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 March 1, 2024
In this issue...
Reflections from Oregon Health Authority's Child and Family Behavioral Health Director
Spring break offers a fantastic opportunity for families to spend quality time together and create lasting memories. While it's a time for relaxation and fun, it's also essential to engage in activities together, such as outdoor adventures, arts and crafts projects, or even volunteering as a family; this not only strengthens bonds but also provides opportunities for learning and growth.
Whether it's exploring nature trails, visiting museums, or simply having a movie night at home, staying actively involved ensures that children feel supported, valued, and connected during the break, fostering positive relationships and cherished moments that they'll carry with them for years to come. For spring break mental health resources see our new section below: Nurturing Hope – Suicide prevention in Oregon.
One of the ways our unit stays connected is through in-person retreats. We were able to meet in Salem at the end of January and we spent the afternoon talking about the things we’d like to see improved in our systems and at OHA.
We also spent some important time talking about our successes. While much was accomplished in 2023, and more difficult work lays ahead of us, we took the time to look at all that we have done, and all that we have been able to provide the community, our community partners, and children, youth and families in Oregon.
Together we asked all the members of our unit to offer their insight into the many things that went well last year. We do this to bolster our strength for the years ahead, and all the mountains that we’ve yet to climb in order to achieve health equity by 2030.
As we reflect on the joys of spring break, the importance of family bonding, and building strength in our unit, it's inspiring to see how moments of togetherness can shape our lives. Whether it's embarking on outdoor adventures or engaging in meaningful activities, these shared experiences strengthen the ties that bind us.
As we look ahead, let's carry forward this spirit of connection and reflection. Just as our unit gathers to celebrate achievements and envision a better future, let's continue to support one another in our journey towards health equity. Together, we can overcome challenges and scale the heights ahead, ensuring brighter tomorrows for all.
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OHA has been working with the University of Connecticut’s (UConn) Institute for Innovation on a holistic system assessment of Oregon’s current Medicaid State Plan and waiver structure for children, youth, and young adults through age 25.
The review will make immediate, medium- and long-term recommendations and identifies:
- Barriers to OHA’s goal of health equity by 2030.
- The applicability and understandability of current waiver language.
- Missing components from the Centers for Medicare and Medicaid Services approved authorities which would benefit the children’s system of care.
- The efficiency of transitions between and within authorities, settings, and services.
- Areas where the implementation of waivers by Coordinated Care Organizations (CCOs) do not align between CCOs, or whether CCO implementation of contractual requirements are causing barriers for member transition between CCOs.
You can also review the report findings at the UConn team’s virtual presentation on March 6 from 2 to 3 p.m.
CFBH knows that protecting the mental health of children, families and communities across Oregon is a priority. In Umatilla County, funds from Mental Health Promotion and Prevention (MHPP) legislative funds help families connect to the services and resources they need to thrive.
The Umatilla County CARE Program has long-standing partnerships with local school districts and communities, and through this collaboration they have created shared referral pathways which begin in schools.
CARE is built on a foundation of core practices that:
- Build connections with identified individual/family.
- Reduce systemic barriers.
- Identify and navigate helpful resources/services.
- Promote equity.
 From left to right: CARE Specialists Mayra Zepeda, Briana Reyes and Bobby Spencer; Marissa Medrano, CARE administrative aide; CARE Specialists Maggie King and Ayana Sanchez; Jenni Galloway, CARE supervisor. Not pictured: Carla Llamas, CARE specialist
CARE specialists offer trauma-informed, culturally responsive support to the whole family, help strengthen protective factors and strive to meet everyone in their native language with an emphasis on inclusion and equity. They assist and advocate for families in school and community meetings, and doctor’s appointments. They discuss topics that include:
- Physical and psychological safety.
- Bullying prevention.
- Suicide prevention.
- Healthy coping skills.
- Self-advocacy and the promotion of mental health awareness.
Heidi Sipe, superintendent of Umatilla School District, states “Umatilla County CARE steps in and provides connection, understanding, and resources to families. They prevent the bureaucracy that can often prevent families from accessing vital resources. They serve as a conduit and a point of contact who will see them through the entire process from application to accessing services. CARE is a vital part of our district and I'm thankful for all they do."
Examples of services include:
- Housing navigation.
- Parenting support.
- Educational support.
- Resource advocacy.
- Coordinated mental/dental/physical health services, and more.
CARE meets people where they are at and works to provide solutions for individual needs. Transportation, affordable housing and mental health needs are significant. CARE is the bridge between families and services, delivered in a culturally sensitive and equitable way. Furthermore, Union County observed the impact CARE was having and through partnerships with their local school districts and community agencies began their own CARE program in 2014.
For more information about the CARE Programs and other Mental Health Promotion and Prevention (MHPP) programs, contact Fran Pearson at fran.pearson@oha.oregon.gov.
There is a critical need for support, guidance and effective strategies to address suicide prevention, intervention, and postvention for youth in Oregon. This new section in Holding Hope will offer monthly resources aimed at preventing youth suicide and fostering hope and healing for Oregon’s young people.
Online resources from Sources on Strength
Spring break is coming up this month and Sources of Strength has two online resource packets. The first is Resources for Practicing Strength at Home, and the second is a shorter version that also offers a wellness plan. Any resource in these packets can be used in classrooms, staff meetings, in individual or group counseling, or to practice strength wherever you are.
“You Matter to Klamath” video contest winners
The You Matter to Klamath Coalition announced the winners of their annual video contest in which participants were asked to record a video that captured the importance of mental health awareness and the power of community support in preventing youth suicide. The winning videos (current and past winners) are posted on the You Matter to Klamath YouTube and Facebook pages.
This year’s winners:
Together, we can continue to make a difference in the lives of young people and promote a culture of support and understanding around mental health.
Early and Periodic Screening, Diagnostic and Treatment (EPSDT) is a federally required benefit for children and youth under age 21 who are enrolled in Medicaid. EPSDT covers all medically necessary and medically appropriate services, based on the member’s individual needs.
In Oregon, EPSDT is the child and youth benefit within the Oregon Health Plan (OHP). EPSDT does not need separate enrollment. Every member under age 21 and enrolled in OHP has EPSDT coverage. This is true whether the member is enrolled in a coordinated care organization (CCO) or not. Services include well child visits and adolescent well visits following the Bright Futures Periodicity Schedule, including developmental assessments, and referrals for both physical and mental health treatments.
EPSDT coverage spans a broad spectrum of essential health care services, ranging from behavioral health and prescriptions to dental care and rehabilitation services. Prior authorization may be required for certain services, although screening services are exempt from this requirement. Additionally, services must align with appropriate diagnoses and billing codes while adhering to Medicaid coverage eligibility criteria.
The services offered through EPSDT are intended to meet the evolving needs of children and youth. However, until 2023, certain treatments were subject to denial based on their placement on the Prioritized List of Health Services. Effective Jan. 1, 2023, EPSDT now covers all medically necessary and appropriate treatment for members under age 21, regardless of Prioritized List placement. If a treatment is not covered according to the Prioritized List, the member’s CCO (or OHA for open card members) will review for medical necessity and appropriateness.
We have been continuing the work set out in the CFBH strategic plan, also known as the Roadmap. We have been providing regular updates to keep you up to date on progress. The latest summary covers work from July to December 2023 and can be found on the CFBH website and also by following this link.
Although progress is often slower than we would wish, in the last six months we have issued the Youth and Young Adult Substance Use Treatment and Recovery Report and the 2023 Oregon Health Authority Oregon Department of Human Services Capacity Memo on Intensive Treatment Services. We have also started work on a paper about unhoused youth. We are pleased to report that more than 80 percent of items in the Roadmap are in process or complete.
Community engagement has begun on the new version of the Roadmap. This time, instead of just focusing on the work of CFBH, the next Roadmap will have a broader scope, including the work of Medicaid and other parts of OHA.
Our Hatfield Fellow, Molly Sandmeier, has been actively engaging with youth across Oregon. The information she is gathering is crucial and will inform the prioritization of our work. So far, she’s talked with more than 100 young people in 10 engagements. If you have a youth council or youth group that is interested in participating before the end of April, please let us know by contacting Hilary Harrison at hilary.harrison@oha.oregon.gov.
Our next phase is talking with families and care givers and with providers and community. Our key question: If you were running the system for children and young adult mental health or substance use treatment and supports, what would your top two priorities be?
You are welcome to give us your answer by emailing Hilary Harrison.
Since 2021 Chelsea Holcomb has been carving out an hour a week for "A Time for Families." This time gives families direct access to her and the state team. In the last year more than 40 family members have dropped in to talk about their challenges and frustrations.
In 2023 the top concerns and themes have been:
- A lack of proactive supports. This means that families and youth often have to “fail up” into needed services and supports.
- Families lack knowledge of what services and resources they might access. Most did not know that there were services or supports until problems had become unsolvable within the family system.
- The loss of mental health care resources due to changing circumstances. The examples of changing circumstances were incarceration, graduation, child custody, county location, and moving into the US from a different county.
- Parents being afraid of, or experiencing, being reported, and even having founded charges for abuse or neglect for seeking residential care for their child.
- Minimization and stigmatization of families. Systems are not respecting parents, especially those using languages other than English.
In many of these cases, families received specific case management supports. Families also received referrals to the Ombuds Program, Oregon Family Support Network and other appropriate supports and services.
If you or someone you would like to talk about your experiences as a family member, view and share these flyers about “A Time for Families”:
Intensive Treatment Services (ITS) capacity remains a critical concern to CFBH. Each week we receive data on capacity for acute psychiatric inpatient beds, psychiatric residential treatment facility (PRTF) beds, and substance use disorder (SUD) residential beds. ITS programs include psychiatric day treatment programs, residential treatment programs, secure inpatient programs and acute psychiatric inpatient units.
Total PRTF bed capacity
This bar graph shows the number of PRTF beds in Oregon compared to the goal bed count of 286 PRTF beds. The red line is the number of beds our PRTF programs physically have, and the green columns represent the highest census snapshot for each month. PRTF beds specifically include three levels of residential care: secure inpatient program (SIP), subacute, and psychiatric residential treatment services (PRTS).
 SUD residential capacity
As of January 2024, Madrona Recovery was newly licensed as an integrated PRTF program. This means they can provide either substance use disorder treatment or mental health treatment. Or both! The flexibility of this type of license gives Madrona the capacity to serve youth with complex needs that may not have met criteria for their previously operated SUD residential program.
Since the license has changed, Madrona Recovery’s beds will now be included in the PRTF graph above and not in the graph below. That is why the graph below shows a decrease in beds. We have not actually lost those beds; they have just been recategorized. This graph shows the highest possible number of SUD residential beds compared to the highest number of SUD beds that were filled at one time during represented months in 2023-2024.
 Referral and Capacity Management
We continue to make progress towards collecting referral and program capacity data in our new system, Referral and Capacity Management (RCM). RCM is a secure web-based platform designed as a tool for providers to manage referrals and waitlists to their programs. RCM will give providers a high-level view of their census and upcoming openings. Given the varying size of PRTF programs, there needs to be a tiered approach for implementing RCM. Stay tuned in later this spring to see what kind of data and reports RCM can produce.
Behavioral health crisis among top priorities for new OHA director, Oregon Public Broadcasting, by Gemma DiCarlo.
Governor Kotek, Chair Vega Pederson, Mayor Wheeler Declare Coordinated Fentanyl Emergencies, State of Oregon Newsroom.
Find events, opportunities, trainings and resources in last month’s posting. Many of these trainings are also on our website. We will send updates mid-month — Look for the next one in your inbox on March 15.
For feedback and suggestions for our newsletter and information: kids.team@oha.oregon.gov.
Subscribe to OHA Behavioral Health Updates
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