "It's essential that there is a partnership with behavioral health," he said.

Richard, as quoted in NC Health News, told the audience that North Carolina has an opportunity to make a significant change in the future of healthcare. "And if we get it right - if we get it right together - then we'll have a chance to look back and say, 'This has made a difference.'"

The panel was moderated by Lanier Cansler, President of Cansler Collaborative Resources and former Secretary of the N.C. Department of Health and Human Services.
Smoky, MAHEC partner to train providers, promote whole-person care

MAHEC loo

Smoky logo
Smoky and the Mountain Area Health Education Center (MAHEC) have joined forces alongside other regional stakeholders to increase skilled integration of physical and behavioral healthcare in western North Carolina.

The Whole-Person Care Project (WPCP) aims to help providers detect, treat and follow the behavioral and physical health needs of the individuals they treat and serve. Project goals over the next three to five years include training more than 400 directly-contracted Smoky providers, 1,500 credentialed practitioners, 300 staff and 200 peer support specialists, along with providers and residents in 23 counties. Some trainings will incorporate distance-learning technology, and MAHEC will work with Northwest Area Health Education Center to coordinate activities in Smoky's northernmost counties.

The new project is the latest milestone in a history of collaboration between Smoky and MAHEC, which have worked together to offer integrated behavioral health services and psychiatric consultation in MAHEC practices and projects including Caring 4 You and Project 1300. In December, Smoky and MAHEC will accept the Partnership to Improve Services Award from the N.C. Council of Community Programs for their work together.

"Smoky is extremely proud of this relationship and the unbelievable opportunity we share to truly create an innovative healthcare system for western North Carolina," said Smoky Chief Operating Officer Christina Carter. "... . Smoky could not have a better partner." 

For more information, email [email protected].
Not just 'sick kids': Summer brings outdoor adventures for Innovations participants
 
Janet Rhudy and sons
Janet Rhudy with sons David (left) and Joshua
Janet Rhudy remembers the doctors telling her that her newborn son, David, didn't have long to live. 

Then they gave him until age 5. Then age 10.

David, now 31, has a heart condition and cerebral palsy. He and brother Joshua, who is 25 and also has cerebral palsy, are nonverbal and use wheelchairs. But their mother, along with a friend who also has an adult child with a developmental disability, is determined to help them experience all they can.

"At first, you hold your breath all the time, Rhudy said. "After a while, you quit living your life waiting for them to die. I want my children not just to live, but to have a life."

Merlie Jackson and daughter
Merlie Jackson and daughter Jessie
Rhudy's friend, Merlie Jackson, feels the same way. In late July, the two Wilkes County women organized a four-hour tubing trip down the Yadkin River for David, Joshua and Jackson's 23-year-old daughter, Jessie, who has GM1 gangliosidosis. Rhudy and Jackson had met Chris Johnson, co-owner of Wilkesboro's Foothills Outdoors Adventures, this summer while staffing a First in Families booth at the Wilkesboro open-air market. They asked him if a river tubing trip was feasible for people with severe disabilities who use wheelchairs. Johnson said yes and personally helped David, Joshua and Jessie into river tubes with safety nets as they, along with a group of younger relatives, set out on the river.

The three had a blast, their mothers said. Together, they've taken their children on adventures including local concerts, the movies and the Dixie Classic Fair. They also walk on a local greenway trail and go to restaurants. Next up is a pumpkin-decorating event. They know they have to be careful and take precautions to ensure their children's safety, but at the same time, they want them to live full, rewarding lives.

When Jessie was diagnosed, Jackson said, she told herself that "No matter what, no matter how long, she was going to live life as a young adult and do adventures," she said. "She wasn't going to be just the sick kid."

Jessie Jackson on motorcycle
Jessie Jackson riding at CrossRoads Harley Davidson
All three young adults are N.C. Innovations participants, and their mothers are their primary caregivers. Recently, Jessie experienced a second adventure when staff at Wilkesboro's CrossRoads Harley-Davidson took her on a motorcycle ride around the business parking lot. Two salesmen rode next to Jessie's bike to film the bike ride, which they've posted to Facebook.

"It's amazing to me that these are people you just meet, and they see beyond the disability or the wheelchair," Jackson said. "They see your kid."
Smoky gets OK from state to train peer support specialists with own curriculum
 
Three Smoky peer support specialists are now scheduled to begin training prospective peer support specialists following state approval of Smoky's own unique training curriculum.

Hugo Santos, Sam Sutker and Richie Tannerhill will lead sessions beginning in November and December in Boone, Asheville and Sylva. The N.C. Certified Peer Support Specialist Program and the N.C. Division of Mental Health, Developmental Disabilities and Substance Abuse Services approved Smoky's training curriculum in early October.

The 40-hour curriculum is unique to Smoky but meets core state standards. Key topics include personal recovery, relationships and communication, peer support interaction, systems competencies, ethics and boundaries, substance use disorders, trauma-informed practice, support of veterans, cultural competence and the overcoming of barriers. Successful completion of the course is one of the main requirements for state peer support specialist certification, which is required to work as a peer support specialist in North Carolina.

A Smoky Consumer Relations Team workgroup spent nine months writing the curriculum. State approval will allow Smoky to conduct trainings that meet local needs, helping increase the number of qualified peer support specialist applicants. Smoky's trainers can also train other trainers in the future and offer training in any part of the state.

Interested individuals must apply to participate in the training. For information, email [email protected].
Peer support: A helping hand for whole health 
 
PSWHR graduates
Peer Support Whole Health and Resiliency training participants from Smoky, provider agencies
Smoky is building on the successes of its peer support program by gearing up to lead "whole-health" support groups throughout western North Carolina.

In addition to receiving approval in October to conduct core peer support specialist training, Smoky's peer support specialists, along with peers working for network providers, completed training in September in Peer Support Whole Health and Resiliency (PSWHR). They'll use the knowledge to motivate others through support groups that will last eight weeks, with discussion topics including healthy eating, smoking cessation and exercise, as well as the connection between mental and physical health. 

Participants use the groups to craft their own wellness goals and pursue these with the help of an action planning process and peer support. After the support groups are up and running, some of the peer support specialists trained in September will participate in additional, "train the trainer" sessions to sustain the program over the long term.

"The people we serve are excited that we're asking them about themselves as a person - what are their life challenges, what are their whole-person goals," said Smoky Consumer Relations Director Brian Shuping. "We're supporting them in their daily lives."

The program focuses on 10 healthy lifestyle domains developed by the Appalachian Consulting Group and the Benson Henry Institute for Mind-Body Medicine. Participants with both Medicaid and who receive state-funded services are eligible.
Students make time to learn about mental health at A-B Tech

Smoky staff delved into topics including the opiate abuse epidemic, peer support, recovery and local resources during a series of panel discussions held October 7 at Asheville-Buncombe Technical Community College.

A-B Tech panel
(Left-right) Participants included Karla Mensah 
and Ashley Edmonds with Smoky, Becky 
Garnett with RHA Mobile Crisis Management 
and Tricia Henshaw with RHA.
Karla Mensah, Senior Director of Customer Services, and Community Specialist Ashley Edmonds participated in three 50-minute open panel discussions at the Asheville campus. The event aimed to raise awareness and answer questions about local resources. College students, staff and faculty attended and posed questions about early warning signs or mental illness and addiction, C3@356, services available in western North Carolina, diversity and trauma.

Other participating agencies included RHA Behavioral Health and RHA's Mobile Crisis Management, Family Preservation Services and Skyland Behavioral Health Associates.
CIT grads get special visit from 'autism ambassador'

Law enforcement officers completing Crisis Intervention Team (CIT) training in September got the chance to meet a young man who travels across the country to educate officers on how they can support and respond to people with autism.
CIT graduates
Jake Edwards with recent CIT grads

Jake Edwards, 13, is the autism ambassador for Montgomery County, Md. Jake, who has an autism diagnosis, spoke to officers who were graduating from a Smoky training in Rutherford County made possible by a United Way grant. Jake travels frequently to tell people his story and that he wants to help police understand people with autism.

Participating officers represented the Rutherford County Sheriff's Office, the Rutherford County Communications Center 
and the Forest City Police Department. Also, in October, officers from the Henderson County Detention Center and Columbus Police Department graduated from a Smoky CIT training in Henderson County.
November is time to celebrate caregivers

Most caregiving, according to the Caregiver Action Network, occurs not in hospitals, nursing homes or doctor's office. It happens in the home. In fact, 60 million people in the United States are family caregivers, looking after parents, children and other loved ones.

Every November, National Family Caregivers Month recognizes and celebrates the contributions of family caregivers. In November 2014, President Barack Obama praised these sacrifices in an official proclamation: "Across our country, parents and children, siblings and spouses, friends and neighbors heroically give of themselves to support those in their lives affected by illness, injury, or disability," he said. " ... Many of these dedicated people work full time and raise children of their own while also caring for the needs of their loved ones. Caregivers support the independence of their family members and enable them to more fully participate in their communities, and as a nation, we have an obligation to empower these selfless individuals."

Learn more about National Family Caregivers Month from the Caregiver Action Network or the Centers for Disease Control and Prevention.
From the doctor
Dr. Craig Martin is Smoky's Chief Medical Officer
  
Are you a caregiver? 

I believe we're all part of the caregiving family at some point in our lives. Parents and grandparents regularly care for children, and younger people often care for older relatives.
I've been honored to meet many of these special people through my work at Smoky. We encourage caregivers - who often juggle multiple responsibilities in life - to take care of themselves and recognize signs of overload or burnout before a crisis occurs. Caring for a child with autism or a parent with dementia is easier on days when the rest of your life is not pushing you over the precipice. Some days, it just seems hard to remember to breathe.

We all can learn by sharing stories of our experiences. Rating scales are also available to measure caregiver burnout. The National Caregivers Library's scale looks similar to some rating scales for depression and anxiety. That's because burnout, and feelings of being overwhelmed and alone, can lead to these clinical conditions. 

Evidence-based programs and practices to help caregivers include the National Institute of Mental Health Best Practices Approach and the New York University Caregiver Intervention, a professionally led program with counseling and support groups. Closer to home, Smoky provides caregiver education through the Geriatric and Adult Mental Health Specialty Team, one-on-one support through peer support specialists, guidance through family partners/navigators and improved clinical practices through the Clinical Advisory Committee. Respite care is also a significant support to caregivers.

This month, we tip our hat to caretakers everywhere. We encourage you to both reach out for support when needed and to let us know how we can continue to improve caregiver support and engagement.

State news: Staff changes, merger delays
 
New healthcare developments out of Raleigh slowed in October after the General Assembly wrapped up this year's session. In the interim, new data from the Kaiser Family Foundation show that about 40 percent of North Carolina's uninsured are eligible for either Medicaid or subsidized insurance under the Affordable Care Act but have not yet signed up. That includes 152,000 uninsured adults and children who could be eligible for Medicaid but have not applied for coverage.

Many people, experts say, remain unclear about how the president's signature healthcare law works or don't know they're eligible for coverage.

Also in October, the N.C. Department of Health and Human Services (DHHS) declined to approve the potential merger of the managed care organizations CenterPoint Human Services and Cardinal Innovations Healthcare Services. The board of directors for CenterPoint, based in Winston-Salem, had approved the merger a day before, with a merger goal date of February 1. Cardinal is based in Kannapolis. The Winston-Salem Journal quoted Cardinal's chief executive as saying DHHS Secretary Rick Brajer conveyed that he is not approving new consolidations until the state moves forward with Medicaid reform.

In other news, Brajer has named Dee Jones as operations director for the new Division of Health Benefits (DHB), which will run the revamped Medicaid program. Jones currently serves as operations director for the N.C. Division of Medical Assistance, which will close down as the DHB comes online. Also in October, Todd Drum was named Director of the J. Iverson Riddle Developmental Center. Drum previously served as Residential Services Director and Unit Director. He replaces Joyce Jensen, who served as Interim Director for 19 months.
Need services? We're here to help.
Smoky Mountain LME/MCO manages services for mental health, substance use and intellectual and developmental disabilities in  Alexander, Alleghany, Ashe, Avery, Buncombe, Caldwell, Cherokee, Clay, Graham, Haywood, Henderson, Jackson, Macon, Madison, McDowell, Mitchell, Polk, Rutherford, Swain, Transylvania, Watauga, Wilkes and Yancey counties. For immediate help or information about services, call us toll-free, 24 hours a day, 7 days a week, at 1-800-849-6127 (TTY calls: Relay NC at 711). unencrypt
    
OUR MISSION
Smoky is a public manager of care for individuals facing challenges with mental illness, substance use and/or intellectual/ developmental disabilities. Our goal is to successfully evolve in the healthcare system by embracing innovation, adapting to a changing environment and maximizing resources for the long-term benefit of the people and communities we serve.
 
OUR VISION
Communities where people get the help they need to live the life they choose

OUR VALUES
Person-centeredness
Integration  ~  Commitment
Integrity
IN THIS ISSUE
QUICK LINKS
READ MORE
Local Innovations forums continue in November

Smoky will offer two additional public sessions in November to inform stakeholders on the final draft N.C. Innovations Waiver amendment. Sessions will be on November 9 in Franklin and November 16 in Clyde. See times and more information.

National Employment Disability Awareness Month

Held each October, National Disability Employment Awareness Month celebrates the contributions of America's workers with disabilities. The theme for this year - "My disability is one part of who I am" - stresses that at work, it's what a person CAN do that matters.

Smoky is proud to support employment for people with disabilities and encourage individuals to develop their skills and talents. Learn more from the U.S. Department of Labor's Office of Disability Employment Policy.
President urges help for addiction

President Barack Obama visited West Virginia in October to listen to stories of the impact of addiction on individuals and families. Obama touched on his own past drug use and the fact that a majority of overdoses involve prescription drugs. Read more in the New York Times.

Access to naloxone increasing in WNC

Western N.C. organizations are increasingly distributing naloxone, which quickly reverses the effect of an opiate overdose. Recently, the Health Resources and Services Administration awarded a $100,000 grant to Full Circle Recovery Center in Franklin to buy and distribute naloxone as part of the Macon Overdose Prevention Coalition.

A recent grant also allowed Watauga County sheriff's deputies to begin carrying naloxone in nasal spray form. Read more.
 Smoky Mountain LME/MCO | 828-586-5501
  200 Ridgefield Court, Suite 206 | Asheville, NC 28806