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March 1, 2023
In this issue ...
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Spring has nearly sprung, and it is almost time to set our clocks forward for daylight savings time. March can often bring with it wild and shifting weather, and as we make this transition from winter to spring, my mind goes to the numerous ways people celebrate this month. Celebrations include Ramadan, Holi and St. Patrick's Day.
March is also Women’s History Month which celebrates the often-overlooked contributions of women in history, society, and culture. It has been observed in the United States and other countries, including the United Kingdom and Australia, every March since 1987.
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March is also Developmental Disabilities Awareness Month and the National Association of Councils on Developmental Disabilities (NACDD), and their partners have a social media campaign that highlights the many ways in which people with and without disabilities come together to form strong, diverse communities.
This year they are featuring artwork by Jamila Rahimi at a studio in Washington D.C., Art Enables.
Butterfly, 2019 by Jamila Rahimi
Oregon Health Authority (OHA) has partnered with the Oregon Department of Human Services (ODHS) since 2017 to identify potential solutions to support individuals with intellectual and developmental disabilities. Current OHA initiatives include the Annual Children’s IDD Mental Health Summit, and a contract with the National Association of Dually Diagnosed (NADD) to offer trainings, learn more by visiting our website.
Let’s take this month to spread awareness about the inclusion of people with developmental disabilities in all facets of community life by lowering barriers to service and support; relieving the inequalities that people with disabilities face in health, mental health care, and education systems; and strengthening their connection to community.
The CFBH’s primary advisory body is Children’s System Advisory Council (CSAC) a monthly group that includes providers, families, youth and other interested people. The System of Care Advisory Council (SOCAC), formed in 2019, oversees the children’s system of care. Both groups seek to ensure young people and their families get their needs met. CSAC formally started a connection between the two groups with an issue brief in June 2021 followed by a response and connection to begin a collaboration.
In January, the Executive Director of SOCAC Anna Williams formally met with CSAC to increase the linkages. During this session recommendations and concerns were expressed. One recommendation from CSAC members is that the SOCAC improve their marketing and outreach strategies to include multi-media, including creating a more vibrant website, and increasing its social media presence. This aligns with the SOCAC work on a marketing and outreach plan. They will be working with the Local System of Care Councils, to talk with youth and family members in this design and development.
CFBH recognizes the importance of the two groups working together. “The continued partnership of the two advisory councils is crucial,” said Chelsea Holcomb. “Together we can compare strategies, elevate and amplify the voices of our communities and the agencies that serve them, and further our mission to achieve health equity by 2030.”
CSAC shared several concerns that Anna will take back to the SOCAC, including the frustration that parents and youth who participate on councils feel about:
- The slow pace of change
- Finding effective ways to engage legislators regarding the concerns of the various councils
- Removing barriers around meeting schedules that are preventing participation for youth and family members
- Lack of investment in the people who do this important work across our state.
To grow connections, Anna Williams will be joining future CSAC meetings. She also invites CSAC members to attend the SOCAC subcommittee meetings and join in that work as well.
In reflecting on the first of many conversations she expects to have with CSAC, she said, “I am inspired by the passion and expertise at the CSAC table. I look forward to working closely with CSAC to achieve our shared goals of improving the children’s behavioral health system in Oregon together with the members of CSAC and other councils. Centering lived experience with our current systems will help us anchor our work on transforming current systems into the truly accessible, responsive, and affirming system we know we can build for Oregon’s children and families.”
Many health plans across the nation are working toward creating patient-centered care models, while struggling with how to compensate providers who provide culturally and linguistically specific services (CLSS). CLSS are services that are grounded in the cultural values of communities that have experienced historical and contemporary racism, trauma, and social, political, and economic injustices, to elevate their voices and experiences.
CLSS aims to provide emotional safety, belonging, and encourage a shared collective cultural experience for healing and recovery.
Last year, Alfonso Ramirez, director of Behavioral Health Equity and Community Partnership at OHA, initiated the process of providing enhanced payments to providers who offer CLSS. His team approached the Alliance for Culturally Specific Behavioral Health Providers in Portland (The Alliance). The Alliance works to bring issues facing Oregon’s culturally specific communities to the forefront. Since 2019 the Alliance has partnered with Health Share of Oregon and CareOregon to develop an incentive program for culturally and linguistically specific providers.
Nationally, numerous studies have shown that communities experiencing social, political and economic injustices are disproportionately impacted by lack of access to mental and behavioral health supports. Over the last year, OHA has been working closely with the Alliance to find a way to incentivize CLSS at the state level. Enhanced payments went into effect Jan. 1, 2023, for qualified participating providers that deliver CLSS and for qualified behavioral health providers that offer direct services in a language other than English, or in American Sign Language (ASL).
Alfonso said, “In 2021 the Coalition of Communities of Color (CCC) released their behavioral health report which really laid out the gaps in access to care that existed for culturally specific communities and documented what community members said they needed. One of the things that they said they needed was culturally specific services, because communities didn't feel heard or validated in traditional dominant culture settings. My team saw this report and we considered how we could operationalize some of the recommendations in the report to achieve more equitable outcomes.
“Providers who practice CLSS told us that it is embedded in every service they provide, from the time the patient comes in the door until they leave. As we broadened our understanding by engaging in and becoming more familiar with the conversations being had between different providers, the community, the Alliance and CCC, we were able to co-create rules needed to support CLSS enhanced payments.
“Through these conversations we came to understand some of the specific needs of the LGBTQIA2S+ community, and people who were deaf, deaf-blind, and the intersectionality experienced by people from different communities also needed to be addressed. We focused on all minoritized communities and from that, we were able to make these rate increases happen over the last year. We still have a lot to learn and more conversations to have but we think we have a good start.”
For more information on CLSS, the fee schedule, and how to apply, please visit the Behavioral Health Rate Increase web page, or contact Alfonso Ramirez at alfonso.ramirez@oha.oregon.gov.
The CFBH Unit teamed up with the Office of Recovery and Resilience and Behavioral Health Equity and Community Engagement Team to host community conversations on the topic of Applied Behavior Analysis (ABA) throughout November 2022 and January 2023.
ABA is a therapy-based treatment provided primarily to people diagnosed with autism and is currently an Oregon Health Plan (OHP) benefit. Administrative rules for ABA address Medicaid payment and provider requirements but do not address oversight or management of ABA programs or facilities.
These community conversations took place over the course of six virtual, public meetings. Participants included persons with lived experience of autism and ABA treatment, parents, caregivers, ABA therapy providers, advocates, and community members.
Participants were asked to provide information about their experiences with ABA, especially regarding access, quality, and oversight of services. Participants were also asked to consider what is important for Oregon Health Authority to consider in implementing the ABA model in Oregon.
There are currently two bills before the legislature regarding ABA: Senate Bill (SB) 791 and House Bill (HB) 2421.
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SB 791 requires OHA to study ABA and report findings to the legislature no later than Sept. 15, 2024. The bill currently lacks specificity on what aspects of ABA are to be studied and reported on.
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HB 2421 calls for:
- Allowing ABA professionals to provide mental health or substance use disorder treatment within their scope of practice, without necessarily gaining parental consent, for minors ages 14 and over.
- Requiring ABA professionals to report child abuse and prohibited or unprofessional conduct of another ABA professional.
- Prohibiting ABA professionals from practicing conversion therapy.
At the time of publication, the bills have not been scheduled for hearings.
Proposals are now being accepted for the state of Oregon to hire a marketing and communications vendor to help create a multi-year, comprehensive 988 awareness, outreach and advertising campaign. Oregon needs to reach diverse communities and ensure people see 988 as a service that reaches them and understands their concerns and challenges, to build long-term trust in 988.
Proposal submission must be submitted electronically, vendors can go to OregonBuys and search open bid solicitations for Bid Notification - Bid # S-44300-00005929, Request for Proposal 5601 for 988 Suicide and Crisis Lifeline Marketing and Communications. Detailed instructions on how to submit a Proposal can be found at OregonBuys Vendor Formal Solicitation Response.
If you know any marketing, strategic communications, community engagement or other businesses that specialize in reaching diverse communities, please encourage them to apply for the Request for Proposals (RFP). This can include subcontracting and/or establishing community engagement and partnership networks with culturally specific and community-based organizations and providers.
OHA intends to award an initial Contract for Phase 1 not to exceed $100,000 to develop a comprehensive strategic communications and community engagement plan (including research, if needed) and an anticipated $1,000,000 for additional project phases to implement, evaluate and maintain a full advertising and outreach campaign. Future state and federal funding to support the campaign is anticipated but not certain.
The RFP is a competitive process managed by OHA’s Office of Contracts and Procurement. Proposers shall direct all communications related to any provision of the RFP only to the Sole Point of Contact, whether about the technical requirements of the RFP, contractual requirements, the RFP process, or any other provision. The Sole Point of Contact for this RFP is Jewelee Bell: 971-208-4144 or jewelee.m.bell@odhsoha.oregon.gov.
Please share this information with any organization that may be interested in applying.
The birth to prison pipeline has had deep historic and systemic roots going back over 50 years. Currently, a third generation is experiencing racial and health disparities across child and family serving systems.
Exclusionary school discipline, including suspensions and expulsions, worsened by racial bias, created a system that still pushes Black and Brown communities impacted by poverty and historical trauma out of school and into the criminal justice system. The widely known term for this recurring multifaceted issue is the “school to prison pipeline.” The CFBH Unit (and others) view this pipeline as originating at birth and recognize the term “birth to prison pipeline.”
The pipeline began with economic shifts, the rise of mass incarceration, and the war on drugs; resulting in a huge increase in police presence, and more disadvantaged families living in neighborhoods with concentrated levels of poverty. “No child left behind” began the largely punitive national efforts to improve the educational system, built on standards-based accountability.
The pipeline’s impact on parents and caregivers, particularly single parents, has eroded the bubble of protection that parents so often place around their children to ensure healthy brain development and social emotional regulation.
When an unwanted behavior is shown in a school setting, what educators often perceive as disrespect, or bad behavior, is often the child trying to communicate a need, whether that is a quiet space to regulate, or that they are hungry. Black students and students with disabilities continue to be suspended at higher rates than White students and students without disabilities. This pipeline system has reinforced multi-generational historical trauma, poverty, and suffering.
OHA has received feedback from youth and families, providers, the Children's System Advisory Council, partners and interested communities. OHA has heard loud and clear from families and young people that there is a need for access to a broad, flexible array of community-based services and supports for children, and their families and caregivers; to address their emotional, social, educational and physical needs. Families and children need a network of providers that is responsive to children, youth and families in a way that is trauma-informed and culturally responsive.
CFBH aims to interrupt the birth to prison pipeline by prioritizing children, youth and family voices, and examining biases and practices within the behavioral health system that have led to and continue to do harm. The next phase is reporting, refining and getting feedback for the CFBH Roadmap 2020-24. The roadmap is a living document that reflects ongoing input from communities, including the System of Care, on direction and further investments.
Fidelity Wraparound is a voluntary and intensive care coordination model. It offers a set of community services and supports tailored for a youth and family to reach positive outcomes. Fidelity Wraparound is available in every Oregon county. Youth and families work with a team trained to support youth and their families. Together they create a plan of care. This is a crisis and safety plan that helps youth and family members move toward their goals and vision for the future.
On Feb. 1, OHA updated the Behavioral Health Fee-for-Service (FFS) Fee Schedule to add Fidelity Wraparound Care Coordination effective Nov. 30, 2022. This expansion will increase provider capacity, providing eligible youth who are FFS OHP members access to Fidelity Wraparound. Learn more by reading the memo from OHA. OHA will approve flexible funding requests to Fidelity Wraparound programs. You can find the form here.
To become an approved Fidelity Wraparound program, please contact OHA. OHA and the Portland State University System of Care Institute will identify and support the training and certification needs of new programs. Please contact orwrap@pdx.edu if you are interested in becoming an approved Fidelity Wraparound provider.
If you have any questions, please contact Chelsea Holcomb at chelsea.holcomb@oregon.state.gov.
If you have questions about billing OHA, please call Provider Services at 800-336-6016.
We have now published the full Roadmap for 2020-2024. This is accompanied by the Roadmap spreadsheet which sets out all the top-level strategies and steps, and progress report, so that everyone can track the work.
This Roadmap is mapped through 2024. We will begin revisiting it later in 2023 to ensure that we are prioritizing the issues and concerns youth and families, our partners and community see as the highest needs. The next phase is to add some graphics to help frame the work and this plan.
Please let us know your thoughts, comments, and additions at kidsteam@oha.oregon.gov.
The System of Care Advisory Council has two vacancies:
- A youth member (under age 25, who 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)
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.
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.
The bottom bar chart represents a monthly summary of reported weekly operational capacity, a combination of beds in use and open beds. In the last 12 months the largest impact on capacity has been the ongoing struggle to fill workforce vacancies and manage staffing levels.
Interdisciplinary Assessment Teams
We continue to meet with community and system partners to assess the needs of the Interdisciplinary Assessment Team project. 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.
We are about to launch Expedited Assessment Services for Youth (EASY). 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. It 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.
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Stress & Trauma Toolkit for Treating African Americans in a Changing Political and Social Environment: This tool kit from the American Psychiatric Association provides mental health assessments and treatment options for Black youth in the United States. It also gives context to better understand the unique factors that lead to increased trauma and risk for mental health problems for this population.
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The Impact of Racism on Child and Adolescent Health: This article from the American Academy of Pediatrics discusses how racism as a social determinant of health. It provides an evidence-based document focusing on the role that racism plays in the development and health outcomes of children and adolescents.
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Resilience in African American Children and Adolescents: This report from the Task Force on Resilience and Strength in Black Children and Adolescents from the American Psychological Association identifies factors that contribute to the healthy development of African American youth. It also describes the need for identifying and promoting strength and resilience.
Events, opportunities, trainings and resources may be found by following this link, and can be found on our website. They will be sent out mid-month, look for March events in your inbox on March 15.
We are currently hiring for a Wraparound and System of Care Coordinator. This position requires specialized and advanced knowledge of Wraparound and System of Care models, assessment, diagnosis, and treatment of mental health disorders in children and adolescents. Knowledge of children's mental health treatment systems of care and evidence-based practices is required. General knowledge of methods and techniques of building community alliances and partnerships to develop, implement, and mentor programs and leverage resources.
For feedback and suggestions for our newsletter and information: kids.team@dhsoha.state.or.us
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