Behavioral Health Home (BHH) services - April 2022 newsletter

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Behavioral Health Home (BHH) services

Quarterly newsletter

April 2022

In this issue:

This newsletter has been sent to all authorized representatives on each BHH services team. Please forward to other BHH services staff at your organization.

Quarterly updates

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News, programmatic updates, and useful information.

Coming May 5, 2022:

The Department of Human Services (DHS) Behavioral Health Home (BHH) services policy team will be hosting a “meet-and-greet” for BHH services providers and representatives from managed care organizations (MCOs) across Minnesota.

During our meet-and-greet, the BHH services policy team will:

  • Provide an opportunity for individual introductions that include asking each participant to share a community partnership or resource that you find valuable in your work;
  • Provide a brief overview of BHH services and the role of communication between MCOs and BHH services providers;
  • Review the new BHH services language in the 2022 MCO contracts; and
  • Provide time for questions and discussion.

A “save the date” calendar invitation for this event was recently sent to all BHH services providers and MCO representatives. If you did not receive the invitation and are interested in attending, contact Michaelyn Bruer:

Update for BHH services providers about the impact of Uniform Service Standards (USS)

The impact of USS on BHH services should be limited to changes in mental health staff definitions. You can see the conforming changes to BHH services law in Minnesota Statutes, 256B.0757, subdivision 4c. DHS recommends that providers carefully review the new 245I staff definitions that are planned to go into effect July 1, 2022. The DHS BHH services team will provide additional information as it is available.

BHH services provider spotlight



Highlights from the front lines


Behavioral health affinity group participation

DHS would like to thank the providers who are participating in “Improving Behavioral Health Follow-up Care Learning Collaborative Affinity Group” (BH AG).

The BH AG was launched by the Centers for Medicare & Medicaid Services (CMS) and it works with states and their partners to drive measurable improvements in improving behavioral health follow-up care. The goal of BH AG project is to increase the number of BHH services participants who receive follow-up care within seven days after hospitalization for mental illness, after an emergency visit with a principal diagnosis of mental illness or intentional self-harm, and after an emergency visit for alcohol and other drug abuse or dependence. DHS looks forward to providers’ continuing participation as part of this project. DHS will share findings and updates along the way. 


Introducing Metro Behavioral Health

Written by Richard Gardell, Abdulahi Mohamed, Dr. Ahmed Karie and Mahamud Abdi of Metro Behavioral Health

Metro behavioral Health is led by Dr. Ahmed Karie, PsyD, LICSW and Abdulahi Mohamed, LICSW. They speak English and Somali. They lead a dedicated staff serving the Somali and Arabic speaking immigrant community. Eighty percent of all staff members are from the Somali Community. Our office is conveniently located on University Avenue SE in Minneapolis. We make it a practice to assist all of our clients with transportation and support services which address the unique challenges of a refugee, immigrant population.

Primary providers and their languages

Dr. Jerome Kroll, Psychiatrist, English

Dr. Thomas Nguyen, PsyD, LP, English

April Wolfson, APRN, CNP, English

Amal Shariff, MA, psychotherapist, English

Adman Heify, MS, psychotherapist, English and Arabic

Waris Abdi, RN, English and Somali

Clinic managers

Mohamed Abdi, Clinic Manager, English and Somali

Mohamed Qas, Program Manager, English and Somali

Metro Behavioral Health currently serves over 1,000 clients. Seventy five percent of our clients are refugees and immigrants who are struggling with post-traumatic stress disorder (PTSD), adjustment disorders, anxiety disorders, or major depressive disorder. Some of these clients are suffering severe psychosis and bipolar disorder compounded by medical, PTSD and adjustment related problems. We specialize in assisting our clients with coping with adjustment, acculturation, and assimilation challenges and barriers.

A majority of adult refugees and immigrant patients struggle with language barriers. They arrived in the United States with limited English language proficiency and, as result, face significant barriers to adjusting to life in America.  Patients and families with limited English language proficiency face barriers to access healthcare services, employment, education, social service programs and housing. They also experience cultural identity crisis and mental health problems. This population depends on interpreters for accessing needed community resources.

This population also faces adjustment challenges. Newly arrived immigrants, who may have medical and mental health conditions, face difficulties navigating the fragmented healthcare system in America and as a result experience limited access and healthcare disparities.

New immigrants also experience acculturation and assimilation related problems. This includes learning a new language and culture, raising their children in unfamiliar environments, learning new parenting skills, dealing with extreme weather conditions that they are not accustomed to and becoming law abiding citizens. Immigrant families tend to isolate from mainstream culture and tend to create their own culturally based community resources (mosques, malls, restaurants, charter schools, adult and childcare centers and group homes for mentally ill patients). 

Through BHH services, we are identifying participants that have gone without prolonged preventive health care or mental health services due to a variety of reasons, such as COVID-19 restrictions, a language barrier, lack of transportation, and limited access to culturally specific service providers. Our integration specialist and system navigators are using the BHH Brief Needs Assessment and the new BHH Health and Wellness Assessment to identify this population and coordinate with their primary care or mental health providers to schedule needed appointments.

We have identified cases in which clients have run out of essential prescription medications. BHH system navigators are actively coordinating with medical services and mental health providers to refill medications for clients and accompany them to their pharmacy for pickups. We also assist families accessing needed resources available in the community, including housing, immigration, public assistance benefits, legal services, medical services, and education resources. All of the services provided by mental health professionals or practitioners who speak the primary language of our clients.

Incorporating tobacco treatment

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Information related to the use of commercial tobacco products, and how to help people address their use of them.


Did you know that, according to the American Lung Association, tobacco use is the number one cause of death in people with mental illness? Not only that, but it affects people with mental illness at alarmingly disparate rates compared to the general population. This section will provide ongoing information related to commercial tobacco products and how to help people address their use of them.

Tobacco Use among Individuals with Mental Illness or Substance Use Disorders

A four-part webinar series for Minnesota behavioral health professionals; up to 6 Continuing Education Units available.

Hosted by Lung Mind Alliance

Presented by Jill Williams, MD, Director, Robert Wood Johnson Medical School-Division of Addiction Psychiatry

The presentation slides can be downloaded from the resources dropdown tab at these recording links.

Webinar 1: Tobacco Use and Behavioral Health: Overview

Learning Objectives:

  • Understand the prevalence of tobacco use among those with mental illness or substance use disorders
  • Understand the impact of tobacco use on this population
  • Recognize the roll of mental health and substance use disorder professionals in addressing tobacco

Webinar 2: Clinical Assessment of Tobacco Use Disorder and Withdrawal

Learning Objectives:

  • Understand the importance of assessment and documentation as a clinical activity
  • Understand how to measure and assess the severity of a person’s tobacco use disorder
  • Understand how to match treatment strategies to the client’s motivational level

Webinar 3: Evidence-Based Treatment with Counseling and Medication

Learning Objectives:

  • Understand counseling techniques that can be used in tobacco treatment
  • Understand Nicotine Replacement Therapy (NRT) and other medications to consider for first-line tobacco treatment
  • Understand treatment approaches for people not ready to quit

  Webinar 4: Developing Supportive Organizational Policy

Learning Objectives:

  • Understand the benefits and perceived obstacles to creating a tobacco-free environment for mental health and addiction programs
  • Understand the steps an organization can take toward implementing tobacco-free grounds or implementing tobacco-treatment into their program
  • Understand resources available in Minnesota to help you and your organization make such policy and procedural changes

MN DHS Partner Portal

To obtain access to the MN DHS BHH Services Partner Portal have your organization’s MN-ITS administrator create a profile for you.

Send an email to with the following information:

  • Username
  • Email address
  • Work phone
  • MN–ITS username

You will receive a follow-up email letting you know when access has been granted. The email will include resources to support you in using the partner portal.

Learning and Resources

Information on upcoming learning opportunities and available resources that may be helpful for BHH services providers

Register Now for Health Care Homes Learning Days: April 28, 2022


Don’t miss this annual opportunity to meet with peers from Health Care Homes and community partners for a full day of learning and inspiration. This year’s virtual event will focus on how COVID-19 has impacted primary care practice and providers and offer resources and encouragement for the future. The agenda will feature a variety of peer-led breakout sessions and workshops, as well as opening and closing keynote speakers.  

Visit the Learning Days website for details on learning and sponsorship opportunities, registration, and updates. Connect with others attending the event through the new “Join the Community” feature! 

Partnering to better coordinate care & increase referrals

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Building collaborative relationships with other providers to address whole-person care & promote service sustainability


Collaboration with managed care organizations

Regular communication and coordination between BHH services providers and managed care organizations (MCOs) helps ensure that an individual’s services and activities are coordinated to most effectively meet the goals of the person, and to avoid duplication between the MCO and the BHH services provider.

In an effort to improve communication and collaboration between BHH services providers and representatives of MCOs, DHS added new language in the BHH services portion of the 2022 MCO contracts. This new language requires that if an MCO has assigned a care coordinator or case manager for an enrollee and the enrollee is enrolled in BHH services, the care coordinator must respond to the BHH services provider upon receiving notice of the BHH services enrollment.

You can access the new language in all of the BHH services section of the MCO contracts by doing the following:

  • Click the following link: DHS MHCP managed care contracts;
  • Select the “current contracts between DHS and managed care plans” tab; and
  • Search “BHH” within the contracts to find the BHH services section in each contract.

The DHS BHH services policy team has created two additional resources for providers and MCOs:

  • DHS has created a guidance document outlining some best practices for communication and collaboration between BHH services providers and MCOs. You can find this document on our website at the following link: BHH Services Providers and MCO Roles and Responsibilities; and
  • The BHH services MCO contact list provides contact information for MCOs that providers can utilize to contact a person’s care coordinator, locate where to send the notification of eligibility form and more. You can find this document on our BHH Services MCO Contact Information website

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