BHPAC Combined Committee Priorities

Prevention
1. Explore specific evidencebased primary prevention programs, promising practices, and strategies for Substance Use Disorder
and Mental Health and develop a rationale for why these services should be selected in areas where assessments indicate
they are appropriate.
What do we already know about this focus area and can recommend to OBH for the Block Grant? (Note where this differs for MH/SUD)

We know the issues facing Colorado communities and can focus prevention programming based on these needs:

Early childhood promotion and prevention (e.g. Pyramid Model, Adverse Childhood Experiences, etc.)
Prescription drug abuse prevention (SBIRT, media campaign,etc.).
Marijuana prevention (youth focused) (e.g. SBIRT, media campaign, etc.).
Suicide prevention (e.g. SWAG, Safe to tell, check your head, etc.).
Early identification and intervention of substance use and mental health issues (e.g. SBIRT, ACES, Check your head, etc.)
Campaign to reduce stigma

Consider focusing programs on special populations: e.g. military, veterans, LGBT, criminal justice, etc.
We know that integrated physical/behavioral health models are emerging across the state and that prevention is a key strategy in
the new healthcare delivery models.
What steps are needed in order to provide additional guidance to this focus area? (Note where this differs for MH/SUD)

Identify additional programming necessary to address needs (mental health first aid, Adverse Childhood Experiences, etc.)
Identify opportunities to integrate prevention services into healthcare delivery models, regional care collaborative, and other
innovative programs in the state; demonstrate the value of prevention!
Assess how programs are being funded currently and prioritize block grant funds based off current funding. Identify
opportunities to blend/braid funding and to prioritize block grant on areas where funding is limited and to meet the needs of
populations who experience barriers to care (criminal justice, military, HIV) how do you ensure prevention services reach these
populations?
Assess how prevention programming will change with implementation of ACA; Prevention is a priority in the ACA; how will this
change block grant priorities? How will integrated physical/behavioral health change landscape? What training is needed to
prepare workforce?

Specific Recommendations for Prevention Focus Area 1 from August 1, 2013 BHPAC Meeting
a. Support funding of specific evidenced-based program models that focus on a wide range of social-emotional issues for the
pre-k population. An example of this is the Pyramid Model. Require potential grantees to choose from a menu of EBPs to
ensure higher likelihood of success.
o Provide support for sound implementation and fidelity measurement.
o Use a public health approach to support implementation at multiple levels.
o Support use of the Strategic Prevention Framework at the local level to organize service implementation efforts
b. Support funding of specific evidenced-based program models that focus on a wide range of social-emotional issues for
middle and high school population. Examples could include Botvins Life Skills and Wellness Recover Action Planning (WRAP).
Require potential grantees to choose from a menu of EBPs to ensure higher likelihood of success.
o Provide support for sound implementation and fidelity measurement.
o Use a public health approach to support implementation at multiple levels.
o Support use of the Strategic Prevention Framework at the local level to organize service implementation efforts
c. Support implementation of the Adverse Childhood Experience assessment approach through targeted training and technical
assistance. Draw on lessons from SBIRT efforts to inform sound and effective implementation.
d. Fund referral efforts, services and supports that directly connect to ACE assessment areas to ensure that adopters of the
assessment approach have a way of accessing needed services based on results.
2. Explore data related to Substance Use Disorder and Mental Health issues to identify the types of primary prevention services
that are needed.
What do we already know about this focus area and can recommend to OBH for the Block Grant? (Note where this differs for MH/SUD)

We know that data exists on prescription drug abuse overdose in the state; suicide rates; depression rates; on youth perception
of risk due to accessibility to marijuana, etc. How can data be evaluated to identify gaps in services? How can these data be
shared across systems (healthcare) to increase awareness?
We know that there are other data sets available RADARS, primary care, CDPHE data, etc. that may help inform decisions.
Assure that programs demonstrate evidence base and rationale for why program is being proposed.
Assure that programs demonstrate criteria used to demonstrate outcomes and fidelity monitoring.
What steps are needed in order to provide additional guidance to this focus area? (Note where this differs for MH/SUD)

Increase collaboration across systems to promote awareness of substance use and mental health issues and availability of
services
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Identify what data are useful to other providers/departments/organizations in making decisions and prioritize data collection
efforts based on this feedback.
Determine mechanism to share data across systems (e.g. behavioral health, healthcare, policy makers, criminal justice, etc. )
Specific Recommendations for Prevention Focus Area 2 from August 1, 2013 BHPAC Meeting
a. Support development of local Epidemiological Workgroups as reflected in SAMHSAs Strategic Prevention Framework to
enhance local assessment, program identification and monitoring.
b. Support training and technical assistance efforts to build the capacity of local groups to use data for decision making.
c. OBH to provide centralized support in the organization and provision of data needed to assess and monitor behavioral health
issues and needs at the local level.
3. Determine what outcome data the state should collect on its funded prevention strategies and how these data could be used
to evaluate the states prevention system.
What do we already know about this focus area and can recommend to OBH for the Block Grant? (Note where this differs for MH/SUD)

How are these outcomes shared? Need to identify what we are measuring based off priority focus areas:
Decrease in suicide
Decrease in substance abuse
Increased awareness about risks of marijuana use on adolescent health
Increase in primary care providers routinely identifying and intervening for substance use and depression
Increase in awareness about the effects of substance use on health
What steps are needed in order to provide additional guidance to this focus area? (Note where this differs for MH/SUD)

None Specified yet.

Specific Recommendations for Prevention Focus Area 3 from August 1, 2013 BHPAC Meeting
a. Align evaluation measures with funded programs and approaches.
b. Implement training and technical assistance efforts at the local level to support funded program staff learn how to use data
to assess and modify, as needed, program efforts.

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Treatment
1. Develop recommendations for what priority treatment and support services not covered by Medicaid, Medicare, or private
insurance for low income individuals should be funded.
What do we already know about this focus area and can recommend to OBH for the Block Grant? (Note where this differs for MH/SUD)
Overarching goal: Enabling support services to make it possible for individuals to benefit from treatment to include but not limited to: Case
management/navigation, linkage to resources such as transportation, housing, childcare , social and or medical detox, MAT to improve
integrated care barriers. We know these are not covered and vital to recovery and wellness in general.
Future considerations: Parity to MH/SUD Payer requirements, enhancements through the development of the ACA, adding an income test
for deductibles and copays- understanding whether these may deter individuals from buying full insurance coverage. Actualize /implement
the integration of MH/SUD combined treatment rules. This effort will streamline service and documentation requirements effectively
enhancing compliance, system oversight and consumer protection. This effort may also assist in payer reform and transparency.

What steps are needed in order to provide additional guidance to this focus area? (Note where this differs for MH/SUD)
Future considerations: Parity to MH/SUD Payer requirements; what will be covered after ACA kicks in- will block grant dollars be available to
cover gaps in service? What are the requirements for order of payers some require billing to go to feds first then the state then ??? What
barriers exist and are not just perceived between integrated providers (primary health)

Data and information not yet available from exchange, can we gather a waterfall guide looking at costs and coverage. We are requesting a
visual and written (town hall type) presentation of OBH on their progress of actualization and implementation of the rules integration 16
months after consolidation. In addition it is requested that ongoing updates of the status of the integration process and progress be posted
on the website.

2. Develop recommendations on what priority treatment and support services should be funded for individuals without
insurance or for whom coverage is terminated for short periods of time.
What do we already know about this focus area and can recommend to OBH for the Block Grant? (Note where this differs for MH/SUD)
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This population should have access to the same plan coverage that Medicaid provides to Medicaid clients, we also need to look at
populations who have gaps in coverage (i.e., Military , tribal populations).
What steps are needed in order to provide additional guidance to this focus area? (Note where this differs for MH/SUD)
Understanding of barriers to health care access to include access to integrated care MH,SUD, and primary care.

Many people may not be able to afford deductibles even with subsidies; We would ask OBH create some type of process or rule that
Medicaid providers or those receiving funding provide services for these folks needs to remain simple for providers as navigation can
be time consuming.
It is suggested that OBH give authority to use some block grant dollars to provide treatment coverage when persons are following
their treatment plan but providers have recommended a treatment not covered by their plan (Iop, inpatient etc.) and there is
documented financial need, for instance Suboxone or ACT team services.
We would as a workgroup of BHPAC review definitions of physical health integration and recommend a standard working definition
be accepted by council this will allow our workgroup to better understand all the work across the state on physical health and
behavioral integration being completed outside of council.

3. Development of estimates of the number of individuals served under the Mental Health (MHBG) and Substance Abuse (SABG)
block grants that are uninsured in CY 2013 and an estimate of the number of individuals served under the MHBG and SABG
who will remain uninsured in CY 2014 and CY 2015.
What do we already know about this focus area and can recommend to OBH for the Block Grant? (Note where this differs for MH/SUD)

Monitor and inform council on the continuing gaps of coverage and services so we can identify the needs that exist and
determine where block grant assets be best targeted. For example homeless, rural LGBT, CJ, military family populations.
We know some of the data from PIN, and projected penetration rates but what are the real barriers to accessing care, benefits, what dollars
will be allotted. How will they be used remain unanswered .
What steps are needed in order to provide additional guidance to this focus area? (Note where this differs for MH/SUD)

Data, decisions impact of funding due to sequester and what the exchange programs will look like and what Medicaid package will be
due to large expected numbers in Medicaid. Workforce with expansion how will MHCs FQHC be able to handle increase in numbers.
CHIs report that shows 400K are projected to remain uninsured.
Can we post Triwest report to portal?
What do we know about the impact of stigma?
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What can be done to implement the 2008 Law that addressed temporary Medicaid Depression and why has it not been implemented
by counties. Can we find and post the Colorado Trust Workforce report?
We would like to request a report be provided by OBH that breaks down the data/statistics provided via SAMSHA, CCAR, DACOD,
COPIC , etc.. This would allow us to use the collective data to identify where gaps exist in data collection. It is further suggested that
the CCAR and DACOD be combined into one assessment tool.

Recovery Support
1. Development of recommendations related to how the state should support and help strengthen and expand recovery
organizations: public, private and faith based; family peer advocacy; self-help programs; support networks; and recoveryoriented services public, private and faith based.
What do we already know about this focus area and can recommend to OBH for the Block Grant? (Note where this differs for MH/SUD)

Lack of like services (parity) for MH/SUD recovery community organizations, peer and family advocate support networks and
ROSC.
We have ATR, WRKE, Soc (CME) that have been implemented statewide Let these grants teach us what they have learned.
We know that there is opportunity to fund support services due to block grant changes and health care reform. OBH should create
funding opportunities through the block grant to support innovative, recovery related, culturally responsive projects that support
equitable outcomes for special populations (i.e., ethnic minorities, LGBT, hearing impaired etc.).

What steps are needed in order to provide additional guidance to this focus area? (Note where this differs for MH/SUD)

Look at WRKE, ATR, SOC outcomes and data to identify best practices or promising practices to expand services for the BH Recovery
Community.
Identify someone or some group/organization to look at the data that exists & develop an outcome document summarizing
information. This information would provide the Council/OBH with information needed for next steps to move the system in the
direction of a fully integrated continuum of care.
Expand funding for recovery support services/recovery services beyond licensed facilities, including 501(c)(3), or organizations in the
process of pursuing 501(c)(3), or organizations in partnership with a fiscal agent [must be a 501(c)(3)].
Provide parity in recovery support services to make mental health and substance use services (behavioral health services) equitable
and behavioral health support services equitable within physical healthcare.

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2. Development of a definition of recovery and develop training recommendations to support the professional workforce on
recovery principles and recovery-oriented practice and systems, including the role of peer providers in the continuum of
services.
What do we already know about this focus area and can recommend to OBH for the Block Grant? (Note where this differs for MH/SUD)

SAMSHA has definitions of recovery, peer support, etc.

Facility/organizations and people, and individuals see definition of recovery differently

What steps are needed in order to provide additional guidance to this focus area? (Note where this differs for MH/SUD)

Ensure the Office of Behavioral Health uses language in line with SAMSHA guidelines/definitions and person first language within
grant applications and in all other methods of communication.
Review definitions from SAMSHA and recommend edits/additions or none, to Office of Behavioral Health as state wide definition.
Establish qualifications for both organizations and individuals to build a professional peer and family workforce that aligns with the
standards developed by the Behavioral Health Transformation Council.
Develop and provide training to professional (clinical) workforce and students in school to become clinicians to highlight the value of
peer provided services.
Review established trainings in Colorado for peer recovery coaches, peer support specialist, family advocate, family system
navigators and ensure that Colorados Combined Core Competencies which are fully integrated throughout behavioral health, are
being met.
Develop a campaign to reduce prejudice, discrimination, biases in the community.
Work to integrate funding sources to reduce silos.
Create a funding stream to support training for recovery/peer support professionals or define professions.
Collaboration and integration of SUD/MH into behavioral health peer specialist and recovery coach trainings.

3. Development of recommendations related to peer, cultural and linguistic services designed to meet the needs of specific
populations, such as veterans and military, families, people with a history of trauma, members of racial/ethnic groups, LGBT
populations, and families/significant others.

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What do we already know about this focus area and can recommend to OBH for the Block Grant? (Note where this differs for MH/SUD)

The Colorado Trust identified mental health disparities for members of racial/ethnic groups.
The Colorado Multi-Ethnic Cultural Consortium is one organization in Colorado dedicated to advocacy and education around
culturally congruent behavioral health services.
The Office of Behavioral Health (OBH) is taking positive steps to address cultural and linguistic behavioral health equity issues
through a cultural competency committee.
There is no centralized information about available about peer delivered cultural/linguistic services which makes it difficult to refer to
appropriate recovery support services.
There is a lack of funding available for culturally responsive recovery services.

What steps are needed in order to provide additional guidance to this focus area? (Note where this differs for MH/SUD)

Include funding in the block grant to support cultural/linguistic recovery services.

Create funding to develop an ongoing database of cultural/linguistic recovery services.
Create a funding system for culturally responsive recovery services.
Stronger education as to what services are available in Colorado for seniors.
(Some local mental health agencies have services for seniors but are lacking.)
Establish a database as to what services are available for seniors that are not active with a local mental health agency and how they
can easily active services and resources.
Establish and fund programs that service nursing homes...Nursing home residents lack pro active programs.
Establish a strong line of communication with NAMI for members and family members to better educate themselves as to up to date
information concerning families and older adults. NAMI has strong programs that are available.
(NAMI CONNECTION is a strong program that has a lot to offer.)

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