DMH Community-Based Flexible Supports (CBFS) Program

Tracy Rose, Case Manager Supervisor from the Department of Mental Health and Peter Schindler, Director of the North Suffolk Mental Health Association CBFS Program, introduced staff to a new DMH program "Community Based Flexible Supports" and discussed its implementation at the July CRC Info. Session.

Sections:

About DMH
DMH Sites in Metro Boston
DMH Eligibility
     Determination Time Frame
     Appeals/Right to Reapply
Community Based Flexible Supports (CBFS) Explained
Implementation
Referral Process
Other DMH Programs
DMH Cutbacks
CBFS Vendors
CBFS DMH Contacts
     Metro Boston Contacts
     Metro Boston Sites
     Other DMH Area local CBFS representatives
     CBFS Lindemann DMH Contacts
     CBFS North Suffolk Contacts

About DMH

The Massachusetts Department of Mental Health (DMH) sets the standards for the operation of mental health facilities and community residential programs and provides clinical, rehabilitative and supportive services for adults with serious mental illness, and children and adolescents with serious mental illness or serious emotional disturbance.

DMH divides the state into 6 service areas. The Metro Boston area covers the smallest geographic area, but serves the largest number of consumers. A detailed contacts list is available online at: http://www.mass.gov/eohhs/provider/guidelines-resources/clinical-treatment/mental-health/dmh-offices/

DMH Sites in Metro Boston

DMH Eligibility

The primary mission of DMH as established by Chapter 19 of the Massachusetts General Laws, is: "to provide services to citizens with long-term or serious mental illness." Availability of DMH services is limited, DMH must prioritize to whom and how those services are provided.

Eligibility is based on three domains: Clinical, Needs, and Means, and consumers must qualify under all three.

Clinical - An adult applicant must have a severe and persistent mental illness that has resulted in functional impairment that substantially interferes with or limits one or more major life activities. Severe and persistent mental illness is a disorder of thought, mood, perception, orientation, or memory that grossly impairs judgment, behavior, capacity to recognize reality, and that results in an inability to meet the ordinary demands of life. An individual with a substance abuse problem (i.e., use, abuse, disorder) is eligible if he or she is determined to have a qualifying mental disorder, meets impairment and duration criteria, requires DMH continuing care services, and has no other means for obtaining them.  See full clinical eligibility criteria for more detail for adults and children.

Needs - If it is determined that the applicant meets the clinical criteria, the Area Director or designee will then determine whether the applicant requires continuing care services and what kind of access to appropriate community services may be available to the applicant.

Means – Assess whether or not the individual has access to other services that can sufficiently meet their needs. Does the individual have access to other current entitlements and/or insurance, or are they eligible for services through other public or private entities available such as the Massachusetts Rehabilitation Commission, Department of Children and Families, the Veterans Administration or a local education agency, etc.

In Metro Boston, the Area Office Eligibility Specialist determines Clinical eligibility and then the Site Office determines Needs and Means.

Applications and release forms are available online.

Determination Time Frame

After clinical determination is made, sites have

Appeals/Right to Reapply

An individual denied eligibility for DMH continuing care services may appeal, or reapply if his or her clinical condition or access to insurance or medical entitlements has changed. To appeal, submit a written statement to the Area Director or designee indicating the basis for the appeal. This written statement must be submitted within thirty (30) business days of receiving the notification of denial of eligibility. If the denial of eligibility is not reversed by the Area Director, the applicant may petition the Department of Mental Health Commissioner or designee for a fair hearing. The petition for a fair hearing must be submitted in writing within ten (10) days after receiving the Area Director’s written decision. Appeal forms are available online.

Community Based Flexible Supports (CBFS) Explained

In 2007, DMH began a review of the adult community service system. These changes are unrelated to recent budget cuts. The re-procurement of contracts for residential and community rehabilitative supports was a multi-year effort that would have occurred regardless of reductions in budget allocations.

Some of the underlying principles of this new service model include person-centered planning, incorporating the use of peer specialists, an increased emphasis on addressing employment goals, and incorporating more of the “Recovery” philosophy into service delivery.

“Recovery” in mental health services was defined at a November 2002 conference sponsored by the Center for Psychiatric Rehabilitation at Boston University as

…an ongoing, dynamic, interactional process that occurs between a person’s strengths, vulnerabilities, resources, and the environment. It involves a personal journey of actively self-managing psychiatric disorder while reclaiming, gaining, and maintaining a positive sense of self, roles, and life beyond the mental health system, in spite of the challenges of psychiatric disability. (Psychiatric News January 3, 2003, Volume 38 Number 1, American Psychiatric Association, p. 10, http://psychnews.psychiatryonline.org/toc/pn/38/1). >

CBFS is now (as of July 1, 2009) the cornerstone of the DMH Community Mental Health system. Person Centered Planning describes a process in which a client’s strengths, experiences, culture, values, preferences, needs, hopes and life goals guide the type, intensity, and duration of the services provided. Through Person Centered Planning, consumers control their treatment. Person Centered services are culturally-competent, trauma-informed, and based on a person’s strengths rather than diagnosis. CBFS vendors are expected to deliver services utilizing a person-centered planning approach. One of the keystones of the program is “flexibility”- allowing CBFS programs to design treatment plans and access services without requiring DMH level of care approval for programs such as residential placement, supportive housing, respite, etc.

North Suffolk ’s CBFS program for example consists of 6 care teams with 100 consumers per team. Each team has 10-12 staff including Managers, Clinical Coordinators (a licensed mental health professional), Recovery Support Specialists, Peer Specialists, Substance Abuse Specialists, Housing Specialists, Health and Wellness Specialists and Employment Specialists. One of the unique aspects of this program is the inclusion on each care team of a housing specialist. This enables this program to assess for housing needs earlier and better integrate housing search and advocacy with the rest of the treatment plan. Another innovation is the inclusion on the care team of the previously-mentioned Peer Specialists. The people in these positions have first-hand experience as consumers of mental health services. Peer Specialists have perspectives that can better engage consumers, provide hope of recovery and wellness, and also help staff to gain increased understanding of the consumer perspective. Health and Wellness services are provided by nurses, dieticians and nutritionists. “Recovery Support Specialist” is the new name given to those previously known as Outreach workers. Their role is to coordinate treatment, help clients to keep appointments, provide life skills training, etc. Supported employment services are offered with the goal of real-world, competitive employment for those who want it.

Implementation

CBFS services began on July 1, 2009. Within one month of one’s enrollment into CBFS the service delivery vendor will develop an Individualized Action Plan with the consumer. Prior to the transition, DMH worked with CBFS contract awardees to transition consumers to new services. For vendors not awarded a CBFS contract, DMH is working in partnership to transition consumers to the new vendor.

Referral Process

Referrals to CBFS services are made by DMH Site Offices, based on client needs and preferences. CBFS vendors respond to referrals and assess immediate needs within 72 hours of referral.

Other DMH Programs

As noted previously, those with unstable housing situations may particularly benefit from CBFS program’s access to in-house housing specialists. DMH expects that ultimately about ¾ of DMH consumers will be enrolled in a CBFS program (about 600 out of 768).

Case Management - The case management model still exists within DMH and is expected to continue. A consumer will either have a case manager or be enrolled in a CBFS program. Those best suited to the case manager model will be those who need less intensive services.

TheProgram of Assertive Community Treatment (PACT) program is an intensive psychiatric services program specifically for those with schizophrenia, schizoaffective disorder or Bipolar illness. It offers a higher level of intensity of psychiatric services.

Services for Children - CBFS is for those 18 and older. One new DMH initiative related to children is the Children’s Behavioral Health Initiative. CBHI was created in response to the Rosie D. lawsuit related to the situation of “stuck” kids, children who were ready to leave inpatient psychiatric hospitals, but had no appropriate services available so ended up waiting inpatient for extended periods. Not only was this inappropriate for those children, but it lead to a shortage of inpatient psychiatric beds for children since beds weren’t turning over. CBHI focuses on wrap-around services and intensive case management. If staff are interested in a presentation about this program, please inform CRC Staff or your CRC Advisory representative.

DMH Cutbacks

An audience member asked about the effects of recent state budget cuts on DMH. 100 case manager positions were cut from DMH earlier this year. One site in Metro Boston lost 10 case managers, which was approximately 50% of their case management staff. Caseloads will stay capped at approximately 30 per worker, so this may result in expanded waitlist for case management services. Future cuts may occur but there are no plans for service reductions at this time.

CBFS Vendors

CBFS DMH Contacts

Metro Boston Contacts

Metro Boston Sites

Other DMH Area local CBFS representatives

CBFS Lindemann DMH Contacts

CBFS North Suffolk Contacts

-Thanks to Tracy Rose and Peter Schindler for their informative presentation and help with this article.

 

7/09