The Community Mental Health Authority of Clinton, Eaton and Ingham Counties (the Authority) is a locally-based, public organization, created in 1964 with the purpose of serving the mental health needs of the residents of the tri-county community. Annually, the organization serves over 10,000 persons at 122 sites throughout the tri-county region with over 900 employees.
The Authority and the mental health centers that it operates did not have a particular focus on first-episode patients prior to this study. The main motivation was to develop further understanding and build capacity to address the needs of patients with first-episode psychosis. The state has a steering committee disseminating information on evidence-based practices in mental health services, such as assertive community treatment (ACT), family psycho-education, supported employment, and medication algorithms. Lead members of the RAISE study team serve on this steering committee.
The main source of referrals was the inpatient unit operated by the CMHC as well as other hospitals and providers through brochures or word-of-mouth. They had a total of 50 referrals that went through initial screening by the project manager Cathy Adams. The 26 of them were sent for further interviews for medical diagnosis and 18 participants, ages between 18 and 33, finally enrolled in the study.
Financing of Services
Among the study participants, 12 came with health insurance coverage from their parents and six were uninsured. Those who were uninsured applied and obtained Medicaid coverage (either through SSI eligibility or some other eligibility status) to pay for services. The Center receives per enrollee per month capitated allocation from Medicaid. There is also some revenue that comes from state General Funds under categorical funding mainly for the uninsured. State mental health block grants are also available for evidence-based treatment services. However, for the agency overall, the capitated Medicaid payment is the main source of income both for RAISE clients and clients in general (Table 3.3).
In general, the participants had a focus of continuing their education and mostly requested supported education services to achieve their learning and recovery goals and the case managers were able to provide such support to a great extent. In terms of supported employment services, although the Center had some earlier initiatives aligned with providing supported employment services, they did not have a dedicated staff assigned to provide for these services. There were a couple of referrals to Michigan Rehabilitation Services for employment and training services.
The site is also using presumptive eligibility to some extent to streamline the Medicaid enrollment process. Presumptive eligibility enables patients who appear to be income eligible for Medicaid or the Children's Health Insurance Program to receive temporary coverage while a full determination is processed. Beginning January 1, 2014, states can allow Medicaid-participating hospitals to conduct presumptive eligibility determinations for any Medicaid-eligible populations regardless of whether the state is using presumptive eligibility in any other setting or for any other populations in the state (ACA, 2011). The study team did not think they would be able to sustain all components of the NAVIGATE treatment, particularly SEE. They saw this study as a good learning experience.
|TABLE 3.3. Community Mental Health Authority, East Lansing, MI: RAISE NAVIGATE Early Treatment Components and Funding Sources|
(e.g., VA, Tricare)
|Outreach and engagement||X||X||X||X||X|
|Alcohol and substance use treatment||X||X||X||X||X||X||X|
|Other outpatient visits||X||X||X||X||X||X||X|
|Inpatient care as needed||X||X||X||X||X||X||X|
|Planning (e.g., treatment and/or recovery plans)||X||X||X|
|Job coaching and other vocational supports||X||X||X|
|Individual resilience training||X||~||~||~||~||~||~|
|Benefits counseling (e.g., WIPA)||X|
|Treatment and primary care coordination||X||X||X||X||X||X|
|Other (e.g., occupational or psychosocial therapy, groups, etc.)||X||~||X||~||~||X||X|
|NOTE: In-house or Other means services provided by staff directly and not billed to any payer. Out-of-pocket means services were paid for either entirely out-of-pocket or some cost-sharing was required.
~ Denotes possible funding if billed under therapy code.