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 Sept. 3, 2024
In this issue...
Reflections from Oregon Health Authority’s (OHA) Child and Family Behavioral Health (CFBH) Director, Chelsea Holcomb
Summer is coming to a close and school is starting with my son getting ready for 4th grade! I have my own very fond memories of being 9 years old. I had a wonderful teacher that year, someone with an amazing gift of seeing and nurturing strengths in children, before they might even know their strengths themselves. She created a classroom environment that inspired creativity, collective learning and brought nature into all our learning activities.
This sort of classroom promotes mental health, including physical and emotional safety, security, social connection, identity, diversity, and purpose. A great link to explore is the Oregon Department of Education web page and toolkit with information and resources for schools, communities and families to promote care and connection.
Thinking about connection, at a recent conference I was introduced to the idea of “lived expertise” as a replacement for “lived experience”. I really like lived expertise because it focuses on recognizing the wisdom and knowledge that individuals have gained on their journey. For me it speaks to true partnerships and joining around the insights people have into our systems. We are curious about your thoughts around words that resonate for you in this area.
We continue to value and commit to hearing and elevating lived expertise. One of the areas where this truly informs our work is suicide prevention. September is Suicide Prevention and Recovery Month and an article below shares more.
Lived expertise in partnership with our team needs to inform the direction of our strategic planning and programming. Walking the walk, in August we started a process of having youth and families inform the work on developing home and community-based services. We appreciate the time people take in helping us increase our understanding and in starting to co-create policies with us.
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In July, Chelsea Holcomb had an opportunity to ground herself in the work of other states, find common themes and look for inspiration and innovation. She joined Ebony Clarke, OHA Behavioral Health Director and Christa Jones, OHA Behavioral Health Service Delivery Deputy Director at the National Association of State Mental Health Program Directors (NASMHPD) annual meeting.
This year focused on innovation and efforts around suicide prevention, continued implementation and expansion of 988 and crisis systems and resources, including The Link Center. This center works to improve supports available to children and adults with intellectual and developmental disabilities (I/DD), brain injuries, and other cognitive disabilities with co-occurring mental health conditions. They provide resources, trainings and technical assistance for systems, programs and families. As part of the conference, OHA Older Adult Behavioral Health Lead Strategist, Nirmala Dhar, had the opportunity to share Oregon’s work on the other end of the age spectrum. She focused on intervention points for services to older adults.
Many sessions and presentations highlighted work that centers equity, naming and elevating the disability community and the importance and “must” of walking with people with lived expertise. The conference began with a film called Moving America’s Soul on Suicide, a powerful film highlighting survivors with lived expertise and powerful wisdom, insights and hope. Please take the time to watch this and share it widely.
The U.S. Department of Health and Human Services highlighted their 2024 National Strategy for Suicide Prevention report, developed with intentional lived expertise at each and every point of the development and publication. Directions within the report include health equity in suicide prevention, community-based suicide prevention, treatment and crisis services, public health surveillance, quality improvement and research. (Public health surveillance is the continuous, systematic collection, analysis and interpretation of health-related data about people.) What stood out to Chelsea was “how many of the strategies and suggested directions align with Oregon’s current work and strategies through our Youth Suicide Intervention and Prevention Plan and the amazing work of our Big River Programs.” Chelsea expresses “huge gratitude to The Alliance to Prevent Suicide and all of you doing this important work all over the state.”
As we recognize Suicide Prevention Month, please share these resources and reports in your community.
OHA participants at NASMHPD: Nirmala Dhar, Chelsea Holcomb, Christa Jones, Ebony Clarke
The month of September is designated as Suicide Prevention Awareness Month.
The suicide prevention team at OHA often uses the phrase, “Suicide prevention is everyone’s business.” And we mean it — that is one of our core beliefs. If you are human, you have a role to play in suicide prevention — all the time, not just in September.
Having an awareness month gives us the chance to take a pause and check in about how we are each doing our part. Here are some places to get started:
- Are your firearms stored unloaded and in a locked place, separate from ammunition? Most community mental health programs have safe storage devices available.
- Have you been trained in the basics of how to help someone who maybe feeling suicidal? If not, consider taking Question, Persuade, Refer.
- Do you know who and where to refer someone for help?
- If you’re a provider, are you trained and equipped for your role?
- Does your organization have suicide prevention policies and procedures in place?
- How are you building places for connection and belonging with others?
There is great reason for hope in the field of suicide prevention — Oregon is full of champions for suicide prevention who are doing good work. There is so much that can be done to create more safety against suicide, and we are here to do that work with you.
Suicide prevention is everyone’s business. Thank you for considering ways to make it your business!
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This year’s Youth IDD Mental Health Summit took place August 21 and 22 in Corvallis. With over 100 people in person and many online, the energy was palpable. Geographically online attendees included people from Mexico, Australia, India, Kenya and Romania. American participants covered the United States from New York to Florida, Texas and California. The audience spanned parents and self-advocates through providers and agencies, as well as many from school districts and Educational Service Districts. Our thanks to The Arc Oregon and the other sponsors who made the event possible.
Core to the two days was occupational therapist Greg Santucci. He explained re-framing behavior and the need to move away from behavioral intervention into connection and collaboration. Behavioral interventions have been the primary strategy when working with people who are having difficulty meeting expectations. This often means offering rewards and reinforcers to try and motivate children and youth to comply. This assumes a motivation problem is preventing them from engaging. Very often, professionals say these strategies “work,” but with all of the new knowledge we have about brain function, we have to ask, “Works for whom?” and, “At what cost do these strategies work?” Understanding how the brain influences behavior and learning will help change our approach to how we support children with concerning behaviors. It will also positively change the trajectory of their progress, and our relationship with them. The conference sessions helped attendees to gain a new understanding about “the why” of childhood behavior and learn strategies to support children and youth, improve their behavior and help them thrive.
Anis writes, “I am a Ph.D. candidate in public affairs and policy with extensive international work experience. I am a critical thinker who is passionate about bringing positive societal changes. I enjoy working with public policies, with a special emphasis on equity and social justice. For the next eight months I will be working with the Young Adult Behavioral Health Work Group to look at developing age-appropriate comprehensive service programs. Across Oregon, young adults, ages 18 to 26 face challenges accessing appropriate behavioral health services. They do not fit neatly into either adult or children’s systems and need special attention.
“I have had an interesting career. Before starting my master's program in Conflict Resolution at Portland State University in 2017, I worked as a peacekeeper for the United Nations for more than two years in Liberia. I worked with internally displaced populations and refugees along with many national and international agencies, donors, and programs. This has led to my commitment to equity work.
“In my personal time, I enjoy traveling to new places — I love exploring new cities and their food. I am also a great fan of soccer and volleyball.”
Welcome, Anis!
OHA now has a strategic plan in place and the Behavioral Health Division is in the process of finalizing its own strategic framework. The children’s behavioral health work nests beneath these layers.
This CFBH Roadmap was designed to cover a period from 2020 through 2024. We believe it is important to keep our community up to date with our progress. The dashboard for this Roadmap can be found on the Roadmap page.
Since it was published in 2022, we have been working with 29 different internal departments, started 30 new items and completed 47 components in the Roadmap. For more details, please explore our progress report. We plan to issue a short summary of this work in the next several months.
We are now in the development and engagement phase for the subsequent workplan for children’s behavioral health. This will continue unfolding over the next six months.
Senate Bill (SB) 1557 (2024) seeks to ensure appropriate access to Home and Community-Based Services and supports for children and youth under age 21.
Section 4: Exploring K-Plan expansion
Section 4 of the bill asks us to look at how to expand these supports so that children and youth can remain in the least restrictive setting, which means how to support them to remain in their homes and communities.
We are working with youth and families with lived expertise, and with other agencies and partners to explore this work. The goal is both a preliminary report due October 1 and a final report due March 1 for the Oregon Legislature. To inform the first preliminary report we have held family and youth listening sessions in English and Spanish and collected written feedback. We appreciate the time that many families and youth have shared for this.
As we continue this work, we look forward to establishing an ongoing engagement process and will communicate the process here.
Section 5: No denials for children or youth under age 21 in access to mental health assessment, treatment or services based on their intellectual or developmental disability.
Section 5 of the bill states that OHA, a community mental health program, a licensed medical provider or other certified or licensed practitioner, an education provider or a coordinated care organization may not deny any individual under the age of 21 years access to mental health assessment, treatment or services on the basis that the individual also has an intellectual or developmental disability.
- In July, OHA communicated this by memo to behavioral health system partners and hosted a well-attended listening session to hear community concerns. We will be following up with further resources and information.
- As a start, we encourage exploration of resources available at The Link Center, which provides resources, trainings and technical assistance for systems, programs and families.
We wanted to hear the voices of youth on their priorities and thoughts around behavioral health. This work is part of both the larger OHA and Behavioral Health Division strategic planning processes and anchored in the OHA health equity goal.
The final report has now been published and includes the voice of 175 young people from across Oregon. The key themes were access, quality of care, the need for behavioral health promotion and prevention and improvements to the service array. We also received some specific feedback from youth experiencing houselessness.
A special thank you goes to the young people and organizations who have been part of this ongoing community work and engaged in meaningful, and sometimes difficult, conversations about the behavioral health system. Thank you to Molly Sandmeier, Portland State University, Hatfield Fellow for her dedication to talking with youth and then collating and reporting this information.
Fear and trauma can accompany identifying as an LGBTQIA2S+ (lesbian, gay, bisexual, transgender and trans, queer and questioning, intersex, asexual or agender, and two-spirit) youth or young person. In a rural area or small town, it can also feel isolating and have a severe impact on mental health. According to The Trevor Project’s 2021 research brief, LGBTQ Youth in Small Towns and Rural Areas, LGBTQIA2S+ youth experience higher rates of discrimination and physical harm compared to those LGBTQIA2S+ youth in urban and suburban areas of the country.
Closer to home, OHA’s 2022 Student Health Survey data show that 9 percent of 8th graders in Eastern Oregon’s Baker County report being bullied because of their sexual orientation, compared to 4.5 percent of 8th graders statewide. Being discriminated against, physically harmed and bullied all contribute to greatly elevated suicide risk in this group of young people. One local advocate has worked for years with mental, behavioral, business and faith-based partners to uplift the LGBTQIA2S+ population, to help them feel seen and to know they are not alone.
Pride events are a critical part of support for the LGBTQIA2S+ community, as they celebrate this community’s differences from, and similarities with everyone else. This past June, Haley Hueckman, Mental Health Promotion and Prevention Coordinator for New Directions, NW, Inc., with guidance and help from the Baker County Safe Communities Coalition and the Baker High School Gay-Straight Alliance, held the city’s fourth-ever Pride event. With 125 people in attendance, the event brought together local and regional partners including Oregon Department of Human Services, Greater Oregon Behavioral Health, Inc., First Presbyterian Church and other. People cheered with Pride flags and signs of hope, unity and advocacy on a 1.2 mile walk through downtown Baker City. The walk culminated with a celebration at a nearby park with a live band and tables with local resources.
In talking with Haley about the event, her passion and commitment is clear. “Pride in Baker City is more than a celebration; it’s a powerful statement of visibility and belonging. I know we still have work to do, but 125 people in the park that day was a bold affirmation that everyone deserves to be seen, heard and celebrated.” We know that visibility, belonging and the acceptance that can come from that can greatly help in reducing suicide risk for youth who identify as LGBTQIA2S+.
Haley’s story is one highlight of the many mental health promotion and prevention activities happening year-round across Oregon. Funded at just over $2 million in legislative funding annually and representing 23 local public health, behavioral health, and mental health agencies, culturally specific community-based organizations and coordinated care organizations, these projects build community mental health awareness, normalize help-seeking behaviors, and lift up communities.
Pride walk in Baker City (picture courtesy of Sage & Oak Photos)
In 2001 my second child was born and I soon realized that I would need a new set of tools in my parenting toolbox. After countless engagements with mental health and medical systems, my child and I discovered Fidelity Wraparound in 2004. At that time, we had no idea how much Wraparound would change the course of our mental and physical wellness. For around 14 years my child and I were engaged on and off in the Wraparound process. Throughout that time, the 10 principles of Wraparound began to teach us some powerful life lessons.
The 10 principles of Wraparound are:
- Family-driven, youth-guided
- Team-based
- Natural supports
- Collaboration
- Community-based
- Cultural and linguistic responsiveness
- Individualized
- Strengths-based
- Persistence
- Outcome-based
Some life lessons we learned from Wraparound:
- My son is the expert on himself.
- I am the expert on myself and my family.
- We are stronger than we know, we can all learn to be advocates and be resilient.
- We don’t need to have all the answers but can continue to have hope and persist.
- We have community and connections, and it is OK to lean on them and ask for support.
- Self-care is more than action steps; it is a sense of well-being and ongoing practice.
My son’s physical and mental health have improved tremendously over time. At 23, he resides in a developmental disability group home just two miles from me. He is active in his own health care, attending appointments, and advocating for his health, medical needs and care choices. He is more physically active and socially connected and has found a passion for cooking. He has a goal to one day live in supported housing. The life lessons we have learned by adopting the principles of Wraparound have positively impacted both of us.
Fidelity Wraparound is a holistic approach. Our experiences in Wraparound are what bring me to my role at OHA as the Wraparound and System of Care Coordinator. I look forward to carrying these experiences and championing passion for the Wraparound process, as I know how powerful and life-changing the process has been for me and my son. Wraparound is more than mental health; it is overall health and well-being.
Christianna and Blaze Rhoads
EASY provides expedited full psychological testing for youth with complex behavioral health needs, and when appropriate, collaborates with the Office of Developmental Disability Services (ODDS) for eligibility screening. EASY demonstration projects in Multnomah and Deschutes Counties have helped over 113 youth (and families), and plans are in motion to expand throughout the state.
Youth and families have been waiting significantly long periods of time to access comprehensive psychological testing and assessment services. EASY is both fast and thorough. Many youth referred to EASY have been in a variety of services and levels of care, yet still have unmet needs. In many cases EASY has revealed mental health conditions and/or developmental disabilities that were missed — sometimes for years.
We hope to expand this service statewide. OHA has opened a Request for Proposal to find clinics who can provide EASY services. OHA anticipates awarding up to four proposals.
As you may know, Oregon expanded Medicaid benefits for youth from birth until they turn age 21 with the EPSDT program beginning Jan. 1, 2023.
These benefits include comprehensive preventive health care such as:
- Age-appropriate medical exams, screening and diagnostic services and
- Medically necessary Medicaid-covered services (defined in Section 1905 (a) of the Social Security Act) to treat any physical, dental, developmental and mental health conditions discovered.
OHA is planning a provider education webinar for this October. The EPSDT team would appreciate your input on how you’d like the webinar to be run and what information to cover. This will help us ensure the session will be of value to you.
Family-based Treatment for Eating Disorders: Compassion and Care through the Storm of Phase 1
Applying concrete skills and vignettes, this webinar illustrates the principles of helping families and teens face eating disorder recovery with courage and compassion in a three phased approach to family treatment.
Find events, opportunities, trainings and resources in last month’s posting on our newsletter page. Many of these trainings are also on our training opportunities web page. We will send updates mid-month — Look for the next one in your inbox on September 16.
For feedback and suggestions for our newsletter and information: kids.team@oha.oregon.gov.
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