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The Statewide Behavioral Health Coordinating Council met on November 30 to take up the agenda posted here.

This report is intended to give you an overview and highlight the various topics taken up. It is not a verbatim transcript of the discussions but is based upon what was audible or understandable to the observer.

 

Item 4. Presentation: Behavioral Health Collaborative Matching Grants – Status Report to the Statewide Behavioral Health Coordinating Council

Pamela Benett, HHSC

  • Link to Presentation
  • Report on behavioral health collaborative grants, impact, and outcomes directed by HB 1 from the 88th Session
  • Slide 4 provides details on the collaborative grants: 1) Mental Health Grant Program for Justice-Involved Individuals, 2) Health Community Collaborators, 3) Community Mental Health Grant Program, and 4) Texas Veterans + Family Alliance
  • Report gathers info from several sources, incl. performance data, billing data, SBHCC online survey, etc.
  • Highlights benefits of collaborative partnerships on Slide 7, incl. growth of sustainability & program, access to evidence-based care, etc.; quotes from grantees highlighting successes on Slide 8, challenges on Slide 9, suggestions for support on Slide 9
  • Provides overview of reporting on performance data, now utilizing Tableau dashboard to allow quicker & quarterly analysis, charting trends over time; now reporting on demographic data from grantees
  • Examples of demographic data and comparisons on Slides 12 & 13
  • Next steps: Tableau being used as blueprint & testing ground for performance reporting, further development & enhancement based on lessons learned, using data for technical assistance & monitoring, and automation in a Grant Management System

 

Ariana Coombs, Permiacare

  • Grantee spotlight on provider receiving a Mental Health Grant Program for Justice-Involved Individuals
  • 302k residents in Midland & Odessa, serving a high crime area with many individuals needing services
  • Provides history of Permiacare in the area, working with 7 district courts in Odessa & Midland
  • Providing competency restoration in Ector County Detention Center
  • Highlights certain cases, successes & challenges
  • Excited to see expansion, have been able to reduce waitlist from 64 to 35, hoping to continue providing services in the future

 

Pamela Benett, HHSC

  • Opens for Q&A
  • Dr. Courtney Harvey, SBHCC Chair – Appreciates work of providers like Permiacare & enthusiasm for the work; some of the needs highlighted are in-patient beds, child care, breaks in services as children are transferred; what would Permiacare want to see happen this session for services expansion?
    • Coombs, Permiacare – Would like to see expanded buy-in from the judicial system, not all courts are participating in jail-based competency restoration yet
    • Understand expansion can be hindered by number of staff, but continued support of the state is important
    • Services that assist released individuals to continue care would be helpful, don’t have as many community resources as we would like, especially in housing
  • Harvey – Housing is such a major issue, is it a lack of brick & mortar? Reticence to house these kinds of clients?
    • Coombs – More along the lines of qualifications for housing, housing is expensive
    • Manpower is also an issue in Odessa, e.g. Salvation Army was closed for several years due to staffing issues
    • Will also not be able to obtain services with certain charges; lack of services for those with the highest mental health needs and judicial charges
  • Harvey – These are concerns that have been voiced to many of us, helpful to have this reinforced
  • Dr. Blake Harris, SBHCC Member – You are doing some great work out there
  • Brandon Wood, Texas Commission on Jail Standards – Appreciate the presentation, would like to share things that are working with others
  • Harvey – On Tableau dashboard, is it available to non-HHSC parties like members of the Statewide Behavioral Health Coordinating Council
    • Benett, HHSC – I believe this is the goal, main concern now is validation of data; no one currently can access Tableau now, but can do screenshots, reports, etc. that can be shared
    • Should validate with HHSC prior to sharing, want to get to point where Tableau is a real-time presentation of data
  • Harvey – On training and technical assistance, as monthly/quarterly calls occur, might be helpful to have representatives from the SBHCC
    • Benett – Great suggestion, GICU does not coordinate, but do participate
  • Harvey – Will give opportunities to strategize about resource needs & plans

 

Item 5. Subcommittee Updates

Behavioral Health Workforce Subcommittee

  • Link to Presentation
  • Have been meeting around formalizing goals & objectives of the S/C
  • Goals incl. reviewing legislation, adding new members, preparing for recommendations to the legislature, bi-annual live meetings, monitor & review BHP workforce shortages, and identify gaps in the statewide strategic plan
  • Harvey – S/Cs and HHSC staff have been meeting to talk through work plan and agenda for S/Cs; asks for thoughts on focus topics
    • S/C Chair – Trauma-informed care is overused & misunderstood that it is only for frontline care workers; looking more towards creating a trauma-informed care workplace in general, creating a healthy & safe workplace
  • Harvey – Seeing a lot of agreement
  • Trina Ita, DFPS – Trauma-informed care is very loosely used, many don’t understand implications; multilevel, multilayered, systemic approach that starts with executive buy-in and must filter through the organization
  • Ita – Also interested in your thoughts on workforce issues, ability to recover as a system is a long term effort; even competent people reach burnout
    • Biggest concern is licensed mid-level professionals, they get reimbursed through Medicaid at 70% instead of the typical mid-level rate of 92%
    • 92% would be a great bump, but most mid-level providers wouldn’t be satisfied with 92%
    • Private insurance pays off the code & not the profession, e.g. psychotherapy from an RMFT
    • Also need to look at reciprocity with other states
    • Should also be using unlicensed, skilled workers as extenders for the behavioral health field
    • Working with UoH to conduct training in Spring for community health workers
    • Community health workers are also looking for career advancement support
  • Evan Norton, TJJD – Will take awhile & effort needs to continue through legislative sessions, work done by S/C has been a big catalyst for ongoing efforts to improve staff morale
  • Ita – Could you speak more about the community health workers as extenders? Often find scalability challenges as people don’t understand extenders
    • Best way is to figure out how to properly compensate community health workers
    • Others have created standard policies & guidelines for the extender position to help others understand how to use them
    • Highlights example of organizing a home health worker cooperative to allow for higher wages and better service
  • Blake Harris, TVC – Might be very additive to have representatives from each profession on the Board
    • Have been working on adding specific personnel from disciplines like psychology and psychiatry; certainly a focus and appreciate feedback
    • New representatives listed on Slide 4
    • For Medicaid reimbursement, takes 9 to 12 months to credential someone through state Medicaid, difficult to employ someone for that time period while they can’t be reimbursed
  • Harvey – Love the focus on unlicensed professionals, can allow orgs to preserve resources & allow others to step in with supervision to provide needed services
    • Will send along the bipartisan policy document & the membership list; can take recommendations on who else needs to be added

 

Suicide Prevention Subcommittee

  • Meets monthly, last meeting, started looking at legislative report due next November in 2024 on suicide prevention; SBHCC is required to submit report every other year per budget rider
  • Bulk of report is gathering data on suicide & identifying opportunities for state agencies to assist in reducing suicide rates across the state
  • Focused on using data that is digestible; last report from 2022 came in just under 300 pages, but included a lot of disaggregated data
  • Looking at policy recommendations and reaching populations most affected by suicide
  • Draft should be ready by next summer for review
  • Harvey – Have had conversations about strategizing on info, understand report has info required by legislation, but could have doc with most critical data, executive summary, key recommendations, etc.
    • Thinks there are ways to make it easier to access info & make it easier to use for SBHCC, agencies, etc.
    • Key aspect of the report is putting all of this data in one place
  • On Technical Transformation Initiative Grant recently awarded to HHSC, will apply to age range 15 to 24, will be able to create youth & young adult focus groups on factors leading to suicide, create tools to target populations with difficulty accessing health care, and developing video messaging to strengthen crisis supports for intervention & prevention; will be starting on these this month, starting on contracts, etc.
  • Harvey – Wonderful work; want to offer training and technical assistance in applying tools in the tool kit; excited to seer focus on children & youth who are deaf and hard of hearing
  • Norton – Appreciates HHSC’s work with workgroups; TJJD recently looked at working with youth and improving coping skills & surveyed what resonated with that group

 

Children’s Mental Health Strategic Plan

  • Have been meeting monthly since September & plan to get together monthly through June, currently working to bring info into the S/C and determine what we are trying to build for a plan
  • Very close to having vision, mission, & guiding principles finalized
  • Also working to understand what is needed in order to respond to the budget rider
  • Plan is due on December 1, 2024, want to have plan ready for review by May or June
  • Next meeting is in January & doing a lot of info gathering between now & then
  • Looking at services provided to determine gaps & what can be done about it; what are the services provided & is everyone defining those services the same way
  • Have been discussing accessibility of language in the plan; goal is to have it be understandable by everyone picking it up
  • Over winter going to begin looking at outline of the plan, hopefully will have words on paper the next time it is presented before the SBHCC

 

Item 6. Presentation: Suicide Prevention Initiatives and Data

Jennifer Haussler Garing, HHSC

  • Link to Presentation
  • 2019 & 2020 TX rates remained the same at 13.4 deaths per 100k, rose to 14.2 per 100k in 2021
  • Graphs highlighting incidence by certain factors on Slide 4-7
  • Data on suspected suicide attempts from poison control calls to CDC on pages Slide 8-11
  • Mortality statistics on Slides 11-13
  • Harvey – Are there specific interventions you are familiar that could be employed with he adolescent female population 6-12, 13-19, that could be included in the children’s mental health strategic plan? What are the factors contributing to increased rate? Always think of cyberbullying, social media, etc.
    • HHSC – Suicide is multifactorial, would be easier to be able to point to one factor like cyberbullying, but many different things affect children & youth, especially those identifying as female
    • Will be working with focus groups and asking them for insight on what increases thoughts of suicide
    • One of the most telling graphs is one that showcases higher rates while school is in session & during certain times of the school year; need to work with education staff to help create a safer environment
  • Harris – Did the military statistics lump in veterans?
    • Just military, one of the five branches

 

Lisa Sullivan, Texas Suicide Prevention Collaborative

  • Talking about collaborative relationships, public-private spectrum, and resources coming together to bolster outcomes
  • Overview of the Texas Suicide Prevention Council, previous state plans on Slides 18-22
  • Council has five key responsibilities, 1) Collaboration & Capacity Building, Outreach, Coalition Development, Training & Symposia, and developing & implementing the Texas State Plan for Suicide Prevention
  • Texas Suicide Prevention Collaborative is a statewide nonprofit that focuses on technical assistance, promoting evidence-based best practices, and administering the Council
  • Looking to promote collaboration via the State Plan for Suicide Prevention, document is a working document & executive committee meets quarterly to discuss the plan & next steps
  • Key performance areas for the Collaborative are highlighted on Slide 26
  • Significant research efforts are ongoing in TX, current plan tries to capture these efforts & outcomes of research
  • Council also wanted to highlight commitment to postvention in state plan
  • Harris – Often rely on this expertise when working on veteran suicide prevention
  • Harvey – The explanation of differences between the Council & Collaborative was helpful; preparing for the next session, curious about critical recommendations we may want to highlight, have heard of things like lost teams as a postvention support; also curious about funding
    • Sullivan – Vast majority of coalitions receive no funding, all volunteer led
    • Primary funding sources for the collaborative tend to be private sector, some grant funding from mental health orgs
    • Biggest challenge is in supporting local coalitions
    • On recommendations, not only loss teams & grief response, but also community planning support & holistic approach for larger postvention strategy
    • Would defer legislative priorities & happy to circle back as it matures a little bit
  • Harvey – Will want to follow up; who is running the coalition at the local level? County, city, public health departments?
    • Varies quite a bit, unique to each community; sometimes completely volunteer led via community partners, sometimes LMHA led, etc.
    • Collaborative has encouraged coalitions to use co-chair system for interested parties

 

Item 7. Presentation: Texas School for the Deaf

Rebecca Mowell, Director of Student Support Services

Ashley O’Niell, School-Based Mental Health and Wellness Coordinator

  • Link to Presentation
  • Provides overview of TSD on Slide 2; focusing today on instruction, student supports, and student life divisions
  • Staff and student profile and demographics on Slide 3 and 4, hometowns of origin for students on Slide 5
  • Expecting student numbers to grow as there is a waiting list for January
  • There are students who fly back and forth from home to school, residential services available for these students
  • Special Education eligibilities highlighted on Slide 6
  • Challenges listed on Slide 7
  • Recognize growing need for mental health services, can be impacted by lack of services in hometown, lack of signing in the home/communication breakdown
  • Also see greater gaps in language and educational growth sometimes
  • Other challenges include cultural and language acquisition, culture shock when returning from TSD; holiday season can be difficult as students don’t want to return home where communication and cultural access can be difficult
  • TSD provides residential program, but isn’t all-inclusive with specialized behavioral treatment programing
  • TSD is not a residential placement, students can be placed for academic services, but this is a not an RTC
  • Current services and supports highlighted on Slide 8
  • TSD conducts self-harm/suicide screening, can be done by counselors, resource specialists, etc.; will reach out to MCOT and deputies if needed
  • Also have an intake/social work referral team
  • TSD services and support goals incl. 1) establishing a clear definition of on-site mental health services and supports, 2) develop strong collaborative relationships with off-site agencies and orgs, 3) Review and update policies and procedures concerning mental health, 4) clarify and finalize tiered services, and 5) establish an on-site mental health clinic or services
  • Currently reviewing mental health policies and procedures
  • TSD Access policies are highlighted on Slide 11; have varying policies to fit the individual
  • Ideal collaboration at TSD would involve one designated person for contact with SBHCC and other agencies, could serve as the person who gathers and distributes information as well
  • Other things to consider:
    • 1) always consider a deaf client may be a deaf plus individual, e.g. deaf individual with IDD, etc.; shouldn’t assume basic access tools may not be enough
    • 2) ADA rights and application in your workplaces, e.g. interpreter access is legally required; ADA knowledge is important, very few loopholes exist & important to recognize your responsibility
    • 3) How to find and identify qualified interpreters; quite a few agencies exist in Austin
  • Harvey – Excited about this presentation & new information, e.g. accounting for linguistic differences at TSD is massive; helpful to hear aspects like having any interpreter is not good enough & important to have quality interpretation
  • Harvey – Would like to link HHSC in review of mental health policies
  • Harris – What is the standard for training for interpreters
    • O’Niell – Interpreter providing voicing services now is lead interpreter if they want to speak
    • Mowell – No, there is not local trainer or training for interpreters regarding mental health
    • Lee Godbold, TSD Lead Interpreter – For interpreters the only training available is the State of Alabama Mental Health Interpreter Training Program, intensive week long program with certification test
    • In the nation there are only 135, only 4 in TX
    • Unfortunately not widely accessible due to finances, but would love to see an expansion of mental health components and programs
  • Harvey – Is the Alabama proprietary or are other states able to develop like training?
    • Would think they can, Texas Mental Health Program for Deaf Youth exists & offers a smaller 2 day training
    • Alabama program was the result of a lawsuit because deaf people were not served in mental health facilities in the state
  • Harvey – Would like to see the litigation outcomes document from that & actions Alabama had to take
    • O’Niell – Also wanted to highlight how complex it can get when a person is in crisis & law enforcement is involved; a lot of layers to consider & a lot of abilities need to be involved
  • Harvey – Very informative presentation, members of SBHCC are your partners & want to work on solutions

 

Item 9. Public Comment

Liz Piñón, Self

  • Highlights struggles of children to receive appropriate services, services obtained are short lived due to insurance constraints
  • Son was incarcerated wrongfully without any consideration of IDD services; should have clear plans to prevent individuals with IDD from wrongfully being involved in the justice system

 

Deborah Winters, Self

  • Son has SMI, have struggled with accessing the right care at the right time & place; son passed away at the Kauffman County Jail after being put in solitary confinement
  • LMHA gave them list of medications on Friday after he was arrested on Thursday; have tried to contact many state agencies about this issue, son died due to lack of continuity of care, no one intervened in a timely manner
  • Should identify people with SMI, services & medication are not being provided
  • Harvey – Wanted to acknowledge these comments, heard the issues of continuity of care & issues with access to services in jails; you both are aware of resources, but needs of your children weren’t met; want to keep people out of justice system as much as possible
    • Winters – Had to shrink info by half to fit in the 3 minute time limit, son had a psychotic break & jail didn’t respond

 

Nan Terry, Self

  • There are a couple of concerning situations in the Tarrant County jail, IDD individuals have not received timely care; another detainee was put in a competency restoration program when they had not been competent ever before
  • Hard to obtain data
  • Tarrant County needs facilities to house autistic adults in crisis instead of the jail

 

Kirsh Gundu, Texas Jail Project

  • 136 deaths in county jails, 13% suicides; jails lack suicide lifelines, other services are lacking
  • Highlights recent suicide death in county jail, serious behavioral health issue was criminalized
  • Harvey – Appreciates work from the Texas Jail Project & comment on lack of 988 access; seems like there is a real need for respite services and for individuals with cooccurring behavioral health issues

 

Elle Cross, Mano Amiga

  • Highlights instances of clients arrested for mental health episodes; lack of appropriate care like SSLCs, services, etc.
  • Need more options for supervised & structured settings; different aspects like social determinants of health can drive poor outcomes
  • Harvey – Want to speak more afterwards; comments on social determinants are well noted

 

Sonya Burns, Self

  • SBHCC should push for IMD waiver to increase access to beds; need adequate lengths of stay for individuals with behavioral health & mental health needs
  • Serious issues with lack of access to Medicaid & trauma resulting from that that leads to further issues
  • Should look at housing & collect 90 day data, submit records to federal government; need school records
  • LIDDAs need to tell you about SSLCs and bed availability
  • Harvey – Will speak to you after the meeting as well; have discussed IMD waiver before, looking at Medicare, and access to school records
    • Burns – IMD waiver extends 15 days to up to 60, would be huge