UnitedHealthcare Integrating Primary and Behavioral Health ...

UnitedHealthcare

Integrating Primary and

Behavioral Health Care

Overview of Children’s

Behavioral Health Services

© 2019 Optum, Inc. All Rights Reserved United Behavioral Health and United Behavioral Health of New York, I.P.A., Inc. operating under the brand Optum BH2314_08/2019

• Overview of Optum and UnitedHealthcare

• Behavioral Health Services for Children and Families

• Resources and Tool to Support the Integration of

Primary and Behavioral Health

Today’s Agenda

2 © 2019 Optum, Inc. All Rights Reserved United Behavioral Health and United Behavioral Health of New York, I.P.A., Inc. operating under the brand Optum BH2314_08/2019

Our United Culture


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• Dedicated to providing benefits to the economically

disadvantaged and medically underserved

• Manage benefits in 24 states, plus Washington D.C

• Serves more than 5 million beneficiaries

• Uniquely designed to address

the complex the chronically ill,

disabled, and people with higher

risk medical, behavioral and

social conditions

UnitedHealthcare Community Plan


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Behavioral Health Services for

Children and Families

Medicaid Redesign Team (MRT) Goals for Children's

Medicaid Transformation

• Keep children on their developmental trajectory

• Maintain child at home with support and services

• Maintain the child in the community in least restrictive settings

• Identify needs early and intervene

• Focus on recovery and building resilience

• Prevent escalation and long term need for higher end services

• Maintain accountability for improved outcomes and delivery of quality care

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Children and Family Treatment Services and Supports

(CFTSS) Six Core Principles

. Child Centered • Ensure services are child-specific

• Consider child’s:

Family

Community

Development

Strengths

2. Community Based • When possible, services are

delivered in the child’s home

• Draw on formal and informal

community resources

Culturally Competent • Ensure agencies demonstrate congruent behaviors, attitudes, skills

policies and procedures that allow care givers to work effectively and

efficiently with persons and communities of all cultural backgrounds


4. Family Focused • Empower families to advocate for themselves

• Promote family participation in all decisions & treatment planning

5. Multi System • Services planned in collaboration with all child-serving systems

• Family and system representatives collaborate to:

Define Goals

Identify Resources

Evaluate Progress

6. Least Restrictive/Intrusive • Services take place in settings that meet the needs of the child and

family

• Least restrictive and intrusive as available

• Most appropriate and natural for the child and family

Children and Family Treatment Services and Supports

(CFTSS) Six Core Principles (Continued)

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Develop Service Plans

Provide Support


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Children and Family Treatment and Supports

Implementation Timeline

January 1, 2019

Children and Family Treatment and Supports

(CFTSS)

• Other Licensed Practitioner (OLP)

• Community Psychiatric Supports and Treatment (CPST)

• Psychosocial Rehabilitation (PSR)

July 1, 2019

Children and Family Treatment and Supports (CFTSS)

• Family Peer Support Services

SSI children begin receiving State Plan behavioral

health services in managed care including:

• Three-year phase in of Level of Care (LOC) expansion

begins


All Children and Family Treatment and Support

Services (CFTSS)

• Youth and Peer Support and Training

• Crisis Intervention

Home and Community Based Services

Consolidated Waiver

SSI Children Only - Children and Family

Treatment and Support Services (CFTSS)

• Youth and Peer Support and Training

• Crisis Intervention

Children and Family Community Support Services

Implementation Timeline

October 1, 2019

January 1, 2020

© 2019 Optum, Inc. All Rights Reserved United Behavioral Health and United Behavioral Health of New York, I.P.A., Inc. operating under the brand Optum BH2314_08/2019 10

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Mental Health Services Covered by Medicaid

Managed Care

Assertive Community Treatment (ACT)

Personalized Recovery Oriented Services (PROS)

Inpatient Psychiatric Services

Operation of Outpatient Programs

• Continuing Day Treatment (CDT) Program

• Partial Hospitalization

Comprehensive Psychiatric Emergency Program (CPEP)

Clinic Treatment Programs

• Outpatient Clinic Services

• OMH Licensed SED designated clinics

• Integrated Outpatient Clinic Services (IOP)

• Licensed Behavioral Health Practitioner Services (LBHP)

July 1, 2019


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Substance Use Disorder (SUD) Services Covered by

Medicaid Managed Care

Part 816 - Withdrawal and Stabilization Services

• Hospital Based Medically Managed Inpatient Detox

• Medically Supervised Inpatient Withdrawal

and Stabilization

• Medically Supervised Outpatient Withdrawal

and Stabilization

Part 818 - Chemical Dependence Inpatient

Rehabilitation Services

Part 820 - Residential Services Stabilization

and Rehabilitation

Part 822 - Outpatient Services

• Chemical Dependence Outpatient (CD-OP) Clinic

• Rehabilitation Services

• Opioid Treatment Programs (OTP)

July 1, 2019


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Resources and Tools to Support the

Integration of Primary and Behavioral

Health Care

Behavioral Health - Health Homes

• A Health Home is not a physical place. It is a group of health care

and service providers working together to help the member map out

and follow a care plan

• Criteria – individual must be enrolled in Medicaid and have:

Two or more chronic conditions (e.g. substance use disorder, asthma,

diabetes) OR One single qualifying condition which includes only

HIV/AIDS, Serious Emotional Disturbance (children), Complex Trauma

(children) or Serious Mental Illness (adults)

• To learn more or make a referral for Health Home services, contact a

Health Home in the area where the member lives. Each Health

Home has a referral line or web portal for easy referral:

health.ny.gov/health_care/medicaid/program/medicaid_health_homes/h

h_map/index.htm


https://health.ny.gov/health_care/medicaid/program/medicaid_health_homes/hh_map/index.htm






Clinical Practice Guidelines (CPG)

• A series of documents intended to assist clinical decision making

by presenting systematically developed patient care strategies in a

standardized format

• Evidence-based and emerging best practice recommendations

• Resources include:

American Academy of Child & Adolescent Psychiatry:

aacap.org/aacap/Resources_for_Primary_Care/Practice_Parameters_

and_Resource_Centers/Practice_Parameters.aspx

American Psychiatric Association CPGs for Bipolar Disorder,

Schizophrenia, Depression, Substance Use Disorders:

psychiatry.org/practice/clinical-practice-guidelines

American Academy of Pediatrics CPG for Attention Deficit

Hyperactivity Disorder:

pediatrics.aappublications.org/content/128/5/1007/


http://www.aacap.org/aacap/Resources_for_Primary_Care/Practice_Parameters_and_Resource_Centers/Practice_Parameters.aspx








http://www.psychiatry.org/practice/clinical-practice-guidelines





https://pediatrics.aappublications.org/content/128/5/1007

http://pediatrics.aappublications.org/site/aappolicy/

Depression, Anxiety and Other Behavioral Health

Conditions

• Estimated 13%-20% of US children have been diagnosed with a

mental disorder *

• Pediatric primary care providers often identify and manage their

patients’ behavioral health problems

• Optum Behavioral Health Tool Kit for Medical Providers

• providerexpress.com/content/ope-provexpr/us/en/clinical-resources/PCP-

Tool-Kit.html

• Resources to help better understand BH conditions:

National Federation of Families for Children’s Mental Health: ffcmh.org

Mental Health Conditions Affecting Children and Adolescents:

samhsa.gov

National Alliance on Mental Illness (NAMI): nami.org

* Behavioral Health Integration in Pediatric Primary Care: Considerations and Opportunities for Policymakers, Planners, and Providers by Elizabeth Tobin Tyler, JD, MA, Rachel L. Hulkower, JD, MSPH, and Jennifer W. Kaminski, PhD March 2017


https://www.providerexpress.com/content/ope-provexpr/us/en/clinical-resources/PCP-Tool-Kit.html













http://www.ffcmh.org/

http://www.samhsa.gov/

http://www.nami.org/

Screening Tools: Depression, Anxiety and Other

Behavioral Health Conditions

• Substance Abuse and Mental Health Administration Evidence Based

Practice (EBP) Web Guide: samhsa.gov/ebp-resource-center

• Depression Patient Health Questionnaire (PHQ-9):

uspreventiveservicestaskforce.org/Home/GetFileByID/218

• Generalized Anxiety Disorder 7-item Screener (GAD-7):

integration.samhsa.gov/clinical-practice/gad708.19.08cartwright.pdf

• Children with Special Health Care Needs Screener (CSHCN Screener):

cahmi.org/projects/children-with-special-health-care-needs-screener/

• Ask Suicide-Screening Questions (ASQ) Toolkit for youth (aged 10 to 21

years): nimh.nih.gov/labs-at-nimh/asq-toolkit-materials/index.shtml

• Columbia Suicide Severity Rating Scale (C-SSRS):

cssrs.columbia.edu/scales_cssrs.html


https://www.samhsa.gov/ebp-resource-center






https://www.uspreventiveservicestaskforce.org/Home/GetFileByID/218



https://www.integration.samhsa.gov/clinical-practice/gad708.19.08cartwright.pdf



http://www.cahmi.org/projects/children-with-special-health-care-needs-screener/













https://www.nimh.nih.gov/labs-at-nimh/asq-toolkit-materials/index.shtml











http://www.cssrs.columbia.edu/scales_cssrs.html

Substance Use

• Pediatric care providers have a unique opportunity to provide

educate about the dangers of substance use

• Two National Institute on Drug Abuse (NIDA) screening tools to

assess for substance use disorder risk among adolescents 12-17

years old:

drugabuse.gov/nidamed-medical-health-professionals/screening-tools-

for-adolescent-substance-use

• "Substance Use Screening, Brief Intervention, and Referral to

Treatment" (SBIRT) to guide physicians released in June 2016

pediatrics.aappublications.org/content/pediatrics/early/2016/06/16/peds.2

016-1210.full.pdf


https://www.drugabuse.gov/nidamed-medical-health-professionals/screening-tools-for-adolescent-substance-use


















https://pediatrics.aappublications.org/content/pediatrics/early/2016/06/16/peds.2016-1210.full.pdf




Substance Use: Screening and Brief Intervention and

Referral to Treatment (SBIRT)

• Screening : quickly assesses the severity of substance use and

identifies the appropriate level of treatment

• Brief Intervention: focuses on increasing insight and awareness

regarding substance use and motivation toward behavioral change

• Referral to Treatment: provides those identified as needing more

extensive treatment with access to specialty care

American Academy of Pediatrics' SBIRT guide

aap.org/en-us/Documents/substance_use_screening_implementation.pdf

New York State Office of Substance Abuse Services (OASAS)

oasas.ny.gov/AdMed/sbirt/index.cfm


https://www.aap.org/en-us/Documents/substance_use_screening_implementation.pdf




https://www.oasas.ny.gov/AdMed/sbirt/index.cfm






Children and Youth with

Serious Emotional Disturbance (SED)

• Serious Emotional Disturbance (SED)

Children ages 4-18

Diagnosable mental health problem

Mental health problem that severely disrupts functioning

• SED characteristics and behaviors include prolonged periods of:

Hyperactivity, short attention span and impulsiveness

Aggression or self-injurious behavior such as acting out or fighting

Withdrawal, failure to initiate interaction with others or avoid social

interactions through fear or anxiety

Immaturity characterized by inappropriate crying and temper tantrums,

and poor coping skills

Learning difficulties exhibited by academic performance below grade level

New York State Multiple Systems Navigator: msnavigator.org/


https://www.msnavigator.org/

Early Childhood: 0-5 Years Old

• 8%-10% of children younger than 5 years experience mental

health problems*

• New York State Early Childhood Direction Centers (ECDCs)

Information and referral services for children with disabilities

(0-5)

Professional development and technical assistance for families

and preschool providers

p12.nysed.gov/specialed/techassist/ecdc/home.html

• The New York State Early Intervention Program (EIP) is part of the

national Early Intervention Program for infants and toddlers with

disabilities and their families

* Mary Margaret Gleason, Edward Goldson, Michael W. Yogman, Council on Early Childhood, Committee on Psychosocial Aspects of Child and Family Health, Section on Developmental and Behavioral Pediatrics


http://www.p12.nysed.gov/specialed/techassist/ecdc/home.html







Early Childhood: 0-5 Years Old

• Early Intervention (EI) is a statewide program that provides many

different types of therapeutic and supportive services to infants and

toddlers (0-3) with disabilities and their families: health.ny.gov/community/infants_children/early_intervention/

• New York State Department of Health (DOH), in coordination with

the Bureau of Early Intervention, created a specialized Health

Home care coordination program: health.ny.gov/health_care/medicaid/program/medicaid_health_home

s/hh_children/early_intervention.htm


https://www.health.ny.gov/community/infants_children/early_intervention/





https://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/hh_children/early_intervention.htm










Intellectual and/or Developmental Disabilities (I/DD

• Intellectual and Development Disabilities are most often first

identified by the doctor

• Referring to treatment is challenging and involves multiple systems

with their own processes and pathways to care

• New York State Department of Health (DOH), in coordination with

New York State Office for People with Developmental Disabilities

(OPWDD), created a specialized Health Home care coordination

program specific to the I/DD population called People First Care

Coordination Organization Health Homes (CCO/HHs): health.ny.gov/health_care/medicaid/program/medicaid_health_homes/idd/i

ndex.htm


http://www.health.ny.gov/health_care/medicaid/program/medicaid_health_homes/idd/index.htm






Transition Age Youth (TAY)

• Teens and young adults with disabilities ages 16-22 who typically

have experience in the children’s public mental health system or

other child-serving systems, including education, child welfare and

juvenile justice

• Need is to strengthen emotional and social development and

learning as the individual transitions into adulthood and more

independence

• Connect to information and resources specifically for young people

transitioning to adulthood, their families and service providers:

omh.ny.gov/omhweb/consumer_affairs/transition_youth/resources/

omh.ny.gov/omhweb/consumer_affairs/transition_youth/resources/ment

al_health.html

cbhny.org/


https://www.omh.ny.gov/omhweb/consumer_affairs/transition_youth/resources/







https://www.omh.ny.gov/omhweb/consumer_affairs/transition_youth/resources/mental_health.html








http://cbhny.org/

First Episode of Psychosis (FEP)

• An estimated 60,000 New Yorkers have psychotic illnesses1

• Around 2,000 new cases of psychotic illnesses each year in NYC2,3

• Typical age of onset 18-24, most cases appear at 13-30, with males

exhibiting signs 1-2 years earlier4

• 40%-50% of individuals with psychotic illness receive ongoing care5,6

• Average duration of untreated psychosis is 1-3 years

• Without follow-up treatment, 25% of individuals with first episode

psychosis will be re-hospitalized within 1-year7,8,9

NYC DOHMH Patient Characteristics Survey 2011 2) Bladwin P et al. Schiz Bull 2005 31;3, 624-38. 3) Kirkbride JB et al. Int J Epi. 2009; 38-1255-64. 4) https://www.earlypsychosis.ca/pages/curious/who-gets-psychosis 5) NYC DOHMH Medicaid analysis

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6) Buchanan RW, et.al. Schizophrenia Bull. 2010;36(1):71-93 7) Marshall M, et al. Archives of General Psychiatry 2005; 62:975- 983. 8) Perkins D, Gu H, Boteva K, Lieberman J. Am J Psychiatry 2005;162:1785–1804. 9) Hegelstad W, et al. Am J Psychiatry 2012;169:374-380


First Episode of Psychosis (FEP): Signs and Symptoms

• Delusions

• Paranoia

• Hallucinations in any of the five senses

• Disorganized thought process, speech or behavior

Positive Symptoms

• Flat affect

• Restricted speech and verbal fluency

• Slowed thought process

• Decreased motivation

• Social isolation

Negative Symptoms

• Cognitive symptoms

• Mood shifts, anxiety

• Suicidal thoughts or behaviors

• Substance use

• Sleep disturbance

• Decline in function

Other Symptoms


First Episode of Psychosis (FEP): Resources

OnTrackNY:

• Offers specialized clinical service for adolescents and young adults

between the ages of 16 and 30 who have been experiencing psychotic

symptoms for more than a week but less than 2 years

• Our NY BH Assessment and Triage (A&T) call center will notify

OnTrackNY when a member fitting the above criteria is admitted into an

inpatient unit

• To learn more or make a referral visit the OnTrackNY website and click

on Providers tab: ontrackny.org/

NYC Start (Supportive Transition and Recovery Team):

• Employs the evidence-based practice of Critical Time Intervention (CTI)

to engage adolescents and young adults between the ages of 16 and 30

experiencing their first adult hospitalization for psychosis

• To learn more visit the NYC Start website:

1.nyc.gov/site/doh/health/health-topics/crisis-emergency-services-nyc-

start.page


https://www.ontrackny.org/

https://www1.nyc.gov/site/doh/health/health-topics/crisis-emergency-services-nyc-start.page













First Episode of Psychosis (FEP): Resources

Center for Practice Innovations (CPI) out of Columbia Psychiatry/ New

York Psychiatric Institute:

• Funded by New York State Office of Mental Health (OMH) to develop

resources and web-based trainings that promote recovery principles

and best practices, including engagement and treatment of individuals

experiencing first episode of psychosis

• To learn more visit the CPI website: practiceinnovations.org/


http://practiceinnovations.org/

Trauma Informed Care Strategies

• Health policymakers and practitioners increasingly recognize the

destructive effects of trauma on the health status of children and

adults

• Adopting trauma-informed approaches can improve patient

engagement, enhance outcomes, and reduce avoidable care and

excess costs for both the health care sector and social service

systems

• Practicing Trauma Informed care may include:

Educating clinical and non-clinical workforce about the impact of trauma

Incorporating patient voice and choice (e.g. input on treatment plan)

Creating a safe environment (e.g. well lit, ask permission to close door)

• Trauma Informed Care Resources: store.samhsa.gov/system/files/sma14-4816.pdf


https://store.samhsa.gov/system/files/sma14-4816.pdf



Free Trainings on UHC On Air

• UHC On Air is an online provider education resource where you can earn

free CEU/CMEs

• Go to uhcprovider.com and log into Link with your Optum ID, click on the

UHC On Air app, and go to the New York channel to find programs for all

lines of business and topics that you want to see

• Care providers that need an Optum ID can go to uhcprovider.com and click

on New User in the upper right of home page to register


http://www.uhcprovider.com/

http://www.uhcprovider.com/

Free Trainings on UHC On Air

Access trainings including many evidence-based and emerging best

practice topics:

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• Assertive Continuing Care &

Adolescent Community

Reinforcement Approach

• Dialectical Behavior Therapy

(DBT)

• Seven Challenges Program

• Trauma-Focused Cognitive

Behavioral Therapy (TF-CBT)

• Trauma-Informed Child-Parent

Psychotherapy (CPP)

• New York Children's Health

Home Understanding the

Program Requirements

• Multidimensional Family

Therapy (MDFT)

• Functional Family Therapy

(FFT)

• Mutisystemic Therapy (MST)

• Multi-Dimensional Treatment

Foster Care (MTFC)


Free Trainings and CMEs on

OPTUM Health Education Portal

optumhealtheducation.com


http://www.optumhealtheducation.com/

http://www.optumhealtheducation.com/

Additional Provider Resources on Provider Express Portal

https://store.samhsa.gov/system/files/sma14-4816.pdf http://www.cebc4cw.org/program/child-parent-psychotherapy/detailed

providerexpress.com






https://www.providerexpress.com/

Community Technical Assistance Center of New York (CTAC)

Managed Care Technical Assistance Center of New York (MCTAC)

• Training, consultation and educational resource center serving all

behavioral health agencies in New York State

• The goals of CTAC/MCTAC include:

Strengthening clinical and business infrastructure though training

opportunities focused on implementing evidence-based practices

Providing trainings and updates that address challenges associated

with recent changes in regulations, financing and overall healthcare

reforms

Provides credentialing, managed care, and business resources,

manuals and general guidance

• To learn more or access an archived or upcoming training, visit:

ctacny.org


http://www.ctacny.org/

NYC Well

• Connects New Yorkers to free, confidential mental health support

• Speak to a counselor via phone, text or chat and get access to

mental health and substance misuse services, in more than 200

languages, 24/7/365:

Suicide prevention and crisis counseling

Peer support and short-term counseling via telephone, text and web

Assistance scheduling appointments or accessing other mental health

services

Follow-up to check that you have connected to care and it is working

for you

Referral to NYC adult and children mobile crisis services

• UHC partners with NYC Well if a caller identifies as a

UnitedHealthcare member to assist that individual with non-crisis

related inquiries: 1-888-NYC-WELL (1-888-692-9355)


Project Training Education for the Advancement of

Children’s Health (TEACH)

• To strengthen and support the ability of New York’s pediatric primary care

providers (PCPs) to deliver care to children and families who experience mild-to-moderate mental health concerns

• Project TEACH provides specialized training, consultation, and linkage with mental health treatment for primary care physicians statewide

• Collaboration of OMH with the Department of Health (DOH), Conference of Local Mental Hygiene Directors, American Academy of Pediatrics

(AAP), and the New York State Academy of Family Physicians (AAFP)

• The program seeks to provide ongoing training and consultation services

to better meet the mental healthcare needs of some of the children seen in primary care practices

• To learn more about Project TEACH and how to access its resources, visit: projectteachny.org/


https://projectteachny.org/

State Offered Program Directories

• New York State Office of Mental Health (OMH) – Find a Mental

Health Program: my.omh.ny.gov/bi/pd

• New York State Office of Alcohol and Substance Abuse Services

(OASAS) – Find a Provider:

oasas.ny.gov/providerDirectory/index.cfm

• New York State Office of Children and Family Services (OCFS)

– Find Services for Children and Families:

ocfs.ny.gov/main/default.asp

• New York State Office of People with Developmental Disabilities

(OPWDD): opwdd.ny.gov/


https://my.omh.ny.gov/bi/pd/saw.dll?PortalPages&PortalPath=/shared/Mental Health Program Directory/_portal/Mental Health Program Directory&nquser=BI_Guest&nqpassword=Public123

https://my.omh.ny.gov/bi/pd/saw.dll?PortalPages&PortalPath=/shared/Mental Health Program Directory/_portal/Mental Health Program Directory&nquser=BI_Guest&nqpassword=Public123

https://www.oasas.ny.gov/providerDirectory/index.cfm




https://www.ocfs.ny.gov/main/default.asp

https://opwdd.ny.gov/

Contact information:

Thank you

Gayle Parker Wright, LCSW-R NY

Network Trainer

UnitedHealthcare Community Plan

Office: 1-612-642-7307

[email protected]

Questions?

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