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.

  

At Smoky, we value our community partnerships. We know that sometimes, we don't have all the answers - or the resources, expertise or mandate - to do all we'd like to do. In this newsletter, you'll read about the impressive accomplishments of the Juvenile Justice Services Continuum. It's an initiative that we could never successfully pursue alone, but through collaboration with myriad community partners and our network of providers, we're helping make a significant difference in the lives of young people throughout western North Carolina.

This initiative has both simplified and improved the process of assessing court-involved youths for behavioral health needs and referring them to services. This often includes Multisystemic Therapy (MST), an intensive program for young people at risk for placement outside of the home due to their behaviors. MST involves working with multiple people in the youth's life - family, teachers, neighbors and even peers - to produce positive, long-term behavioral changes. Smoky staff, juvenile court counselors and providers work together not only to provide counseling, but also to meet other needs that youths and families may have.

Real community change does not come from a single organization. It is not one-sided. It comes from multiple local groups who have the knowledge and experience to know what works in their neighborhoods and how to collaborate with others to effect positive change. This month, please join me in recognizing the contributions of all organizations that, like us, have the community's best interest at heart.

 

The juvenile justice services continuum ensures that youths are screened for treatment needs and, if needed, referred for a comprehensive clinical assessment and appropriate services. Many youths participate in an intensive treatment program called Multisystemic Therapy (MST), which involves families, communities, schools and friends to help young people make effective life changes.

 

"Through the partnership among Smoky, juvenile court system and providers, we've been able to assess youths and provide them with the right levels of care," said Donald Reuss, Smoky's Provider Account Director. "It helps identify earlier in the process what treatment is most needed and helps young people have better outcomes."

 

Youth Villages, a nonprofit that helps children with emotional or behavioral problems, conducts assessments and offers MST for youths who receive Medicaid. The small number of court-involved youths who do not receive Medicaid also receive assessments and other services. Local comprehensive care centers provide outpatient mental health and substance use services, medication management and Intensive In-Home services, when appropriate. Other providers offer evaluation and treatment for youths who are sexually reactive and, if needed, residential care for up to three months. 

 

The initiative employs the System of Care model to support both youth and their families. Under this model, Smoky and initiative partners work as a team to coordinate community-based services, supports and resources to meet families' needs related not only to behavioral health, but also in areas including physical health, education and overall welfare. Families themselves are an important part of this team.

 

The initiative was developed in the late 2000s after juvenile court counselors in the westernmost part of the state approached Smoky to help them develop a consistent and focused System of Care for court-involved youths and their families. Area behavioral health providers responded to these needs by working with Smoky and juvenile court counselors to streamline the process and ensure needed services were available in the community. The model spread throughout the counties Smoky serves and merged with a similar program operated by Western Highlands Network when the two organizations consolidated in 2014.

 

"I am pleased with the direction that we have been going with services," Krista Hiatt, District 22 Chief Court Counselor, told Smoky. "I'm optimistic that the timeliness and quality of mental health services to juvenile justice youth in Alexander County have the potential to be the best in my four-county, four-MCO district."

Participants in an August CRM training in Burnsville teach neuroscience to each other using the hand as a model to represent the brain.

Sometimes, what works in Thailand also works for people in western North Carolina.

The Community Resiliency Model (CRM) training, an evidence-informed, promising practice developed by social worker Elaine Miller-Karas to help survivors of the 2004 tsunami that killed 8,000 people in Thailand, is taking off throughout the region. In the past two years, Smoky has introduced more than 1,250 community members to the CRM model and basic principles and has begun teaching the skills to a variety of groups across 14 counties, to date. CRM teaches participants skills to better manage chronic stress and trauma while creating more resilient communities.

Most major U.S. cities still don't offer CRM, said Smoky Community Outreach Director Ann DuPre Rogers, a CRM trainer. "It's really cool that this movement is starting here," she said. "Community groups are calling and asking to be trained. CRM is helpful not only in the face of natural disasters or armed conflict - it's also very useful in situations involving domestic and community violence, poverty or other life stressors."

Local CRM participants include healthcare provider staff, school counselors, parent groups, university faculty and social workers. The standard, one- to two-day training covers the impact and prevalence of chronic stress and trauma, findings of the Adverse Childhood Experiences study, how to lessen the impact of trauma and how to build resiliency. It also includes skills informed by neuroscience to regulate the nervous system and use the mind-body connection to reduce anxiety, depression and unwanted physical symptoms. 

Once participants learn to use the skills for their own stress management, they then learn how to teach these skills to others - creating a ripple effect of wellbeing.

The partnership allowed Smoky and the advocacy center to offer Darkness to Light: Stewards of Children trainings at three schools on October 23. Smoky Community specialists Melissa Ledbetter and Robin Winkler led trainings at Hardin Park Elementary and Blowing Rock Elementary, while advocacy center Director Selena Moretz held a training at Green Valley Elementary. A donation from a Blowing Rock family to the advocacy center funded the training.

Stewards of Children, an evidence-informed program, offers practical abuse prevention training to increase knowledge about abuse and about how to help protect children. "One person can create change in a community," said trainer and Smoky Community Outreach Specialist Robin Winkler. "This opportunity shows how the partnership with the school system, advocacy center, a parent and Smoky came together to discuss how to protect children from child sexual abuse."

Smoky staff also distributed handouts with information on local resources for responding to abuse and state laws governing reporting of abuse.

In October, the N.C. Department of Health and Human Services (DHHS) postponed any consolidation between CenterPoint Human Services and Cardinal Innovations Healthcare, LME/MCOs operating in the Piedmont region, and the absorption of Nash County into Cardinal's service area. At the November hearing, state Medicaid Director Dave Richard told lawmakers who questioned those decisions that DHHS Secretary Rick Brajer wants more certainty about the state's path toward Medicaid reform before approving major changes.