CHP: NYS DSRIP 2.0 Eyes Greater Community Focus, More Involvement by Health Plans

NYAPRS Note: NY is making its case for an extension of our DSRIP program (https://www.health.ny.gov/health_care/medicaid/redesign/dsrip/) to the federal government by “highlighting the ways the second phase of DSRIP would align with federal priorities, such as addressing substance-use disorders and the opioid crisis; care for people with serious mental illnesses; the social determinants of health; and primary care improvement and alternative payment models.”

The first iteration of DSRIP was roundly criticized for its failure to sufficient incorporate the experience and effectiveness of community behavioral healthcare providers who have long focused on addressing the social determinants of health, e.g. housing, finances (entitlements/employment), social connection, hunger, transportation and the like. NYAPRS and our colleagues will be working with the Cuomo Administration to see a far greater role for community based approaches as a preferred strategy to serving people in inpatient and emergency department settings.  

 

DSRIP 2.0 Eyes Greater Community Health Focus

Another five years of DSRIP calls for a greater focus on high-need and high-cost populations, according to the state Department of Health.

In particular, it would require providers, managed care organizations and community-based organizations to focus on practices to address their "specific population challenges" and "most pressing community health needs," the department said in its $8 billion request of the federal government. That includes reducing maternal mortality, focusing on children's population health and reforming long-term care.

Chad Shearer, senior vice president for policy and program at the United Hospital Fund, called the additional areas a "great recognition of who was left out," when it comes to DSRIP 1.0.

The focus on women and children is particularly valuable in DSRIP 2.0, said Dr. David Cohen, executive vice president and chair of population health at Maimonides Medical Center and chair of Community Care of Brooklyn. The current iteration of DSRIP really focuses on reducing avoidable hospitalizations by 25%, but children aren't hospitalized very often.

"This will really consolidate some of the gains that we've made," Cohen said.

Rose Duhan, president and CEO of the Community Health Care Association of New York State, said in a statement provided to Crain's that the association is pleased to see the work of community health centers "recognized in the priorities defined in the next generation of DSRIP."

"Community health centers recognize emerging trends, define health care priorities and develop best practices to address those needs," she said.

The state Department of Health said in its request that, ultimately, a focus on additional high-need priority areas and community health needs will "lay the groundwork" for the continued adoption of valued-based payment. —Jennifer Henderson

---------------

In Second Round of DSRIP, State Looks to Better Incorporate Insurers

Crain’s Health Pulse   September 19, 2019

New York State health officials are seeking deeper involvement from managed care organizations as they pursue a second $8 billion to continue the transformation of New York's Medicaid program.

The state Health Department said it would like to provide more flexibility to participants in how they operate the organizations that are funded by the Delivery System Reform Incentive Payment program after receiving feedback from health care providers.

In the next iteration, the Health Department said the organizations receiving funding from what is proposed to be a $5 billion DSRIP pool would include Performing Provider Systems or a subset of those networks, community-based organizations and a state-approved managed care organization. To describe that partnership, the Health Department is introducing a new phrase—and acronym—into the health policy lexicon: value-driving entities or VDEs.

"With 4.7 million people enrolled in Medicaid managed care, the inclusion of the MCOs as active partners in the delivery system collaboration and in the development of more sophisticated [value-based payment] models is necessary to best support the maturing networks," the state Health Department wrote in its draft proposal, which was released to solicit public comments on Tuesday.

Nathan Myers, director of the United Hospital Fund's Medicaid Institute, said the involvement of insurers stood out in the state's proposal.

"The state is trying to embed a very explicit strong role for managed care organizations in this next iteration," Myers said. "It is really trying to provide a bridge to value-based payment and create reforms that can be more sustainable under value-based payment without additional performance-based funding."

The changes are part of New York's four-year waiver renewal, which would continue the DSRIP program through March 2024. The Centers for Medicare and Medicaid Services must approve the renewal, which would provide $5 billion for DSRIP, $1.5 billion to address social determinants of health, $1 billion for workforce development and $500 million for an Interim Access Assurance Fund that would support cash-strapped safety-net hospitals.

The state expects to submit its waiver request in November and will hold a hearing for public comments on Oct. 25 at Baruch College in Manhattan.

Eric Linzer, president and CEO of the state Health Plan Association, said "this new proposal reflects the health plans' work to date in the state's efforts to reform the Medicaid program and the important role of plans in the state's next phase."

The Cuomo administration is making its case to the Trump administration, with whom it has frequently butted heads, by highlighting the ways the second phase of DSRIP would align with federal priorities, such as addressing substance-use disorders and the opioid crisis; care for people with serious mental illnesses; the social determinants of health; and primary care improvement and alternative payment models.

States such as North Carolina, which received approval for its Section 1115 federal waiver, have targeted similar priorities, including using Medicaid funding to target gaps in housing, transportation and food access, said Chad Shearer, senior vice president for policy and program at the United Hospital Fund.

The proposal's prospects for approval by CMS is "the great unknown," Shearer said. "The state's got a reasonable case, given what CMS has approved for other states."

Oct 1 Free Web Seminar: Badge of Life: Building a Better Cop

NYAPRS Note: The following comes courtesy of the NYS Office of Mental Health.

Event:

Badge of Life: Building a Better Cop

Event address for attendees:

https://meetny.webex.com/meetny/onstage/g.php?MTID=eef21844600c0a7daf53eb7999c7dcb34

Date and time:

Tuesday, October 1, 2019 10:30 am
Eastern Daylight Time (New York,)
Tuesday, October 1, 2019 9:30 am
Central Daylight Time (Chicago,)

Duration:

1 hour 30 minute

Description:

Law enforcement officers respond to and witness some of the most tragic events that happen in our communities. On-the-job stress can have a significant impact on their physical and mental well-being, which can accumulate over the course of a career. Many officers struggle with alcohol abuse, depression, suicidal thoughts, posttraumatic stress disorder and other challenges.

The Badge of Life organization is a 501 (c) 3, Not for Profit organization that focuses on educating and training law enforcement on mental health and suicide prevention. Their mission is to inspire hope and contribute to the health and well-being of law enforcement personnel.

This web seminar will focus on: Identifying critical incidents; trauma and stress related issues that can lead to Post Traumatic Stress Injury and police suicide; teaching how to help a colleague manage their troubles with a positive outcome; and the advantage of the peer support program.


Although this web seminar is intended for law enforcement, all are welcome to attend.


The presenter is Dr. Ron Rufo Ed.D, Chicago Police Department, Retired and is the author of, "Police Suicide: Is Police Culture Killing Our Officers?"


Please note that this web seminar is for educational purposes only and is not to be used as a substitute for professional mental health counseling.

Event number:

642 196 930

Event password:

nysomh123

Audio conference:

To receive a call back, provide your phone number when you join the event, or call the number below and enter the access code.

US Toll Free

1-844-633-8697

Local

1-518-549-0500

Access code: 642 196 930

Event material:

Ronald Rufo - Dr. Ron Rufo FINAL 2019 Impact of Truama.pptx (29.1 MB)

 

MHW: Disability Community Decries Proposal to Monitor People with MI to Predict Violence

NYAPRS Note: A large number of advocates from across the spectrum of the disability advocacy community have joined forces to strongly oppose false connections between gun and other forms of violence and people with mental health related conditions, as well as recent proposals favoring re-institutionalization and electronic monitoring. See below for a list of suggested social media messaging and references developed by members of the group.  

 

Proposal to Monitor People With MI to Predict Violence Sparks Field Outcry

By Valerie Canady Mental Health Weekly  September 16, 2019

 

Following a recently announced proposal by the Trump administration to create a new research arm within the proposed Health Advanced Research Projects Agency (HARPA), mental health and disability rights advocacy groups banded together on a preliminary conference call last week to weigh concerns and discuss potential steps should this proposal move forward.

 

Following the recent shootings in El Paso, Texas, and Dayton, Ohio, President Trump has repeatedly made references and comments linking gun violence to mental illness. Last month, he called for a return to mental health institutions. The mental health community immediately flooded the public with statements opposing the link (see MHW, Aug. 26).

The more recent proposal calls for an early identification of people with mental illness who the administration says are at risk of committing violence. This effort would be part of a larger program to establish a new agency, HARPA, which would be part of the U.S. Department of Health and Human Services.

The HARPA proposal is based on the Defense Advanced Research Projects Agency (DARPA) for the military, The Washington Post reported. DARPA serves as the research arm of the Pentagon and collaborates with other federal agencies, the private sector and academia.

‘Troubling’ situation

The director of policy and legal advocacy for the Bazelon Center for Mental Health Law said she predicts a public outcry if this proposal actually moves forward. “It is extremely troubling that the White House is apparently exploring an effort to monitor people with psychiatric disabilities to try to identify when they might become violent,” Jennifer Mathis told MHW. “The entire premise of this effort is that having a mental health diagnosis makes a person likely to become violent, but the evidence is clear that that's false.”

Mathis added, “It is also concerning how the information gleaned from monitoring people would or could be used. This proposal has alarming Orwellian overtones. All that it would do is promote fear, prejudice and stigma and make it harder for people with psychiatric disabilities to participate as full members of our society.”

The American Psychological Association (APA) released a statement condemning the use of technology to predict who will become violent. “The idea for an agency focused on developing technology to improve health care and act as an innovation engine is a good one,” said Arthur C. Evans Jr., Ph.D., CEO of the APA. “But it is illogical to task HARPA with solving a real problem of violence by connecting it to a fallacious idea — that people with mental illness are the cause of mass shootings. Research consistently shows a weak link between mental illness and mass shootings.”

Evans pointed to a need to focus on funding more research on the causes of gun violence so that effective preventive strategies can be developed.

Joint Action Needed

“National mental health and disability groups have joined together and are planning a steady stream of joint action to counter these proposals and to fight against the level of scapegoating that is occurring at this time,” Harvey Rosenthal, CEO of the New York Association of Psychiatric Rehabilitation Services (NYAPRS), told MHW.

“These are dark times for us,” said Rosenthal. “Public fears, gun lobbying tactics and the failure of politicians to stand up to the NRA [National Rifle Association]” are fueling these proposals, he noted. “A proposal to monitor people with mental health conditions and look for neurological signs of potential violence would be ludicrous, if not outrageous,” he said.

The dark times, which include (calls for) the institutionalization of people with mental health conditions, increased coercion and (proposed) electronic marking, are reminiscent of Orwellian times, Rosenthal noted, adding that it's something right out of George Orwell's 1984, his dystopian novel about the dangers of totalitarianism, published in 1949.

Rosenthal noted that potentially some kind of smart device tactic could be implemented and used to determine if someone has the potential for violence.

If used, something like this “would amount to a gross violation of people's rights,” he said.

Rosenthal said all hands will be on deck as NYAPRS and other mental health and disability groups move forward.

So far, there has been a huge level of support and commitment from the groups, he said. One of the advocates on last week's call was previously involved in the campaign to pass the Americans with Disabilities Act. “He said this current level of resolve reminds him of the time advocates fought for the ADA,” said Rosenthal. “This is going to be a large campaign,” he said. “We're fighting for our very rights and our basic dignity.”

Debbie Plotnick, vice president for mental health and systems advocacy for Mental Health America, joined in the call with Rosenthal and the others last week. “We came together about how to re‐message and take action,” Plotnick, told MHW. “This is not just about mental illness; it's the entire disability community standing up on this,” she said, adding that they will not stand idly by to see people get “demonized” based on a health condition. “This is like science fiction,” she said. “The proposal is based on false assumptions. This goes back to old prejudices.”

Plotnick added, “A lot of mass shootings are motivated by hate, which is not a mental illness.” If people with mental health conditions were to be monitored, they would be less likely to reach out for help, she noted. “That's counterproductive,” she said.

Indicators of violence, Plotnick noted, include previous violent encounters. “Even driving under the influence is [putting] people at risk, doing violence to others,” she said. Anger and hate are emotions connected to violence, she noted. In fact, Mental Health America has recently come out with T‐shirts that proclaim, “Hate is not a mental illness,” she said.

“This is something every person should be concerned about,” she said. “They're going after the wrong people in a way that is particularly frightening.” Turning people with mental illness into targets and blaming them for cultural and societal problems is the wrong approach, Plotnick said. “Blaming people is not where real solutions lie,” she said.

=============

Sample Social Media Language:

  • Mental health disabilities are not the cause of gun violence.

  • Blaming people with mental health disabilities is a distraction; address the real problem—gun violence.

  • Institutionalization, segregation, and registration of people with mental illness are not the answers — institutionalization is harmful & will not stop gun violence https://time.com/5645747/gun-violence-mental-illness/

Scapegoating people with mental illness stigmatizes all people with disabilities.

“Whether based on ignorance, discrimination or hate, the belief that ending gun violence can occur by targeting people with mental illness is wrong...” https://thehill.com/opinion/healthcare/458017-guns-that-are-killing-us-not-mental-illness 

Mental illness and mental health disabilities are not predictors of violent act or mass shooting. “...in the real world, these persons are far more likely to be assaulted by others or shot by the police than to commit violent crime themselves.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4318286/ 

Mental illness isn’t a major risk factor for gun violence. Legislation efforts must focus on the real problem: anger, hate and access to weapons. https://nbcnews.to/33hOjL7 

Here’s what people with mental health disabilities have to say about gun violence: https://rootedinrights.org/video/people-with-mental-health-disabilities-shut-down-dangerous-ideas-about-gun-violence/ 

Social Media Posts to Share / Retweet

https://twitter.com/ACLU/status/1171915320673497088?s=19

https://www.facebook.com/18982436812/posts/10156282119876813/

https://twitter.com/ACLU/status/1171915320673497088

Increasing Surveillance of Mentally Ill People Won’t Stop Mass Shootings – Talk Poverty https://talkpoverty.org/2019/09/17/surveillance-mentally-ill-mass-shootings/ 

I have a mental illness. Don’t scapegoat, institutionalize people like me after shootings. – USA Today
https://www.usatoday.com/story/opinion/voices/2019/08/20/gun-reform-mental-illness-health-violence-column/2051696001/

White House weighs controversial plan on mental illness and mass shootings – Washington Post
https://www.washingtonpost.com/health/white-house-considers-controversial-plan-on-mental-illness-and-mass-shooting/2019/09/09/eb58b6f6-ce72-11e9-87fa-8501a456c003_story.html

Trump’s Plan to Stop Violence Via SmartphoneTracking Isn’t Just a Massive Privacy Violation – Slate
https://slate.com/technology/2019/09/trumps-harpa-smartphone-tracking-mental-illness-privacy-wont-work.html

Trump’s plan to monitor the mentally ill to curb gun violence is messy and flawed – Washington Post – Op-Ed
https://www.washingtonpost.com/opinions/trumps-plan-to-monitor-the-mentally-ill-to-curb-gun-violence-is-messy-and-flawed/2019/09/14/a942979e-d40a-11e9-86ac-0f250cc91758_story.html

Mental Illness is a distraction in conversations on gun violence advocates say – Hartford Current
http://www.courant.com/politics/hc-pol-mental-illness-gun-violence-20190902-sziituso4fh5dh5pejw6mbb7nq-story.html

Experts reject Trump’s call for mental hospitals to fight gun violence – PBS
https://www.pbs.org/newshour/nation/experts-reject-trumps-call-for-mental-hospitals-to-fight-gun-violence

Reports:

Wrong Focus: Mental Health In The Gun Safety Debate – Bazelon http://www.bazelon.org/wp-content/uploads/2019/08/Wrong-Focus-Mental-Health-in-the-Gun-Safety-Debate-2019-nh.pdf

The Relationship between the Availability of Psychiatric Hospital Beds, Murders Involving Firearms, and Incarceration Rates – Bazelon
http://www.bazelon.org/wp-content/uploads/2017/04/1.16.13-Analysis.pdf

Diane Smith Howard

Managing Attorney for Juvenile and Criminal Justice

National Disability Rights Network (NDRN)

Sen Schatz: Shame on the President of the United States for Equating MI to Dangerousness

NYAPRS Note: Yesterday, Senate Democrats took the floor to call on Senate Republicans and the Trump Administration to approve gun background checks and to decry deflection from this measure by blaming gun violence on Americans with mental health conditions.

In particular, Senator Brian Schatz of Hawaii gave the following remarks from the Senate floor:

…To make it worse in the week since the attacks in Ohio and Texas, we keep hearing from Republicans that gun violence is not caused by guns.

To quote the President directly, mental illness and hatred pulls the trigger. Not the gun. Mental illness and hatred pulls the trigger. Not the gun.

I want to spend a little time on this one because this one is really offensive and really deeply hurtful.

Setting aside the lack of progress on guns, we're also losing 10, 20, 30 years of progress that we made in destigmatizing mental health services. Now mass shooters and regular experience mental illness of the same rate.

There is no indication that mass shooters or individual people who are homicidal experience mental illness than any other part of the population. It's more insidious than that. 

About 20% of all Americans at some point need mental health services and the great difficulty in terms of of getting mental health services is not just availability of care, it's that people still feel embarrassed to say I need some help.

And shame on the President of the United States to equate someone who may need care for postpartum depression or post traumatic stress coming back from Iraq or Afghanistan or may experience a bipolar disorder or whatever it may be, a kid with autism, shame on the President of the United States to imply that people who need mental health services are somehow dangerous and they are the ones that should be cracked down on.

That is a deeply, deeply dangerous thing to say about 20% of all Americans who simply need to get better and who simply need to not be characterized as crazy or dangerous or that they should be ashamed of what they are experiencing.

Shame on the President of the United States for equating mental illness with being dangerous to society. Consider for a minute the progress that we made as a society to destigmatize mental health. We've reduced the shame around living with the challenges and more people are willing to prioritize their mental well-being.

People should not be embarrassed or scared to seek the help they need and shouldn't be blamed for the gun violence epidemic in our country...

https://www.c-span.org/video/?464372-2/senate-democrats-call-action-gun-violence-prevention-legislation&start=25755

 

NYAPRS Seeks Hudson River Training & TA Facilitator

NYAPRS Seeks Training & Technical Assistance Facilitator for the Hudson River Region

The New York Association of Psychiatric Rehabilitation Services (NYAPRS) is a nationally acclaimed behavioral health systems change agent that promotes the recovery, rehabilitation, rights and community inclusion of people with mental health condition through state and national mental health advocacy, training and technical assistance and peer service innovations.

NYAPRS seeks to fill the following position:

Hudson River Region Training & Technical Assistance Facilitator

NYAPRS currently has an opening for a Training & Technical Assistance Facilitator to develop and implement training for Hudson River regional behavioral health providers on recovery practice innovations as part of our statewide NYAPRS Training Collective for Recovery, Rehabilitation and Rights.

In this position, you will have the opportunity to act independently, develop and deliver formal trainings to the provider community, and actively engage them in learning. You will also provide technical assistance to support providers implementing practice changes.

This is a work-from-home design, with extensive travel involved, primarily throughout the Hudson River region but also includes travel outside the region.

Lived experience with a mental health condition and the mental health system and the ability to use that experience to enhance training is highly preferred.

This is an excellent opportunity for an individual who enjoys a collaborative environment and would enjoy being a member of a dedicated team that is playing a pioneering role in our state and nation.

The right candidate will have:

• A GED or High School Diploma, BA/BS preferred

• Great oral and written communication skills

• Experience delivering formal training or leading groups

• Demonstrated ability to engage others in learning and exchanging ideas

• Facility with computers and technical equipment

• A valid NYS driver's license and their own personal vehicle for traveling.

• The ability to work independently and organize their work schedule from a "home" office

We offer a highly competitive benefit package including health, dental and vision care benefits, retirement plan, flexible spending accounts, employee assistance program and paid time off and holidays.

Please submit cover letter, salary requirements and resume by October 4 to hr@nyaprs.org with subject line "Training Facilitator" or submit by regular mail to NYAPRS, 194 Washington Avenue, #400, Albany, NY 12210 ATTN: HR Manager.

NYAPRS is an equal opportunity employer.

 

See more about us at www.nyaprs.org

 

Register for Oct 15 MCTAC+ Supervision Webinar!

NYAPRS Note: Register for the next webinar in the MCTAC+ Supervision Series. NYAPRS’ own Ruth Colón-Wagner will be presenting on how to engage in difficult conversations with supervisees. She will be sharing her expertise in how to have positive outcomes when facing difficult conversations. Click the register now button below for this webinar, which takes place from noon-1pm on October 15th.

Reminder to Register: MCTAC+ Supervision Webinar Series

Supervision: Difficult Conversations

As you navigate all of your many responsibilities as a supervisor, inevitably you will encounter the need for engaging in difficult conversations regarding employee performance and taking corrective action. This webinar will review eight steps for maximizing the effectiveness of these conversations so that people feel safe and are open to change. We will introduce the Transactional Analysis of communication as an approach to support the supervisor/supervisee relationship through these difficult conversations.

Webinar participants will:

1.    Recognize the challenges inherent in the supervisor role

2.    Identify the steps necessary for successful outcomes when facing difficult conversations

3.    Describe the Transactional Analysis approach and its role in effective conversations

Date: October 15th, 2019

Time: 12:00pm-1:00pm

Presenter:  Ruth Colón-Wagner, LMSW

 

 

 

 

 

Correction: This very special screening will be show on Wednesday September 25 (the earlier message incorrectly referred to September 26). See you there!

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You are invited to attend a work-in-progress presentation! 

UNLOCKED:  Stories of Public Mental Health Care 

a video-based, online, educational resource aimed at the mental health community with special focus on people going into healthcare and working professionals 

Filmmaker Lucy Winer Will Speak And Share Video Highlights From The Project 

Our Mission

We believe that the stories of individuals with firsthand experience of our public mental healthcare system have the power to shift attitudes and inspire much needed positive change. To this end, building on the ongoing success of our documentary, Kings Park, we have created Unlocked.

Our mission is to address the gaping hole in the education of students and seasoned professionals alike who know little of the public mental hospitals’ tragic past, and the impact of that past on conditions today. Especially right now, people may conclude that the re-opening of institutions is a good solution to current problems. We disagree. The history of what went on at Kings Park, and throughout our state hospital system, cannot be forgotten. 

Through this interactive video website, vivid and deeply personal stories are shared that have not been seen before. People of lived experience, peers, family members, direct care staff, clinicians, administrators, inmates, law enforcement and corrections personnel share markedly different realities. Seen together, these varied points of view provide an overview that supports better understanding and open dialogue.

To realize this ambitious project, filmmaker Lucy Winer has teamed up with author and historian Nancy Tomes, PhD. They are joined by four early partners: University of Pennsylvania School of Nursing, Columbia University Psychiatric Residency Program, CSPNJ (Collaborative Support Programs of New Jersey) and Stony Brook University Dept. of History.

 

JOIN US TO EXPERIENCE IN-PERSON PHASE ONE OF UNLOCKED!

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