Webinar: Discharge Planning, Aftercare, and Recovery Supports

This webinar will support providers to be able to describe key elements of continuing recovery planning, contextualize the role of Recovery Coaches in discharge planning and aftercare services, identify trauma-informed discharge practices and aftercare services for individuals living with behavioral health disorders, survivors of domestic violence and other trauma, and introduce the evidence-supported intervention Recovery Management Checkups (RMC) as a core component of aftercare services. more

Register Here for Discharge Planning, Aftercare, and Recovery Supports

When:Thursday, January 16, 2020
10:00 AM – 12:00 PM
Where:United States
Presenter:Gabriela Zapata-Alma LCSW CADC
Contact:Marc Weeks
(850) 878-2196

Organizational Member Showcase: The Bougainvilla House

By Cici Kelly, CEO, The Bougainvilla House

When another healthcare organization, or another member, thinks of The Bougainvilla House what do you want them to visualize?

The Bougainvilla House is not your typical outpatient facility. When people come for a tour or for the first time they always say “wow this is not what I was expecting.” I always hesitate before saying “what were you expecting?” Our property is 5 houses that we have converted into administrative and clinical space. We are nestled in a neighborhood surrounded by lush landscaping. People are not aware that we are a therapy center; they think someone lives here, which we love. We decorate the property for every major holiday and it makes it feel very homey.
We want our clients to feel like they are at home when they come to see us. We deal with the most vulnerable population – our children and teens – and I believe that when kids feel relaxed and safe, they are more apt to open up and talk about things that are bothering them. We pride ourselves on doing right by the community. Our goal is not to be a fit for everyone but to focus on our niche areas and provide quality of care for those we do serve.

How has growth affected The Bougainvilla House over the years?

As a center that works with the adolescent and teen population, our growth has been slow and steady. It’s sad to say but until the shooting at Stoneman Douglas, parents really didn’t want to acknowledge that their child might be struggling with a mental health issue. Unfortunately the stigma that surrounds mental health and substance use is still very alive today. Over the past 3 years we have spent a great deal of time in schools educating students, teachers, parents and staff on issues in our community around mental health and substance use disorders. In Broward County, 1 in 5 children and adolescents have a diagnosable mental, emotional, or behavioral problem. Our mission is to try to reach and help educate as many people in our community as we can. By going into the school we reach a lot of kids at one time who then have at least a little knowledge and at least know where to go if they or someone they know needs help. We always post a slide with the phone numbers of all the relevant hotlines and tell the kids to take out their phones and take a picture of it so they have it with them at all times.

Are there any recent new programs or new innovative services you would like to highlight?

We are strictly an outpatient facility. We do not want to be everything for everybody. We want to focus on what we do best which is adolescents and teens. We have intensive outpatient services for substance use and outpatient services for mental health. We are the only facility in Broward County that offers intensive outpatient groups for substance use that also offers individual and family therapy as part of their program. We have created a beautiful sensory room in one of our clinical buildings. The kids love to do sessions in this room. They love the bubble tubes and the shooting starts that go across the ceiling and walls. If a family session gets heated we try to move the session to the sensory room to help calm everyone down. One of our therapists just received her certification in EMDR therapy as we are seeing a rise in kids with trauma related issues.

What is the most common challenge you find when speaking with executives at other community-based behavioral health care organizations?

The most common denominator among organizations is battling with insurance companies for approval of services. It is very scary to me that my team is forced to speak with peer review people at the carriers who have spent a total of 2 minutes hearing about my client and that person is going to determine if my client is allowed services. As an organization we need to do more about stopping this type of behavior. I attend a lot of events in our community and I am usually the only CEO who is at the event. Most companies send their outreach people but as a CEO, I think it is really important to be out in the community speaking with the people we serve and hearing their comments about needs and services available. It helps me to look at my organization and see if I am doing all I can for the population I serve.

How does your organization define successful outcomes?

Like all agencies, Bougainvilla House responds and tracks outcomes required by accrediting agencies. However, I believe that kids leaving our program with their goals accomplished and their self-esteem restored are really the testament of our outcomes. Families who refer us to their friends for services speak volumes of the work we do. We have a hard time getting our clients to want to discharge which is funny in that most come in kicking and screaming that they are fine and don’t need to see a therapist. We focus on teaching our clients the coping skills and applying the skills that are taught in their everyday life. I always get a kick out of watching a client use the skills we teach in a family session and rendering their parent speechless. That indicates what we do here works!

Are there any awards or recognitions received by Bougainvilla House that you would like to share with readers?

Awards no, but plenty of thank you letters from schools and certificates recognizing us for helping to educate them on mental health and substance use. We also have placques from the local teams we sponsor for soccer and baseball.

What else is important to know about Bougainvilla House?

We want everyone to know that if they don’t know where to turn for help we would love for them to call us and we will do everything we can to assist them in finding someone or someplace that can help.

Kimberly McGrath, of Citrus Health Network, Heals Trafficked Children

By Tina Rosenberg, New York Times

Kimberly McGrath at Citrus Health Network. Photo: Maria Alejandra Cardona for The New York Times

“Now we know they really are just extremely traumatized youth.”

What happens to a child who is exploited commercially for sex?

Kimberly McGrath is changing the answer to that question. Historically, trafficked children have been arrested for solicitation and sent to juvenile court.

Today, all children sold for sex are, by definition, trafficked. Yet some are still arrested. Most are sent to group homes. “The core understanding was that these were defiant, rebellious youth who would rebel in a family,” Dr. McGrath said.

In 2013, Florida officials asked Dr. McGrath, who coordinates foster care services at the Citrus Health Network in South Florida, to come up with a different response. She started from the premise that these children were not defiant criminals. A vast majority had been abused, which made them more susceptible to the manipulations of traffickers. And they had never gotten help to recover from that abuse.

Dr. McGrath and her colleagues looked at what had worked for other traumatized children and adapted it to trafficked children. They educated not just therapists and social workers, but also foster parents.

It has been difficult to recruit foster families, but Dr. McGrath’s program has done it — finding courageous and dedicated families who receive special training and help from psychologists and social workers. This therapeutic foster care costs less than group homes, and the children do better in every way. “When foster parents are equipped and prepared to deal with their special needs, children thrive in family-based environments,” she said. “They really are just traumatized kids.”

A Community of Practice on Smoking Cessation in St. Augustine

By Melissa Knabe, Associate Director FSU-AHEC

The Area Health Education Center (AHEC) Program at Florida State University College of Medicine (FSU COM) (a part of Tobacco Free Florida) in collaboration with the National Council for Behavioral Health and Smoking Cessation Leadership Center is convening a Community of Practice to assist behavioral health organizations to adopt tobacco-free policies and incorporate treatment for tobacco use disorder along with other behavioral health services. 

Communities of practice provide continuous learning by fostering the development of newer or deeper levels of knowledge that result from regular interaction and activities with particpants who share a common interest. Members learn from their participation in the activities and discussions and are encouraged to apply their new knowledge to their own work and drive more impact.

The Community of Practice will consist of a 1.5 day in-person orientation and action plan development meeting to be held January 23-24, 2020 at the oceanfront Embassy Suites in beautiful St. Augustine Beach. Participants will have access to experts in tobacco control for behavioral health populations, such as Taslim van Hattum from National Council for Behavioral Health and Christine Cheng from Smoking Cessation Leadership Center. Additionally, they will have an opportunity to develop and refine organizational action plans for tracking and monitoring goals. After the initial meeting, participants will engage in three follow-up calls where guidance and technical assistance will be provided.

Participation is limited to 8-10 mental health and/or addictions treatment programs, with only a few slots remaining. FSU will cover travel expenses (registration, transportation, hotel, breakfast and lunch) for two participants per organization to attend the launch meeting in January. If your organization is interested in participating please contact Melissa Knabe at melissa.knabe@med.fsu.edu. Come brainstorm with us at the beach!

FCC advances plans for 988, a national suicide-prevention hotline

By Taylor Telford, The Washington Post, December 13

The Federal Communications Commission is moving forward with plans to make 988 the nation’s suicide prevention hotline in the face of a mental health pandemic that claims more than 130 Americans each day.

The agency says three digits will be simpler to remember in times of crisis, as 988 echoes the national 911 emergency hotline. “We believe that this three-digit number dedicated for this purpose will help ease access to crisis services, it will reduce the stigma surrounding suicide and mental health conditions, and ultimately it will save lives,” FCC Chairman Ajit Pai said Thursday during the commission’s open December meeting.

The proposal is now open for public comment before the agency begins the rulemaking process. Currently, the proposal calls for carriers to implement 988 within 18 months. The decision comes as the United States grapples with a spike in suicides, even as rates are on the decline in other parts of the world. The suicide rate hasn’t been this high since World War II, according to the National Center for Health Statistics.

From 1999 to 2017, the U.S. suicide rate rose 33 percent, and the jump has sharpened since 2006. It is the fourth leading cause of death for people ages 35 to 54, according to the American Psychological Association, and the 10th leading cause of death overall. In 2018, the national suicide rate was 13.9 per 100,000 people, according to the United Health Foundation. And 2019 is on track to surpass it.

The trend line is even more dire among certain populations: Among Native Americans, rates have skyrocketed 139 percent for women and 71 percent for men since 1999, the federal Centers for Disease Control and Prevention reported in June. Experts think this is tied to Native Americans’ higher rates of poverty, substance abuse, unemployment and post-traumatic stress disorder, as well as geographical challenges that keep them sequestered from mental health resources.

Other at-risk groups include veterans and LGBTQ youth, who experience far higher suicide rates than the rest of the population, commissioners noted at Thursday’s meeting. More than 20 veterans commit suicide each day, and more than 500,000 LGBTQ youth attempt to kill themselves annually. In 2018, more first responders died by suicide than in the line of duty.

“Those facts are not easy to hear,” Commissioner Jessica Rosenworcel said Thursday. “Because for those of us who have lost family or friends they loved — myself included — they are cruel reminders of birthdays missed, holidays gone and words of encouragement that were never received.”

Suicides also have swelled in farming communities, which have been rocked by disastrous weather that is ruining crops, a protracted trade war that’s erasing profits, and towering farm bankruptcies and loan delinquencies. One 2017 study found that farm owners and workers were three to five times as likely to kill themselves on the job compared with other occupations.

The data speaks to the correlation between declining economic and social well-being and high suicide rates among America’s white working class. Research from Princeton University economists Anne Case and Angus Deaton found that overall deaths from suicide, drugs and alcohol, or “deaths of despair,” have risen steeply since 2000, especially for middle-aged white Americans without college or high school educations. The rise in these deaths has contributed to a drop-off in American life expectancy, which has fallen each of the past three years.

“Feelings of isolation and crisis — those are not experiences that happen to ‘them’ or ‘others.’ What we’re talking about is what our parents feel, our kids feel, what we feel,” Commissioner Brendan Carr said at the meeting. “Anything we can do to break down barriers, to make it easier for conversations about mental health and counseling to feel within reach, is something we should do.”

The push for a 988 line began in August 2018, when Congress and President Trump signed the National Suicide Hotline Improvement Act, which ordered a study of the efficacy of a three-digit hotline and a review of the existing National Suicide Prevention Lifeline (1-800-273-TALK). According to the FCC’s report, the lifeline responded to more than 2.2 million calls in 2018, with an average of 183,790 calls per month. The lifeline’s crisis chat function responded to more than 102,500 chats in the same period.

The FCC’s report found that it would be easier to put a new, three-digit number in place than to mount a campaign to repurpose an existing N11 code (such as 211 or 911). The new three-digit hotline will cost about $570 million the first year, the FCC estimated in its report to Congress, and about $175 million the second year, but the agency believes that the benefit would quickly outweigh the initial costs: Suicides and suicide attempts cost the nation nearly $70 billion annually in lifetime medical and work-loss costs alone, according to the CDC.

Certified Community Behavioral Health Clinics Set to Expand to More States

From the National Council for Behavioral Health

Leaders of the US Senate Finance Committee reached an agreement in early December on a 2-year extension that more than doubles the current number of Certified Community Behavioral Health Clinic Medicaid programs by adding 11 additional states. This agreement was announced by Senators Chuck Grassley (R-IA) and Ron Wyden (D-OR), the two lead negotiators on a year-end package of health care bills.

While this is an exciting development, there is still work ahead before this legislative package becomes law. The package must still be voted on by both the House and Senate before going to President Trump for his signature.

The National Council thanks its dedicated advocates for their work in building nationwide support for CCBHCs. Your voices have been heard!

Please see below for a statement on today’s announcement from National Council President and CEO Chuck Ingoglia.

“We applaud the members of Congress who worked so hard on this agreement to fund and expand our nation’s Certified Community Behavioral Health Clinics. Extending and expanding this successful program is vitally important to people who rely on the mental health and addiction services provided by CCBHCs. It’s crucial that the delivery of care not suffer from disruption, and this agreement would ensure programs and services continue uninterrupted.

“Just as importantly, expanding the program means more people in more states will benefit from access to high quality care provided by CCBHCs. In a nation reeling from an opioid and suicide crisis, that is welcome news. While the mental health and addiction crisis continue to devastate the lives of people across the country, CCBHCs represent our nation’s best response. Expansion of the program is both a fiscally responsible decision and a compassionate response from lawmakers who understand the impact CCBHCs provide in communities across the country. Expansion represents a profound opportunity to help people and heal communities.

“We understand there are many hurdles to overcome before this agreement to provide funding and expand the CCBHC program becomes a reality, but we want to applaud the leadership of those responsible for championing the CCBHC program – Chairman Charles Grassley (R-Iowa), Ranking Member Ron Wyden (D-Ore.), Senator Debbie Stabenow (D-Mich.), Senator Roy Blunt (R-Mo.), Representatives Doris Matsui (D-Calif.), Markwayne Mullin (R-Okla.), Greg Walden (R-Ore.) and Frank Pallone (D-N.J.).

“We also want to thank our partners in the field who joined forces with us in this shared mission. The National Alliance on Mental Illness, Mental Health America, National Association of State Mental Health Program Directors, the National Association for Behavioral Healthcare and many others have served as leaders in championing this vital program.”

Ravaged by Opioid Deaths and HIV, Broward Approves Needle Exchange. Miami is the Model

In the text of the ordinance authorizing a needle exchange in Broward County, commissioners ticked off a list of alarming public health statistics: 1,642 opioid overdoses in 2017, more than 21,000 people living with HIV, 387 heroin- and fentanyl-related deaths in 2018.

Needle exchanges are designed to prevent the spread of infectious diseases among drug users by providing clean syringes and help reverse opioid overdoses by distributing naloxone directly to people who use drugs, as well as offering them access to other services like testing for hepatitis.

After a three-year test run, Miami’s exchange, the first in the state of Florida and run by the University of Miami’s Miller School of Medicine’s harm reduction research group, has become the gold standard.

“We have an epidemic in our community,” said Broward Commissioner Nan Rich, who spearheaded the legislation that passed with unanimous consent Tuesday. “This is a best practice now, as far as I can see from other experiences in other places.”

UM created the exchange under the leadership of Hansel Tookes, who had advocated for the program for years before getting the Florida Legislature on board with a pilot run by his research group in 2016. Earlier this year, state lawmakers authorized Florida counties to go ahead with more needle exchanges.

On Tuesday, the same day that Broward authorized a needle exchange of its own, Miami-Dade commissioners made that pilot program permanent, passing the ordinance unanimously with little discussion and all the commissioners joining in as co-sponsors.

“It’s huge,” said state Rep. Shevrin Jones, a Broward Democrat who co-sponsored the bill that became this year’s needle exchange law. “You’ve got the two largest counties in the state of Florida who have passed life-saving pieces of legislation.”

Last month, Tookes put the life-saving component of exchanges into context, highlighting new data showing a steep drop in opioid-related deaths in Miami-Dade County: down by nearly 100 to 213 in 2018, compared to 305 in 2017 and 321 in 2016, the years that the exchange came into operation.

Not only are the exchanges designed to combat the opioid crisis, but they could also be a boon to HIV prevention. South Florida has some of the highest rates of new HIV diagnoses in the country.

Heather Davidson, director of policy for the United Way of Broward County, said needle exchanges lead to reductions in HIV transmissions and hospital costs for indigent people who need care.

“Syringe change programs have been shown to create a bridge where someone can be in crisis from intravenous drug use, and they need to be able to access a clean syringe,” Davidson said. “That ends up being a bridge to have a warm handoff into treatment, and that may take some time.”

William Green, who is overseeing the logistics of the needle exchange for Broward County’s human services department, said the clinic will be modeled closely after Miami’s: It will distribute clean syringes and naloxone, also known under the brand name Narcan, which is administered via a nasal spray and can almost immediately reverse an overdose. The clinic will also test for Hepatitis A and B, Green said.

Green said the county is in the process of convening potential funders, as the law passed by the Florida Legislature prohibits state or county funds from being used to operate the exchanges.

Rich, the Broward commissioner, said it will likely be funded by grants and donations.

“We’re pretty good at that in Broward,” she said. “That will not be an issue.”

Tookes, the UM doctor who served as the architect for Florida’s needle exchanges, said the news out of Broward and Miami-Dade was welcome this week, “but it’s not over until we reach all of the affected communities in the state.”

“They have to act,” Tookes said of the other counties. “I don’t know how they can see the overdose numbers and the HIV numbers and even hesitate. It’s their move.”