Community Network

Co-Management

On April 23rd of 2007 the Addictions and Mental Health Division (AMH) initiated the Co-Management directive to Local Mental Health Authorities (LMHA) throughout Oregon. The over arching principles are to "effectively manage the valuable resources of the state hospital and facilitate re-integration of patients from the state hospital into the community".

To that end the Co-Management Plan necessitates very close collaboration and timely communication between both county and state representatives responsible for the plan's implementation. To ensure accountability to the over arching principles LMHA's are held financially liable for daily cost of state hospital care based on a formula of hospital bed day usage and civil commit data. AMH sends monthly reports to LMHA's for review and planning.

In Marion County a Co-management group was formed in the fall of 2006 to begin the process of using state hospital census data, state hospital wait list data and AMH data to respond to the Co-Management directive. Community and Provider Services (CAPS) staff, Adaptive Community Integration and Support Team staff, Marion County Residential Coordinator and a Marion County Division Director make up the group. The group meets weekly to review Marion County adult residents who are in: 

• acute care that are waiting for transfer to the state hospital.
  
• acute care that could be appropriately diverted to a lower level of care.
  
• the state hospital who are ready to place in the community.
  
• the state hospital who are not ready to place yet but need treatment review.
  
• state funded Extended Care Management placements in/outside Marion County.
  

During the weekly meeting the group addresses client/patient recovery goals around hospital discharge, clinical/environmental supports that would aid successful discharges from hospital care, over-coming system barriers and administrative/resource issues.

Outside the weekly Co-management meeting the CAPS Adult Care Coordinator reviews Acute Care Unit's requests for state hospital transfer. If, after on site review, the patient is found to meet medical necessity for state hospital level of care, approval is given to the Acute Care Unit. If not, the CAPS Adult Care Coordinator reviews the case(s) at the weekly Co-Management meeting and with the ACU treatment team for final disposition. All work is carried out in a collaborative manner among IDS, CAPS and hospital partners.

For those adult patients who are approved for state hospital level of care, but could be diverted to state funded Post Acute Intensive Treatment Services, the Co-Management Group would also be responsible for clinical reviews, discharge planning and teaming with the client's outpatient provider (if enrolled).

Consumer Care Partnerships (CCP)

Consumer Care Partnerships (CCP) is a nationally recognized Marion County peer support program designed to provide peer-based outreach and support for people struggling with mainstream treatment modalities, recurrent crises and social isolation. The CCP program was designed to help consumers surmount barriers to hope and recovery and build meaningful connections to their communities by assisting them with creating community based support teams.

The goal of each team is to focus on the strengths of the individual and strive to nurture them through personal support, decreased isolation, increased involvement in desired activities, mentoring and just plain fun.

All Oregon Health Plan (OHP) Members are eligible to request CCP services. Each Individual requesting support will be match with trained facilitators who will work with them for up to a year. CCP Facilitators assist Members with:

• Creating his/her own unique support team.
  
• Organizing and facilitating team meetings.
  
• Identifying strengths, needs and goals.
  
• Facilitate the team in development/implementation of an action plan to reach identified needs/goals.
  
• Community participation and connection.
  

Request for CCP services may be made directly by an IDS agency and/or clinician by completing and returning the Consumer Care Partnership Request Form. Agencies may assist the member with a direct request by offering to place a call or facilitate a meeting with a program representative. 

Request Form (PDF)

Fore more information, please contact Helen Lara, Peer Services Coordinator, at (503) 566-2991 or by fax (503) 361-2782.

Co-occurring Disorders

Many people have both mental health and substance abuse problems. They are welcome to choose the provider where they are most comfortable. All of our providers are able to screen for and provide or refer people for other behavioral health services as needed. Please contact Community and Provider Services (CAPS) at 503-585-4977 for assistance in locating the appropriate services. If you would like consultation on more complex cases, you may also contact the Chemical Dependency (CD) Member Services Coordinator at (503) 576-4574.          

Evidence Based Practice (EBP)

In response to Senate Bill 267, the Oregon Addiction and Mental Health Division (AMH) finalized a definition of Evidence Based Practices in 2004 to guide programs in their development and service delivery. Marion County Community and Provider Services (CAPS) is committed to fostering and supporting the use of clinical interventions that are based on sound evidence of their efficacy. It is also understood that this is a developmental process and resources have been lacking for implementation and achieving full fidelity to some models of evidence based practices.

In keeping with these considerations, we envision a partnership with our Integrated Delivery System (IDS) and Marion/Polk Community Health Plan (MPCHP) Providers in taking concrete and practical steps towards fulfilling the intent of Senate Bill 267.

If you would like more information and/or a list of currently approved evidence-based practices please see the AMH website.

In recent months there have been some additions to the list and some adjustments made in definitions. You may also find minutes from key stakeholder meetings that have been convened in crafting these documents. We recommend that agencies visit the site periodically for updates. In addition, CAPS will be available to provide support and technical assistance as we make these transitions in practice.

You may also find information on the National Registry of Evidence-Based Practices at     http://nrepp.samhsa.gov/

New Solutions

The Children’s System Change Initiative was implemented across the state of Oregon in October 2005. This broad reorganization of the intensive mental health services for children places responsibility of all levels of care under the Managed Health Organizations. The Managed Health Organization (MHO) in our region, the Mid-Valley Behavioral Care Network (MVBCN) has developed a range of intensive community-based treatment and family support services as an alternative to residential and day treatment placements. In the MVBCN region this support is accessed through New Solutions. In addition to providing access to these community based supports New Solutions also acts as a gateway to higher levels of service, including residential and psychiatric day treatment programs.

Some of the services available include:

• Crisis respite
  
• Routine respite
  
• Treatment Foster Care
  
• In-home behavioral supports
  
• Mentors
  
• Short term assessment and stabilization placements
  

The New Solutions Staff determine eligibility for this level of care based on a current mental health assessment, a standardized instrument called the Child and Adolescent Service Intensity Instrument (CASII), and a review of acuity factors e.g., dangerousness to self and others, family stress level, history of hospitalizations. Once eligible, New Solutions staff referred to as “Wrap Around Facilitators” facilitate the development of a Child and Family Team, which includes the child, their family, professionals working with the family and "natural supports" the family has in the community. The goal is to keep the child in the home if at all possible.

The Child and Family Team develop a Care Plan that builds on family strengths and provides supports to meet individual family needs. The team also does a functional assessment of behavior and develops crisis plans to assist families in responding to challenging behaviors. Wrap Around Facilitators follow the progress of the children in care and provide discharge planning to ensure that step down services are available in the community.

For information, please contact the New Solutions Intake Coordinator at (503) 361-2724.

Program Supervisor: Cydney Nestor
Service Location: New Solutions
Marion County Health Department
3876 Beverly Ave NE Bldg G
Salem, Oregon 97305
Hours: Monday - Friday  8:30 am – 5:00 pm