In early October, First Lady Casey DeSantis formally announced a $58.8M federal grant will go toward fighting opioid abuse. The new federal funding from the CDC will be earmarked for pregnant women, mothers, and newborns addicted to opioids and living with neonatal abstinence syndrome, or NAS.
The First Lady continued her fight against opioids throughout October and toured Northeast Florida as part of her Hope for Healing Florida Initiative. She toured a neonatal intensive care unit in Jacksonville and held a listening session with NAS experts.
The Florida Behavioral Health Association led a team of seventeen Floridians who participated in the National Council Hill Day 2019 held September 18. The goal of Hill Day is to bring mental health and substance use disorder awareness to Congress. Priorities advocated this year included: continued opioid attention and funding, removal of the waiver requirement for healthcare providers to prescribe buprenorphine, removal of Medicare’s exclusion for marriage and family therapists and mental health counselors to bill Medicare, reinstating Medicaid eligibility for incarcerated individuals 30 days prior to release, and expansion of Certified Community Behavioral Health Centers.
The Hill Day advocacy was effective with 27 Congressmen joining as co-sponsors on the above bills including Florida’s Al Lawson. The Florida team held meetings in the offices of both Florida U.S. Senators and in the offices of 22 members of the Florida Congressional delegation.
Congratulations to Asha Terminello on her appointment as Chief Executive Officer of the Agency for Community Treatment Services, Inc (ACTS) in Tampa, effective June 2019.
Asha has been with the ACTS for more than 27 years and has extensive experience with behavioral health, juvenile justice and criminal justice systems of care. She served as the Chief Operating Officer for more than 11 years where she was responsible for a wide array of clinical treatment and community-based services in Hillsborough, Pinellas and Polk counties. Her experience in the field has enhanced community relationships, and has helped ACTS build strong alliances with law enforcement, the courts, Department of Juvenile Justice, Department of Children and Families, Child Welfare, Veteran’s Administration and Central Florida Behavioral Health Network. She was instrumental in the implementation of the first Juvenile Assessment Center in Hillsborough County and assisted on the implementation of several JACs in Florida. She currently serves as a board member for Florida’s Behavioral Health Association, Florida Juvenile Justice Association, Hillsborough Anti-Drug Alliance, Hillsborough County Behavioral Health Task Force and the Health Care Advisory Board’s Management Subcommittee. She earned her Bachelor’s Degree in Psychology from the University of South Florida and a Master’s Degree in Mental Health Counseling from Nova Southeastern University.
In the Tampa Bay area, one in six people suffers from depression. One in twelve has a substance abuse disorder. And there is only one mental health professional for every 700 people in Florida. These are some of the statistics given Thursday to highlight the region’s need for more mental health coverage.
Leaders from organizations around the region gathered in Tampa to discuss a new initiative to address the mental health crisis. They announced that they’re forming a nonprofit called The West Central Florida Mental Wellness Coalition. While BayCare is the company leading the coalition, CEO Tommy Inzina said it will take a community effort for it to succeed. “We’re not in the school systems every day, we’re not dealing with everything law enforcement has to deal with, there’s a lot the business community can do,” said Inzina. “So we had this idea of creating a community coalition.”
Pasco County Sheriff Chris Nocco said police officers deal with the mental health crisis first-hand every single day. “Last year we handled 19,283 mental health calls. Approximately 11% of our calls for service are mental health related. We weren’t built for this. But we have to adapt because this is the environment,” he said.
The sheriff went on to say that deputies responded to over 2,000 suicide calls last year. He said one night he was dispatched to a suicidal person’s house and when he got there, the person just wanted someone to talk to.
Mental health is an issue in schools as well, according to Hillsborough County Assistant Superintendent Trayce Brown. “It is nothing for us to think about taking our students to the nurse for a physical ailment, but often times we don’t do the same thing for mental wellness,” she said. Brown said it’s important that schools feel equipped to get students the help they need, and that’s why the school district is joining the coalition.
Barbara Daire, CEO of mental healthcare provider Suncoast Center, Inc. said the coalition is a dream come true for her. “It’s just so wonderful to have everyone really look at this very important issue because we have a lot of unhappiness and a lot of unsettled people in our community,” Daire said. “This has been a lifelong dream of mine. I see that this group is going to be able to raise awareness and break the stigma in a big way across four counties (Hillsborough, Pinellas, Pasco, and Polk). “We could potentially be the model for the rest of the country.”
The West Central Florida Mental Wellness Coalition has three primary goals. They want to start a public awareness campaign to get people educated on the scope of the mental health issue, they want to increase urgent care access for behavioral health, and they want to provide resources for patients seeking mental health help.
The coalition has already raised a little over $5 million toward their goal of $7.5 million that they need to cover operating costs for the first five years.
BayCare is matching any donations given to the coalition. So far, companies like Advent Health, Florida Blue, and Tampa General Hospital have donated. Inzina said that the board for the nonprofit will be representative of all stakeholders. He said he hopes hospital systems, mental health providers, local businesses, law enforcement, and schools will be included. “This is not a BayCare initiative, it’s only going to be as successful as the support we can get.”
In late June, Governor Ron DeSantis signed the FY2019-20 “Bold Vision for a Brighter Future” budget, nearly seven weeks after the Legislature adjourned “sine die.” During his press conference DeSantis said, “it’s a fiscally responsible budget. I think we put taxpayers first.”
The General Appropriations Act (SB 2500) went into effect on July 1, 2019 with roughly $131.3 million in line-item vetoes. This compares to $64.1 million vetoed in FY2018-19 by his predecessor. Among the $131.3 million special- project vetoes, $14.182 million were for local initiatives for substance abuse, mental health, and housing, including cost of living increases at contracted state hospitals ($4.14 million); affordable housing project in Jacksonville ($8 million); and CESC homeless housing ($1 million).
In his press release, the Governor highlights that the budget, “includes more than $123 million in total funding to fight the opioid epidemic and $106 million to provide funding for services to children and families who depend on Florida’s child welfare system. Furthermore, the budget provides more than $70 million to serve individuals on the Agency for Persons with Disabilities home and community-based waiver program.”
As passed the FY2019-20 budget totaled $91.1 billion. After the Governor’s line item vetoes the total dropped to $90.9 billion, but still up approximately $2.2 billion from last year’s budget.
When John Bryant accepted the job of Assistant Secretary for Substance Abuse and Mental Health Services at the Florida Department of Children and Families (DCF) in 2015, DCF Secretary Mike Carrol called him, “a champion for substance abuse and mental health services in Florida,” and added that the department was “privileged to bring his extensive experience and expertise back to this department.” John Bryant had served the Department of Children and Families in the past, when the state agency was known as the Department of Health and Rehabilitative Services (HRS). HRS would eventually split into the Florida Department of Health and DCF, but Bryant’s background remained firmly planted in behavioral health.
Bryant was Vice President over Legislative and External Affairs at the Florida Council for Community Mental Health (FCCMH), working with and advising state agencies on legislative and budget priorities, policy development, contract services, behavioral health program design, research and advocacy. Prior to FCCMH he served for over 35 years with HRS and DCF in both regional and statewide positions including Chief of Operations for the Substance Abuse Program Office, Chief of the State Mental Health Treatment Facilities, Assistant Secretary for Mental Health Programs, Chief of Adult Mental Health and others.
Our Association caught up with the longtime behavioral health advocate last month to get a glimpse of how he views the past, present, and future of behavioral health in Florida. He was just days away from retirement when our team breezed into his office for an interview. He was affable, accommodating, and full of information. We share his interview with you today.
(Q) What were some of the first issues you began to address as you assumed the executive leadership role as Assistant Secretary for Substance Abuse and Mental Health at DCF?
(A) First of all, conditions in the state hospitals – that was the first big issue for me. Primarily because, in the past, there had been some substantial staffing reductions to personnel and as a result of that the people that remained faced some real serious challenges relative to employee safety, resident safety, and the ability to provide treatment. So that was a first priority for me – to at least start getting things better. Of course, that’s one of those never-ending jobs, but we’ve come a long way in the last 4 to 5 years of getting the quality of services back to where they needed to be.
(Q) How have you seen things change – relating to Substance Abuse and Mental Health – over the course of your 40-plus year career?
(A) When you look at Substance Abuse (SA) as an example, I think SA was a very rough and tumble almost totally abstinence-based type of service delivery system. It was sparsely funded and had sparse capacity. Over the course of the last 20 or 30 years, we’ve gotten much better. We’ve changed our practices. We’ve expanded the scope of what the system is able to do in terms of running detox programs, intensive outpatient, residential, the whole nine yards. I think it’s a much more robust system than when I first got here and started working in the business.
I still think there’s a lot of growing that needs to be done in terms of the adoption of evidence-based practices, and I think there are some cultural issues that need to be addressed in terms of how we address relapse. We need to not be casting people out of our programs because they relapsed. I think we need to figure out how we accommodate relapse in the system that is clearly composed of a client group that is going to relapse. Instead of saying “Move out, you’re done. You came back with a positive urine, you’re done.” Really? I just don’t think that’s smart.
I think on the mental health side, in the past, community mental health was kind of a mom and pop proposition. Most of the community mental health centers in the state of Florida started as child guidance clinics back in the late 50’s and then they started evolving. I think one of the most amazing things that I’ve seen is the development of acute care service delivery systems, the emergence of crisis stabilization units (CSUs) and what that means to the public.
(Q) What does that mean to the public?
The first CSU was in Gainesville, it was a two-story wood-frame house and it was basically- you couldn’t get that license as anything today in our business, which is a mixed bag – but it was basically kind of a drop-in center. Law enforcement would drop people off and you would have kind of a low-impact assistance provided to folks. And it reduced burdens on the jails, it reduced burdens on the hospitals, and it provided people with options. . . . We’ve just come a long way. We have much more capacity in the community. Our system has grown from child guidance centers to comprehensive community mental health agencies. We are more professional and more integrated with other health care providers in the community and people know we exist and that the services exist. I think the problem of course is still capacity and access. I think people don’t always know the best way to get into care and treatment. Even if they know they need it they don’t know how to access it. “Does my insurance cover it, is my plan going to approve it?” The nice thing about what the Department of Children and Families does, is, we’re basically the safety net. If you’ve exhausted all your other means you’re coming to see us. People are amazed sometimes at how limited the scope of our authorizing statute is, of who we serve: it’s severely mentally ill, it’s severely emotionally disturbed children, it’s IV drug users, and yet, I think a lot of people think when you say community mental health it’s everybody, but it’s not. The focus is on the people most in need.
(Q) I’ve heard you say most great innovation happens locally. Can you say what you mean by that or give an example of that?
(A) FIT (Family Intensive Treatment) and CAT (Community Action Teams) teams are perfect examples. CAT teams came out of the work of community mental health agencies down in Manatee County, that was picked up. FIT teams the same thing. I mean, it was multidisciplinary services directed at child welfare populations. Those were things we didn’t invent up here, but once they caught on and once we were able to determine, that, “yeah, this is a smart service, this is what people need,” then we could build in a sense the support structure around it: how to contract for these services, how to expand them and make them accessible to people throughout Florida. That’s the clearest example. I think the other example is how communities respond to high-utilizing people, high-demand people – those people that are in many instances homeless, or refuse traditional methods of treatment and engagement in treatment. How do you get those people engaged in treatment and how do you keep them out of jail, and out of acute care settings? In my view, you start seeing some examples of housing – of permanent-supportive housing being developed in the community – that we need to replicate statewide. Because in the absence of a stable place to live we’re not going to be very successful with people that have a longer history with some of our service providers.
(Q) What was the biggest victory- or victories – you saw come out of the most recent 2019 Florida Legislative session?
(A) One, we got budget authority for $83 Million dollars and spending authority for the opioid projects. We got additional funding capacity for care coordination in the community. We got some statutory changes around background screening so that we can hopefully expand the role of peers in peer services throughout the state. This was much more of a child welfare kind of session. Hopefully the Department will be able to come back next year with some options to promote to the legislature on improvements on children’s mental health, children’s Baker Act issues, and start developing some expanded community capacity to meet the needs of kids, their parents, and families without them having to get involved in our acute care system before they receive services. Whether that be Baker Act, or CAT teams, or FIT teams, we need to start developing treatment capacity upstream of those things.
Not this past session, but the one in 2018, out of horrendous events, specifically the Marjory Stoneman Douglas shooting, we were able to expand the FIT and CAT teams, and also the mobile response teams. But also, what was very important, is that it brought these programs into the realm of recurring funding. So it took them out of non-recurring funding every year and basically built them as a recurring commitment from the legislature.
(Q) What has been accomplished as a result of the opioid grants, known as the State Targeted Response (STR) and the State Opioid Response (SOR) grants?
(A) The STR was a major infusion of federal dollars into the states for addressing the opioid epidemic. What it did, which was pretty earth-shattering to us – was it basically 1.) focused on the opioids, and 2.) placed an emphasis on evidence-based practice and medication-assisted treatment, and it was the first big, large-scale opportunity that the department had to address the opioid epidemic. I mean, we had been seeing it for a couple years. We had, in prior years, received some federal funding to distribute Narcan out into the field, but the STR was a game changer and enabled us to expand the types of medication we were using: naltrexone, suboxone, and methadone. But one of the things that we were able to do that I think a lot of states have had difficulty doing is 1.) impact the culture of what historically were abstinence-based programs. I’m not discounting abstinence-based, but in certain presenting issues, when people come to you with a raging addiction, sometimes it’s very smart to get them into detox and residential programs, other times, that’s not necessary. If you add medication-assisted treatment to what the treatment response is to them you get much better results.
I think one of the smart things this office did, and primarily it was Ute Gazioch and her team, they designed a scope of services around medication-assisted treatment, that addressed not just medication, but case management, care coordination, residential services – a whole range of services – that were in a sense bundled as part of medication-assisted treatment and supports. That was very smart.
STR lasted almost two years, then SOR came in last year in the Fall. And in both circumstances what we were able to do is get that money out very quickly. We used the authority of the Executive Order of the Governor to allocate those funds to find what the services were that we wanted to purchase consistent with what the Feds wanted. We got that money out and the services began within 90 days. We also indicated that if you’re not actively engaged in the provision of medication-assisted treatment, then you’re not going to be eligible for this money. That was the incentive to bring providers along, who, heretofore, may have been inclined to stay with abstinence-based. That was a huge cultural shift.
We’re in pretty good shape in terms of getting the funding out. That original amount of money was around $27 Million, then the next year we got $50 million. When we got notice of that money, same thing, same issue, we needed to get that money out and again used the Executive Order of the Governor to get it out. We were good performers in terms of the Feds. They saw that we were conscientious about getting the money out, conscientious about getting the right kinds of services. We checked all of their boxes. Other states were delayed and other states couldn’t spend the money, they couldn’t get the culture right, and so we ended up picking up additional dollars. That speaks volumes about the good policy work that went into this but also the willingness on the part of the community agencies out there to step up.
(Q) What insights or advice may you have for our providers for the future of behavioral health care?
(A) When I worked at an association we spent a lot of time doing advocacy and support based upon the issues that they had identified for us. But I think where that system kind of breaks down is that there have been a number of innovations that have been explored by associations in this state around health homes, around looking at federally qualified health center participation and basically a more closely aligned relationship with managed care, even up to and including perhaps being the behavioral health care provider. But every time we seem to get close to those kinds of major public policy and service delivery breakthroughs, something breaks down.
People that have signed on to an initiative break ranks. For one reason or another they think that it’s going to have a minimal impact on what they do.
Their job is to keep their business viable. That’s what they do. But in the absence of some kind of cohesive pitch to the legislature about one innovative treatment effort, proven efficacy of engagement in substance abuse and mental health services; in the absence of a much broader welfare of the State of Florida approach, that I think we’re going to be stuck in Special Projects driving what the system looks like: non-recurring special projects. And I think it’s important that when we did the Central Receiving System, we had a lot of collaboration on the part of community agencies to make that happen. Those are the kinds of initiatives that the system needs to ensure a commitment to expand access, capacity, and innovation.
(Q) If you could wave a magic wand as you leave your executive post what would you do? What would you make happen?
(A) For me, a cohesive, accessible, well-funded system of care for both children and adults, something that is responsive to whatever happens next: whether it be a new drug of choice, whether it be a reemergence of alcoholism, or cocaine, or methamphetamines, or natural disasters. Basically, the capacity within this state to be viewed as a resource for all citizens in the state of Florida that is responsive to their needs, well staffed, with competent people, and with good outcomes.
(Q) What are your plans for retirement?
(A) I have a copy of the Mueller Report and I’m going to read that. Then I think I’m going to learn how to throw a cast net better and catch more fish. I have plans to go to Alaska first. And as soon as I can talk my wife into leaving the house for more than a week at a time, I’d like to go to Ireland, Scotland, and France. I’ve put off traveling, seems like forever, because you have to get the kids through college, or the job keeps you here, or other duties, but I’d like to get some good traveling in our lives!
John Bryant’s last day on the job as Assistant Secretary of DCF’s Substance Abuse and Mental Health Program was May 31. We wish him well and thank him for his thought leadership and contributions to Florida’s behavioral health programs.
Florida Behavioral Health Association visits WARM Program at Vince Carter Sanctuary in Bunnell, Florida: (Pictured L-R) Exec. Advisor Mark Fontaine, FBHA; CEO Ivan Cosimi, SMA; VP Alicia Vincent, Flagler County Services; COO Rhonda Harvey, SMA; Pres. Melanie Brown-Woofter, FBHA
Overview of WARM @ VCS
WARM @ VCS is a residential behavioral healthcare program housed in what was earlier the Vince Carter Sanctuary. Named after the famous NBA all-star who help set it up, the facility was an upscale treatment center that was repurposed into a state-funded rehabilitation center. The treatment center is situated about 10 miles away from Daytona Beach in Bunnell, Florida.
WARM is an acronym for Women Assisting Recovery Mothers. As the name implies, the facility serves substance abuse victims who are pregnant women, postpartum or parenting young children. The residential track offered here ensures that children are provided with daycare support while their mothers undergo rehabilitation and therapy. All residents are housed in rooms either with a roommate or mothers with their children in a room to allow for private alone time to spend with their babies or toddlers. The aim of the initiative is to empower these women and enable them to reintegrate back into society as fully functioning adults. To this effect, the team at the treatment center provides every client with individualized plans to better address their specific needs.
Accommodation and Food
The residential facilities at WARM @ VCS are capable of housing a maximum of 70 residents at a time. All the bedrooms come furnished with basic furniture including twin-sized beds, cribs and toddler beds as needed, in room bathroom and storage space in the form of a closet. The residential quarters are also equipped with common rooms for residents to socialize, computer room, mediation room and baby spas for bathing/diapering children.
The dining area serves as a common space for everyone to eat together. An Executive Chef is the instructor over the culinary program at WARM @VCS. Under the direction of the Chef, clients can volunteer to be members of the culinary program, this involves preparing 3 meals and 2 snacks per day for all residents and children. The culinary students spend one and a half hours per day in classroom training with Chef. In addition they work in the kitchen every other day under the direction of the Chef for “on the job training” in preparing meals and snacks. This program offers those who volunteer to join culinary the opportunity to earn four certifications from University of Florida in: Sanitation, Dining Room/Kitchen Management, Nutrition, and Food Service Management (ordering, costing). This program offers culinary students job skills to assist them transition back into the community with skills to help them gain employment.
Treatment Options at Project WARM
The specialized treatment programs provided to clients at the facility are immersed in 12 step philosophy. They also incorporate the tried and tested evidenced-based techniques along with various other therapeutic approaches. These treatment methods are all bundled into specialized programs that are tailor-made to each individual client’s particular needs. The facility only offers rehabilitation in a residential setting with no outpatient support. The programs are most suited to those who require intensive care and closer supervision for themselves as well as for their young children. Some of the treatment options offered here are: • Substance abuse treatment program • Parental Education
Therapy Choices at Project WARM
The various therapy choices offered at this facility include the following: • 12-step meetings • Individual counseling • Group therapy • Motivational Interviewing • Cognitive Behavioral Therapy (CBT) • AA/NA meetings • Seeking Safety • Stages of Change Model • Relapse prevention • Life skills classes • Moral Reconation Therapy • Anger management • Education on healthy Parenting techniques