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Jan. 4, 2023
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Happy New Year! Many of us are busy taking down holiday decorations and preparing for the year ahead by setting intentions. Our intentions will be as varied as we are as individuals, but for myself, I intend to identify how to move forward with hope and to be more intentional with the language we use when we are talking about mental health and wellness. The Chinese New Year is Jan. 22, ushering in the Year of the Rabbit. The sign of the rabbit is a symbol of longevity, peace and prosperity, and 2023 is predicted to be a year of hope. But hope isn’t something you do by yourself; hope is a cognitive process and practice with other people. I plan to bring that practice into my daily conversations and the work we do. |
The language we use is an important and powerful tool as we move forward and change the narrative in Oregon. We create goals by having the agency and the ability to achieve those goals, and by recognizing both the positive things that are happening in our community and how much further we need to go.
Some positive things we carry forward from 2022 were the launch of the 988 Suicide & Crisis Lifeline in July 2022, the launch of Mobile Response and Stabilization Services (MRSS) this month and expanded eligibility for wraparound and School-Based Mental Health (SBMH) services. Research shows that these services promote health equity, reduce racial and ethnic disparities and enhance engagement among youth who face barriers to accessing care.
Jan. 17 marks the beginning of the 2023 legislative session. Ideas become laws by passing through the legislative process; for 2023, this officially begins on Jan. 17. You can find information on OHA’s proposed legislative concepts and Policy Option Packages (POPs) on the Government Relations page. This session, we are excited to be able to share and consult on these publicly before the Governor-elect reviews what she wishes to propose in her budget to the Legislature. We look forward to ongoing conversations with all of you to support the evolution of the children’s behavioral health system and ask you to join us in holding hope for the Year of the Rabbit.
The Children’s System Advisory Council (CSAC) originally began as a family and caregiver workgroup nearly 20 years ago in December 2003. The purpose of the group was “to prepare recommendations designed to ensure meaningful family involvement the Children’s Mental Health System of Care Initiative.” As the workgroup evolved, it became clear there was a need for a statewide advisory committee, and the first official CSAC meeting was held in 2005. While a lot has changed in Oregon since 2003, CSAC continues to work to ensure meaningful youth and family involvement. CSAC has representation from youth and family members with lived experience, the Office of Intellectual Developmental Disabilities, Child Welfare, Coordinated Care Organizations, behavioral health providers and others who are advocates for an improved behavioral health system for youth and families. CSAC has been meeting virtually since spring 2020.
CSAC officially acts as an advisory council to OHA’s Child and Family Behavioral Health (CFBH) unit. The council provides feedback and recommendations on programs, policies and policy option packages that the OHA CFBH team is working on. The November 2022 CSAC meeting focused on School-Based Mental Health (SBMH), with guest presenter Fran Pearson, OHA’s SBMH program and policy coordinator. Through dynamic conversation and vulnerable sharing, Fran was able to take away meaningful key strategies, barriers and recommendations highlighted by CSAC. Fran said, “Two of the most powerful messages I took away from the discussion were around the need for educating parents, caregivers and families that these services exist and are available in their children’s schools. There is a need for culturally specific youth peer support and needing someone a few steps ahead to light the way.”
For more information about CSAC, contact Nat Jacobs at nat.jacobs@dhsoha.state.or.us.
The beginning of MRSS in Oregon
January marks the culmination of a multi-year effort by the OHA CFBH unit, the Adult Behavioral Health (ABH) unit, those with lived experience, youth, young adults and their families, those from underserved and underrepresented communities, and service providers to direct the launch of a new mobile crisis response system in the state of Oregon.
As of January 2023, Mobile Response and Stabilization Services (MRSS) will provide crisis response services and supports for people under age 20. The mandate of HB 2417 (2021) is to expand and enhance crisis response services for Oregonians across the lifespan. HB 2417 illustrated the need for our system to specifically address people age 20 and younger, whose unique needs may have gone unmet. MRSS is a national model designed to meet the developmental needs of youth, young adults, and their caregivers in a crisis response setting.
Throughout the process, OHA and the CFBH team have worked with community partners to create a system that adequately meets their needs. Following the creation of the MRSS Policy Option Package in 2018, Youth Think Tanks, the Crisis System Advisory Workgroup, the Crisis System Steering Committee, MRSS Community Conversations, CFBH Workgroup (with families and peers), the System of Care Advisory Council, the Children’s System Advisory Council, the Association of Community Mental Health Programs, and CFBH MRSS Learning Collaborative have all provided feedback, guidance and vision in creating the MRSS program model. To aid in the evaluation of MRSS, the 988 call center and MRSS teams will use customer satisfaction surveys at the conclusion of service. Finally, a complaint process is also being developed to expand opportunities for public feedback and keep OHA apprised of opportunities to improve both MRSS and broader crisis response systems.
The evolution of MRSS in Oregon
Previously, the Crisis and Transition Services (CATS) program provided crisis services for people under age 21. However, the CATS program wasn’t statewide and required that young adults experiencing a crisis go to the emergency department to receive services. CATS was successful at developing a service array that addresses the unique needs of those under 20 in crisis and, thanks to the work of our county partners and community providers, that model is reflected in MRSS. CATS will be phased out in 2023 as we transition to MRSS as the standard crisis response model, with two-person mobile crisis intervention teams providing a face-to-face response. MRSS best practices, based on the CATS model, include the following:
- A continuum of care for crisis response that includes someone to call, someone to respond, and a community of support.
- A crisis is defined by the parent/caregiver and/or youth.
- Recognition of the strengths of those in crisis and incorporating those strengths into service plans.
- “No wrong door" approach to access MRSS.
OHA is requiring all counties to provide these youth-focused services to eligible youth and their families, regardless of insurance status, and will continue to provide technical assistance and trainings to county and other providers under this expanded model in 2023 and beyond. Providers can review the new Oregon Administrative Rules for MRSS and mobile crisis intervention services through the Secretary of State website.
MRSS Learning Collaboratives
CFBH is also continuing the MRSS Learning Collaboratives, which bring together community advocates and service providers to learn more about MRSS. The Learning Collaboratives are now held twice a month as providers implement MRSS.
Join us the second and fourth Mondays of each month from 10 a.m. to 11:30 a.m.
Learn more about 988 and the crisis response system in Oregon on OHA’s 988 web page. If you promote the National Suicide Prevention Lifeline in your work, consider how you will switch messaging from NSPL over to 988. The NSPL number (1-800-273-TALK (8255)) remains available.
Contact Brian Pitkin at brian.m.pitkin@dhsoha.state.or.us or Beth.Holliman@dhsoha.state.or.us with any questions.
Since producing the draft Child and Family Behavioral Health Policy Vision in 2020, the CFBH unit has been gathering community feedback and refining the outlined strategies There are four strategic pathways guiding the focus of the unit’s work:
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Continuum of Care - OHA’s CFBH work addresses gaps and quality in the children’s behavioral health continuum of care, centering communities that have been disproportionally impacted by health inequity and systemic racism.
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Youth and Family Engagement - CFBH work incorporates meaningful youth and family participation, centering communities of color, indigenous and Tribal communities, individuals who identify as LGBTQIA2S+ and other traditionally marginalized populations.
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Data - CFBH work centers health equity by making policy and program decisions based on accurate and timely data and in seeking data that can assist in understanding health inequities.
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Cross System - CFBH work supports and prioritizes cross-system collaboration to improve the behavioral health continuum of care for youth and families.
A new roadmap will be available for review in early January. We are excited to provide updates on progress and timelines for the various milestones in the plan, as well as restarting regular connections with community partners and the CSAC to create alignment on system needs, priorities and direction.
Young Adults in Transition (YAT) Residential Treatment Homes (RTH) are for young adults (17.5 to 25 years old) who experience complex behavioral health challenges.
YAT RTHs provide 24-hour supervision and support, focusing on helping residents develop the skills needed to manage their mental health symptoms and transition into adulthood.
Services and supports include, but are not limited to:
- Therapy and medication management
- Case Management to connect to additional services as needed (i.e. supported employment, etc.)
- Skill development focusing on:
- Self-managing emotions and mental health symptoms
- Nutrition, personal hygiene, clothing care and grooming
- Managing physical or health problems as needed
- Money and household management
- Communication skills for social, health care, community resources
- Recreational and social activities
Starting January 1, 2023, all referrals for YAT RTH will be submitted directly to the programs. The current application can be found on CFBH’s Supports for Young Adults web site, under the Young Adult in Transition Residential Treatment Home Section. Contacts for the programs can be found on page one of the application.
All referrals must include a completed application form, along with supporting clinical documentation (list of documentation can be found on page two of the application).
Referral sources include, but are not limited to, Oregon Department of Human Services, Child Welfare, Oregon Youth Authority, county mental health programs, community mental health agencies, acute psychiatric units and young adults themselves. Read more about the YAT program in the System indicators portion of this newsletter.
Contact Jessica Stout at jessica.l.stout@dhsoha.state.or.us with any questions.
The System of Care Advisory Council has three vacancies:
- A youth member (under age 25, has been involved in foster care or juvenile justice),
- A Tribal representative (must be a member of one of the nine Federally Recognized Oregon Tribes or a designee of a Tribe), and
- A pediatric physician.
Do you know someone who could serve in one of those seats? These are some of the most vital voices we need to hear from to transform our systems to work for every Oregon child and family. SOCAC staff can support people in applying, attending meetings and learning about the council. Some members are eligible for a stipend, currently set at $157 per day. Please share among your networks!
Email Christy Hudson at christy.j.hudson@dhsoha.state.or.us if you would like to apply or if you have someone to recommend.
Community conversation about Applied Behavior Analysis
OHA is seeking community feedback on the topic of Applied Behavior Analysis (ABA). ABA is a therapy-based treatment provided primarily to people diagnosed with autism and is currently an Oregon Health Plan (OHP) benefit. Current administrative rules for ABA address Medicaid payment and provider requirements but do not address oversight or management of ABA programs or facilities.
If you or your family has lived experience with ABA, please consider joining this community conversation. ASL and Spanish interpretation and closed captioning will be provided. If you need other accommodations, please contact Tamara Bavaro at tamara.bavaro2@oha.oregon.gov.
Review the current rules about eligibility and Medicaid payment for ABA rules:
Learn more about ABA.
Three meeting options are available:
- Tuesday, Jan. 10 from 6 to 7 p.m.
To join using your computer, tablet, or smartphone, please click here:
Meeting ID: 161 419 6159 Passcode: 882603
One tap mobile+16692545252,,1614196159# US
- Wednesday, Jan. 18 from noon to 1 p.m.
To join using your computer, tablet, or smartphone, please click here:
Meeting ID: 161 414 9234 Passcode: 829262
One tap mobile+16692545252,,1614149234# US
- Thursday, Jan. 26 from 6 to 7 p.m.
To join using your computer, tablet, or smartphone, please click here:
Meeting ID: 160 563 2048 Passcode: 479171
One tap mobile+16692545252,,1605632048# US
A Time for Families
As a family member, being able to talk directly to people who have the power to change policies and influence direction is important advocacy. A Time for Families is that chance: it is an open forum that has been running for over a year, giving opportunity for direct communication between parents, family members and Chelsea Holcomb, director of the CFBH.
This drop-in is informal and hosted by Chelsea and Hilary Harrison, System of Care policy strategist, who is also a family member. Often family peers come with family members to ensure that they feel comfortable and see a familiar face.
Join us Thursdays from noon to 1 p.m.
Join by computer or other mobile device
Join by phone: 1-669-254-5252, Meeting ID: 161 993 2307, Passcode: 676907
Please contact hilary.harrison@dhsoha.state.or.us if you have questions or need interpretation services.
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) certification training
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is an evidence-based treatment to help children and adolescents recover after trauma. Research shows that TF-CBT successfully resolves a broad array of emotional and behavioral difficulties associated with single, multiple and complex trauma experiences. This is a structured, short-term treatment model that effectively improves a range of trauma-related outcomes in eight to 25 sessions with the child/youth and caregiver.
Dr. Alicia Meyer, a national trainer in TF-CBT and a global trainer in Parent-Child Interaction Therapy, is offering a two-day online training, Jan. 19-20, 2023, from 8 a.m. to 4 p.m. each day, for clinicians to become certified in TF-CBT treatment. The training is free for people sponsored by OHA; for others it is $500.
Other upcoming training dates, 8 a.m. to 4 p.m. each day:
- March 15-16, 2023
- June 1-2, 2023
For more information, including prerequisites and required reading materials, visit Dr. Meyer’s website. The prerequisite TF-CBT course costs $35, offers 11 continuing education units and must be completed prior to the two-day training.
Collaborative Problem Solving
OHA funded The Child Center to help families strengthen positive relationships and build the skills needed for success at home, at school, in the community and throughout life.
Collaborative Problem Solving (CPS) is a philosophy based on the understanding that youth with challenging behaviors may be having delays in the development of skills in five different areas which are needed to adaptively solve problems and make decisions in their lives. CPS works to strengthen existing skills and teach them skills to do better in their environment; the philosophy is that “Kids do well if they can.”
The Child Center:
- Offers free CPS classes to people throughout Oregon. Sessions are once a week for eight weeks.
- Is focused on providing services to seven regions in Oregon that have limited mental health provider resources.
For more information, please visit The Child Center’s website and share widely with families and communities.
Suicide Prevention Trainings
Public QPR Trainings, free virtual and open to all:
- Wednesday, January 11, 10 a.m. to 11:30 a.m.
- Tuesday, January 17, noon to 2 p.m.
- Thursday, January 26, noon to 2 p.m.
Want to become a QPR trainer?
Question Persuade Refer (QPR), Training for Trainers (T4T):
- Wednesday, January 25, 9 a.m. to 4 p.m.
- Wednesday, April 26, 9 a.m. to 4 p.m.
Contact QPR@linesforlife.org for more information.
Sources of Strength
Virtual Info Sessions (Elementary model):
- Jan 30, 8:30 a.m. to 9:30 a.m.
Elementary Coaches training
- April 19-20 (Location TBD, likely virtual)
Training for Trainers for Middle, High, and Post-secondary School programs
- April 27-March 2, 2023, in Ashland, OR
Register for all sessions and find more information at the Sources of Strength website.
Advanced skills trainings (such as DBT and AMSR) for mental health providers serving those struggling with suicidal thoughts, ideation or behaviors can be accessed at no cost by contacting Maria Gdontakis Pos at mpos@aocmhp.org or by visiting the AOCMHP training web page.
System of Care Learning Collaborative
Every second Tuesday of the month, from 3 to 4:30 p.m., Oregon Family Support Network (OFSN), Youth Era and OHA facilitates a conversation for people involved in Oregon’s local System of Care (SOC).
The SOC Learning Collaborative is an engaging space for anyone involved with SOC to openly discuss challenges, solutions, gain a deeper understanding of SOC values and build a community with folks across Oregon. Attendees are encouraged to bring their questions to the collaborative and get support from each other. OHA, Youth Era and OFSN attend as consultants and trainers to offer additional and specific support outside of the collaborative.
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Meeting ID: 995 6012 8631 Passcode: 947033
Contact Nat Jacobs at nat.jacobs@dhsoha.state.or.us for more details.
Warmline
Reach Out Oregon, funded by OHA as part of Oregon Family Support Network, has a warm line at 833-732-2467, a website, a chat room for any family member needing support and a weekly virtual support group.
Capacity monitoring for Intensive Treatment Services
Intensive Treatment Services remain a critical concern to CFBH. Each week we receive data on capacity for acute care, sub-acute and psychiatric residential, as well as substance use disorder residential programs. OHA monitors these to understand patterns and to offer help in keeping programs operational.
The graph below shows capacity over time. The top line represents the 2020 goal for the system, of having 286 beds available for youth. The line below shows the highest possible capacity that could have been available, given full staffing and removal of all other barriers..
 This possible capacity has declined over three years with the closure of two Kairos residential programs in 2020 and the temporary closure of Crystal Creek at Jasper Mountain. The bottom bar chart represents a monthly summary of reported weekly operational capacity, a combination of beds in use and open beds.
OHA issued a Request for Grant Applications (RFGA) to support the development of Children’s Psychiatric Residential Treatment Facilities for children with severe emotional disorders. This solicitation closed Sept. 24, 2022, and the awardees are Community Counseling Solutions and Madrona Recovery.
We continue to work on both supporting existing providers in maintaining capacity and developing new resources. In 2023 we expect to see 18 beds added at Madrona, which will be the first Integrated Psychiatric Residential and Substance Use licensed beds in Oregon. Community Counseling Solutions is proceeding with plans to break ground on a new facility, and we will provide updates in subsequent newsletter editions.
Capacity has to be reported to the Legislature, as required in House Bill 2086 (2021). Annually we also report, in collaboration with Child Welfare, on intensive treatment services and we will provide a link to the memo here and on our website next month
OHA received a historic investment from the Oregon Legislature during the 2021-2023 biennium to transform the state’s behavioral health system. A report was released in September on the progress of behavioral health investments in Oregon which documents the progress OHA has made on funding several central priorities.
CFBH put forth two Requests for Proposals for the psychiatric residential system and Young Adult Transition residential as a part of these investments. Awards were recently made and as noted below. The Young Adult Residential Treatment programs will be reposted for further consideration.
OHA has published information on its 2023 request bills and budget requests. You are welcome to explore these pages and find CFBH requests in the budget requests.
Young Adult Residential Treatment Homes ($9.2 million)
Young Adult Residential programs are for young adults who experience complex behavioral health challenges and support them with developing the skills needed for a successful transition into adulthood. Services and supports include but are not limited to: access to therapy and medication management, understanding and managing behavioral health symptoms and skill development around activities of daily living.
OHA has issued a Notice of Intent to Award to Trillium Family Services, to develop a new Young Adult in Transition Residential Treatment Home in Linn County.
OHA will be reposting this solicitation of a Request for Grant Applications (RFGA) in collaboration with the Intensive Services, Housing & Social Determinants of Health Unit that focuses on Young Adult Residential Treatment programs.
This RFGA focuses on:
- Centering health equity, expanding the Young Adult Residential programs, including up to an additional 20 residential treatment home beds for ages 17.5 through 24 years of age, and
- Developing a 10-bed Secure Residential Treatment Facility for young adults aged 18 through 26 years of age with higher acuity needs.
More information is to come. If you are interested, the RFGA will be posted on the Social Determinants of Health website.
Contact Jessica Stout at jessica.l.stout@dhsoha.state.or.us with any questions.
Interdisciplinary Assessment Teams ($5.7 million)
We continue to meet with community and system partners to assess the need of the Interdisciplinary Assessment Team (IAT) project and creative ways to move forward. The first goal, set out in Senate Bill 1 (2019), is to provide rapid access to evaluation, assessment and stabilization services for youth and especially for those who are in child welfare custody and placed in temporary lodging, in emergency department boarding, in shelter care, in county juvenile facilities or in the custody of Oregon Youth Authority.
Chelsea Holcomb presented to the System of Care Advisory Council on Dec. 6 and her slides are available here.
Expedited Evaluation Services (EES) has a new name, Expedited Assessment Services for Youth (EASY). The service remains the same and will provide much-needed support to our communities that are clearly struggling. In some situations, all that may be needed is a full psychological evaluation to help a youth and family get on the right path to the services they need. EASY provides quick access to full psychological and assessment services within seven to 10 days of referral. EASY includes a full review of clinical documents, determination of need for testing, conducting of psychological testing, communication with current clinical providers and (where appropriate) coordination with local Intellectual and Developmental Disabilities intake screening departments. EASY can be mobile and meet the youth in the community, either in person or via telehealth as needed.
If you are interested in this work, please contact John Linn at john.r.linn@dhsoha.state.or.us.
For feedback and suggestions for our newsletter and information: kids.team@dhsoha.state.or.us
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