Autism Insurance Reform

The CDC estimates that 1 in 88 children has been identified with an autism spectrum disorder. This is a 23% increase since their last report in 2009. ASD's are almost five times more common in boys, 1 in 54, than in girls, 1 in 252!

Applied Behavioral Analysis (ABA) is an 'evidence-based treatment' that has demonstrated success for children with autism, especially those who are younger.  It has its origins in behavioral therapy and teaches social, motor, and verbal behaviors as well as reasoning skills.  ABA treatment is especially useful in teaching behaviors to children with autism who may not otherwise "pick up" these behaviors on their own as other children would.  

ABA has been around for quite some time, but there has been barriers from accessing it.  First, it took many years of research for autism to be recognized as it is now.  Second, insurance companies haven't historically covered 'specialty treatments' for behavioral health.  ABA is a specialty treatment and very costly.  However, the long-term savings is great.  Lastly, even if this were a covered service there is a lack of professionals competent to deliver the service.  Very few areas in Michigan have a Board Certified Behavioral Analyst. 
   
This week the Michigan House of Representatives overwhelmingly approved a series of bills that, if signed into law, would compel insurance companies to cover autism diagnoses and treatments for children, specifically Applied Behavioral Analysis (ABA).  Governor Snyder is also setting aside funding for children on Medicaid or MI Child that need this treatment.  Additionally, there is a plan to develop provider networks and increase the number of certified professionals.

Shiawassee County Community Mental Health Authority is a strong advocate for young children and supports any reform that improves behavioral health care for this population.  Focusing on people's needs when they are young significantly improves their quality of life and in the long-term reduces cost.  However, as advocates will agree, it requires care that is 'gold standard' and evidence-based treatment proven to be successful.

Representatives from SCCMHA have been involved in a state level work group that will make recommendations regarding evaluation and covered ABA services for children with autism receiving Medicaid.  Focus will also be on increasing the number of providers across the state.  This role is an honor and a responsibility that is taken seriously.

Due to the increasing number of young children being referred for services and in preparation for the future, SCCMHA is recruiting a behavioral assistant to increase our capacity to serve young children with behavioral needs.  We are also recruiting a Certified Occupational Therapy Assistant to assist our Occupational Therapist in delivering much need sensory services to the increasing number of children being served in the Sensory Clinic.  One of the reasons for developing a robust team of professionals to provide ancillary specialty services is to more effectively serve children with complex issues, i.e. autism and other disorders on the spectrum.      

Shiawassee County Community Mental Health Authority looks forward to being a partner and playing an active part in treatment reform for children with autism.

Duplication of Services

Throughout the country, duplication of mental health service is a major problem.  In graduate school, mental health professionals are taught that consumers seeing multiple therapists can be detrimental.   It tends to confuse consumers and doesn't create for a therapeutic alliance and promotes "splitting"and limits effectiveness.  That said, in accord with sound ethical practice, SCCMHA doesn't generally provide ongoing services to someone actively receiving such care elsewhere.

Throughout the human service industry, some believe "more is better."  However, the more services in one's home, the greater chance duplication will occur--primarily due to the lack of collaboration and coordination among service providers.  


Human service systems, by nature, operate in silos.  Good coordination and collaboration is difficult among agencies.  In part, due to the differning idiologies.  But also because staff are burdened due to job responsibilities.  "Doing more with less" is the culture of most industries, providing little to no time for consulting and sharing information.  Unfortunately, this doesn't benefit anyone and generally costs more in the end.

One of Shiawassee CMH's values is "teamwork."  This includes continuity of care among the service spectrum.  Teamwork is ensuring that consumers aren't tangled in the confusing web of duplication, coordinating and collaborating with other service providers, and advocating for what the consumers should expect.

During the intake and assessment process, it is important that our staff obtain information regarding other services being provided to consumers.  We are then able to sort out what, if any, duplication of services may be occuring.  During this process, it may be important for our staff to collaborate with those from other agencies.  Or during the treatment process, this may also occur.

Most recently, Shiawassee CMH, Shiawassee Regional Education School District (SRESD), DHS, and Public Health have partnered with the goal being to reduce duplication of services for children ages 0-5.  It is our intent to improve continuity of care by increasing coordination and collaboration among early childhood providers.  Therefore, these staff have co-located in the same building hoping to dismantle silos among agnecies.

When multiple agencies are serving the same family, clarifying treatment boudaries, goals, and developing a unified approach is best-practice.  Anything less is not providing appropriate care.
       

Peer Support Services

Peer Support services provide individuals with opportunities to support, mentor and assist consumers with a mental illness to achieve community inclusion, participation, independence, recovery, resiliency and/or productivity.  Peer are individuals who have a unique background and skill level from their experience in utilizing services and supports to achieve their personal goals of community membership, independence and productivity. Individuals receiving peer support services must participate in choosing the peer who will be providing the service.  Services may be provided on an individual basis or in a group format and must be tied into the consumers identified outcome in their Person Centered Plan.

Peer Support Services include an array of services that include vocational assistance to support consumers seeking education, training and/or employment activities; housing assistance to find and maintain independent living, move to less restrictive living situations, and applying for housing vouchers; person centered planning; self determination; sharing recovery stories, accessing entitlements, developing wellness plans, developing advance directives, pursing alternatives to guardianship, supporting consumers in crisis; and developing, implementing and providing ongoing guidance for advocacy and support groups.

The Peer Support Program is intended to serve adult consumers of SCCMHA who have a diagnosis of a serious mental illness or a co-occurring disorder of a mental Illness and a substance use disorder who are receiving Supports Coordination or Case Management, Assertive Community Treatment or Outpatient Services. 

Consumer-provided services arose from a number of problems with traditional mental health services including:

• Consumers falling through the cracks,
• Lack of opportunity for consumers to develop competencies, autonomy, involvement and relatedness with others,
• Need for supports for rehabilitation, and
• Professional lack of knowledge, theory and techniques that lead to Recovery.

Peer Supports evolved from the consumerism movement that includes self-help, mutual support and consumers as providers.  At the same time, there has been a shift from the medical model to the recovery model in the delivery of mental health services, a move that parallels the system transformations efforts are associated with integrating mental health, substance abuse and physical health care interventions, person-centered planning, and the emphasis on self determination as basic value in service delivery.  Many direct services now provided by professional staff, can be more effectively provided by peers.

Peer Supports, one of a number of peer delivered services, benefit consumers who receive the service, consumers who provide the services, and the agency.  For consumers who receive peer support services, benefits include:

• Increased social supports and nurturance,
• Increased opportunities for decision making, choice and increased independence,
• Increased sense of hope,
• Increased sense of empowerment, and
• Opportunities for development of a network based on friendships.

Ensuring That Our Veterans Are Provided Mental Health Services

There seems to be a misconception that community mental health doesn't offer many services to our veterans.  Contrary to this belief, Shiawassee County Community Mental Health Authority has served veterans for many, many years.

There are many veterans that have medical benefits allowing them mental health treatment through the Veterans Administration.   However, the service array is limited.  That said, community mental health does try to link and coordinate with the Veterans Administration for those services that are covered and can be obtained through that system.  Generally, this is psychiatry, outpatient therapy, an limited case management.

As you may recall from earlier Blog entries, Shiawassee County Community Mental Health provides services to those diagnosed with a severe and persistent mental illness.  This applies to all, whether or not the consumer has no insurance, has Medicaid, private insurance, or happens to be a veteran.  Services provided mostly include community-based, e.g. Assertive Community Treatment, Targeted Case Management, Home-Based, etc.  These community-based services are not covered by private insurance companies, nor the VA, and therefore wouldn't be available unless provided by the public mental health system. 

That being said, there are many veterans served by Shiawassee CMH.  Depending on the symptoms, functioning status, resources, and supports, veterans are enrolled in our community-based services and many times see our psychiatrist.  Emergency mental health, outreach and education, and linking and collaborating with the VA are also available.

It is important that our veterans obtain the needed assistance.  SCCMHA is dedicated to ensuring that this is done...either directly or through the VA.  In both cases, SCCMHA staff are willing to help and make sure that the appropriate services are in place.    

Compassion Fatigue and How To Stay Healthy

Written by: Lorri Wilkerson, Peer Support Specialist, SCCMHA

Compassion Fatigue

Anyone who works in a field that requires one to care for others, such as a therapist, nurse, peer,  or other, can become burned out over time.  Even healthy workers or helpers with an optimal balance of life and work can experience compassion fatigue when faced with an overloaded work schedule, dealing with a client with a lot of traumatic content, or finding the caseload suddenly filled with a lot of people who are in a major crisis.

Compassion is a limited resource; one that needs refilling from time to time.   Listening to people who are suffering and not being able to do enough for them puts tremendous pressure on the caregiver.

Compassion fatigue can affect anyone; the most caring and dedicated nurses, social workers, physicians, or psychiatrists alike are at risk.  These problems can affect  professional  and personal lives.  Some symptoms include difficulty concentrating, intrusive thoughts, loss of hope, anger, exhaustion, irritability or thoughts of suicide.  It can make you feel cynical at work, make more clinical errors, violate  client boundaries, and lose  respect towards your clients. It makes it harder to empathize with someone.  You may simply stop caring. You may find yourself avoiding one of your clients.  Or avoiding work all together. If you are someone in recovery, compassion fatigue can be harder to deal with. The feelings of guilt over not feeling  compassionate or "right" towards others can overwhelm you.

It is important that you recognize the signs of compassion fatigue, and take the steps needed to help yourself. Take the time to inventory your life, both personal and professional.  What is demanding of your time?  Work? Family? Home? Volunteering?  List them all, try to make the list as detailed as you can.   

Once you have your list, look at it.  What jumps out at you?  What factors are making your plate too full? What would you like to change the most?

Overcoming compassion fatigue means coming to terms with  anger, fear and self-doubt. This requires honest self-reflection, a process that some find quite painful. Yet, if you're compassion fatigued, getting in touch with yourself is perhaps the most important step in the recovery process. Without it, the lifestyle changes you're trying to make may not be enough to sustain you.   Make sure you have someone you can talk to about this; a close friend or counselor who will listen non-judgmentally.

Start gathering ideas for self care.

 Maybe include some co-workers or friends in this.  Gather as many ideas as you can and place them in a list.  Include them all, even if you don't think you would use them.  You never know.

Make time for yourself every day.

Can you think of simple things you could do for yourself?  Maybe a 10 minute cat-nap during your lunchtime.  Maybe close your office door and listen to 5 minutes of your favorite music.  Or at home, turn the TV off early and spend some quality  time before bed. Even small changes can make a difference in a busy life.

Learn to say "No" more often.

Do you always volunteer your time? Are you the crisis go-to person for your family and friends?  It can be exhausting!  Can you set realistic limits for your time? Find the reasons why you can't say no.  Is it because of issues such as self-esteem or some other personal issue?  Take a moment to think about this.  Also, have you stopped saying yes to family, friends and new opportunities?

Get enough sleep

When people are stressed, it is easy to forget to eat, take breaks, get exercise, or get enough sleep.  These are all important to over-all health. Pay close attention to your habits. Maybe start a journal to keep track.

Know your "ABC's"

Awareness

Journal writing, therapy, and talking with a supervisor or friend are examples of good habits that build self awareness.

Balance

Maintain healthy boundaries between work and home.  Develop new interests and hobbies.  Do something relaxing, such as meditation or reading a book.

Connection

Having supportive colleagues or peers at work can help reduce isolation and give opportunities to share. It is also an important way to develop and nurture more trust in relationships.

All together, these things will help you get back on track with the goals you have set for the future.  You can feel better about yourself, if you take the time to nurture yourself.  It may not happen overnight, but you CAN do it.

If you are having thoughts of suicide, PLEASE talk to someone or call a hotline.  Don't give up on yourself or on life.

RESOURCES

*Workshops for the Helping Professions

www.compassionfatigue.ca

*wiseGEEK search engine

www.wisegeek.com/what-are-the-best-tips-for-treating-compassion-fatigue.htm

*Wikipedia

www.wikipedia.org/wiki/Compassion_fatigue

*Overcoming Compassion Fatigue

http://www.aafp.org/fpm/2000/0400/p39.html

Other Resources

Professional Quality Of Life Test

www.proquol.org/uploads/ProQOL_5_English.pdf

(They assess compassion fatigue as well as levels of satisfaction.)

 

DBT...An Evidence-Based Practice

Over the past several years, the focus of public mental health treatment and support has increasingly been on “evidence based practices.”   Evidence-based practices are treatments that have been shown through clinical research to produce positive outcomes. 

In recent years, Shiawassee County Community Mental Health Authority has implemented many evidence-based practices.  One that SCCMHA started using in 2005 is Dialectical Behavior Therapy (DBT).  DBT was designed as a treatment for individuals who are diagnosed with Borderline Personality Disorder but is currently being studied to treat many other diagnoses including anxiety disorders, substance use disorders as well as eating disorders.  

Individuals who have a diagnosis of Borderline Personality Disorder often have multiple other psychiatric diagnoses and often experience suicidal ideation, self harm behaviors and have multiple psychiatric hospitalizations.  Historically, it has been a challenge to find a treatment modality that is effective in improving the quality of life and reducing high risk behaviors for these individuals.

DBT  treatment is meant to improve the individual’s ability to regulate intense emotions and behaviors in order to create a life worth living. The modes of treatment that DBT uses to accomplish this is weekly individual therapy, weekly Skill Training Group, availability to DBT Phone Coaching, as well as access to a DBT trained Peer Support Specialist.

The DBT team at SCCMHA has been intensively trained and is certified by the Department of Community Health. The team consists of Emergency Services workers, Case Coordinators, DBT therapists and a Peer Support Specialist and are required to meet for weekly consultation in order to maintain the certification.  In 2007, the team began collecting data.  This data demonstrates that DBT treatment has a significant impact on reducing targeted behaviors such as self harm incidences.

Similar to DBT, SCCMHA offers many other services that are evidence-based.  The future of public mental health is demonstrating that intervention is successful.  Without using evidence-based treatment, one runs the risk of providing a mediocre service.

Contributed by: Stacy Fisher, LMSW, CAADC, Supervisor for Adult Community Services 

Parents Helping Other Parents

In recent years, the public mental health system has come to embrace the idea of parents helping others parents.  Specifically, a parent or primary caregiver of a child with emotional, behavioral and/or mental health challenges assisting another.  Shiawassee County Community Mental Health Authority is one of many public mental health agencies throughout the state that has integrated this into the service array.  This was done through a partnership with the Association for Children's Mental Health.

The purpose of Parent Support Partner's is to increase family involvement and engagement within the treatment process and to equip parents with the skills necessary to address the challenges of raising a youth with special needs thus improving outcomes for youth with severe emotional impairment involved in the mental health system.

Role of the Parent Support Partner:

§  Provides peer support to parents of children with mental health concerns

§  Facilitates access to appropriate services for children and families

§  Serves as a source of credible information about resources, programs, and services

§  Demonstrates effective collaboration

§  Assists parents in learning skills to obtain resources for their families

§  Becomes a trusted ally in whom parents can confide

§  Helps parents navigate a variety of systems including community mental health, schools,

   hospitals, child welfare, and juvenile justice programs

Peer support has been shown to improve outcomes for youth and their families. Having access to a peer who “has been there” improves caregiver engagement thus improving retention rates in treatment, decreases caregiver sense of hopelessness and isolation, and increases satisfaction with services. 

Parent Support Partner’s, serving as an equal member of the treatment team, assist families with identified goals within the Person-Centered Plan that support the parent to develop skills, knowledge, resources, and confidence in parenting a child with serious emotional disturbance.

The PSP service, provided by another parent who has first-hand experience navigating public child serving agencies and raising a child with mental health challenges, focuses on increasing confidence and competence in parenting skills, increasing the parent’s knowledge to better navigate systems and partner with service providers, and empower the parent to develop sustainable natural support networks after formal service delivery has ended.

 

Emergency Services/Crisis Intervention 101

In the previous Blog entry, I discussed the "pre-admission screening" that occurs prior to psychiatric hospital admission.  This is only one function of emergency services...the other is general crisis intervention.

In this day and age, the incidence of mental health issues seems to be increasing.  People are struggling in all areas of their life, putting more of a burden on families, causing depression to become more prominent.  That said, it is important that the public mental health system continue doing a better job educating the entire community about the accessibility of crisis intervention. 

Throughout Michigan, the public mental health system is required to provide emergency mental health services to the general public.  It's one service not dependent on certain criteria, i.e. income, residency, insurance, diagnosis, etc.  It's there to ensure that the mental health needs, in time of crisis, are met and people are supported.

No matter where people may be residing, visiting, or vacationing, the local community mental health should be able to provide crisis intervention, provided by licensed social workers, counselors and psychologists.  During business hours it's always available face-to-face, as well as telephone.  After regular hours, each community mental health has local protocols for delivering this service.  In Shiawassee County, mental health workers answer crisis calls after 5 p.m., weekends and holidays.    

People that are suffering from mental health symptoms or situational crisis, and require support and assistance, are encouraged to contact our agency day or night.  If the problem is serious and you may require psychiatric hospital admission, either contact our agency immediately or  go to the local emergency room.

Emergency mental health staff can be reached at 989-723-0710 or 723-6791. 

   



 



        

Psychiatric Hospital Admissions

Many people in the community aren't aware that public mental health is responsible for managing psychiatric hospital admissions for children and adults on Medicaid only, MI Child, ABW, or identified as meeting indigent status or no ability to pay.  Similiar to private insurance companies needing to authorize and manage inpatient care for their members, the Michigan Department of Community Health transfers this responsibility to community mental health for those on public assistance.

The primary method for managing psychiatric hospital admissions is the pre-admission screening process.  It's called "pre-admission" because it occurs before the admission.  This is simply a face-to-face assessment usually completed in the office or hospital emergency room.  But, it's not limited to these settings.  Our staff complete these pre-admission screenings in the school setting, jail, other community agencies, etc.

During the "pre-admission" screening, community mental health staff performs an overall evaluation.  They assess the level of crisis, degree of risk and safety issues, support system, symptoms, coping skills, etc.  If done in the emergency room, there is collaboration with the physician regarding possible medical or medication issues.

Many times during this type of assesment the consumer just needs someone to talk to and the crisis is resolved.  However, there are times when consumers do require hospital admission.  Their symptoms are too acute and risk and safety factors are high.  When this occurs, the "pre-admission" screener arranges it.  Our goal is to use the local hospital if appropriate.  That being said, children are more difficult to place due to the limited number of hospitals around the state.

If community mental health staff determine hospital placement is appropriate, they are approving payment for an initial number of days determined at the onset.  Once the person is admitted and treatment begins, hospital staff are required to contact community mental health each day to discuss improvement or lack thereof.  Continued authorization for payment is then determined on a daily basis.  That said, the community mental health hospital liaison is typically involved in the consumer's care and stays abreast of any changes.

Once consumers are ready for discharge, the hospital liaison ensures that appropriate outpatient care is arranged and follow-up appointments are scheduled.  Community mental health staff typically meet with these consumers soon after discharge, making sure that things are ok and supports remain in place.

Even though all community mental health agencies have this same responsibility, it is important to keep in mind that they all employ this process somewhat differently.  This can be frustrating for the community; however, processes are generally designed around available resources.  Some counties lack in this area and others are plentiful.

For more information on this subject, please call Emergency Services @ 989-723-6791.  

     

Consumer Run Drop In Centers

Consumer drop-in centers provide a wide range of services to consumers.  At their most basic, they offer a place that is accepting, safe, supportive, and normalizing; where consumers can feel needed and grow in self-worth, dignity, and self respect; and where they can learn about community support. Common characteristics include social and recreational programs, information and referral, and advocacy, with a strong emphasis on empowering and teaching consumers to be independent and involving them in providing support to other consumers.

New Directions Drop-In Center, Owosso, MI, was established in 1994 and is one of numerous Drop-In Centers in Michigan. While Drop-In Centers work in close cooperation with each county Community Mental Health, they are consumer run locations for self-help, advocacy, education, and a natural support towards recovery. Consumers develop their programs to supplement existing mental health services.

All persons with a mental illness, regardless of whether they are an open consumer, are eligible to become a member of New Directions. Persons interested in attending New Directions may call the center or “drop in” to talk to one of the staff about becoming a member. All persons accepted are assured of a lifetime membership.

At New Directions members come together to make friends, socialize or simply relax in a non-judgmental atmosphere of acceptance and understanding from others who have “been there.” It is often difficult to find these same qualities in clinical programs managed by professionals, or in their own families and the community at large.

Among the attractions found at New Directions are a lounge with big-screen satellite TV, a regulation size pool table, arts and craft room, and a complete equipped kitchen.  

A feature of New Directions, not found in all drop-in centers is a year round schedule of special events such as cook-outs, parties on all major holidays, and trips to various places of interest.  In January we are starting a monthly membership meeting where all members’ comments will be heard.  At these meetings we will also have our Birthday Recognition, recognizing everyone’s birthday for the month.  Once a month, we are having a Men’s Night and a Women’s Night with different activities according to what the members prefer.

Questions about New Directions: Peggy Smith @ 989-723-0875

Content Contributed By: Peggy Smith, Director, New Directions