Behavioral Health Services

Multiple States (California, Vermont, Oklahoma, Mississippi, Colorado, Louisiana, Rhode Island, Washington) and Locations (Los Angeles County, City of New Haven, Rural CA)  
Crisis Systems and Services Design and Implementation, Including 988  
Oxford-HMA has a core crisis behavioral health team with seasoned experts coming directly from states, managed care plans and providers supporting implementing of crisis systems and services best practices that are tailored for local communities. Our crisis work includes supporting clients to develop operational solutions including payment approaches and crisis response pathways across crisis system partners such as 911, law enforcement, schools, and social services. The Oxford-HMA team has supported several states on their 988 planning and implementation, the new three-digit number for the National Suicide Prevention Lifeline operational in July 2022 and have a keen understanding of the vital need for effective coordination across entities involved in crisis care. The team is also working in multiple states (CA, VT, OK, CO and others) on the CMS Mobile Crisis Planning grants supporting states with benefit design, and best practices and technical implementations in mobile crisis. The Oxford-HMA team also has first-hand experience in developing and implementing outcome crisis measures and benchmarks that are now used throughout the country and are cited in the SAMHSA’s National Guidelines for Behavioral Health Crisis Care Best Practice Toolkit as well as the recently in the National Council for Mental Wellbeing’s published Quality Metrics in Crisis Services. Our team currently participates in all the national collaborative crisis system learning communities and is continually staying current with all the promising practices and ideas, including those related to funding approaches that are being generated across the nation to design and implement crisis care. The following are some specific examples of the crisis focused work HMA has provided to states: 

Colorado – HMA provided technical support and advised the Colorado Department of Human Services (CDHS), Office of Behavioral Health (OBH) in the development of its implementation plan for the 988 mental health crisis and suicide response line. The team investigated approaches for addressing the key planning considerations required by the 988 State Planning Grant from Vibrant Emotional Health (Vibrant). The team prepared communications and conducted outreach to planning group members to develop a shared understanding and commitment to the group’s goals, objectives, and activities regarding 988. The team reviewed national best practices in 988 implementation through leveraging existing relationships and knowledge of behavioral health crisis systems to take stock of what other states are doing to prepare for 988 implementation. The team supported Rocky Mountain Crisis Partners, the current crisis hot line in Colorado, by providing landscape analysis of Colorado’s Crisis Services and its capacity to support 988 implementation. The work culminated in a draft implementation plan with recommendations for the development of the infrastructure and operations necessary for the full implementation of 988 in Colorado.  

Mississippi – HMA has supported and continues to support the Mississippi Department of Mental Health (DMH) in forming and facilitating a MS 988 Planning and Implementation Coalition comprised on many stakeholder across the state including individuals and families with lived experience in receiving crisis services, loss survivor family members, first responders, crisis providers and 988 crisis call centers. HMA has also supported DMH in developing crisis protocols, providing input on best practices on mobile crisis and facilitating a learning community across crisis providers.   

California – HMA is currently assisting the California County Behavioral Health Directors Association to support their 58 members counties to implement the new Medicaid mobile benefit focusing on operational business strategies to successfully launch the benefit (financing, predicating mobile crisis demand, recruitment and retention) and to support collaboration with law enforcement.   

Colorado Department of Public Health and Environment and the Colorado State Innovation Model Office  
Environmental Scan of Behavioral Health Promotion and Prevention Programs and Call to Action  
HMA conducted a statewide environmental scan, literature review, and gap analysis of population-based health initiatives focused on health promotion and prevention. The scan included key informant interviews and the collection and review of relevant documents. HMA conducted a brief literature review of best practices in preventing mental illness and substance abuse to identify effective principles and examples of programs. We analyzed all information collected to identify gaps and opportunities. From this analysis, HMA facilitated a cross-sector group of experts to determine a specific health promotion topic and to create a detailed call to action with specific roles per sector. The group focused their call to action on male suicide in the state and HMA facilitated the group to create a multi-year approach that aligned with partners across sectors. HMA then wrote the Call to Action for Behavioral Health Promotion and Prevention.

Eskenazi Health  
Planning for Diversion and Re-entry Programs  
Eskenazi Health engaged HMA to support planning activities for diversion and reentry programs conducted in partnership with the City of Indianapolis. HMA conducted an environmental scan of the current continuum of crisis, inpatient, and diversion-related behavioral health services within Marion County to inform planning for any new facilities or programs. This inventory included a catalogue of Eskenazi Health programs as well as a summary of other stakeholder programming and capacity. In addition, HMA provided information regarding existing diversion program models in other cities and counties as well as potential funding streams for new or expanded diversion and reentry services. A final report and presentation provided a summary of the information gathered from these activities as well as recommendations for consideration prior to a presentation to the City County Council. HHC reengaged HMA in 2017 to conduct an evaluation of the Legacy House, a program providing counseling and advocacy to victims of violence, to identify potential operational efficiencies. As part of this review, HMA reviewed resources available at Eskenazi-Midtown Community Mental Health Center and the Marion County Department of Public Health Department of Social Work for potential overlap of services or opportunities to realize Legacy House service efficiencies through partnerships with these agencies. 

District of Columbia Department of Health Care Finance    
Curriculum Development and Individualized Technical Assistance  
Oxford-HMA is leading the Integrated Care Technical Assistance (TA) five-year program aimed at facilitating training/coaching to support Medicaid providers’ efforts to provide whole-person care by integrating care for physical, behavioral health, and SUD conditions of Medicaid beneficiaries. The TA curriculum was developed to meet the goals to improve care and patient outcomes within three practice transformation core competencies: 1) delivering person-centered care across the care continuum; 2) using data and population health analytics, and 3) engaging leadership to support person-centered, value-based care. The multitiered TA program includes individual practice coaching, webinar sessions, learning collaboratives, and an online virtual learning community. The work includes development of the program website, dashboard and learning library at integratedcaredc.com. 

Vermont: Statewide Mobile Crisis Services Redesign 
Model Program Development and implementation support
HMA is collaborating with the Vermont Agency of Human Services leadership and appropriate stakeholders to develop a new benefit created by the American Rescue Plan Act of 2021 – Section 9813 State planning grant and subsequent funding for qualifying community-based mobile crisis intervention services. This project is advancing prior planning to achieve a unified statewide, equitable, mobile crisis response system of care that is community-based and meets the needs of individuals in crisis. Key activities include conducting wide-ranging virtual stakeholder focus groups and interviews, including with first responders and people with lived experiences, and developing the performance measures and key metrics mobile crisis that will be required to collect and report to support program oversight and quality improvement efforts.

Centers for Medicare and Medicaid Services (CMS)  
Medicaid Innovation Accelerator Program (IAP) Technical Assistance 
HMA has supported the Opioid Data Analytics project assisting states in collecting, reporting, and analyzing data specific to opioid use disorder (OUD), Medications for Addiction Treatment (MAT) services and supports, and neonatal abstinence syndrome. In addition, HMA led development of a technical resource for states to access Medicaid data to better understand individuals with serious mental illness (SMI) within their Medicaid populations. HMA staff participated as coaches in the IAP cohort Using Data Analytics to Better Understand State Medicaid Beneficiaries with Serious Mental Illness. HMA staff have served as SMEs in the development and delivery of the CMS IAP national webinars, in-person meetings and direct coaching support offered to participating states. To date, HMA has provided coaching to state agencies and providers in the District of Columbia, Indiana, Maryland, Michigan, New Jersey, Oregon, Texas, Utah, Virginia and others. 

Arnold Ventures  
State Opioid Response National Technical Assistance for Grantees 
HMA was selected and funded by Arnold Ventures, in partnership with the Federal Bureau of Justice Assistance and its agency, the Institute for Intergovernmental Research, to provide technical assistance and consultation to counties around the nation in support of implementing Medications for Addiction Treatment (MAT) programs.  The HMA team worked with 15 county jails to develop a comprehensive continuum of care model that targets the jail population and bridges in-custody and community-based treatment designed to facilitate successful reentry. This project included developing resource tools, facilitating convenings with the counties, and providing coaching and technical assistance through on-site and telephonic coaching.

California Department of Health Care Services  
Curriculum Development and Technical Assistance  
Through multi-year engagements, HMA has worked closely with the Department to support their addiction treatment community-based ecosystem. Separate, but related, projects have focused on justice-involved populations (both jails and prisons), neonatal substance exposure evaluation and treatment, county level SUD system improvement and harm reduction strategies, among other workstreams. HMA delivers statewide live and recorded webinars, conference calls, office hours, and individualized technical assistance (TA). Material follows a curriculum developed specifically for the implementation of community-based programs that will increase access to addiction treatment. As part of the engagement, HMA develops and maintains the project website and dashboard where more information about the workstreams, deliverables and outcomes can be found. Through the criminal justice components of this work CA went from 24 people as of October 2018 (pre learning collaborative) and 31,712 by December 2022, including 19,000 initiated on buprenorphine.

California Department of Corrections and Rehabilitation
Implementation of MAT Programs in the State Correctional System  
HMA supported the implementation of medication for addiction treatment (MAT) programs in the state correctional system. HMA addiction experts created an evidence-based curriculum that was delivered through group and individualized training on best practices for implementing MAT programs and prescribing MAT. Work also included supporting systems for effective transitions of care and re-entry for justice involved populations. To date, technical assistance and trainings have been offered to licensed clinical social workers (LCSWs), AOD counselors, primary care providers, and nurses. Additionally, individualized support has been provided to division leadership, which has included mentoring, documentation review, workflow identification, care management evaluation, and screening and assessment support. These efforts have resulted in >94,813 persons screened for substance use disorders and >15,547 treated with MAT as of 1.6.22. https://cchcs.ca.gov/isudt/dashboard/ 

Colorado Office of the Attorney General  
Community Conversations to Information Youth Suicide Prevention: A Study of Colorado Youth Suicide  
The Colorado Office of the Attorney General, Office of Community Engagement, contracted with HMA to study four counties in the state (El Paso, Pueblo, Mesa, La Plata) which had experienced recent suicide clusters among middle and high school-aged youth and had historically high rates of suicide across every age group. Findings from these four counties were used to inform youth suicide prevention strategies for the state. HMA designed a multi-pronged approach to the study with the goal of learning about opportunities and approaches to youth suicide prevention in each of the four counties, and across Colorado. Central to the study was the concept of community conversations. The project team conducted 42 key stakeholder interviews with representatives from public health, behavioral health, schools, and youth serving organizations. The team also facilitated 34 focus groups with adults and youth from various communities and sectors. For comparison, focus groups were conducted with school staff and parents in Douglas and Larimer Counties, where the youth suicide rates were lower and/or there had not been recent suicide clusters.  

HMA conducted secondary analysis on data for fatal and nonfatal suicidal behavior, including death certificate and hospitalization data, the Colorado Violent Death Reporting System, the Colorado Child Fatality Prevention System, and the Healthy Kids Colorado Survey. HMA also reviewed information on current suicide prevention activities and resources in the four counties and across Colorado, reviewed traditional and social media coverage related to suicide in the four counties and the state, and reviewed publicly available information on school policies and procedures related to suicide intervention, prevention, and response in the aftermath of a student suicide or suicide attempt. 

Douglas County Mental Health Initiative, Colorado  
Behavioral Health System Roadmap and Governance Structure  
The Douglas County Mental Health Initiative (DCMHI) is a collective impact partnership with more than 35 organizations working together to improve behavioral health in the country. The partners include both public and private entities representing hospital systems, inpatient psychiatric facilities, law enforcement, mental health and substance user providers, intellectual and development disability organizations, faith-based organizations, and other community partners. HMA worked closely with DCMHI from 2017 to 2021 on multiple projects. Initially, HMA worked with the partnership to develop their roadmap for creating an improved behavioral health system and assisting in the creation of a collective impact governance structure and process. HMA has also supported their co-responder teams (law enforcement and a mental health clinician) who work in the community and in the school system. As part of the DCMHI initiative, HMA supported the county in designing and implementing a care compact which is a high touch and coordinated care coordination approach for the most complex needs in the community. The care compact brings together health systems, Medicaid managed care, the county attorney, providers (behavioral health and intellectual and developmental disabilities), social determinant of health organizations and the co-responder teams to work closely to plan proactively for community transitions and reduce acute care needs. In 2021, HMA helped the county obtain additional funding and is supporting the design of a pilot to expand the collaboration among the co-responder program, the hospitals, and behavioral health providers to create an alternative to assisted outpatient treatment for individuals with outpatient involuntary mental health treatment.  

Baton Rouge Area Foundation  
Development of Crisis Continuum of Services  
HMA assisted the Baton Rouge Area Foundation with the development of a comprehensive model of care for individuals in East Baton Rouge (EBR) Parish with behavioral health and substance use needs who, under the current system in place in EBR, may otherwise end up behind bars. HMA’s scope of work included an analysis of the operations and business plan components, as well as steps necessary to achieve implementation. HMA’s plan which was eventually implemented proposed a crisis model including: a crisis center, a use of a crisis intervention team comprising law enforcement officers, a child and adolescent mobile response team, expansion of a mobile adult outreach team, and a new Baton Rouge mobile behavioral health team. The Bridge Center for Hope opened in 2016 and is the  first-ever adult crisis receiving facility in East Baton Rouge Parish and the State of Louisiana designed as a short-term crisis stabilization center to treat individuals 18 years or older who are experiencing a mental health crisis and/ or substance use challenge.

Delaware Division of Public Health and Division of Substance Abuse and Mental Health (DPH and DSAMH)  
Multiple Technical Assistance Projects  
Through multi-year engagements, HMA has worked closely with DPH and DSAMH by assisting the State in establishing the legislatively-directed Overdose System of Care, which includes a management of an organizing committee and multiple issue-specific subcommittees; supporting the development, deployment, and management of Community Response Teams that use an HMA trained volunteer corps to provide community-based prevention, education, and outreach; helping to develop and manage a faith-based community group that focuses on prevention and treatment education and awareness for faith leaders across the State; supporting industry-specific prevention education and communications campaigns for construction and restaurants (the two industries with the highest rates of opioid use disorder among employees); and delivering statewide individual and group technical assistance to improve the community based systems of care for individuals with addiction and other behavioral health conditions. HMA has provided technical assistance to providers within primary care settings including community behavioral health centers and federally qualified health centers (FQHCs), individual and group SUD and behavioral health providers and emergency departments.