More changes in mental health and substance use disorder service delivery are afoot in Douglas County. By the end of 2022, Bert Nash Community Mental Health Center will have transitioned to a new model of care known as Certified Community Behavioral Health Clinic, or CCBHC.
Out of 26 community mental health centers (CMHCs) across Kansas, Bert Nash will be one of the first nine to transition to the CCBHC model, said Andy Brown, commissioner of Behavioral Health Services for the Kansas Department for Aging and Disability.
“All in all, we think it’s going to be a pretty big benefit to Kansans. And in Douglas County, in particular, it’ll tie in really well with a lot of the efforts that the community has been making around mental health efforts.”
Brown said in a phone interview that the biggest difference between the current CMHCs and the newer CCBHC models would be a higher emphasis on evidence-based programs – or therapies that have been shown consistently in scientific studies to improve client outcomes.
Those programs include cognitive behavioral therapy, Housing First, Assertive Community Treatment through the Treatment and Recovery Campus of Douglas County, and the employment program Individual Placement and Support, commonly referred to as IPS.
“It also requires that the CCBHCs provide SUD (substance use disorder) outpatient services, mobile crisis response team services, and other 24/7 crisis stabilization programs. And so it really expands beyond what we think of as the traditional mental health services, and looks at how to integrate those into more holistic care, and it does that by connecting people with care coordination.”
Brown said CCBHC clients would receive care coordination for a variety of issues they might need help getting access to whether the services are directly provided by the clinic, a partnering agency or another community resource.
That translates to “a very tailored” service experience, Brown said. Individualized care plans will be developed for each client after an assessment, making it more person-centered care. And there are other anticipated benefits.
“There’ll be shorter wait times to get access to care, that the care will be more robust. And that the outcomes will help reduce things like hospital stays and readmissions.”
Federal certification requirements also direct the centers to provide care that is patient-centered and not to refuse service to anyone because of ability to pay or place of residence.
Although primarily outpatient-based and community-centered care, CCBHCs would deliver services to clients via telehealth or at their home, place of employment, school or maybe even public spaces such as the public library. Overnight crisis stabilization units and respite care that doesn’t qualify as long-term care also fall under the model, Brown said, making the possibilities to provide individualized services “pretty exciting.”
Additional resources in the CCBHC model
From 2017 through 2021, the City of Lawrence’s budget contributed an average of $308,000 annually toward the Lawrence school district’s Working to Realize Alternative Possibilities, or WRAP program — a school-based mental and behavioral health program that launched in 1997. Douglas County continues to support WRAP financially, and in 2018, county voters approved a quarter-cent sales tax to expand it and other behavioral health support services.
The city’s 2022 budget, however, did not include WRAP dollars, which forced a need to fill a funding gap between $350,000 and $400,000 for the 2022-23 school year.
Porter Arneill, spokesperson for the city of Lawrence, explained the city’s priority-based budgeting process in an email.
“The City did decide to redirect dollars in 2022 that were previously used to support outside agencies like Bert Nash, to the City’s new Housing Initiatives Division,” Arneill said. “This decision came out of the City’s strategic planning process. We heard from over 3,000 community members as we put together our strategic plan and, working to address homelessness and to support people experiencing homelessness was identified as a priority.”
Bert Nash Center CEO Patrick Schmitz announced in April that a long-term solution had been found for sustainable funding to fill that gap and allow WRAP to continue. Schmitz said the Lawrence school district and the center had agreed on a partnership that would “embrace the CCBHC model.”
“This model will allow us to bring more resources to our community to support the WRAP program. As a result of these changes and agreements, no positions will be eliminated in the WRAP program.”
When asked how the CCBHC model would bring more resources to the community, Schmitz responded via email that moving to the model’s Prospective Payment System would bring in more state and federal dollars through Medicaid.
He said unlike the traditional fee-for-service model that pays for a single service, the Prospective Payment System considers the entire cost of care delivery for all approved services.
“As such, it smooths out revenue, makes it more predictable, and since it is connected to Medicaid, the stability of this revenue stream is supported through federal legislation and policy.”
Schmitz said drawing down more state and federal Medicaid funds would allow Bert Nash to extend funding from other resources to better serve its uninsured and under-insured clients.
Addressing workforce shortages
Brown said nuances of the CCBHC model could help address numerous challenges, including workforce shortages of care workers across the state. Cost-based reimbursement creates an opportunity for providers to be able to pay competitive salaries to specialty staff.
Get mental health help in Lawrence
These resources are available 24/7 if you or someone you know needs immediate mental health help:
• Bert Nash Community Mental Health Center: 785-843-9192
• Treatment and Recovery Center of Douglas County: 1000 W. Second St. in Lawrence; trcdgks.org
• Kansas Suicide Prevention HQ (formerly Headquarters): 785-841-2345
• National Suicide Prevention Lifeline: 1-800-273-8255 (TALK); veterans, press 1
“CCBHCs can hire the staff that they want to hire to provide the services that they feel like their community needs the most and be reimbursed based on the cost of providing that service, rather than on a fee structure that sort of limits what their income is, or income potential is.”
When behavioral health and substance use disorder services are integrated, provided and assessed on a regular basis by an adequate workforce, Brown said, the state is qualified to provide better outcomes.
“A lot of times right now, across our state, when people are in crisis, there really isn’t much of a service structure to respond to that crisis. So usually, that ends up falling on law enforcement and emergency rooms.”
Legislation signed by Gov. Laura Kelly in 2021 guides this significant transformation in behavioral health services. Brown said the state’s first phase of the implementation amounts to a $22 million investment from state funds. Kansas has set its goal for CCBHC implementation in all of 26 of its CMHCs by the end of 2024.
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Tricia Masenthin (she/her), equity reporter, can be reached at tmasenthin (at) lawrencekstimes (dot) com. Read more of her work for the Times here. Check out her staff bio here.
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