New Jersey: Embracing Change
The potential for effecting positive change attracted New Jersey to the CCBHC demonstration program. Assistant Division Director at the Division of Mental Health and Addiction Services (DMHAS) and state point of contact for the CCBHC demonstration program Suzanne Borys shared, "In New Jersey, we have separate licenses for providing MH/SUD treatment. We required our CCBHCs to have both licenses. The demonstration program provided an opportunity for people with addictions to get the same level of care as those with mental illness, and it brings us a step closer to our long-term goal of an integrated licensure structure for both physical health and behavioral health."
Director of Care Management Vicki Fresolone added, "Many of the professional staff at the CCBHCs are mental health providers, and the requirement that they provide AWM was a real challenge for them. Once trained on and experienced with it, they wholeheartedly embraced it." Prior to the CCBHC demonstration program, withdrawal management was typically delivered "unbundled" from other treatment services in residential settings and AWM was limited to very few providers, most of which did not accept Medicaid. Now, it is an allowable service within the CCBHC's outpatient addiction treatment license, which has significantly increased access to this level of care.
Another significant change in New Jersey is the increase in availability of MAT for service recipients with SUDs. Formerly, unless licensed as opioid treatment programs, most outpatient SUD treatment providers did not provide MAT. The seven CCBHCs, however, are required to offer naltrexone or buprenorphine and to establish referrals for clients who need methadone. Building on the success of the CCBHCs, the state is creating a buprenorphine network through which all outpatient settings can offer MAT and counseling.
CCBHCs play a significant role in New Jersey's Opioid Overdose Recovery Program (OORP), as well. OORP's recovery specialists help individuals in emergency departments who have received a naloxone reversal accept treatment or recovery support and connect them to service providers. The first five counties to offer OORP (now available statewide) also hosted a CCBHC. Connections were made between OORP and CCBHC providers that enabled individual referrals from the OORPs to CCBHC services.
Leveraging partnerships such as this has been key to the success of the CCBHC program. One very important relationship is between DMHAS and the state's Medicaid agency, the Division of Medical Assistance and Health Services. Borys commented, "We've always worked well together. We were equal partners during the Medicaid expansion, and that laid the groundwork for jointly pursuing the CCBHC demonstration program. We had a better understanding of how each division worked and the needs of the population." The third state partner is the Department of Children and Families' Children's System of Care, which contributes its expertise and resources on delivering mental health services to children and SUD services to adolescents.
Rutgers University's School of Social Work (SSW) rounds out the CCBHC project team. SSW played a significant role in preparing the state to become a CCBHC planning and demonstration grantee in the areas of outcome collection and EBP. Dr. Robert Eilers, DMHAS Medical Director and CCBHC Project Director, explains, "Several years ago, Rutgers' Center for State Health Policy secured a Center for Medicare and Medicaid Innovation State Innovation Model (SIM) design award for New Jersey. Goals for this SIM award included advancing behavioral and physical integration strategies and addressing Medicaid cost and value, especially for patients generating high costs. This led to a landscape survey, which, in turn, led to a comprehensive review of related regulations by the Seton Hall Center for Health and Pharmaceutical Law and Policy. Truly, Rutgers helped get the ball rolling and, then, paved the way with technical assistance and training on evaluation, data collection, reporting, and EBPs."
Extensive technical assistance and training have paid off, helping providers adjust to significant changes in practice that ranged from adjusting to a new funding methodology--the CCBHC PPS-2--to connecting with emergency departments and other providers through a health information exchange. As noted by Fresolone, "CCBHCs have lifted morale among provider staff. Historically, clinicians faced client needs for which they had no means to help. The scope of services available with the CCBHC enables them to meet client needs, resulting in much happier staff!"
Even more to the point of the CCBHC demonstration program, clients are benefitting from improved access to and a higher quality of community-based mental health services and from the enhanced capability of CCBHCs to coordinate care. Case in point? "Marcus" is a veteran who struggles with post-traumatic stress disorder (PTSD), childhood trauma, and addiction. Through the CCBHC AWM program, he detoxified from heroin. He embarked on MAT for long-term opioid dependence under the guidance of an outpatient psychiatrist and a therapist trained in PTSD and veteran's issues. Marcus' therapist, case manager, nurse, and psychiatrist worked closely together throughout Marcus' treatment to help him navigate each phase of care. He has been sober for several months and is learning to manage his anxiety and trauma. He has not had any suicidal ideations in more than 6 months, nor exhibited any violent behavior since entering the program. He has reconnected with family and secured employment as a union carpenter. The CCBHC program worked with Marcus in an open-minded, empathetic, and non-judgmental manner, helping him creatively overcome obstacles that prior traditional treatment programs were unable to help him circumvent.