The Problem of States Like Colorado Making---INTENSIVE MENTAL HEALTH SERVICES At the HIGH END of the CONTINUUM of CARE---"ALTERNATIVE"

THE BOTTOM LINE:  We've Created a System that caters to the Needs of State Governments & the Mental Health Industry --- and NOT THE PEOPLE WHO NEED THE MOST CARE.

Most of the Services listed to the right from the Colorado Code of Regulations as NON-TRADITIONAL "ALTERNATIVE BEHAVIORAL HEALTH SERVICES"--- are actually pretty TRADITIONAL in 2022.

Further, funding ASSERTIVE COMMUNITY TREATMENT, INTENSIVE CASE MANAGEMENT & MENTAL HEALTH RESIDENTIAL SERVICES---as  NON-TRADITIONAL ALTERNATIVE SERVICES---

• THIS Kind of SHORT-SIGHTED POLICY-MAKING IS WHY WE HAVE A HORRIBLE MENTAL HEALTH SYSTEM.
• Additionally, yeah CMS has it's own OUTDATED FEDERAL APPROACHES & REGULATIONS --- BUT a State like Minnesota has made ASSERTIVE COMMUNITY TREATMENT a STANDARD SERVICE ---
  • Meaning if you meet the CRITERIA --- you can get it.
    • It is not treated as some "NON-TRADITONAL ALTERNATIVE SERVICE" that is dependent on COST SAVINGS and HIGHLY RATIONED.
  • We need ACT -- the "GOLD STANDARD" in INTENSIVE COMMUNITY MENTAL HEALTH TREATMENT treated LIKE OTHER HEALTH CARE SERVICES.
  • AND we need States holding themselves ACCOUNTABLE to MEET THE NEED --- not AFRAID of the NEED.

 
Colorado (& probably most States) spend so much more TIME & ENERGY "CONTRACTING" with PROVIDERS than they do on OLMSTEAD COMPLIANCE --- and it shows.

 FURTHER, there are a MULTITUDE OF VARIABLES when it comes to NEURO-DEVELOPMENTAL DIFFERENCES, PSYCHIATRIC DISORDERS and SOCIETAL INTEGRATION.

• OLMSTEAD is really about Title II of the ADA & the INTEGRATION MANDATE.
• There isn't just one way to achieve OLMSTEAD COMPLIANCE --- the problem has been there is not just one way to achieve OLMSTEAD NON-COMPLIANCE.
• If States are really concerned about COST (and who isn't) --- then the HONEST WAY to deal with that is to stay on top of the SCIENCE and promote reasonable TRANSLATIONAL RESEARCH & MEDICINE EFFORTS that can INTEGRATE NEW UNDERSTANDINGS into EVIDENCED-BASED TREATMENT APPROACHES.
  • That needs INCLUSION, too.
    

CODE OF COLORADO REGULATIONS 10 CCR 2505-10 8.200

8.205.9 STATEWIDE SYSTEM OF COMMUNITY BEHAVIORAL HEALTH CARE

8.205.9.B.8 --- Alternative Behavioral Health Services

Alternative behavioral health services--Administration of non-traditional, community-
based services not available through the State Plan but authorized through the
Department’s 1915(b) waiver with the Centers for Medicare and Medicaid Services.

a. Assertive Community Treatment (ACT) – Comprehensive, locally-based,
individualized treatment for adults with serious behavioral health disorders, that is available 24 hours a day, 365 days a year. The ACT team actively engages  Members in their community to develop skills and monitor status, rather than function as an office-based team. Services include case management, initial and ongoing behavioral health assessment, psychiatric services, employment and housing assistance, family support and education, and substance use disorders
services.

b. Clubhouse and Drop-in Center services – Peer support services for people who have behavioral health disorders, provided in a Clubhouse or Drop-In Center setting. Clubhouse participants may use their skills for clerical work, data input, meal preparation, providing resource information and outreach to clients. Drop-in
Centers offer planned activities and opportunities for individuals to interact socially, promoting and supporting recovery.

c. Intensive Case Management -- Community-based services averaging more than one hour per week, provided to adults with serious behavioral health disorders who are at risk of a more intensive 24 hour placement and who need extra support to live in the community. Services are assessment, care plan development, multi-system referrals, assistance with wraparound and supportive living services, monitoring and follow-up. Intensive case management may be provided to children/youth under the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) program.

d. Mental Health Residential Services – Twenty-four (24) hour care, excluding room and board, provided in a non-hospital, non-nursing home setting, appropriate for Members whose mental health issues and symptoms are severe enough to require a 24-hour structured program but do not require hospitalization. Services are provided in the setting where the client is living, in real-time, with immediate interventions available as needed. Clinical interventions are assessment and monitoring of mental and physical health status; assessment and monitoring of safety; assessment of/support for motivation for treatment; assessment of ability
to provide for daily living needs; observation and assessment of group
interactions; individual, group and family therapy; medication management; and behavioral interventions. Residential services may be provided to children/youth under EPSDT.

e. Prevention/Early Intervention Services – Proactive efforts to educate and empower individuals to choose and maintain healthy life behaviors and lifestyles that promote positive behavioral health. Services include behavioral health screenings; educational programs promoting safe and stable families; senior workshops related to aging disorders; and parenting skills classes.

f. Recovery Services – Community-based services that promote self-management of behavioral health symptoms, relapse prevention, treatment choices, mutual support, enrichment, rights protection, social supports. Services are peer counseling and support services, peer-run drop-in centers, peer-run employment services, peer mentoring, consumer and family support groups, warm lines, and advocacy services.

g. Respite Care – Temporary or short-term care of a child, youth or adult client provided by adults other than the birth parents, foster/adoptive parents, family members or caregivers that the Member normally resides with. Respite is designed to give the caregivers some time away from the Member to allow them to emotionally recharge and become better prepared to handle normal day-to-day challenges. Respite care providers are specially trained to serve individuals with behavioral health issues.

h. Vocational -- Services designed to help adult and adolescent clients who are ineligible for state vocational rehabilitation services to gain employment skills and employment. Services are skill and support development interventions, educational services, vocational assessment, and job coaching