Behavioral Health Services for the Nursing Facility Population – May 3, 2022
good afternoon everyone i’m shayna varner with phca thank you for joining us for today’s webinar behavioral health services for the nursing facility population a few quick updates to share before we get started this webinar is being recorded and will be made available on the phca website and will be shared with oltl leading hpa and paca as a reminder this webinar has been approved for 1.5 continuing education credits for all attendees for those who provided a nab number credits will be uploaded shortly we’ll also be sharing certificates with those in attendance following today’s webinar you will receive a survey your feedback is important to us and our presenters and we hope that you’ll take a moment to complete that survey at the end of today’s webinar as we begin today all attendees will be in listen only mode as we move forward please feel free to submit your questions via the chat box on your screen and we’ll make sure we answer as many of those questions as possible at the end of today’s presentation today’s webinar features presenters from across the commonwealth with connections and behavioral health services for nursing facility residents we found collaboration with oltl and behavioral health services to be very important for our members and we’re hopeful this webinar will help to familiarize you with the valuable often underutilized behavioral health services available to your residents i’ll now turn today’s webinar over to jamie buckenhauer deputy secretary with the pennsylvania department of human services office of long-term living good afternoon everybody thank you for participating in today’s webinar this is a really important topic for the office of long-term living and for the office of mental health and substance abuse services the provision of behavioral health services in nursing facilities is so important obviously now after covid even more so so i’m going to give you a little bit of perspective on how we got here so in the last couple of years the office of long-term living was really focused on the transition of services from a fee for service model in the transition of long-term care services from a fee for service model to managed care we implemented the community health choices program starting in 2018 and concluded the implementation phase of community health choices in 2020 as part of that transition individuals in nursing facilities actually received access to medicaid behavioral health services and were enrolled in behavioral health health choices program and that was really exciting and really one of the benefits of switching to managed care in pennsylvania during the implementation of community health choices a lot of time and effort was spent on educating managed care plans providers including nursing facilities our stakeholders their families and individuals in nursing facilities about the new benefits for those on medicaid and in nursing facilities how they were going to receive these benefits and how to access these benefits however obviously the timing was all important and at the conclusion of the implementation of community health choices which was during 2020 the covid public health emergency intervened we know that covid19 or the planning preparation and dealing with an outbreak or the subsequent workforce shortages that nursing facilities are encountering have been first and foremost in the work for long-term care facilities its administrators and its staff we thank our nursing facility staff for the for working tires tirelessly for two plus years with the focus on keeping your residents safe from covid and learning how to protect them but now hopefully we’re coming out of covid and we know that residents have behavioral health issues in your facilities covid was devastating for them so our goal is to provide the information again to assist nursing facility staff and help you connect your residents with the care that they need as we keep hearing it is desperately needed after the covenant public health emergency so with those i want to say levels that are remarks i will turn it over to doctor of health for some additional remarks good afternoon uh this is dale adair uh from the uh um office of mental health substance abuse services um and i want to lend my thanks for your attending today’s webinar on accessing behavioral health in nursing facilities when community health choices was implemented it presented a new opportunity to provide expanded access to mental health care for adults residing in nursing facilities advocates were enthusiastic about the development and have been eager to hear how it’s going we recognize that the country is aging health care has improved and people are living longer lives which means frequently i’m sorry which means frequency with which adults may be living in nursing facilities is liking to continue to increase mental health care is health care and it is important that we create linkages and supports for adults who need behavioral health care to address their mental health needs substance use disorders or other behavioral needs while the awareness that older adults often have mental and behavioral health needs has been growing in general we cannot overlook how the impact and experiences of the pandemic over the past few years has exacerbated the need for these supports for many people of all ages factors such as being at a higher risk of serious health outcomes if the virus was contracted due to nothing but age alone certainly increased the sense of fear uncertainty and trepidation about going about daily life for many older adults my older mother included the need to mitigate the spread of the virus results in an increased sense of isolation for many individuals who resided in congregate care settings and when outbreaks occurred they faced real dangers as did many of you as i have no doubt you can relate to this given all of this olmsaus is pleased to partner with the office of long-term living to provide an overview of behavioral health services so that you know what kinds of care are available and how service coordinators can make linkages to behavioral health care providers supporting the emotional and behavioral well-being of the residents you care for by helping them access needed supports benefits quality of life for them quality of work environment for you and promotes the values of wellness throughout your facilities thank you so much for spending time with us this afternoon as we we’ve reviewed the importance of reaching the right people at the nursing facilities i.e social workers and nurses etc educating staff in nursing facilities about services available to residents through the behavioral health managed care organizations and how to access them hearing about best practices in nursing facilities and discussing the top three behavioral health training topics for nursing facility staff thank you for your time your attention and for all that you do good afternoon everybody it’s kelly weinzer and i’m the director of western operations in the office of mental health and substance abuse services and some of what we decided to do was also ki and dr roder um graciously mention one of the first questions is we thought we would help individuals think about questions or get to thinking what maybe could be services could be useful in nursing facilities so what we were asking is to answer the question or think about it if you have thoughts please put them in the chat box i mean if there’s time at the end we are going to try to answer questions but um food for thought as you’re listening to this presentation is what are the top three behavioral health training topics for nursing facilities staff so in your opinion if you could think of top three and willing to share those we would appreciate it and again if you could put your remarks in the chat box um that would be greatly appreciated um and next i would like to um introduce duncan bruce i mean he will introduce himself he’s from community care behavioral health and he’s going to discuss on what services are available through the behavioral health managed care organizations duncan great thank you kelly um i see the powerpoint is up so that’s great so my name is duncan bruce i’m the director of mco integration at community care behavioral health and i’m going to review a little bit of information which hopefully will provide some background and context for some of the other presentations that will follow if you can move on to the next slide that would be great so i wanted to start off by just talking about the health choices program so health choices is the uh it’s pennsylvania managed care program from medical assistance recipients often referred to as medicaid it really has three separate but integrated component so the physical health component behavioral health component and the community health choices program which was mentioned earlier i just wanted to mention that all three aspects of the health services program they sort of work together in integrated fashion but they are operated and managed by three uh distinctive separate sets of managed care organizations i’m going to review a little bit of information about the behavioral health managed care organization that’s the the part in the middle so if you can move on to the next slide all right so with a little bit of background the mhid act of 1966 established a county-based service system and you’ll see in a minute where that comes into play the behavioral health choices program is overseen by the office of mental health and substance use uh services and we’ve already heard from kelly and a few other folks from that office today they do work closely with the commonwealth 48 single county or multi-county mhid program offices and i’ll just sort of mention too that the uh uh behavior health choices program started back in 1997 so it’s actually 25 years um old today so sort of a silver anniversary for the program not today sorry this year i meant all right if you could go on to the next slide right so a few things i wanted to to highlight so i as i mentioned behavioral health is part of this integrated human services model in pennsylvania but when we’re talking about behavioral health it actually covers mental health conditions uh substance use disorders and some developmental disabilities so sort of a large umbrella that covers those three areas as i’ll also mention too this is a newer benefit for individuals residing in nursing facilities and getting home and community-based services the health choices program which rolled out in 2018 was when that sort of change came into effect the behavioral health choices program is operated under the direction of the county so this is one area where the behavioral health choices program differs from the other two uh um areas from physical health choices and community health choices for behavioral health the county picks which managed care organization they want to work with and that is the managed care organization which uh uh provides the coverage so unlike uh physical health or the cfc program we have a choice of a couple of different uh managed care organizations for behavioral health it’s dependent upon the county in which you live and further on the presentation i do have a map of some information that shows that breakdown um so one other quick thing i just wanted to point out too it’s important when we’re talking about behavioral health choices and the medicaid program uh a lot of folks that are enrolled in the community health choices program they are dual eligible for medicare medicaid so it’s important to remember that uh medicare also covers behavioral health and there is sort of a hierarchy of who covers what so um we have to sort of bear that in mind when we talk about behavioral health if you could go on to the next slide so this uh slide here shows the state implant benefits every behavioral health mco has to cover all of these uh uh programs and services so you have on the left hand side the mental health services on the right hand side the substance use treatment uh programs and services that are available again uh no matter what county you are no matter what behavioral mca you’re with we all have to cover these um on the list if you could go on to the next one so in addition to those state implant services all of the behavioral health uh mcos have the opportunity to uh create or offer in lieu of our supplemental services um and i would just sort of the one thing i wanted to point out about these is they uh they vary between different regions they’re often developed to serve a specific need that a county or region may have or a specific population they’re too numerous and varied to provide a list from them but just wanted to mention though that um you know they are unique and it’s important that um you know you get to know the behavioral health mco in your area that you work with because many of these supplemental programs may be of benefit to individuals that you work with if you could go on to the next one so this uh shows you the breakdown of the behavioral health mcos and the different areas that we all cover i was sort of listed alphabetically and again you can see all the different counties there you go on to the next one this is the same information just in a uh map format just to make it a little easier to uh um to see if you can move on to the next slide so what i wanted to do is sort of wrap up and just sort of make a a few points about how would somebody get started uh uh with all this finding out about behavioral health and uh what the behavioral mcaos can cover so all of us have uh staff that are always ready willing and able to answer questions whether that’s our customer service staff or care management or other departments um we can definitely help people find providers we can make sure that uh if you’re looking for service that your members are receiving the right type of a service for the uh needs that they have we can make sure that uh you know the service that you’re looking into is covered we all have member services lines we all have provider lines so um lots of things we can do to help and support any questions or information you you may need so um i guess the final message would be um i think we’re all ready willing and able if uh folks do have questions that uh definitely um help and address those i think that was the last slide i had um if you could just double check and move on yep so that was the last slide i had i i know for the next portion of this all of the uh uh behavioral health mca they’re going to take a minute to just discuss some of the uh outreach and and work that they’ve done already trying to uh work with uh nursing facilities to provide some education about behavior also i’ll i’ll kick it off and sort of speak about some of the activities that community care has done and then i’ll sort of uh hand it off to one of my colleagues so just a a quick yes reintroduction of myself as i mentioned uh my name is duncan ruth i’m the director of mcu integration at community care and community care um is one of the behavioral mcos the sort of five that operate in the state we cover 41 counties across pennsylvania i think we have roughly about 1.2 million members we covered we have sort of 11 regional offices across the state um when the community health choices program uh first kicked off we started a number of different sort of activities um to help sort of spread the word about behavioral health so we have uh uh called all the nursing facilities uh in the state that are in our our counties that offered in-person and telephonic meetings we did some survey the nursing facilities to ask about the particular uh behavioral health needs that they had or any particular training needs they had um we did offer uh or sponsored mental health first aid training for uh some of our counties we um have done some i offered some lunch and learns the last four years or so we’ve offered a either an in-person conference or web-based uh training series with uh the uh topic specifically for uh nursing facilities at hcbs providers we’ve also participated in a number of different panels and presentations that the nursing facility trade associations have put on um and on our website we have some specific information particularly for uh nursing facilities uh regarding behavioral health we have a behavioral health 101 training and a couple other flyers and pieces of information so i’ll also wrap up there because i know that all my colleagues have um activities that they’ve done as well so i will uh hand it over now um i guess we’ll just go alphabetically and i’ll hand it over to uh to beacon and that would be rachel all right thanks so much duncan hi it’s rachel lee price i’m a manager of behavioral health clinical services at beacon health options of pa our counties of focus are in southwestern and northwestern pennsylvania um what we did for the chc rollout is worked with our primary contractors and counties to get surveys sent out to the nursing facilities to assess needs we also followed up with that to obtain further information about potential unmet needs and what we could do to help support programming and services we also created coordinated and conducted county specific behavioral health 101 trainings for nursing facilities um the presentation included information on implant and supplemental services and how to access both behavioral health and substance use disorders services within each county we did those uh via webinar and in person and look forward if there’s a need again to go out and do that again and we also attended and presented at several forums for the nursing facility associations um so i appreciate the time and care that we’ve all taken to put this together i’m going to pass it to joe dimeo at cbh thank you rachel good afternoon everyone i’m joe demaio i’m the behavioral health coordinator for community health choices at cbh cbh is community behavioral health we are the managed care behavioral health managed care organization for the county of philadelphia for all residents under medicaid who reside in philadelphia we have over 700 000 enrollees in cbh and we have over 200 providers contracted with us to provide behavioral health services in all levels of care and populations to that need with chc we’ve also we’ve added new providers to work with this population our enrollment has grown since we are now able to fund uh services for residents living in nursing facilities as well as members on the aging waiver and like my colleagues we’ve done many things prior to community health choices and in the past few years but i want to talk about what is available right now uh you’re on this webinar you’re wondering you know how can i access care what is available to to me now so if you’re on this call and you are a philadelphia nursing facility i’m going to provide you with a number that’s 1-888-545-2600 this is our member services line if that is 24 7 you will always speak to a live member there and any question you have around behavioral health services how to access care providers in our network we’re just basic questions on behavioral health they can answer them as i said providers are available to come into your facility through mobile mental health therapy through peer services as well as crnps and psychiatric care so with that said training is also available for your staffs through our department of behavioral health website mental health first aid certification training we have a training department called bh 10 which offers many trainings through for behavioral health care i just passed out a training that’s coming up on crisis management and verbal de-escalation also managing of problematic behaviors and we have a training upcoming on narcan and opioid disorder so these are topics that we really would like nursing facilities to uh take on uh because your populations are changing so uh one of the presenters who was going to do a presentation today could not be here her name was tara winter and she was the vice president and administrator of a nursing home in philadelphia called chapel manor chapel manor partnered with the philadelphia department of behavioral health with the philadelphia department of public health and with cbh and our office of homelessness services for a program that we developed called the peace program the peace program was for individuals with physical health challenges behavioral health challenges and homelessness to have long-term care chapel manor took on many of these members and mental health services was pushed into the nursing facility through mobile mental health therapy mobile mental health therapy is a level of care where lcsw comes out to the facility provides individual therapy or group therapy also does family sessions mobile mental health therapy can also act as a educator to your staff on behavioral health they will interact with your staff talk about the challenges the individuals are going through so we have providers in our network that can do this service and chapel manor was very successful in that in that they even hired a behavioral health uh manager for the nursing home itself so these are just some ideas of what you could be doing in your residences to help with behavioral health so with that said i’m going to pass it off to my colleague lauren keane from magellan and she’ll discuss some of her successes thanks joe so hi this is lauren keenan the director of integrated health at magellan um so to start with uh you know at least annually often uh twice a year we’re outreaching to nursing facilities where we know that magellan residents are residing uh asking for uh you know asking if there’s any need for assistance either connecting to additional behavioral health supports and just looking for opportunities to partner on enhancing any current supports there offering trainings such as behavioral health 101 level of care training and in general again just making connections to other community supports we’ve surveyed our provider network to identify providers who have experience working with the older adult population and those that would be willing to contract with nursing facilities to provide behavioral health support which has come in handy over time as some facilities have reported an interest in switching providers we have contracted with seller providers who work exclusively exclusively with nursing facilities and then have sought feedback from those providers over time as far as what trends they’re seeing are opportunities again just i’m continuing to try to collect data where those opportunities are and the possible partnerships we’ve attended and provided regional trainings um we’ve attended at the uh or presented at association conferences state calls and provided our provider network with training we’ve been engaging the embedment offices and crisis programs to identify needs for the chc population nursing facilities and making connections with crisis programs to help support um those facilities uh whether it be for um crisis intervention and training or at could be at a high level or individual member level trying to be more proactive and behavior plans and so on um and more i would say in the past year or so we have been working on building connections between nursing facilities and uh peer supports agencies in the community that provide those supports setting up meetings to build a relationship develop workflows and get those partnerships in place to advocate for the use of peer supports within nursing facilities for any contact information additional information for magellan you can access our website at www.magellanfpa.com i’m going to go ahead and hand this over now to perform care and i believe it would be dan good afternoon everyone um this is dan eisenhower i’m the director of operations for perform care excuse me i also oversee our community health choices program um so echoing what some of my colleagues have said perform care also does about an annual reach out to all of our nursing homes we did it last may and so we’re scheduled to do another outreach soon um in may of 2022. 2022 our outreaches are particularly focused on whether there’s unmet needs or any training needs that nursing home may have last year we assisted a few nursing facilities and replacing their psychiatric consultation services in the nursing homes and we’ve also added some additional providers that we have credentialed that do specifically nursing home psychiatric um and therapy consultations um we did have what i would say a very difficult sort of launch of chc for us um chc for most of our zone um was implemented january 1st of 2020 and then right after that we had covid and nursing homes as you know we’re struggling with limited options for in-person and visits and connections with the community and so we at perform care are basically just now getting around to sort of restarting um our connections and our relationships with nursing homes prior to implementation we did a round of trainings we did a round of outreaches and like i said we were kind of cut off by the pandemic for a period of time so we’re just sort of circling back and re-establishing those connections and those opportunities for collaboration i also say that we are also working on a couple of different ideas to enhance services in nursing homes including trying to develop more specific peer support services as well as some enhanced nursing home consultation psychiatric services so this is just some of the activities that we have planned for the remainder of this year and as my colleagues and duncan said every nco has 24 7 contact you need additional information you can contact perform care member services our website is www.pa or performcarepa.org thank you again this is kelly um thank you everyone i’m from the behavior health managed care organizations um discussing what they have done in the previous years to reach out to nursing facilities as well as assist the community and providing behavioral health services for those that need it some of the discussion points for question and answer out of this session are what behavioral health services have been the most helpful in your nursing facility and what behavioral health service do you currently need that you do not have access to so next i am going to turn it over to the community health choices um coordinators and i believe the first one is going to be um it was is going to be um john mcfarlane excuse me you are correct nothing to excuse yourself kelly thank you for introducing yes uh john mcfarland’s upmc community health choices um we’re going to switch just lightly to what we’re talking about we realize a half an hour in we’ve given you a lot of information but let’s circle back to the community health choices where the managed care organizations have managed the benefits for folks who are uh nursing facility clinically eligible and most of what we do as mentioned by duncan and others is more focusing on on the functional needs benefits and behavioral health is something that is managed by the behavioral health and cos as well as medicare plans but we still assess for it we still coordinate it we still help out our participants who have behavioral health needs is still considered part of our overall service plans and the domains that we monitor for a person so with that the question often is what would then uh chc be looking for if behavioral health would count or not within the context of nursing facility and really the question fall is not really what we’re looking for we can all have different types of assessments that we use but at the end of the day we’re still relying on information given to us by our participants as a residents in nursing facilities as well as the information off of the minimum data set supplied by the nursing facilities and i hope the questions are still going to be geared to capturing uh the same sort of symptoms so some of the signs that somebody in a nursing facility or somebody who is elderly might be experiencing behavioral health issues even if it sounds obvious i i work over them um adjustment issues could present themselves as sadness boredom disruptive behavior people doing odd things to judge or stay and force a discharge it could be a science will be just struggling to adjust to the environment uh depression it’s it may be obvious but often so discounted uh sadness loss of pleasure uh problems with sleep sleeping too little sleeping too much concentration problems appetite changes activity patterns talking more about this there’s a some factor of ageism with some of these symptoms in particular with depression it’s sometimes considered culturally well older people are sad yeah it’s our stereotype yes we’re going to be talking about that and it’s not necessarily so this again when we interviewed people uh some of our participants some of the things you want to talk more to somebody about and perhaps eat therapy or another service we’re around these feelings even if you don’t put the label of depression on it it still adds up to the same anxiety avoidance hoarding sudden agitation repetitive behaviors can all be signed somebody might be struggling with anxiety psychosis describing odd perceptions it could be a sign of hallucinations feelings of persecution could be signs of the answers of paranoia and substance use which still does happen in some nursing facilities however people get a hold of it intoxication-like symptoms that are not accounted by a medical diagnosis and not responding to treatment again these are all just points to have conversations with is there the primary physician maybe you have psychiatrists on board any other doctors and try to evaluate perhaps this person is experiencing some symptoms of behavioral health issues and it’s also something for further coordination with the rest of us now as far as getting to some specifics for coordination i will turn over to my colleague heather at va health and wellness good afternoon everybody next slide please i just wanted to take um just a minute to explain how behavioral health services can be accessed behavioral health services can be accessed through a number of ways there’s really no no wrong door to access services however the preferred method is through the service coordinator the service coordinator has contacts within each health plan that are very familiar with all of the behavior health services that are available despite care and can help um secure those behavioral health services for those participants that need those services so the preferred method is service coordinator just let the service if you identify that a participant has a behavioral health need you can let the service coordinator know and they will take it from there also if your facility already has psychiatry and a therapy service provider they are the participants can continue to see that provider they don’t need to change that provider just let the service coordinator know so that they can incorporate that behavioral health service and provider into their person-centered care plan and next i will turn it over to amerihou thanks heather um this is my name is dawn i’m behavioral health coordinator for america healthcare trust and keystone first i’m just gonna briefly discuss um behavioral health needs during nursing home transition it’s very important that behavioral health is addressed prior to nursing home transitions so it can be part of the discharge process and treatment follows the participant into the community this type of treatment can include behavioral health medication it’s important to review this with the participants primary care physician as well as if needed locating a psychiatrist in the community so this medication can continue to be prescribed appropriately behavioral health therapy um we need to notify the service coordinator of whatever current services the participant is receiving within the facility so we can ensure that those services follow that person in the community chc plan supports the individual in locating behavioral health services in the community whether they’re already there or they’re transitioning through the nursing facility it would be a referral that the service coordinator would coordinate substance use and supports participants who have a history of substance use concerns often can maintain sobriety while they’re in the nursing facility that have difficulty once they leave due to the decrease in structure however supports are often needed to maintain their sobriety once they leave the chc plan can help support them and locating these community-based supports whether they are individual therapy group therapy naa meetings due to the sensitive nature of substance abuse an updated consent that permits discussion regarding these needs has to be completed and it’s very important that all parties are included on this including whatever nursing home transition provider you may be using as well as any path provider that may have been chosen to follow the participant in the community thank you and i’m going to hand it on back to kelly thank you now we move to what i would refer to um you know as as the meat of the presentation why everyone is actually here um we have some nursing facilities and providers that work and provide services and nursing facilities to discuss some um to discuss their programs and what they’re doing um and so i know that’s what everyone came to hear so i am going to first turn it over to joe demeo so he can just um introduce um speaker thanks kelly this is joe demaio again from philadelphia cbh and uh i’m here to introduce a friend of cvh and a a partner in behavioral health services throughout this whole initiative i am honored and privileged into introducing uh the president and ceo of english diane roth and throughout the crisis pandemic crisis diane reaches out to cvh we we assist with behavioral health needs for her population and uh she is an advocate and a uh supporter of behavioral health care for residents in nursing facilities it went as as far as as diane developing a program a peer support program for the residents living in nursing facilities and she is now a contracted network provider at cvh for this program so without further further ado uh diane is going to speak about this program and all the other behavioral health needs and challenges facing this population diane thank you joe so much and i’m here with paula burnett who is one of our certified peer specialists in our journeys program really quickly i i know i gave too many slides but english is an organization that focuses on people with very complex disabilities and we are comprised of english house which is a 252 bed long-term skilled nursing facility um inglis housing corporation where we do affordable accessible housing communities and then english community services which include an array of different supportive services to people with complex disabilities wherever they live journeys in the blue is the certified peer specialist program that will focus on a bit um today next slide uh next slide um so really quickly english house uh is uh having its 145th anniversary this year and again we we serve 252 residents um all of whom utilize power wheelchairs for the most part um for for mobility uh so their needs are very complex from the staffing as well as the um clinical sides um where it’s a younger population median age of 57. so it’s it’s distinct from the majority of nursing homes in that regard and um the range of diagnoses that um the residents of english have english house have really about a third are people with progressed multiple sclerosis and other um progressive illnesses that lead to paralysis then another third of developmental disabilities such as cerebral palsy and spina bifida and then the final third being traumatic spinal cord injuries uh from various sources next slide relevant to this webinar i think it’s important to know that within english house 85 percent of our residents have a documented behavioral health diagnosis depression and anxiety being the most common but 40 of our current residents have three or more active mental health diagnoses and this really hasn’t changed since the pandemic um what i would say is that uh the pandemic exacerbated existing uh behavioral health uh needs next slide um when uh community behavioral health was um or when chc started uh we were really excited about the opportunities that uh our residents would now have for more behavioral health services but it was a little too early in the process yet and we felt it was critical based on our residents needs to put in staff positions to serve some of the mental health needs of our residents we have a director of social services and behavioral health with a clinical background and we now have also a licensed clinical social worker on the staff who provides direct clinical services but we use the contracted providers through cbh and through medicare for psychiatry and medication management psychological assessments and capacity evaluations and under special circumstances uh we use uh kind of consulting organizations clinical organizations to do specialized assessments that we privately pay for and finally we did as joe mentioned develop a program prior to the pandemic for a mobile certified peer specialist program that we call journeys and journeys was always designed to be um both in person and through telehealth and we were actually the first omsas licensed certified peer specialist program in pennsylvania to build in a telehealth component into the program design that all changed obviously when the pandemic hit and telehealth became a primary uh method for delivering services but we were uh very proud to be kind of ahead of that curve and really ready to start services remotely as soon as that was necessary we have been providing services through journeys to people in nursing facilities as well as people who live in the community and particularly people transitioning from nursing facility into community next slide i think i just covered that and paula burnett is our certified peer specialist she can go through uh really what her role is and how she supports people one of the things i wanted to say before i turn it to paula is that um we really focused on we were opening up a new apartment building last fall and we wanted to make sure that people who had already indicated an interest in moving to independent living last year in from english house were ready to apply for those apartments and it was a pretty intensive process that took over i think a total of of at least six months um and i what i would say is that we learned so much through that process and we did need at that time to bring in the um cbh-funded extra services for capacity assessments and the psychologist to be able to help us with that process and they were very helpful at the end of that five of our residents successfully transitioned to the new apartments um but i think what was really important was as as so an earlier presenter talked about it is so important to make sure that the behavioral health needs of people are really in the discharge plan and the new um chc plan and that all of their services are really lined up tightly particularly around behavioral health when they’re transitioning from the nursing facility into the community next slide okay so yeah i guess i’m just one slide ahead but i’m going to turn it really to paula because paula is the one who makes these services possible and she can tell you a little bit about her role but also um perhaps uh a story or two about how she’s supported people in nursing facilities through this pandemic and people who have transitioned from the nursing home paula hi everyone i’m paula burnette i’m a certified peer specialist with the journeys mobile program and forgive me because i’m truly living the mobile part right about now um one of the things that resonated through this particular webinar is the need of the tran the way to transition real people welcome to route 13 the need to make sure one of the things that i work with about one two three four people who transition from long-term care into their own into the community to their own departments and the importance of having the behavioral health services put in place because as we found out today that even if myself wanted services there’s a long wait list and what what i was hearing and i’m gonna do this real quickly i was thinking about an individual inside of english house before the pandemic his goal was for socialization and getting out and due to the pandemic and a particular diagnosis that he lives with caused him i don’t want to say um to become sick again it just heightened the level of the symptoms right now just like i am glad to have here that you know inside our particular facility long-term facility is that we even getting more providers more um behavioral health needs because not only do i work with in-house i work more in the community and i can’t express that even more i just like my biggest we want to say success is one of the five that transitioned last last year from english house to methodist gardens on how well the team that worked with these individuals was able to make sure that what they were receiving behavioral health-wise inside the long-term care was managed on the outside and i just want to thank you for allowing me to just give a brief synopsis and once again like i said right now i’m truly being mobile today and thank you thank you paula and i think the last thing that we wanted to share was that we really believe that all of our nursing facility staff should have the benefit of mental health first aid training as well as trauma-informed care training and we are now actively taking joe up on everything he sends to us about trainings through behav bh10 in philadelphia but i would also encourage other nursing facilities to do the same with their local behavioral health mcos thank you for the time thank you so very much diane um and and thank you as well paula next i want to turn it over to lauren keane from magellan behavioral health to introduce the next speaker thanks so as i mentioned earlier briefly an effort to increase behavioral health supports within nursing facilities magellan has looked towards peer specialists as a service previously not often utilized in nursing facilities and therefore we saw this as an opportunity to enhance uh already existing support so magellan started engaging nursing facilities last year to assess for those interested in partnering with us and these efforts and we’re lucky to have a great partnership um in peer star who provides peer specialist services we were a bit challenged with covet with being able to go into facilities and often you know also with provider staffing challenges and so on but um but we have had some solid footing at this point and are looking forward to moving uh forward with these partnerships um i will go ahead then and introduce jessica peacock to explain more about certified peer specialists and how they can work within a nursing facility thank you lauren and i will just uh echo echo the appreciation of the partnership that we have built uh this is um i think obviously everyone on this webinar this is a passion of ours uh recognizing the you know behavioral health needs of adults in older adults as well as adults in nursing facilities and so it’s just very refreshing to see everyone on the webinar coming together for for the common good so as laura mentioned my name is jessica peacock i am the chief recovery officer for peer star which is a provider of mental health peer support services in 27 counties throughout the state of pennsylvania and my role in that is program development clinical oversight and guidance a lot of training development as well as research so to give you a little bit of background about peer support one of the things that i have found in the 10 years that i have been working in the field of peer support is that it is still a hidden gem it’s not a common service that people are familiar with because private insurance doesn’t um you know private insurance isn’t something that that typically covers it a lot of people don’t realize that this service is available so i wanted to take just a few minutes to really tell you about what peer support is we just heard from paula paula shared that she is a peer specialist so um just to kind of echo that really break that down into into what that means the the previous slide had mentioned that it’s a community home and community based service so peer support is a mental health support service not a clinical treatment service but a support service so there is no therapy being provided no counseling this is all mentorship and coaching and guidance but it happens in the home and community setting and so what’s nice about peer support is the home setting may be an apartment the home setting may be a house the home setting could be a facility it is wherever this individual considers home but then it can also be provided within the community where the individual is experiencing um struggles you know realistic struggles we are able to go into the community and help them with anxiety at the grocery store we are able to help them with connecting to other community services so just looking at this slide real quick you can see here it is non-traditional as i mentioned it’s a recovery support not treatment it is based on the foundation of hope and the reason it’s based on hope is because peer specialists are individuals nope there we go thanks peer specialists are individuals who have lived experience of having their own mental health struggles and they have um learned how to manage those and have learned how to live well and um work towards recovery and what they do is they go through a pretty intense certification training through the state of pennsylvania to learn how to use that lived experience of overcoming barriers and turning their pain into purpose to help other people so they are inspiring hope because they are the hope they are the hope that recovery is real um they are the living proof that recovery is real so peer support provides encouragement um through that kind of lived experience and through the mentorship and guidance of having someone beside you helping you overcome the barriers and the roadblocks that you experience and helping you um you know really kind of go after those goals that you have created for yourself or it can really be a great extension of the mental health treatment they are receiving from counselors and therapists and psychiat psychiatry so what’s nice is peer specialists are able to you know work with that team and help individuals follow through with maybe the treatment plan aspects that are individual and are to occur more at home or in the community so as i mentioned their coaching their guiding mental health recovery and they’re really modeling and teaching wellness strategies so a big part of peer support is really focusing on that overall health and wellness uh so that people can live their best life in the situation that they are in you can go ahead and go to the next slide please so what are we able to do in peer support uh you know one of the things we do like to mention to everyone is that although there is a companionship aspect you know you have a mentor you have a coach beside you we actually are working on very specific mental health recovery goals you know again not clinical treatment but really those realistic everyday life mental health struggles and barriers that come up those are the things that we’re really helping people work through so we are able to help plan for and manage crisis situations one of the primary things that you will see in peer support is peer support through many many research studies has proven to decrease psychiatric hospitalizations because individuals um learn how to cope with crisis situations actually situations before they turn into a crisis they have somebody navigating those triggers with them in the home and community settings so it decreases uh the the need for crisis support we build community and natural support systems i actually just found out that a lot of people don’t use the term natural support system that’s just something in peer support that we use all the time so natural support system just means we help people find other people to be in their lives that are not paid to be in their life a natural support system is some somebody or an organization that is available to you without insurance paying for it without um some other aspect covering for it so this could be a community organization it can be a person but we really help them try to build those support systems so that they aren’t being i aren’t feeling isolated aren’t feeling alone we help individuals with advocacy we promote personal responsibility and empowerment that’s a big part of mental health recovery is helping people see where they have control in different situations and how they can be personally responsible to to move forward we help individuals with self-help self-improvement we really spend a lot of time on self-worth we have found that a lot of individuals that we support we may be the first person that they found really encourages them and pushes them forward and helps them find their value and their worth and then the last two on here we guide and implement strategies for as i mentioned previously overall wellness and life satisfaction and then we really try to help improve those social networking and connections and even in a nursing facility it’s helping people find the people that are similar to them or that have shared interests helping them learn how to start conversations with other residents or uh you know we’ve had some situations where we’ve actually helped residents learn how to um start groups whether that is some type of faith-based group whether it’s we’ve had a an individual start a knitting group in a facility and even went to the point of getting that material donated from outside organizations so all kinds of creative ways that we’re able to support people go ahead and move to the next slide just so you know who is eligible because again a lot of people aren’t familiar with um peer support services um adults 18 and over we’re going to talk here in just a second about older adults but for peer support through our organization it is any adult 18 and older that can be in a facility that can be in you know in their home and community outside of the facility they must be medicaid eligible they have to have a mental health diagnosis that has a functional impairment so i like to say that that functional impairment means that the mental health struggles they’re having are really impacting their ability to live life love and play um you know they’re not able to care for themselves because of their mental health symptoms they’re not able to engage with other people those kind of things and then i do like to point out especially in a conversation with nursing facilities if they do have to be able to cognitively engage and actively participate in our services so this is just kind of um you know that reminder that someone who’s whose dementia or or alzheimer’s has progressed uh you know peer support isn’t just a companionship service um we actually because we do work on mental health recovery goals the individual needs to be able to you know participate in the action plans and the activities that we are are working on and sometimes that is where i will get involved if we are working with an individual who um who has experienced some progression in or some some cognitive decline over over time sometimes i will go in and do clinical evaluations to see if they are still appropriate for our services so if you’ll go to the next slide please we did want to just share what we have partnered with magellan in we’re piloting a program that um with magellan in nursing facilities what happened is with covid and really focusing on our older adult population at pier star we really wanted to provide more support to our staff who were working with older adults and so we were looking for some training opportunities and with kovid there were no training opportunities so we kind of created our own so what we did is we um we actually created a specialized training that we have called empowered aging peer support and what that does is the it provides very specific staff with additional training on normal aging through the lifespan so what is just expected as we get into our later years we also talk about age related transitions and very specific life experiences that we that we experience as we age unique circumstances and challenges of older adults so we talk about grief and loss and grief and loss isn’t just the death of a friends and family grief and loss is the changes in our physical abilities and changes in our identity and our purpose those kind of things we talk about cultural competency for aging populations ageism different views about mental health depending on the generation that you’re working with and then we also talk about specific strategies for aging adults so with the empowered aging peer support and with partnering with magellan what we have done is we have made some you know connections with nursing facilities that we have very specific staff who are going into those facilities and they have been oriented uh to the nursing facility staff as well as the facility itself that way they are familiar with um you know the resources that are naturally available to the residents you know the the kind of expectations of that facility because we really want it to be a collaborative partnership not just an outside entity coming in and saying hey this is what i’m doing but really um they know what we can do and we know what they’re hoping we can do and it truly is a team approach and then this staff member is um uh scheduled to work with five specific individuals um during this pilot program that meet the requirements and as that continues to grow that individual may continue to see additional we may have to bring in another staff member um but either way it’s it’s a it’s a pilot program that we’re very very excited about um and and just again grateful for the opportunity to help this this aging population but as i mentioned in nursing facilities it can be you know any i know you have more than just the aging population so anyone 18 and older so the final slide is just my contact information if you would have more questions want any more information about empowered aging peer support or this pilot program that we are working on with magellan so yeah thank you for the opportunity lauren i appreciate it that’s all i have thank you so much thank you very much um this is kelly i want to turn it over to duncan bruce again who um unfortunately one of the presenter was not able to be able was not able to be present today so he’s going to give a short overview of the program great thank you kelly um yeah if you can move on to the next slide perfect um so before i get started i just wanted to mention earlier in today’s presentation i discussed um that each of the behavioral health mcos can create in lieu of or supplemental programmable services so the program that i’m going to talk about here is actually one of the supplemental programs it was uh developed actually specifically for allegheny county it was done in partnership with um our county partners and more importantly we actually involved a number of nursing facilities in helping to sort of come up with the uh the i some of the ideas that are in in the program so again i just want to emphasize though this is a supplemental program it’s only for allegheny county as a at the current time so the uh the program is called new connections and you can see the the goals that we have for it there uh really that was to create a uh sort of an innovative behavioral health program specifically for nursing facility residents or those who are nursing facility clinically eligible really to support the uh uh behavioral needs of many of the folks in the chc program the program was designed to be uh you know sort of a holistic approach to working with individuals to cover uh behavioral health and sort of take into account a person’s physical health and social determinant of health needs as well and support individuals uh with their behavior health whether they are in a nursing facility or they are in the process of uh potentially returning back um to live in in the community so there were a number of different really goals for the for the program in addition to those one of them was to increase the behavioral health services available for what’s often an underserved population um the thought was this program too because it is sort of designed to work directly and be embedded within a nursing facility it might uh help decrease the uh uh um the incidence of folks going to inpatient psychiatric care if they have support in the facility um it’s also thought that as folks transition back into the community and if they have uh this team that can continue to work with them during the make during that transition period it might actually decrease the uh um incidence of folks readmitting back to a nursing facility and one of the other uh things too was that the program has built into it a psychiatric consultation piece but so again hoping to uh increase sort of the volume of uh psychiatric consultation that takes place at nursing facilities so the population that this program serves as adults that are 18 or older they have to have a serious mental illness diagnosis and again it’s really for folks at a nursing facility clinically eligible they can either be residing in a nursing facility or at risk of going into a nursing facility it is a team delivered program um and it’s a team consisting of four different individuals a psychiatrist or crmp they really function in the role of a consultant there they consult with the team but they can also consult with the other folks well for as well for example they can consult with medical staff at a nursing facility but i did want to emphasize that that role is a consultation role they’re not going to be prescribing medications or managing medications the team also has a mental health professional which would be a licensed mental health professional in the state of pennsylvania the team has a nurse and also a certified peer specialist and uh as you know from the prior presentation you just heard uh a certified peer specialist there’s a a lot of great work and things that they can do so um the program uh started almost a year ago actually in may 2021 they started taking cases uh clearly the coba uh pandemic made it uh particularly challenging to get things up and running the speed that everybody would have liked but it has been going for a year now as kelly had mentioned uh stacy williams is a social service supervisor at uh kane community living centers that’s a a program or a nursing facility in allegheny county she had actually done a nice presentation talking about her experience working with the new connections team she couldn’t make it today but she did say that um you know i can sort of highlight some of the uh points that she made during the the prior two presentations so just sort of a few things that she had highlighted was that you know she felt that the staff the nursing facility definitely had benefited from the confrontation that the team could provide to the uh nursing facility staff uh they were helpful with uh discharge planning for uh residents that were moving back into the community they did provide a an additional set of behavioral health resources that would otherwise have not been available um she did highlight that the team was very responsive quick to get back to them instead of active in coordinating care with the uh the facility and the member they currently have around uh seven different members that they are working with at the moment that the new connections team is working with in the uh cane facility where stacy works at um the hope is that over time that will continue to uh grow and expand because again she felt the program was uh sort of beneficial and you know expects over time that uh it’ll become hopefully more and more popular i did mention earlier the program has been up and running for a year it’s in allegheny county so you have to be an allegheny county resident but um they do still have some capacity so if anybody happens to be uh from allegheny county and a nursing facility from allegheny county and you have um some behavioral health needs that you think this program could uh meet um there’s definitely some um you know the opportunity for them to to work with your facility kelly if you want uh um that’s all i had for the program i’m happy to take any questions if you wanted to move to the next presenter thank you duncan um and those were actually all the presenters that we had today from um the nursing facilities um and providers of services in nursing facilities um i do want to point out that it has you know something that has been said before but uh many of the members and individuals that reside in nursing facilities are probably dual eligible for both medicare and medicaid um obviously medicare would be the payer medicaid the payer of last resort so all services would have to go through a medicare provider first so i wanted to point that out some of the certified peer specialists however was pointed out is not reimbursed by commercial plans nor medicare so medicaid would definitely be the you know the payer for those services and some of the services that um duncan just referred to as in lieu of services so in lieu of services would be alternative to state plan services and those are offered differently through the counties and the behavior health managed care organizations so again you might want to reach out if you hear of a program that you think all my work i would suggest that you contact the managed care organization and from your county to discuss the possibility feasibility um for a program like that in the in in the area so um with that um i wanted to open it up i want to turn it back to see if there was any questions that were submitted we do have a little bit of time a little less than 15 minutes so i will turn it back over to shayna to see if there were any questions that we could possibly ask an answer thanks kelly um there was one question that came in that was dropped into the chat um but you have addressed that as far as payers one of the secondary pieces of the question that came through are these services available for folks who receive medical assistance due to receiving ssi but perhaps reside in a personal care home or assisted living facility it depends on the service my you know some of the coordinators might be able to speak more but certified peer specialist is available the program might not look the same exactly that it might in the nursing facility but the basic um mentorship is available for anybody whether they’re on ssi as long as they’re mma eligible for anybody in the community in the nursing facility is a state plan service so if you think of someone that would benefit from that i encourage you to reach out to the member customer service line of of the behavioral health managed care organization that is in your county and discuss the the need for that and some of the other services i know certified peer specialists were the two that were really presented today so yes those would be available to everyone great thank you and it looks like that’s the only um the only other question that we’ve received today so on that note i just want to say thank you again to our presenters for sharing this important information today and thank you all for joining us on today’s webinar if you have any follow-up questions please send those to us we’re happy to work and get answers to those for you and we’ll go ahead and give everyone a little bit of time back in their afternoon thank you again for joining us and please let us know if you have any questions take care you
This webinar is a joint effort with the Pennsylvania Department of Human Services’ (DHS) Office of Long-Term Living Office (OLTL), Office of Mental Health and Substance Abuse Services (OMHSAS), the Behavioral Health (BH) MCOs, and the Community HealthChoices (CHC) MCOs and is being hosted by PHCA. Other collaborative partners included the Pennsylvania Department of Health and LeadingAge PA.
Through various stakeholder channels, DHS has received feedback regarding the importance of providing behavioral health services in nursing facilities and making sure nursing facilities know how to access these services. The webinars will be interactive and are meant for nursing facilities to have the opportunity to ask questions and begin dialog on how to improve behavioral health services in their facilities. The webinars will also allow the BH MCOs, the CHC MCOs, and the nursing facilities to further collaborate on this issue.