Colorado experts discuss how BHA is leading a community-informed approach to behavioral healthcare
Since the formal creation of the Behavioral Health Administration (BHA) in May, Colorado has been innovating the delivery of behavioral healthcare to better address the needs of its citizens.
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Speaking on a panel at the 2022 Colorado State of Reform Health Policy Conference, BHA’s Deputy Commissioner of Operations Summer Gathercole outlined the administration’s new networked approach to governance, which strategically coordinates with 13 state agencies to reform the system.
“What’s different is that because for the first time ever, we are sharing things [with other agencies] like, ‘What’s your budget for behavioral health?’” Gathercole said. “How can we plan and break those dollars? How can we be more intentional about legislation or working in and on behavioral health? How can we be more strategic and really have some open dialogue and conversation?
In fact, we have established an interagency council that meets once a month with all of those agencies from the executive branch … We’re getting into the hot topics, and [have] started talking about, ‘What are the challenges that we’re facing and how can we work together to address those challenges?’”
Last year, the state’s Behavioral Health Taskforce brought together partners and disenfranchised community members to develop a community-informed behavioral health care coordination strategy.
The Taskforce’s Planning and Advisory Council was established to lead the conversations around system reform and health equity, which has been an administrative focus in BHA’s engagement with providers.
“We have a group of 20 people with lived experience who are really opening up, sharing their trauma with the systems that they have experienced in helping us figure out [how to reform] the behavioral health system,” Summercole said of the council. “What do we need to do better, to do differently, to address the griefs in our systems and make sure that they’re able to get help to all people across Colorado needed regardless of what their situation is, where they live, and what they do to be able get quality services?”
Another member of the panel, Kiara Kuenzler, CEO of Jefferson Center for Mental Health, highlighted one of her organization’s community-informed practices, Porchlight Family Justice Center (FJC). FJC is a care program working with community partners that assists people experiencing domestic violence and other victims of interpersonal violence.
Kuenzler spoke to the timeliness of the BHA’s work in addressing the behavioral health challenges that have emerged from COVID-19.
“There’s certainly been no bigger challenge, no bigger demand to evolve, than what we’ve seen during the pandemic, what we’ve seen with the rise in mental health leads, the rise in addictions and overdose deaths, and the workforce crisis that we’re facing in behavioral health as well.”
Traditionally licensed professional counselors, social workers, psychologists, and medical professionals make up the care delivery team at Jefferson Center. Kuenzler said the evolving needs of its community members have forced FJC to rethink who delivers care.
Taking this into account, the Jefferson Center added care managers to each of its response teams to perform outreach and wraparound services for clients and their families, which are critical to stability and outcomes, according to Kuenzler.
The Jefferson Center has also moved away from its traditional “one hour every other week” therapy session model to be more responsive and available to people when and how they need care.
“We’re really rethinking how we deliver care,” Kuenzler said. “And some of the ways that we’re doing that includes pulling together care teams in realtime care clinics, so that people can come to our office and see a care provider, a licensed clinician, a medical professional nurse, a care specialist, and resource specialist all in the same space depending on who they need at that time. They can drop in and receive [care in] realtime. So that’s one example of thinking outside the box about how we’re delivering care.”
The Jefferson Center established a community engagement team that provides resources and training on mental health first aid and suicide prevention to family members, teachers, and friends of at-risk individuals.
Kuenzler said the center is doing more to engage directly within the community through telehealth kiosks in places like resource centers, schools, libraries, aid organizations, and homeless shelters.
Melanie Rylander, MD, Behavioral Health Medical Director for the Colorado Community Health Alliance (CCHA) and another speaker on the panel, discussed how CCHA developed a mobile app to address the increasing issue of isolation and loneliness for its members. The technology platform keeps them virtually connected to care staff and resources for both behavioral health and social support.
CCHA is the first Medicaid managed care plan in the state to incorporate such a tool in its care delivery and has registered 350 members on the app since May of this year. The preliminary data from the program show that 55% of users screened as lonely, with the loneliest age group being those 55 years and older. Between the preliminary assessment and post-engagement follow-up, CCHA saw a 21% reduction in loneliness scores with 85% of those who experienced improvement expressing the importance of having human contact. Over 80% of users reported satisfaction with using the app and felt more connected as a result.
“People oftentimes are not coming to us with traditional medical problems,” Rylander said. “They’re coming to us with dissatisfaction in life. And that may or may not be because of medical problems. But historically we have tried to use medical solutions to solve these problems and the outcomes have been less than equitable.”
Providers on the panel pointed to the importance of adopting reforms that promote utilization of flexible payment models and expand coverage for behavioral health services and programs not billable through traditional fee-for-service systems.
BHA has been actively engaged with community members and stakeholders in developing its Behavioral Health Administration Service Organizations (BHASO), which will consolidate substance use disorder treatment, crisis management, and mental health services under the administration’s statewide regional entities.
Scheduled to roll out in summer 2024, BHASOs will provide a continuum of behavioral health safety net services and care coordination for Medicaid members.
“We’re getting to roll out close to $150 million in grants that communities can use to adjust the gaps to help support the crisis system, to put those services in place so that people have access to after-services sooner before they have to go to the hospital or have interactions that involve the criminal justice system,” Gathercole said. “And there’s an opportunity there to really make sure that we are addressing the middle … that we are figuring out what works for the different communities across the state.”