DOH/BADAS Breakout Group

The DOH/BADAS breakout group identified the following barriers, with the first four listed in rank order.

• Lack of standardized tools among funding sources (repetition): The group noted issues of repetition, length of assessment(s), and service expectations as barriers. A potential solution the group listed was a coordinated system of care.
  
  
• ASAM criteria assumes "continuum of care" exists: Such a continuum does not exist, according to the group.
  
  
• Lack of funding: [no details]
  
  
• Resources available: There is a need for knowledge of available resources in terms of training issues and time constraints with respect to increasingly extensive tools. The group noted a potential role for public health nurses. [I combined this with another entry.]
  
  
• Lanaguage: This covered both issues of serving the hearing impaired--which the group described the system as "inadequate, cost-prohibitive" and lacking in resources to serve--and serving Latino and other immigrant communities. Immigration also raised issues about a client's legal status in the U.S.
  
  
• Medication issues: "destabilization."
  
  
• Urban-rural: "Need to look at rural v. urban assessment tool."
  

Editors note: If anyone from this group has details of the discussion on these items, please email robert.c.saunders [at] vanderbilt.edu, and I will flesh out these items.

Education Breakout Group

The Education breakout group listed the following items as barriers that were in their control to do something about (in order listed):

• Training linked to local priorities
  
  
• Dispelling myths re: liability issues
  
  
• Lack of supportive policy re: intervention
  
  
• Info re: availability and criteria [for SA services?]
  

The following were items listed as beyond the control of the group (in order listed):

• NCLB [No Child Left Behind]
  
  
• IDEA [Individuals with Disabilities Education Act]
  

Spanning both lists was:

• Resources

Editors note: If anyone from this group has details of the discussion on these items, please email robert.c.saunders [at] vanderbilt.edu, and I will flesh out these items.

DCS Breakout Group

The DCS breakout group noted that it served two different populations of youth: the dependent/neglected and children in court. The group listed the following items as barriers, with the first four ranked in order of importance.

• Minority Providers, Resource Coordination & Community Partnerships: The system lacks sufficient numbers of both. Recruitment of minority providers and licensure issues are among the problems faced ["We need startup cost to get the person to train the person, licensure."].
  
  
• Co-occurring services: The system (providers?) lacks training in co-occurring problems ["issue is payor sources"] and difficulties with youth who have conduct disorders specifically, but mental health problems generally.
  
  
• Transitional living/services: Youth need these supports because of issues around homelessness, unemployability, and their addiction/MH issues. [Could not interpret: "Adult DOC"--Dept of Corrections?].
  
  
• Funding sources: [no notes listed]
  
  
• JJ youth-No standard screening across courts: [no notes listed]
  
  
• Time constraints: [no notes listed]
  

Editors note: If anyone from this group has details of the discussion on these items, please email robert.c.saunders [at] vanderbilt.edu, and I will flesh out these items.

Juvenile Justice Breakout Group

The JJ group identified and rank ordered the following system barriers:

1. Lack of a system of care and system integration, including cross-department communications regarding youths' services, history and current needs: these limit the capacity of the system to refer/place youth in a timely manner.
   
   
2. Loss of TennCare eligibility among youth placed in "hardware" secure settings: The difficulty is that when youth leave the secure setting, TennCare re-enrollment lags as much as six-weeks, so the courts cannot direct youth, who often have their first screening/assessment/treatment experience in the secure setting, to treatment to capitalize on any momentum.
   
   
3. (In)accessible/(In)effective service: specifically the lack of available providers, available time among those providers who will take the clients, and scheduling/timelienss issues. The BHO's standard for non-urgent care scheduling is within 2 weeks, but this may be too slow for this population.
   
   
4. Cultural competence: This was sometimes an issue, not just with ethnicity but also by urban/rural status, gender, and language. There was an expression of greater need for younger and more diverse treatment providers, and often youth succumb to cultural barriers to using services through the traditional system. However, having someone that "looks like" the client was not strictly enough.
   
   
5. Transportation: A particular problem among the working poor who do not qualify for TennCare. Whatever accessibility issues there are with TennCare's transportation system, youth in TennCare at least have access to those services when provided, which is not the case for non-enrollees.

We brainstormed some about possible solutions for item #2. Part of the root of the problem is that beginning in January, the group understood it to be the case that TennCare let lapse an agreement with DCS regarding suspension of enrollment during incarceration, which previously allowed youth to have their TennCare coverage reinstated upon exit from the facility. One aspect of action would be to identify somebody at TennCare to work with on possible reinstatement of this option.

Another issue the group thought it could address was the inability of the juvenile courts staff to access information on TennCare enrollment status and who a youth's primary care provider is as well as initiate the process of re-enrollment (if suspension proves impossible to regain). Magellan indicated that this information is known and sharable among its providers, but it could not share access out directly to the courts. However, they indicated that some treatment providers have a liaison with DHS at their facility who is able to make determinations there. This suggested two avenues for action: (a) could the courts connect with these DHS liaisons to obtain the information they need (since it would be sharing across governmental bodies); and, (b) could the courts have their own DHS liaison who could help plan for the reintroduction of youth to the community and possibly accelerate the re-enrollment process. Another option was that certain groups (e.g., TennCare Partners Advocacy Line) have at times (and may still) had access to real time TennCare enrollment information: connecting the courts to such groups might resolve this problem.

Finally, we talked about ways to share information between the BHO/providers and the juvenile courts about placement availabilities. Magellan has this responsibility already, and the courts will track down a coordinator. However, often the courts will independently contact facilities, too. One idea considered was a reporting system between the BHO/providers and the juvenile courts, perhaps starting with residential programs (or some other group that would be managable), to update them as to the number of slots available at area providers. This would also help the courts, which struggle to know which facilities and programs to contact and which accept clients, particularly those with behavioral issues in addition to A&D treatment problems. At a very basic level, an up to date "cheat sheet" of key treatment/coordination contacts was considered helpful by the courts.

The group talked about continuing this discussion online in the comments to this blog. Robert will follow up with Nancy/Barbara regarding who might be contacted at TennCare and DHS regarding the enrollment issues. Robert will look into what groups have or might have real time access and connect them to the courts. Magellan indicated it would review what would be possible to provide in terms of "open spaces" and a roster of providers/contacts.

Update: The JJ Breakout Group was combined with the TennCare/BHO breakout group.

More Links on Screening and Assessment

Here is a link to another site, Project Cork, hosted by Dartmouth Medical School and funded through the Kroc foundation, with information about substance screening and assessment tools.

Chestnut Health Systems has information about the different flavors of its GAIN screening and assessment tools.