SAMHSA describes the original CCBHC demonstration program as a new model for care delivery and “an opportunity for states to improve the behavioral health of their citizens by providing community-based mental and substance use disorder services; advancing integration of behavioral health with physical health care; assimilating and utilizing evidence-based practices on a more consistent basis; and promoting improved access to high-quality care.”
The ongoing success of CCBHCs across the country has led to multiple rounds of SAMHSA expansion grants and significant Federal emergency funding during the COVID-19 pandemic. “CCBHCs are closing the treatment gap that leaves millions of Americans with unmet mental health and substance use needs, bringing thousands of new clients into care, decreasing wait times and providing same-day access to care,” reported the National Council for Mental Well Being in its latest CCBHC Impact Report.
“The ability to provide coordinated and centralized care—including crisis intervention along with substance use disorder and mental health services—was crucial before the COVID-19 pandemic. The urgency to connect Americans to such easy-to-access treatment and services has increased exponentially since,” said Miriam E. Delphin-Rittmon, Ph.D., HHS Assistant Secretary for Mental Health and Substance Use and the leader of SAMHSA, in a July 2021 announcement of additional CCBHC funding under COVID emergency legislation.
Launching CCBHC Services During the COVID-19 Pandemic for People with Criminal Legal System Involvement
The CASES Nathaniel Clinic received a 2020 SAMHSA CCBHC expansion grant award to support and expand its integrated, single-site services, including primary care, substance use care, family and peer care, case management services, mental health treatment, mobile outreach and 24/7/365 crisis intervention.
The Nathaniel Clinic serves clients with unique needs. Most have criminal legal system involvement, and many are also unstably housed, with about 20% of clinic clients actively experiencing homelessness. Clinicians at the Nathaniel Clinic are specialized to serve clients with these unique needs without stigmatizing their experiences.
“We always had outreach, but the grant enabled us to address the pandemic by expanding our mobile crisis team–which now has therapists, peers, and case managers–to see people where they are,” said Billy Green, the clinic’s Director of Practice Operations. “The award notice came in the middle of the pandemic when there was so much uncertainty both on the operations side and around the present and future challenges our clients would be navigating. When we received the news, we met with every stakeholder to map out immediate and future changes,” Green said.
As the pandemic continues, CASES is balancing the health and safety of clients and staff against the need to continue answering crisis calls: “We are recognizing the need people have to be seen if they are in crisis. If they need to have an assessment right away, we are supporting Home and Community-Based Services (HCBS) with case managers and housing specialists. If people don’t have housing or jobs, we are getting people into residences or providing other highly individualized support. We’ve even helped to get a mattress delivered to one client’s home,” Green said.
CASES Nathaniel Clinic CCBHC Achievements
As a CCBHC, we can spend more time now on targeted case management, and we can enhance our already existing primary care services for a population that often has multiple comorbidities. The grant enhances our quality of care across our clinic operations, with more sustainability from a financial perspective,” Green said.
“During the pandemic, CASES also started a new Forensic Homeless Intensive Case Management team. When people living with serious mental illness are released from prison straight to a New York City shelter, we can support them to ensure they have a real opportunity for a successful return to the community.”
CASES is also providing technology to support client engagement through remote services: “We can provide cell phones and data plans to people who need mental health treatment but couldn’t access it otherwise,” Green said.
“We planned, and we planned, and we planned, and we are living and breathing our updates to our systems, procedures, protocols and workflows so that we can deliver on our promises,” said Lauren Roygardner, the CCBHC Evaluation Director at the Nathaniel Clinic. “We are seeing the results in our fiscal components, in our outcomes evaluations, in our increased usage of evidence-based approaches, in our revamped intake to address needs, and we are seeing it in our quality measures.”
“CCBHCs strengthen the connectedness of a person across situations and need to resources and services that we can provide under our roof with fewer barriers and fewer handoffs,” Roygardner said. “The engagement pays off, and the outcomes are better. While we are supporting mental health care, we can also coordinate care for hypertension, replace a client’s eyeglasses and engage them in monitoring their diabetes. We want to be moving in the direction of completed treatment.”
Organizational Change Management for CCBHCs
Once the CCBHC grant was approved, CASES needed to design new workflows and processes while elevating its level of data-driven-decision making to meet CCBHC reporting requirements. “CCBHC services require significant usage of evidence-based practices and outcomes metrics, reporting and data analysis to meet grant requirements and program compliance,” said Mary Givens, CCBHC Program Manager for Qualifacts + Credible, who provides subject matter leadership for both the CareLogic and Credible Behavioral Health EHR platforms.
“CASES has reworked and adjusted the Nathaniel Clinic’s workflows to align their clinical, billing, and reporting practices with CCBHC requirements,” Givens said. “CASES chose the CareLogic EHR to support its programs and services, including its expanded CCBHC care, for the platform’s integration of clinical documentation, billing, and claims, evidence-based best practices, capabilities to track and report outcomes and support for coordinated care. CASES is building its clinic’s future on CareLogic.”
CareLogic CCBHC Support for CASES Nathaniel Clinic Programs and Services
From interoperability to keeping coordinated and integrated care teams informed of changes in client status and care to its IMPACT and IMPACT PRO libraries of assessment instruments, the CareLogic EHR supports the CASES CCBHC mission across its programs and services.
“Our digital front door and our established relationships with our clinical partners enable our CCBHC care teams to know when people have been hospitalized or discharged, and they can respond accordingly,” Green said. “We are seeing more clients at risk for adverse health outcomes, and we are getting more referrals from hospitals, so we are constantly dealing with more emergent matters and strengthening our two-way referral connections to the community,” Green said.
“The CCBHC model is the future. The clinic has undertaken this enhancement and expansion of services under the COVID-19 pandemic, supported by the CareLogic EHR, and we have never closed our doors,” Roygardner said. “The missing piece is what happens when the grants run out.”
“The CCBHC model is leading the way toward whole-person care and integrated care. We are seeing more and more emphasis on the CCBHC style of integrated services and wraparound services as we build out our implementations in states where compliance requirements and payer contracts are presenting providers with similar requirements,” said Robert Patton, Qualifacts + Credible VP for Implementation Services.
The CASES Mission and the COVID-19 Pandemic
In the wake of COVID-19, the need for accessible mental health services is greater than ever. CASES’ Nathaniel Clinic has seen significant increases in need and demand for mental health services during the pandemic: from February 2020 to January 2021, the clinic saw a 77% increase in monthly active clients and a 78% increase in average weekly services.
About CASES and The Nathaniel Clinic
The mission of the Center for Alternative Sentencing and Employment Services (CASES) is to increase public safety through innovative services that reduce crime and incarceration, improve behavioral health, promote recovery and rehabilitation and create opportunities for success in the community. The Nathaniel Clinic is one of only two State-licensed outpatient mental health clinics in New York City specifically designed to serve people with criminal legal system involvement and the only one with this specialization licensed to serve youth as young as 13. Features of the clinic’s forensic specialist approach include streamlined intake and assessment to ensure rapid access to care. Clients are engaged in services that do not require them to repeatedly share information, including trauma narratives, as they see different clinic staff for different needs.
The CCBHC grant supports the pathbreaking efforts CASES has made to bridge silos of services and treatments that can be difficult for clients to cross.
Following release from jail or prison, people with behavioral health needs often struggle to successfully manage the transition back to life in the community. Treatment providers based in the community are often reluctant to serve these individuals either due to a lack of expertise or the dual stigma of criminal histories and behavioral health needs. As a result, justice-involved people living with mental illness are particularly vulnerable to a revolving door of arrest, incarceration, release, re-arrest, incarceration, etc.
On any given day, Rikers Island holds more men and women with mental illness than all of New York’s psychiatric hospitals combined. CASES adult behavioral health services include court-based alternatives to detention and to incarceration along with community programs that include intensive mobile treatment services. All of these programs incorporate the evidence-based principles of:
- Risk-need-responsivity: tailoring service intensity to an individual’s unique risks and needs as documented in validated screening and assessment;
- Motivational interviewing: helping participants to overcome ambivalence and/or resistance to change and promoting their commitment to engaging in support and treatment services; and
- Trauma-informed care: delivering services within a framework that recognizes and addresses the likelihood that clients have experienced and/or are currently experiencing trauma.
CareLogic CCBHC Support
CareLogic offers a range of EHR platform capabilities for CCBHCs, including support for evidence-based practices, billing requirements and reporting and required outcome measures. Qualifacts + Credible offers engagement with subject matter experts and a complete kit of implementation success tools for the CCBHC. Our partnerships include a CCBHC Cohort of peers that meets monthly, with peer-selected topics that include guidance on how to market new CCBHC services/programs, set up and configure the EHR and re-engineer workflows.
CareLogic User Group and Peer Leadership
The Qualifacts + Credible Community includes a national CCBHC user group led by experienced agency leaders and supported by staff who are nationally recognized for CCBHC thought leadership. Members share information and best practices, both nationally and state by state. Qualifacts + Credible teams gather and post federal and state updates on funding and support to the forum.
CareLogic CCBHC Clinical Workflows, Assessments, Outcomes, and Field Support
CCBHC providers offer specialized mental health and substance use disorder services across teams who need visibility into the continuum of care.
CareLogic EHR support for CCBHCs includes:
✓ Integrated workflows, configured to the best practices across specialized teams
✓ Clinical decision support triggers that teams can self-configure, with links available to the latest research-based, evidence-based, best practices, and to clinical references and patient education materials, through DynaMed.
✓ The IMPACT outcomes management platform, with a library of more than 80 industry-standard assessments and screening tools, with data integration into clinical documentation; Patient-Reported Outcomes, to support client engagement, are featured in IMPACT PRO
✓ CareLogic MOBILE offers clinicians in the field disconnected documentation capabilities
CareLogic CCBHC Outcomes Measures, Data Analytics and Reporting for Compliance
Reports built specifically to comply with CCBHC outcome tracking measures include:
✓ Caseload characteristics data that can be modified to fit your workflows and business processes
✓ Out-of-the-box drillable dashboards support data-driven decision making to manage clinical, financial, and revenue cycle management reporting
✓ More than 120 standard reports for actionable insights
CareLogic CCBHC Interoperability for Care Coordination, with ONC Certified Capabilities
Qualifacts + Credible has completed more than 80 integrations in the past two years, supporting CareLogic capabilities to:
✓ Exchange CCDAs with clients and external providers, using patient-portal messaging
✓ HIPAA compliant message exchanges
✓ Enable clients to access clinical summaries through an ONC API and third-party apps
✓ Exchange lab orders and results through e-labs
✓ Electronically prescribe medications, including controlled substances, with formulary and drug interaction checks at the point of care, with PDMP capabilities within the clinical workflow
CareLogic CCBHC Support Specialized Billing, Claims, and RCM
✓ Client‐specific fee structure that can be copied forward for easy edits and management
✓ Copy Authorizations feature copies forward Authorization information
✓ Periodic Services Report to track and manage services
✓ Individualized rates and periodic services for PPS billing with daily or monthly frequency
✓ Visibility into client mix, by programs and services
✓ Smart claims for periodic services: Scheduled by date, timeframe, or by number of services delivered
CareLogic CCBHC Configurability
CareLogic’s intuitive, one-click navigation allows users to quickly customize workflows for different roles through a user-controlled back end. Agencies can self-service add and update programs, services and locations without expert IT intervention. Configurable forms provide the ability to design your own service documents to support required CCBHC services, which can include:
- Crisis mental health services including 24-hour mobile crisis teams, emergency crisis intervention and crisis stabilization*
- Screening, assessment and diagnosis including risk management*
- Patient-centered treatment planning*
- Outpatient mental health and substance use services*
- Primary care screening and monitoring**
- Targeted case-management**
- Psychiatric rehabilitation services**
- Peer support, counseling services, and family support services**
- Services for members of the armed services and veterans**
* CCBHC must directly provide
** May be provided by CCBHC and/or designated collaborating organization (DCO)
CareLogic CCBHC Reports and Measures
CareLogic offers these reports and measures are, as well as reports that are specific to individual CCBHCs:
- Caseload Characteristics
- WCC-BH/ NQF-0024
- ASC NQF-2152
- DEP-REM-12 NQF-0710
- I EVAL measure
- BMI-SF NQF-0421
CCBHC References for Results Data and Impact
- CCBHC Impact Report (National Council for Behavioral Health, 2020)
- Data Highlights: Certified Community Behavioral Health Clinics (National Council for Behavioral Health, 2019)
- CCBHCs: Bridging the Addiction Treatment Gap (National Council for Behavioral Health, 2018)
- CCBHC Demonstration Program: Report to Congress, 2018 (Office of the Assistant Secretary for Planning and Evaluation, 2019)
- CCBHC Demonstration Program: Report to Congress, 2017 (Substance Abuse and Mental Health Service Administration, 2018)
ABOUT QUALIFACTS + CREDIBLE
Qualifacts + Credible, is a leading provider of electronic health records systems and related technology for behavioral health and human services organizations. With decades of experience, the company is laser-focused on helping agency partners improve clinical outcomes, enhance operations and create healthier communities.