I_ECR_BH_2021A 09/24/2021 09:07:46 AM Committee Summary

Dr. Hanratty continued to discuss mental and behavioral health needs and where Colorado falls short.  She responded to questions about children's mental health care.

Members of the task force made comments about integrated health care and substance use care. Dr. Hanratty closed her presentation by talking about the barriers and gaps in the existing health care models. She gave her recommendations for improvement, including residential treatment facilities, workforce support, and support for primary practices.

Dr. Hanratty answered questions about peer support from the task force.

Dr. Tracy Johnson, Colorado Department of Health Care Policy and Financing (HCPF), introduced the presentation. She discussed the need for a variety of integrated care models to work for different populations. She spoke about the research behind integrated care and depression treatment, and the savings associated with successful integrated care.

Caitlin Westerson, HCPF, discussed the Colorado State Innovation Model (SIM) project. She outlined the pillars of the SIM project which are aimed at increasing access to integrated care. She spoke about different activities associated with the pillars in the SIM project and the next phase of practice transformation and integrated care.

Ms. Westerson told the task force about opportunities that could be pursued to put integrated care into practice.

The task force members asked about the access to this type of care in rural areas and ensuring that it is available to the next generation. Dr. Johnson talked about quality metrics and different health screenings that are provided in hospitals. Ms. Westerson spoke about the funding and payment models that are needed to provide services.

Task force members made comments about patient experiences and where funds and grant dollars are spent and distributed in hospitals. They discussed where dollars can be leveraged and put to use. Ms. Westerson spoke about restructuring care to meet the needs of patients. She spoke about the money in the healthcare system and where the money goes in order to meet patient needs.

Task force members spoke about how care is currently operated and the greater need for holistic care.

The task force talked about getting to the root of what is causing a health issue and providing those full supports for the individual patient.

The task force discussed primary care providers and difficulties that patients face in getting adequate care for both physical and mental health.

The task force discussed issues with access to behavioral health for individuals on Medicaid. Ms. Westerson spoke about alternative payment models to ensure that payments get made to providers for behavioral health treatment. Dr. Johnson talked about local community centers working with primary care doctors to help coordinate care for individuals that are being served by more than one entity.

Dr. Vincent Atchity, Mental Health Colorado and Subpanel Chair, gave an outline of his presentation and the current funds being spent in the criminal justice system behavioral health system practices. He spoke about the need for diversion and keeping individuals out of the criminal justice system. He discussed county health care costs and Medicaid impacts, lifetime impacts of a sentence, difference in jail versus prisons, and gaps in care.

Dr. Atchity spoke about the lack of consistent care for those who enter the criminal justice system when they have already been under previous care. He discussed the challenges associated with behavioral health care from placing individuals in solitary confinement.

The task force asked about how they could formulate policy from these issues. Dr. Atchity talked about investing in proven intervention programs and support care.

The task force asked about competency care. Dr. Atchity talked about taking care of individuals who have not been convicted of a crime that are being held in jails not getting their health needs met.

The task force asked about changing the language associated with those in the criminal justice system, handling mental illness quickly, and children being missed in the system.

Dr. Atchity spoke about the lifelong impacts of crime and the types of resources that could be utilized at the different levels in the criminal justice system, including where funding could be better directed.

Members made comments about the partnerships that are taking place and could take place at a community-level between hospitals and jails.

Dr. Robert Werthwein, task force member and Director, Office of Behavioral Health (OBH), Colorado Department of Human Services (CDHS) and Jagruti Shah, Director, Forensics Services, OBH,CDHS, introduced the presentation. Ms. Shah gave an introduction to the Sequential Intercept Model (SIM) in regards to how individuals with mental health and substance use disorders move through the criminal justice system. She outlined the steps, or intercepts, that the SIM entails.

 

 

Ms. Shah described the framework behind SIM and gave an example of how the program is used.  She elaborated on the challenges associated with the program, including housing, coordination, and funding.

Dr. Werthwein spoke about challenges with competency care in the criminal justice system and the lack of diversion options.

Dr. Werthwein spoke about the best practices that could be implemented to aid in the care of those with mental health disorders in the criminal justice system. He discussed the need for supportive housing, mobile crisis services, substance use treatment, transition services, and diversion efforts.

The task force asked whether the subpanel is looking at competency restoration. Dr. Werthwein spoke about the charge of the subpanel and what competency means.

The task force members made comments about the lack of electronic records for patients and how it impacts care coordination and quality of care.

Dr. JK Costello, The Steadman Group, introduced the presentation and gave an outline of the topics to be covered. He discussed the prevalence of opioid use disorders amongst those in the criminal justice system and the effectiveness of different types of treatments. He told the committee about the different options for medication for opioid use disorders and the challenges associated with access.

Dr. Costello continued to speak about the different types of partnerships within counties in Colorado and provided an example from Larimer County. He answered a question about the effectiveness of the different types of treatments.

The task force discussed the issues with financial challenges associated with the different treatments.

Dr. Costello discussed the ways in which counties can improve treatment for a variety of different use disorders. He answered questions from the task force about prior authorization and assistance for those transitioning out of the system.

Allyson Gottsman, University of Colorado Anschutz Medical Campus, introduced the presentation. She spoke about how she got involved in the improvement in rural jails. She discussed the process for creating a project within a jail to find solutions and implement change. She told the committee about what her team is doing to facilitate discussions and share potential resources from other jails.

Ms. Gottsman told the committee about future opportunities to improve in rural jails. She answered a question about implementing statewide standards for jails.

Chris Richardson, Mental Health Center of Denver, and Lorez Meinhold, Caring for Denver Foundation, introduced the presentation.. They gave an overview of the background of the Co-Response program and the Support Team Assistance Response (STAR) pilot program in Denver. Ms. Meinhold spoke about how the two programs interact with and support each other. Mr. Richardson and Ms. Meinhold answered questions about the programs and how information is shared between those running the programs and first responders.

The task force asked about the percent of calls that come in that are then diverted to co-responders or STAR. Mr. Richardson said that about 20 percent of calls are forwarded to either of the two programs.

Ms. Meinhold told the committee about how funds can be used for programs like this without taking funds away from other agencies.

The task force asked about what sort of savings the state could see. Mr. Richardson talked about the long term benefits and savings that come from up front dollars to meet the needs of an individual.

Mr. Richardson and Ms. Meinhold gave an overview of how a STAR unit is assigned to a call for service and discussed the current SMART team outcomes that Denver has seen with the pilot program.  They discussed the next steps necessary to expand the SMART team program.      

The task force asked about sweeps of homeless camps and how resources are provided for those individuals. Mr. Richardson talked about how they go out to attempt to get resources for those individuals who are impacted by the sweeps.

Jaime FitzSimons, Summit County Sheriff, spoke about how his department implements crisis response with the STAR program. He discussed the affects of the STAR program in his community.

Sheriff FitzSimons continued to discuss the partnerships within his county aimed at providing mental health services to individuals in crisis.

The task force discussed how to use dollars effectively for these types of programs and funding sources.

Sheriff FitzSimons answered a question about balancing a co-responder program at the state level while also focusing on community engagement. He spoke about working with stakeholders and getting adequate input.

Sheriff FitzSimons talked about medical treatment and screening for behavioral health disorders within jails.

Leonard Woodson, Colorado Department of Corrections (DOC), introduced his presentation about behavioral health needs in the criminal justice system. He told the task force about how DOC identifies the different needs of individuals that enter the system and how DOC meets behavioral health needs across Colorado.

The task force asked questions about the data that DOC collected in regards to behavioral health needs.

Mr. Woodson answered a question about how resources vary across facilities and how they vary between public and private providers. He confirmed that it depends on the facility when it comes to what resources are available to individuals.

Mr. Woodson continued to speak about the federal requirements for providing medications for substance use disorders.

Mr. Woodson spoke about the community transition services and how DOC ensures the continuity of care.

Jacob Bornstein, Wellstone Collaborative Strategies, introduced the presentation.. He discussed the four pillars of the Affordable Housing Task Force.  He elaborated on the efforts to strengthen the safety net by investing in solutions to housing insecurity, transition planning, long-term effects of homelessness, and resolving current homelessness in Colorado.

Mr. Bornstein asked the task force about what is needed to align the work of the Affordable Housing Task Force and this task force.

The task force discussed identifying the unique barriers that people have when it comes to accessing affordable housing.

Mr. Bornstein outlined the upcoming schedule for the work group.

There was no public testimony.