Certified Community Behavioral Health Clinic

Program Description

The NWMHC serves 6 rural and frontier counties in Northwest Minnesota which is approximately the size of the state of Vermont. Because our vast 6,800 square mile catchment area and the complex needs of the individuals we serve, becoming a Certified Community Behavioral Health Clinic was the way to ensure comprehensive services would be available to anyone eligible who walks through our door or requests services. With the NWMHC CCBHC providing birth to end of life, mild to severe chemical and mental healthcare services anchored in care coordination it was important that we had a way to provide as many services as possible in a timely way and at a frequency that was needed to promote the individual and or family’s health and wellbeing. Using telemedicine became one way to provide accessibility in a timely way. By having three tele-psychiatry providers, therapists providing tele-psychotherapy in partner primary care clinics and tele-mental health crisis assessments in the emergency department, the use of telemedicine has increased access to services. Within the last 5 years, we went from serving 2,014 individuals in 2012 to 4,201 individuals in 2017 with Telemedicine a key factor in individuals and families finding their Path to Recovery.

Creativity

We are the only CCBHC in the state of MN that serves frontier counties and the only mental health agency in our geographic area. Becoming a CCBHC changed our way of “doing business”. We have created non-clinic community based regional multidisciplinary teams that serve across the life span to ensure providers meet the needs of the individuals and families where they live. This team is outfitted with mobile technology to access the electronic health record including our telemedicine platform. This allows our team out in the field the ability to collaborate with team members, complete timely documentation for care coordination and during a blizzard, individuals can still receive a needed service instead of being cancelled. In our clinics we have implemented open access for both initial evaluations, new psychiatry and crisis psychiatry patients. This has been done through hiring of new staff or redesigning existing workflows to improve access.

Leadership

The NWMHC CCBHC CEO and directors have been instrumental in delivering information related to CCBHCs and promoting the use of telemedicine in community forums, meetings and partnerships. The goal is to share the new service delivery model and the methods of accessing services which has begun to established an expectation of how to access services within communities and created a demand for their availability since going live in July 2017. Because there are only 6 CCBHCs in MN the NWMHC CCBHC CEO has been very involved in the MN Association of Community Mental Health Programs. Through work with its other 5 counterparts, member agencies have been looking to the first implementers for information, guidance and lessons learned to support their ability to be a CCBHC in the future. This advocacy has also influenced legislative efforts related to helping sustain CCBHC as a service delivery model and increasing access to telemedicine.

Sustainability

The NWMHC CCBHC strategically chose to redesign its service delivery model to become a CCBHC and enhance the use of telemedicine because it was a way to sustain a holistic and comprehensive array of services. Through a broad diversified funding network of Medicaid, commercial insurance, grants, county funding and purchase of service agreements, the NWMHC CCBHC has an infrastructure for continued funding and sustainability. Through our strong partnerships across the region, demonstrated quality and success, has built a reputation and expectation that services will be available for our community. That will help influence decision makers for continued implementation of this new service model. Overall, accessibility through the use of telemedicine, open access and the multidisciplinary teams continues to draw referrals, requests for service and expansion to other areas outside the NWMHC CCBHC catchment area. With double the individuals served over the last 5 years, the only option is to expand.

Replicability

While being a CCBHC is a demonstration the NWMHC CCBHC established its service delivery model so it can be done without it. We took advantage of becoming enrolled, certified or licensed for all mental and chemical health related services available with the exception of residential care. By doing this it allowed for a broad array of services to be available to so individuals or families would have a One Stop Shop experience. We took existing services, staff and reorganized them to be holistic, multidisciplinary and coordinated across the agency. Any agency could look at what they have now, determine what’s missing, ask is what they are missing available to them and if so, develop a plan to redesign and include those services. Services such as telemedicine/psychiatry may be a great first step to increasing access, have minimal expense and expand capacity. Obtaining technical assistance can also support replicability and sustainability.

Results/Outcomes

The NWMHC CCBHC is collecting and submitting data for the federal demonstration project. Accessibility is a key indicator; 1) the time between a new request for service to the evaluation, 2)the time between the new evaluation to ongoing service. Upon initial analysis, prior to delivering this service model, it took 3-4 weeks before a new person was able to get in for an evaluation and since implementing Open Access our average is one(1) day. This is a significant change. Additional demonstration evaluation measures are not yet available. We also found that since going live July 2017 through December 12, 2017 2,362 individuals have received a CCBHC service and 278 of these clients were new to the NWMCH CCBHC. Future focus will be on No Shows and Cancellations as this is an indicator of engagement and appropriate service recommendation based on stages of change and would telemedicine be a positive intervention.