The College for Behavioral Health Leadership

Where behavioral health leaders collaborate to grow and transform communities across the nation.

Journal Articles & Commentaries

Equity as a Foundation for Leadership: Experiences and Recommendations for Behavioral Health Leaders

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The Central East Addiction Technology Transfer Center (CE-ATTC), funded by the Substance Abuse and Mental Health Services Administration (SAMHSA) and operated by The Danya Institute, partnered with The College for Behavioral Health Leadership (CBHL) to develop a report describing and defining Equity Grounded Leadership for use by behavioral health leaders in Health and Human Services Region 3 states. This report builds on the Institute’s ongoing efforts to improve diversity, increase cultural competency, and address population-specific needs of people receiving and delivering behavioral health services in Region 3.

While developed based on the experiences of Region 3 leaders, the recommendations are applicable to leaders across the country.

CBHL partnered with Just Health Collective and the Prevention Institute to develop this report. The purpose is to define and describe equity-grounded leadership, incorporating the experiences and perspectives of Region 3 behavioral health leaders via a survey, key informant interviews, and focus groups; make the case for the importance of focusing on equity as an foundational element of leadership; and offer recommendations for local, state, and national leaders and policy makers.

This publication was prepared for the Central East Addiction Technology Transfer Center (CE-ATTC) under a cooperative agreement from the Substance Abuse and Mental Health Services Administration (SAMHSA). All material appearing in this publication, except that taken directly from copyrighted sources, is in the public domain and may be reproduced or copied without permission from SAMHSA or the authors. Citation of the source is appreciated. Do not reproduce or distribute this publication for a fee without specific, written authorization from the CE-ATTC. At the time of this publication, Miriam E. Delphin-Rittmon, PhD, served as Assistant Secretary of Mental Health Services and Substance Use and the Administrator of SAMHSA. The opinions expressed herein are the view of CE-ATTC and the authors and do not reflect the official position of the Department of Health and Human Services (HHS), SAMHSA. No official support or endorsement of HHS, SAMHSA for the opinions described in this document is intended or should be inferred.

How Communities Must Use 988 to Improve Care and Correct Crisis System Disparities

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As communities are preparing for the 988 launch nationwide, work is prioritized at the local and state levels for the effective coordination of crisis response services. In partnership with national experts in behavioral health, each Think Bigger Do Good paper is focused on the challenge, and provides clear, actionable solutions to our audience. This paper offers resources and serves as a tool for communities to use in developing and enhancing call centers, mobile teams, and crisis care facilities to create better outcomes for people in crises.

A Consensus Approach and Recommendations for the Creation of a Comprehensive Crisis Response System

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A Consensus Approach and Recommendations for the Creation of a Comprehensive Crisis Response System is a comprehensive toolkit offering policymakers a detailed roadmap for implementing a full continuum of mental health and substance use care in conjunction with the federally mandated #988 hotline that goes live on July 16, 2022 in all 50 states.

A key theme is that the deployment of a national mental health crisis line presents a tremendous opportunity for building-out a full-continuum of mental health and substance use care. As leaders in mental health care, we can influence the outcomes by urging that stimulus funding be properly and strategically invested to address the surging demand for mental health services.

Cross-Agency Partnerships for Health Equity: Understanding Opportunities Across Medicaid and Public Health Agencies

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Across the nation, communities of color have experienced enduring health disparities due to systemic racism, which have been exacerbated by disproportionate physical, social, and economic impacts from the COVID-19 pandemic.

State Medicaid and public health programs — working within their own agencies and collaboratively — have great potential to advance health equity for the communities they serve, especially for people of color. Given Medicaid’s role in delivering care to individuals with low incomes, including many from communities of color, the program is uniquely situated to address health disparities.2 Public health agencies are responsible for improving population health for their communities, with a particular focus on addressing social determinants of health and advancing equity.

With support from the Robert Wood Johnson Foundation, the Center for Health Care Strategies (CHCS) and the Association of State and Territorial Health Officials (ASTHO) led a national scan to identify health equity priorities that state agencies can advance in the next two years — especially those shared across agencies. The exploration also sought opportunities to center community voices as part of these efforts. Activities included a literature review and more than 20 interviews with representatives from
state Medicaid agencies, public health departments, Offices of Health Equity, member advocacy groups, community-based organizations, and health equity experts. Drawing from this national analysis, this brief summarizes opportunities to advance health equity in three areas:

  1. Advancing internal-facing health equity work;
  2. Leveraging data to drive health equity efforts; and
  3. Engaging community members authentically

Trauma and Suicide Prevention During Catastrophic Events

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New online modules focus on an equitable approach and rapid strategy development

Suicide is preventable. Unfortunately, over the past 16 months, younger adults, people of color, essential workers, and unpaid caregivers have reported increased thoughts of suicide. Emerging data shows a spike in suicide rates among Black Americans in certain locales and increased emergency department visits for suspected suicide attempts among young people. These and other populations are of growing concern as communities identify those at elevated risk of suicide and endeavor to counteract social isolation, financial stress, racism, and community trauma.

To support communities in planning a comprehensive, multi-sector response to these crises, Prevention Institute partnered with the Center for Law and Social Policy (CLASP) to develop a prevention toolkit.

The toolkit shares strategies for preventing suicide and trauma during catastrophic events like the COVID-19 pandemic, hurricanes, storms, or other disasters. It also includes online-learning modules; suicide-prevention planning interviews with agency leaders in Colorado and Santa Clara County, CA; a new social media video about Building Healing Communities; and an activity booklet that brings together concepts from Modules 1 through 4. 

The newest modules support communities to

  • Understand recent national trends and use interactive tools to identify local communities at elevated risk for suicide.
  • Explore promising interventions addressing the unique needs of communities at high-risk.
  • Understand how the CDC’s technical package and other tools and frameworks can support suicide-prevention efforts.
  • Rapidly assess local fit and feasibility of best available evidence from CDC’s technical package during catastrophic events and beyond.

The toolkit also includes multimedia resources on social connection and trauma-informed systems.

On social connection
 
Rates of social isolation are soaring around the world, with profound impacts on health and wellbeing. As the world heals, how can we weave stronger connections among families, neighborhoods, and communities? We need community-led solutions focused on local talents and assets and rooted in community cultures and values. PI’s most recent short video, based on Healthy Places by Design’s Socially Connected Communities: Solutions for Social Isolation, shows how communities can improve social connection.

Watch the video and share it with your networks and on Facebook, Twitter, Instagram, and LinkedIn. If you want to talk health, you have to talk connection.

For more on the link between social connection and preventing suicide and Adverse Childhood Experiences, including examples of how organizations have fostered connection during the pandemic, check out Strengthening social connections to prevent suicide and adverse childhood experiences (ACEs): Actions and opportunities during the COVID-19 pandemic.

On systems change
 
By integrating trauma-informed practices to change public systems, local government agencies are addressing the needs of the community and essential workers in ways that can last beyond the pandemic. Check out PI’s latest brief, Prioritizing equity and community wellbeing in the wake of catastrophic events, to read about examples in Baltimore, Tarpon Springs, Houston, and San Francisco. 

Prevention Institute’s multimedia resources focus on preventing trauma and suicide during catastrophic events, and include webinar recordings and other materials on supporting youth, addressing social isolation, advancing healing-centered systems, and prioritizing equity in COVID-19 recovery.

This work is funded by the Centers for Disease Control and Prevention. The toolkit is supported by Cooperative Agreement No. 6 NU38OT000305-02-03 from the Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Department of Health and Human Services, or the CDC.

*Photo credit CC by sdttds

National Guidelines for Behavioral Health Crisis Care – A Best Practice Toolkit

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The National Guidelines for Crisis Care – A Best Practice Toolkit advances national guidelines in
crisis care within a toolkit that supports program design, development, implementation and
continuous quality improvement efforts. It is intended to help mental health authorities, agency
administrators, service providers, state and local leaders think through and develop the structure
of crisis systems that meet community needs. This toolkit includes distinct sections for:

  • Defining national guidelines in crisis care;
  • Tips for implementing care that aligns with national guidelines; and
  • Tools to evaluate alignment of systems to national guidelines.

In preparing this information, we could think of no one better to advise you than people who
have worked successfully with crisis systems of care. Therefore, we based the information in this
toolkit on the experience of veteran crisis system leaders and administrators as well as the
individuals and families who have relied on these supports on their worst days. The interviews in
this report’s addendum showcase the diversity and richness of this expertise and experience.

Roadmap to the Ideal Crisis System

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There is broad recognition that behavioral health crises have reached epidemic proportion, with drug overdoses and suicides having overtaken traffic accidents as the two leading causes of death among young Americans ages 25-44. The COVID-19 pandemic has further underscored the dramatic need for behavioral health services, including crisis services. Yet very few communities in the United States have a behavioral health crisis system that would be considered excellent, let alone ideal.

In most American communities today, the behavioral health crisis system isn’t really a system at all, but a combination of services provided by law enforcement and hospital emergency rooms that are typically not designed to meet the needs of individuals in the midst of behavioral health crises. Often the only treatment options for individuals in behavioral health crises are in settings that do not adequately meet their needs despite being extremely costly, such as emergency rooms and inpatient psychiatric units. Further, lack of appropriate and accessible behavioral health crisis response too frequently results in law enforcement being the only available first responders, which may lead to an increase in unnecessary arrest and incarceration for people with acute behavioral health needs.

Thankfully, this situation is changing, as there is growing recognition that behavioral crisis needs special attention to ensure appropriate response for everyone, on par with that provided for medical crises, disaster response, fire response and public safety. Table 1 lists a series of reports over the past decade that describe various components of state-of-the art behavioral health crisis services. Among the most recent is a toolkit from the Substance Abuse and Mental Health Services Administration (SAMHSA) that proposes national guidelines for crisis services (SAMHSA, 2020). Another important driver has emerged from work on reducing inappropriate criminal justice involvement, recognizing the need for focus on “Intercept 0” (an effective community crisis system) in the Sequential Intercept Mapping process (Bonfine, 2019) so that law enforcement involvement in behavioral health crises is minimized. Even more important, federal legislation (National Suicide Prevention Hotline Improvement Act) has led to the initiation of implementation of a national suicide prevention and behavioral health crisis line number – 988 – that is intended to go live nationally by 2022. This major initiative provides an opportunity for the creation of high-quality community crisis response systems that approximate the level of response that we have grown to expect from medical, fire and public safety emergency response since the implementation of 911 several decades ago. For communities to respond to the need for effective behavioral health crisis response and to implement successful 988 response systems, significant guidance will be needed. Existing reports, such as the SAMHSA guidelines, provide helpful direction for making progress but do not address all the essential elements of a behavioral health crisis system or measurable standards and implementational strategies for communities. Consequently, communities (as well as counties and states) have inadequate guidance regarding the development, implementation and maintenance of behavioral health crisis systems that effectively meet their specific population needs.

The purpose of this report is to fill that gap. This report provides a detailed guide for communities to use to create a vision and direction for their behavioral health crisis systems, to evaluate their current behavioral health crisis capacities and to operationalize a strategy for implementing structures, services and processes that move toward an ideal crisis system.

Medicaid Forward: Behavioral Health

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The COVID-19 public health emergency, its economic fallout, and longstanding racial and ethnic inequities are affecting the nation’s mental health and wellbeing. These crises are also destabilizing the behavioral health care system, making it more difficult to meet the increased behavioral health needs of the population. Medicaid and CHIP, as the insurance provider for more than 77 million individuals, including many with complex physical and behavioral health needs, will play a vital role in supporting the recovery of our nation.2 This framework, crafted by an Executive Working Group of Medicaid leaders and national behavioral health experts convened by the National Association of Medicaid Directors, offers states options to consider to promote the health and wellbeing of members and expand access to behavioral health services. It includes strategies along a continuum of need, ranging from upstream prevention and health promotion for all Medicaid beneficiaries to increasing access to behavioral health treatment for unique subpopulations in Medicaid.

E-Book: Partnering with Communities to Improve Health Outcomes

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Beginning September 24, 2020, The College for Behavioral Health Leadership hosted a virtual “Un-Summit” where we examined partnerships whose collaboration resulted in real outcomes as we learned from community initiatives across the country.  Featured partnerships demonstrated improvements in community relationships resulting in measurable impacts to community health, for different populations, using different approaches to multi-sector collaboration.   During the 2020 Un-Summit, we aimed to provide a space to listen and learn from working occurring in communities around the country.

By sharing the case studies and key take-aways from the resulting dialogues, we hope to support a national dialogue where we listen, connect, mobilize groups and work together to improve health and well being in our communities.

This E-book summarizes what we have learned and provides information on and links to the tools used by teams in each community. Join us for an ongoing dialogue on community practice. Dialogue is ultimately the only way for collective actions to be successful. These are the practices we must share with each other as we build a culture of health improvement.

A Unified Vision for Transforming Mental Health and Substance Use Care

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A Unified Vision for Transforming Mental Health and Substance Use Care  calls for policy, programs and standards that prioritize mental health care and address the social and economic conditions – including racism and discrimination – that disproportionately impact people of color and people whose incomes are below the federal poverty threshold, and result in inadequate and inequitable access to effective, humane treatment.

“The importance of aligning agendas and working together across sectors cannot be understated if we are to make real changes to our mental health and substance use care system. The systemic transformation we are embarking on will take a new kind of leader – prepared to innovate, transform and lead us into the future.  CBHL is pleased to support the Unified Vision and stand ready to take the important steps in actualizing it.” – Holly Salazar, CEO, The College for Behavioral Health leadership

A collaboration of mental health and substance use disorder organizations – the American Psychiatric Association, the American Psychological  Association, the Massachusetts Association for Mental Health, Meadows Mental Health Policy Institute, Mental Health America, the National Association for Behavioral Healthcare, the National Alliance on Mental Illness, the National Council for Behavioral Health, One Mind, Peg’s Foundation, the Steinberg Institute, The Kennedy Forum, the Treatment Advocacy Center and Well Being Trust – developed the roadmap as a response to the pandemic, which has greatly exacerbated the fault lines in an already fractured mental health system and heightened mental health issues across our nation – including anxiety, depression, isolation, addiction, domestic abuse, and suicide.

Just as the public health care system was unprepared for a pandemic, an unprecedented mental health crisis afflicting half of all Americans has overwhelmed the mental health care system. Since the onset of the pandemic, prevalence of depression symptoms have jumped three-fold, overdose deaths have increased in 40 states, and the CDC reports that 25 percent of young adults struggle with suicidal ideation.

The strategic plan offers tried-and-tested “pathways for success” across seven critical policy areas identified as:

  1. Early identification and prevention, especially for families and young people;
  2. Rapid deployment of emergency crisis response and suicide prevention;
  3. Leveling inequities in access to care;
  4. Establishing integrated health and mental health care to ensure “whole-person” well-being;
  5. Achieving parity in payment by health plans for mental health and substance-use coverage;
  6. Assuring evidence-based standards of treatments and care; and,
  7. Engaging a diverse mental health care workforce, peer support and community-based programs.

Included in the vision is a detailed proposal for how the new Administration, Congress, Governors and state and local lawmakers must work in tandem with the business community and the non-profit sector to promote systemic changes in the mental health care system.

Among the seven suggestions are a number of ideas that can be implemented quickly, such as, embracing telehealth, and implementing strategic shifts to early intervention that can help provide relief by bringing telehealth outside of a clinical setting – and into schools, community centers, prisons; fast-tracking new emergency response systems, such as the new “988” National Suicide Prevention Lifeline, for immediate access on mobile carriers; and, engaging a diverse mental health care workforce, providing additional support means by expanding access to peer support groups and community based programs.

Peer-run Organizations and Criminal Justice Involvement

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We are excited to release our new document Reentry and Renewal: A review of peer-run organizations that serve individuals with behavioral health conditions and criminal justice involvement.  Based on responses to a recent national survey, Reentry and Renewal highlights a dozen exemplary peer-run programs that serve individuals with both behavioral health conditions and criminal justice backgrounds.

Reentry and Renewal not only provides recommendations for peer-run programs to improve upon effective supports for individuals with behavioral health conditions, but also spotlights needed policy change and the importance of expanded funding and research.

The document is a joint project of The College for Behavioral Health Leadership’s Peer Leader Interest Group, the National Mental Health Consumers’ Self-Help Clearinghouse, Mental Health America, and the Temple University Collaborative on Community Inclusion.

For more information on the survey or related training and technical assistance opportunities, contact the Temple University Collaborative at TUCollab@temple.edu

A webinar on Peer-run Organizations That Serve Individuals with Behavioral Health Conditions and Criminal Justice Involvement will be hosted by the National Mental Health Consumers’ Self-Help Clearinghouse and the Temple University Collaborative on Community Inclusion on January 19, 2017, at 2:00 p.m. EST.

Presenters will be Rita Cronise of the International Association of Peer Supporters, Ellen Healion of Hands Across Long Island, and Steve Miccio of PEOPLe, Inc. Harvey Rosenthal, executive director of the New York Association of Psychiatric Rehabilitation Services, will moderate. The 90-minute webinar grew out of a survey of peer-run programs serving people with behavioral health conditions and criminal justice involvement by The College for Behavioral Health Leadership’s Peer Leader Interest Group, Mental Health America, the Clearinghouse, and the TU Collaborative.

National Survey of Compensation Among Peer Support Specialists

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The peer support specialist workforce has been growing and expanding since Medicaid established funding for these services in 2007. Absent from much of the research on the peer support specialist workforce has been a detailed national review of wages and compensation. The genesis for this study began at The College for Behavioral Health Leadership during an annual summit, with the recognition that leaders in the peer support services field did not have any reasonable benchmarks for compensation standards.

In order to address the focus of this study two surveys were constructed. One was designed for peer support specialists to report their current compensation (N = 1,608). A second survey was developed as a comparison for organizations who employ peer specialists (N = 271). Non-probability sampling methods were used and three leading consumer organizations (Depression and Bipolar Support Alliance, International Association of Peer Supporters, and New York Association of Psychiatric Rehabilitation Services) promoted and disseminate the surveys.

The findings of this study illustrate that there is diversity among the current national structure for the wages of peer specialists. This includes significant differences in average compensation rates between those who work all different hours ($15.42) and only full-time ($16.36). There are also different wage rates among the types of organizations (consumer and peer run organizations, community behavioral health organizations, health care provider organizations, inpatient psychiatric facilities, and health plan and managed care organizations) that employ this workforce. An analysis of the wages of peer specialists in the 10 US Department of Health and Human Services regions also demonstrates geographic differences in compensation rates and compares regional and national averages. Inequities in compensation rates are also noted between male and female peer specialists, with men receiving on average in excess of $2.00 more per hour than women. The implications for the findings of this study are discussed and include the need for greater attention and focus on the wages of the peer specialist workforce.

Peer Services Toolkit: A Guide to Advancing and Implementing Peer-run Behavioral Health Services

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In 2012, members and supporters of ACMHA: The College for Behavioral Health Leadership who shared a lived experience of recovery from mental health and substance use related conditions came together to form the ACMHA Peer Leaders Interest Group (PLIG). Building on ACMHA’s mission, the PLIG has sought to provide the peer recovery community with a “premier forum for the development of leaders and the exchange of innovations that impact the health and wellness of communities and people with mental health and substance use conditions.”

In late 2013, ACMHA and the PLIG were funded by Optum to explore an issue of primary concern to both: the unprecedented opportunities and challenges that peer-run services currently face during the implementation of national healthcare reform. As a result, representatives from over 20 nationally recognized peer mental health and addiction service agencies were able to participate in a March 25, 2014 ACMHA Peer Leaders Seminar that preceded the 2014 Annual ACMHA Summit in Santa Fe, New Mexico. During the day-long program, they shared common concerns that have helped to inform this ACMHA Peer Services Tool Kit, which is aimed at 1) supporting efforts to advocate and expand the capacity, capability and scope of peer services while 2) providing valuable background information for federal, state and local governments and for new payers.

Mental Health Parity and Addiction Equity Act

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The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is a federal law that generally prevents group health plans and health insurance issuers that provide mental health or substance use disorder (MH/SUD) benefits from imposing less favorable benefit limitations on those benefits than on medical/surgical benefits. MHPAEA originally applied to group health plans and group health insurance coverage and was amended by the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the “Affordable Care Act”) to also apply to individual health insurance coverage. HHS has jurisdiction over public sector group health plans (referred to as “non-federal governmental plans”), while the Departments of Labor and the Treasury have jurisdiction over private group health plans.

Mental health and addiction workforce development: Federal leadership is needed to address the growing crisis

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In a commentary for Health Affairs, Michael Hoge and coauthors summarize the substantial and growing body of evidence that the current mental health and substance abuse workforce is seriously inadequate with regard to number of practitioners, lack of diversity in its composition and overall preparation. The authors recognize that, with a growing number of older and ethnically diverse Americans who are at high risk for behavioral health disorders, combined with the sheer influx of newly insured, the system is at a point of crisis. They call on the Federal government to scale up and actually implement already identified “broad strategies and specific actions necessary” to grow and strengthen the mental health and substance abuse workforce to meet the challenges it faces now and in the future.