October 19, 2022
West Virginia Releases RFP for Foster Children, Youth in Medicaid Managed Care
1096 Results found.
SAMHSA releases CCBHC planning grants opportunity for states
Today, the Substance Abuse and Mental Health Services Administration (SAMHSA) released the highly anticipated Cooperative Agreements for Certified Community Behavioral Health Clinic (CCBHC) Planning Grants Notice of Funding Opportunity (NOFO). The NOFO can be found here.
The CCBHC model provides integrated and coordinated community-based care for individuals across the lifespan with and at risk for behavioral health conditions, with a focus on adults with serious mental illness, those with any mental illness, children with serious emotional disturbance, and those with substance use disorders. The model is designed to increase access to behavioral health services; provide a comprehensive range of services, including crisis services, that respond to local needs; incorporate evidence-based practices; and establish care coordination as a linchpin for service delivery. To date, CCBHCs have demonstrated[1]:
- Significant reductions in client hospitalizations
- Increased access to high quality community-based care, including services like Medication Assisted Treatment and care coordination
- Reduced impact of the mental health and substance use care workforce shortage
- Innovative and strengthened partnerships with cross-system partners, including law enforcement, schools, and hospitals
About the Planning Grants
These CCBHC Planning Grants are established to support states to develop and implement certification systems for CCBHCs, establish Prospective Payment Systems (PPS) for Medicaid reimbursable services, and prepare an application to participate in a four-year CCBHC Demonstration program. Through this opportunity, SAMHSA anticipates making 15 Planning Grant awards of up to $1 million per award. Awarded states will have 12 months to use their Planning Grant dollars to accomplish the following:
- Solicit input for the development of a state CCBHC Demonstration program from consumers (including youth), family members, providers, tribes, and other key stakeholders.
- Create and finalize application processes and review procedures for clinics to be certified as CCBHCs.
- Assist clinics with meeting certification standards by:
- facilitating access to training and technical assistance;
- providing workforce supports, including assisting CCBHCs to improve the cultural diversity and competence of their workforce; and
- facilitating cultural, procedural, and organizational changes to CCBHCs that will result in the delivery of high quality, comprehensive, person-centered, and evidence-based services that are accessible to the population(s) of focus.
- Certify an initial set of clinics as CCBHCs, including those that represent diverse geographic areas, including rural and underserved areas. As an option, states can also develop a process for bringing additional clinics into the State CCBHC Demonstration program to reach the desired geographic spread by the end of the four-year CCBHC Demonstration.
- Establish a PPS for behavioral health services furnished by a CCBHC in accordance with the original PPS Methodology Guidelines developed by CMS. A statement indicating that the State agrees to pay for services at the rate established under the PPS during the CCBHC. Demonstration program must be attached with the application.
- Develop or enhance statewide data collection and reporting capacity.
- Submit a proposal to participate in the CCBHC Demonstration Program no later than March 20, 2024.
The Planning Grant project period is anticipated to begin on March 30, 2023. As a Cooperative Agreement, SAMHSA anticipates having substantial federal programmatic participation, including providing input to selected states in the planning, implementation, and evaluation of the program.
These planning grants are the first phase of a two-phase process of the expansion of the CCBHC Demonstration, authorized by the Bipartisan Safer Communities Act.[2] Beginning July 1, 2024, and every two years thereafter, 10 states that have completed planning grants and submitted successful applications to participate in the CCBHC Demonstration will be eligible to join the program for a four-year period.
Eligibility to Apply
Eligibility for this Planning Grant opportunity is limited to the State Mental Health Authorities, Single State Agencies, or State Medicaid Agencies that are located in the 41 states, including the District of Columbia, that were not previously selected to participate in the CCBHC Demonstration Program. Regardless of which state entity ultimately serves as the applicant, each application must include a signed Memorandum of Agreement between the Director of the State Mental Health Authority, the Director of the Single State Agency, and the Director of the State Medicaid Agency demonstrating a partnership to fulfill the requirements of the award.
Updates to CCBHC Certification Criteria and PPS Guidance Expected but Not Before Application Deadline
Updates are expected to both the CCBHC Certification Criteria and PPS Guidance in the coming months, but the NOFO is clear that these updates will not be available during the application period for these Planning Grants. Specifically:
- SAMHSA is in the process of updating the CCBHC Certification Criteria through a process which will include a significant opportunity for public comment. SAMHSA intends to keep the existing framework for the criteria, which is included in the authorizing statute. SAMHSA does not intend to make major changes to the scope and shape of the Certification Criteria.
- CMS is also working to update the CCBHC PPS guidance. Any PPS changes will be made available prior to the planning grant execution period and included as part of technical assistance provided to states during the planning grant execution period.
Because neither of these updates will be released prior to the application submission deadline, applicants will use the existing CCBHC Criteria and PPS Guidance to inform their applications.
Next Steps for Interested State Stakeholders
Applications for this opportunity are due December 19, 2022 at 11:59 pm. Each application will be scored on their 30-page narrative submission, which includes significant emphasis on each applicant’s approach to CCBHC planning (including both certifying CCBHCs and establishing the PPS rates) and the state’s experience with the model to date (including the steps already taken to develop a CCBHC program in their state).
HMA and the National Council for Mental Wellbeing will host a joint webinar about this NOFO on Monday, November 7, 2022 at 1-2 pm ET.
In addition, in anticipation to the NOFO’s release, HMA and the National Council hosted a webinar on October 6, 2022, on “Developing a Strategy for the CCBHC State Demonstration RFP.” During this webinar, we engaged representatives from New York and Michigan to share information about their Demonstration program implementation to date.
[1] https://www.thenationalcouncil.org/wp-content/uploads/2022/06/22.06.06_HillDayAtHome_CCBHC_FactSheets.pdf
[2] https://www.congress.gov/117/plaws/publ159/PLAW-117publ159.pdf
Webinar replay: state strategies for the certified community behavioral health clinic demonstration planning grant opportunity
This webinar was held on November 7, 2022.
The Bipartisan Safer Communities Act offers new funding for states to develop a Certified Community Behavioral Health Clinic (CCBHC) Demonstration program. A new CCBHC Planning Grant Notice of Funding Opportunity (NOFO) for states has just been released with a deadline of Monday December 19, 2022. During this webinar – a follow up to our October 6 webinar – experts from HMA and the National Council for Mental Wellbeing provided an overview of the CCBHC Demonstration program NOFO, offered strategies for using CCBHC as a strategic transformational opportunity for systems improvement, reviewed the NOFO requirements and key changes from previous opportunities, and outline strategies for developing a successful response.
Learning Objectives
- Review requirements of the new CCBHC Demonstration Planning NOFO for states and how it varies from previous efforts.
- Understand the importance of aligning the CCBHC model within a larger state behavioral health and integrated care strategy.
- Learn key considerations for states in responding to the opportunity and steps to improve the quality of a response.
Speakers
Kristan McIntosh, Principal, HMA
Heidi Arthur, Principal, HMA
Josh Rubin, Principal, HMA
Rebecca Farley-David, Senior Advisor, Public Policy and Special Initiatives, National Council for Mental Wellbeing
Did You Miss Part 1 of our CCBHC Planning Grant Webinar Series?
In case you missed it, experts from HMA and the National Council for Mental Wellbeing were joined by state leaders from New York and Michigan (two current CCBHC Demonstration states) for a pre-NOFO release discussion on October 6, 2022. During this prior webinar, we shared lessons learned and strategies states have used to successfully plan for the CCBHC Demonstration Program and leverage the CCBHC initiative as a transformation opportunity that can help behavioral health care systems achieve their broader health quality and access goals. The recording, slide deck, and an associated Q&A document from that previous session can be found here.
HMA explores new trends in Medicaid Section 1115 waiver demonstration programs
This week, our In Focus explores a new trend to watch in Medicaid Section 1115 waiver demonstration programs. As discussed in our previous In Focus, state Medicaid agencies are exploring pathways and concepts to address the historic inequities and health disparities laid bare and exacerbated by the COVID-19 pandemic. These efforts are closely aligned with the Centers for Medicare and Medicaid Services’ (CMS) policy objectives for the Medicaid program, specifically:
- Addressing health inequities
- Improving access and coverage
- Promoting whole person care
Teams of experts from across the HMA family of companies are supporting state agencies, counties, health plans, providers, community and consumer organizations, and other stakeholders with translating federal goals and parameters into concrete proposals for new demonstration programs. HMA’s experts assist stakeholders with proposals as they move through the stages of concept paper, application, negotiation, approval, and implementation. Demonstrations will reflect each state’s unique political and policy landscapes, but the programs will be grounded in certain federal goals and expectations to enhance accountability and improve outcomes.
In the earlier In Focus, our experts shared initial insights and considerations for stakeholders about one of the emerging trends: state Medicaid leaders are seeking to improve health equity in communities by providing health-related social services and engaging community organizations. Building on this and informed by our collective “on the ground” expertise we are writing this week about a second emerging trend we see across states’ Section 1115 activities:
Trend #2: States are seeking to use Medicaid demonstration programs to build essential capacity and infrastructure at the community and organizational levels.
The recently approved and submitted demonstration proposals signal CMS’ willingness to allow states to support some limited capacity building for community-based organizations. Several state 1115 demonstration proposals describe the state-specific types of community-based organizations and other entities that Medicaid programs want to engage to address the social and health-related drivers of health outcomes. This requires augmenting the existing workforce, providing training on Medicaid health plan contracting requirements, and building an infrastructure platform and systems that will support efficient communications and service delivery.
CMS has indicated a strong interest in advancing states’ community-based activities. This is evident in CMS’ decision to revise the federal framework used to determine whether a state’s Section 1115 demonstration program is budget neutral for the federal government. CMS has also decided to reopen the opportunity for states to propose Designated State Health Programs (DSHPs) under more limited size and scope parameters. CMS articulated these updated policies in the recent approval letters for Section 1115 demonstration programs in Massachusetts and Oregon. The federal reinterpretation provides states significantly more flexibility relative to the prior policy to use federal Medicaid funding to do the following:
- Design and implement a broader set of health-related service need (HRSN) initiatives,
- Make investments in the infrastructure to support HRSNs; and
- Invest in building workforce capacity.
States will continue to act on these shifts in federal priorities and policies, crafting proposals aligned with their state-specific environments and goals. However, CMS’ willingness to support capacity building as part of state demonstration programs will need to adhere to certain scope and financing parameters. These guardrails are articulated in more detail in the approval letters for Massachusetts and Oregon. States and stakeholders will also want to be responsive to CMS’ expectations that its investments will be sustainable over time. They may need to plan and develop additional capacity to utilize non-Medicaid sources of federal and non-federal funding in tandem with the demonstration initiatives.
Importantly, the terms of the approved demonstration projects reinforce the need for states, managed care plans, and providers engage in new partnerships with community leaders and ensure the perspectives and experiences of consumers are continuously reflected in programs. Examples of proposed capacity building partnerships include:
Massachusetts’ recently secured CMS approval for a Section 1115 demonstration program which will fund a variety of health-related service needs (HRSN) initiatives. As part of the HRSN initiatives, CMS is allowing the state to receive federal Medicaid funding to support capacity-building, infrastructure, and operational costs for these activities. For example, under the demonstration federal funding will be available for participating “community partners” to pay for health information technology system investments, expand workforce capacity, manage startup costs, and enhance operational infrastructure such as system change resources. Additionally, the state will be able to receive federal Medicaid funding for provider workforce recruitment and retention activities, specifically primary care and behavioral health provider student loan repayment programs and a family nurse practitioner residency program.
In September 2022, Oregon received approval for a Section 1115 demonstration program to provide increased coverage of certain services that address HRSN. These services include critical nutritional services and nutrition education, as well as transitional housing supports for individuals with a clinical need or transitioning out of institutional care, congregate settings, out of homelessness or a homeless shelter, or the child welfare system. Additionally, the state will be able to receive federal Medicaid funding to make infrastructure investments to support those services, such as cultural competency training, trauma-informed training, traditional health worker certification, accounting and billing systems among others.
New York State envisions that Social Determinant of Health Networks (SDHNs) will work to organize and coordinate small neighborhood organizations familiar with their communities’ needs and the capacity to address multiple social risk factors as well as larger county or regionally focused entities. The state aims to allow SDHNs to receive Medicaid funding to invest in developing the infrastructure they need to assist Medicaid enrollees, such as the IT and business processes and other capabilities. Alongside this, the state is proposing a minimum fee schedule for certain services addressing social care needs. In addition, New York is requesting support for a statewide social services referral technology platform.
Washington state has a proposal pending with CMS that builds on its earlier demonstration program to further invest in multi-sector, community-based partnerships and approaches using Accountable Communities of Health (ACH). Specifically, the state is proposing to invest in the development and operation of Community Hubs and a Native Hub, which will serve as centers for community-based care coordination. These hubs will focus on health-related social needs (HRSNs) that provide screening for and referral to community-based services for Medicaid enrollees. These hubs will also distribute funding to build capacity among community-based organizations (CBOs) and community-based providers.
New Jersey has designed an 1115 demonstration proposal focused on the lack of stable housing as a driver of unnecessary hospitalization, institutionalization, or other avoidable instances of high-cost care, negative clinical outcomes, and worsening of chronic conditions. While it does not plan to make direct investments in community-based entities, the state aims to enhance contractual requirements with its Medicaid managed care organizations around housing specialists. This includes requiring health plans to have their housing specialists coordinate with community-based organizations that provide housing services or other related services to address social drivers of health. Its proposal also is designed to facilitate coordination across state and community resources that are essential to the provision of health and housing services.
Conclusion
The Massachusetts and Oregon demonstration programs provide important insight on CMS’ willingness to support state investments in HRSN and the state and local infrastructure to support delivery of culturally appropriate services.
Stakeholders will want to monitor these and other proposals as they move forward, particularly to understand the conditions and timing for funding to flow to community entities. Additionally, each state demonstration will have reporting and accountability structures that could impact payment and future investments made by Medicaid health plans, providers, CBOs and other stakeholders.
HMA’s interdisciplinary teams of Medicaid, human services, and actuarial experts are assisting states as well as stakeholders as they conceptualize, develop, and implement Section 1115 programs. To learn more about our work, contact our expert below.
October 12, 2022
HMA Identifies Key Trends for Emerging Medicaid Section 1115 Demonstration Proposals
Webinar replay: equity-centered approaches to supporting community prevention and treatment
This webinar was held on November 15, 2022.
Deeply rooted structures, systems, and beliefs have perpetuated racial inequities within substance use and mental health treatment and recovery settings. Racism and associated traumas add to these injustices and may influence how people of color experience and seek help for behavioral health needs. During this webinar, hear from community-based practitioners, who are leveraging evidence-based practices centered in equity, to provide support to our most vulnerable through harm reduction, overdose prevention and linkage to community treatment services.
Learning Objectives
- Learn about the importance of centering your approaches in equity.
- Obtain concrete examples of specific equity practices for harm reduction and overdose prevention.
- Develop an understanding of national efforts that can support prevention in communities, driven by communities.
Speakers
Juleigh Nowinski Konchak, MD, Attending Physician, Behavioral Health, Department of Family and Community Medicine and Center for Health Equity and Innovation, Cook County Health
Rashad Saafir, PhD, President, CEO, Bobby E Wright Comprehensive Behavioral Health Center
Moderators
Michelle Ford, Principal, HMA
Leticia Reyes-Nash, Principal, HMA
Webinar replay: collaborating with faith-based organizations on reducing overdose deaths and addressing stigma
This webinar was held on November 8, 2022.
Substance and opioid use disorders (S/OUD) affect people from all walks of life, including those active in faith communities. Yet many faith leaders do not know how to effectively support members of their congregations and their families who are struggling with these diseases. Faith groups and faith leaders from all denominations can be critical allies in addressing the stigma of S/OUD and building safe, compassionate spaces for individuals to get spiritual support along with the physical, mental, and emotional help they need to recover from S/OUD.
Presenters led participants through the myths and facts about S/OUD most relevant to faith communities and how to create faith-based prevention initiatives that can work in collaboration with other state S/OUD prevention and harm reduction strategies.
Learning Objectives
- Find out how Faith-based Organizations (FBOs) can play an important role in helping individuals and families affected by S/OUD.
- Learn how to encourage collaboration between faith communities and systems of care.
- Understand key myths and facts related to S/OUD to share with FBOs.
- Learn how to help FBO start prevention and harm reduction strategies in their communities.
- Find out how to leverage FBOs to expand education about SUD and reduce stigma.
Speakers
Amy Bechtol, West Tennessee Faith-Based Community Coordinator with the Tennessee Department of Mental Health & Substance Abuse Services
Ana Bueno, Senior Associate, HMA
Stephanie Denning, Principal, HMA
Related Video
Our Resilient Communities in the Opioid Epidemic: Partnering for Equitable Solutions
Webinar replay: industry-specific outreach and education for reducing overdose deaths
This webinar was held on October 25, 2022.
Industry stakeholders are non-traditional partners who can be effective in supporting and expanding opioid overdose prevention efforts. During this webinar, attendees heard about one state’s experience using data to identify and target stakeholders in high-risk industries, including construction and food services. We shared a framework for industry-specific prevention efforts—including use of data; identification of key partners; engagement strategies, and education; stigma reduction, and harm reduction activities—that other locales can adapt and integrate into their overall opioid prevention and response strategies. In addition, we identified possible funding opportunities to support this type of effort.
Learning Objectives
- Learn about effective ways to build non-traditional, industry-specific partnerships to support communities to reduce overdose deaths.
- Understand how data can help target and engage stakeholders in outreach, education, stigma reduction, and harm reduction.
- Obtain concrete examples of industry-specific engagement and education activities that have been impactful in the restaurant and construction industries.
Speakers
Kate Brookins, Director, Office of Health Crisis Response, Delaware Department of Health and Social Services Division of Public Health
Mayur Chandriani, Associate, HMA
Kristan McIntosh, Principal, HMA
New Mexico releases Medicaid managed care RFP
This week, our In Focus reviews the New Mexico Medicaid managed care request for proposals (RFP), released on September 30, 2022, by the New Mexico Human Services Department (HSD). The state will transition to a new program called Turquoise Care in 2024, which will build upon the current Centennial Care 2.0 program through a new Section 1115 waiver demonstration. Managed care organizations (MCOs) will provide physical health, behavioral health, and long-term care (LTC) services to approximately 800,000 Medicaid managed care members.
RFP
New Mexico plans to award Turquoise Care contracts to three MCOs. One of the selected MCOs will also be awarded a specialized foster care plan contract to provide services to Children in State Custody (CISC) on a statewide basis. CISC will be mandatorily enrolled and Native American CISC members will have the option to voluntarily enroll.
Turquoise Care will introduce new practices aimed at improving quality based on population health outcomes. The program will focus on three goals:
- Goal 1: Build a New Mexico health care delivery system where every Medicaid member has a dedicated health care team that is accessible for both preventive and emergency care that supports the whole person – their physical, behavioral, and social drivers of health.
- Goal 2: Strengthen the New Mexico health care delivery system through the expansion and implementation of innovative payment reforms and value-based initiatives.
- Goal 3: Identify groups that have been historically and intentionally disenfranchised and address health disparities through strategic program changes to enable an equitable chance at living healthy lives. The target populations will be:
- Prenatal, postpartum, and members parenting children, including children in state custody
- Seniors and members with long-term services and supports (LTSS) needs
- Members with behavioral health conditions
- Native American members
- Justice-involved individuals
Other changes for Turquoise Care include:
- 90 percent Medical Loss Ratio (MLR) aimed at improving quality of care
- Expanded MCO reporting and monetary penalties for non-compliance
- Minimum reimbursement rate for contract providers at or above the state plan approved fee schedule
- More stringent provider network requirements
- A single centralized vendor to process applications
- Enhanced MCO staffing requirements, including qualifications, staffing levels, and training
- Focus on social determinants of health
New Mexico will submit the Section 1115 demonstration waiver for Turquoise Health to the Centers for Medicare & Medicaid Services (CMS) for approval by December 2022. HSD will update the model contract to reflect the requirements related to the waiver renewal upon its approval.
During this procurement, the state will also be developing and implementing a new Medicaid Management Information System (MMIS).
Eligibility
Approximately 83 percent of the Medicaid population is in managed care.
Populations exempt from mandatory managed care enrollment are:
- Native American members not in need of LTC
- Individuals with Intellectual Disabilities (ICF-IID) in Intermediate Care Facilities
- Individuals enrolled in Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLIMB), or Qualified Individuals program
- Individuals covered only under the Medicaid Family Planning program
- Individuals enrolled in the Program of All-Inclusive Care for the Elderly (PACE)
- Individuals covered pursuant to Emergency Medical Services for Non-Citizens (EMSNC)
Members in the Developmental Disabilities 1915(c) Waiver and in the Medically Fragile 1915(c) Waiver will continue to receive home and community-based services (HCBS) through that waiver but are required to enroll with an MCO for all non-HCBS.
Timeline
Proposals are due December 2, 2022. Contracts will run from January 1, 2024, through December 31, 2026, with optional one-year renewals, not to exceed eight years total.
Current Market
New Mexico had 811,732 Medicaid managed care as of August 2022, served by Blue Cross Blue Shield of New Mexico, Presbyterian Health Plan, and Centene/Western Sky. The state also had an additional 163,361 fee-for-service members.
Evaluation
The evaluation process will consist of three phases: review of mandatory requirements, review and scoring of the technical proposals, and review and scoring of the CISC technical proposals.
October 5, 2022
New Mexico Releases Medicaid Managed Care RFP
Funding and strategies to address the youth behavioral health crisis
Communities across the country are seeing elevated numbers of adolescents in the Emergency Department due to suicide attempts, self-harm, anxiety, depression, substance use disorder (SUD), and overdose. While this youth mental health crisis predates COVID, it has been greatly exacerbated by the pandemic. According to the Centers for Disease Control and Prevention (CDC), in 2019, 13% of adolescents reported having a major depressive episode, a 60% increase from 2007, and suicide rates rose nearly 60% for youth ages 10 to 24 by 2018[1]. Then it got worse. Last December, the U.S. surgeon general issued a public health advisory about the adolescent mental health crisis as emergency room visits due to suicide attempts rose 51% for adolescent girls in early 2021, compared to the same period in 2019. For boys, the increase was 4%[2].
The surgeon general recommends a “whole-of-society effort,” including a focus on mental health education and prevention, early identification, and access to high-quality mental healthcare.[3] School-based intervention is ideal because only 20% of students in need of more intensive services typically receive needed care when referred to external providers.[4]
The Bipartisan Safer Communities Act has committed $1.7 billion for mental health support in schools and communities via an array of methods including grant programs. The following programs are currently available for a wide array of eligible entities, including states, cities/counties, Local Education Agencies (LEAs), Indian tribes or tribal organizations, health facilities, and nonprofit entities:
- Project AWARE (Advancing Wellness and Resiliency in Education). This grant program provides up to $1.8 million per year for up to 4 years to develop a sustainable infrastructure for school-based mental health programs and services. Grant recipients are expected to build collaborative partnerships with the State Education Agency (SEA), LEA), Tribal Education Agency (TEA), the State Mental Health Agency (SMHA), community-based providers of behavioral health care services, school personnel, community organizations, families, and school-aged youth. Grant recipients will leverage their partnerships to implement mental health-related promotion, awareness, prevention, intervention, and resilience activities to ensure that students have access to and are connected to appropriate and effective behavioral health services. Applications are due October 13th.
- Resiliency in Communities After Stress and Trauma (ReCAST). This program provides up to $1,000,000 a year for up to 4 years to promote resilience, trauma-informed approaches, and equity in communities that have recently faced civil unrest, community violence, and/or collective trauma within the past 24 months; and to assist high-risk youth and families through the implementation of evidence-based violence prevention, and community youth engagement programs. SAMHSA expects ReCAST to be guided by a community-based coalition of residents, non-profit organizations, and other entities (e.g., health and human service providers, schools, institutions of higher education, faith-based organizations, businesses, state and local government, law enforcement, and employment, housing, and transportation services agencies). Applications are due October 17th.
In addition to these two grants, there will be an expansion of the Certified Community Behavioral Health Center (CCBHC) Demonstration for States that is expected to be released later this month. The Excellence in Mental Health Act[5] established a federal definition and criteria for CCBHCs. These centers are a provider type that delivers a comprehensive range of mental health and SUD services to vulnerable individuals. They meet people where they are, which can include school-based services, and act as a critical partner in ensuring people have access to quality, affordable, and accessible mental health care.
School-based Mental Health Services
School-based mental health services, delivered within a Multi-Tiered System of Supports (MTSS) framework, can be supported by the aforementioned funding opportunities. The MTSS framework is currently used in public schools to target services and supports to students. As shown below, MTSS addresses universal prevention and progressively targeted support for students and families. It also aligns well with partnerships with community providers to establish an authentic community response that addresses the continuum of mental health needs.
The key to a successfully implemented MTSS framework is a strong partnership between the school staff, parents/guardians, children, and community partners. This partnership works well when anchored to an evidence-based socio-emotional curriculum that is reinforced across all Tiers and familiar to all parties.
Suicide and Self Harm Prevention
Dialectical Behavioral Therapy (DBT) was recently identified by the New York Times as “the Best Tool We Have’ for Self-Harming and Suicidal Teens,” because it is one of the only interventions found to reduce self-harm and suicidal ideation, its effects are maintained at one-year follow-up[6], and it successfully engages young people[7].
Curriculum developers Drs. Lizz Dexter-Mazza and James Mazza worked with Marsha Linehan, the DBT treatment developer, to adapt DBT Skills into a universal school-based social emotional learning curriculum, called DBT-STEPS-A. This approach is designed to help schools intervene and support well-being and resiliency before kids are suicidal or self-harming. It trains existing school personnel to integrate skill-building into the school program, universally or as a stand-alone option for youth in 6-12th grade (an elementary version is in development). As such, it is a viable approach, despite the current shortage of mental health care professionals in school-based settings.
In addition, DBT provides a shared language and strategies across all three MTSS tiers so that everyone (students, school staff, teachers, providers, and parents/guardians) can benefit. Because DBT is also commonly provided in inpatient, outpatient, and residential behavioral health programs, the value of extending this approach into school settings is further magnified for youth who transition from the highest levels of care.
A DBT STEPS-A program taught at the universal level provides the broadest application within school-based settings, supports uptake that leads to peer-to-peer coaching and support, along with shifting the school environment and culture to promote mental wellbeing and reinforce the skills via a shared language and common strategies. In Tier 2, students are supported to practice skills and decision-making strategies in smaller group or individual psychotherapy sessions as needed. The third tier is more intensive support for students experiencing ongoing emotional and behavioral difficulties for whom Tier 2–level support is not sufficient. It is designed to supplement individual psychotherapy for those in need of a higher level of care. Parent/guardian skills-training seminars are recommended, so they can learn about the skills their child is acquiring and how best to support them while they are practicing. Engaging parents/guardians proactively helps to increase adaption of the skills across both home and school contexts.
A matched sample of adolescents who received the DBT STEPS-A curriculum demonstrated lower scores on the BASC-2 Emotion Symptom Index and on the BASC-2 Internalizing Problems, indicating fewer mental health difficulties, compared to peers who did not receive the curriculum (Cohen’s F squared equal to 0.65 and 0.83, respectively[8].
The DBT curriculum is accessible via a $50 manual. All handouts for kids are available in English and Spanish and can be printed from a web-based link for free. An array of trainings are available to support rapid school-based service delivery.
To learn more about current and upcoming funding for enhanced school and community-based mental health care or DBT-STEPS-A, contact our experts below.
You can also contact DBT in Schools, LLC for information about DBT-STEPS-A [email protected].
[1] National Vital Statistics reports – Centers for Disease Control and … (n.d.). Retrieved from https://www.cdc.gov/nchs/data/nvsr/nvsr69/nvsr-69-11-508.pdf
[2] Richtel, M. (2021, December 7). Surgeon general warns of Youth Mental Health Crisis. The New York Times. Retrieved from https://www.nytimes.com/2021/12/07/science/pandemic-adolescents-depression-anxiety.html
[3] Protecting youth mental health – hhs.gov. (n.d.). Retrieved from https://www.hhs.gov/sites/default/files/surgeon-general-youth-mental-health-advisory.pdf
[4] Sheryl H. Kataoka, M.D., M.S.H.S., Lily Zhang, M.S., and Kenneth B. Wells, M.D., M.P.H. (2002). Unmet Need for Mental Health Care Among U.S. Children: Variation by Ethnicity and Insurance Status. The American Journal of Psychiatry: https://doi.org/10.1176/appi.ajp.159.9.1548
[5] Excellence in Mental Health Act. (2013, February 7). http://www.congress.gov/
[6] McCauley E, Berk MS, Asarnow JR, et al. Efficacy of Dialectical Behavior Therapy for Adolescents at High Risk for Suicide: A Randomized Clinical Trial. JAMA Psychiatry. 2018;75(8):777–785. doi:10.1001/jamapsychiatry.2018.1109 https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2685324#:~:text=Given%20its%20effectiveness%20with%20adults,suicidal%20youths%20with%20promising%20results.&text=A%20recent%20RCT%20with%20self,1%2Dyear%20follow%2Dup.
[7] Rathus, Jill H. ( 2014). DBT skills manual for adolescents. New York :The Guilford Press,
[8] Elizabeth T. Dexter-Mazza, James J. Mazza, Alec L. Miller, Kelly Graling, Elizabeth Courtney-Seidler, and Dawn Cattuchi (2022). Application of DBT in a School-Based Setting. Pending publication
