Summer Institute 2020 by Kevin Bushaw

Be the solution with locatons in:

Phoenix, Tucson, Yuma + Online

The School of Social Work at Arizona State University is one the largest and most diverse social work programs in the U.S. We prepare practitioners committed to upholding social justice and to serving and empowering individuals, families and communities.

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Credits and Acknowledgements Natasha Mendoza, CABHP Director Adrienne Lindsey, CABHP Associate Director Kevin Bushaw, Conferences and Events Manager Keith Smith, Logistics Coordinator Deon Brown, Contributing Editor Marcelle Costello, Contributing Editor Britany Luna, Contributing Editor Chiranjir (Ravi) Narine, Contributing Consultant

Tadoza@asu.edu Adrienne.Lindsey@asu.edu Kevin.Bushaw@asu.edu Keith.Smith.2@asu.edu Deon.Brown@icloud.com MCostel8@asu.edu BritanyLuna@HeritageArizona.org RNarine@gmail.com

Sponsored by

LET’S GET BETTER TOGETHER CONFERENCE

The ideas, views and perspectives expressed in this publication strictly represent those of the authors. They do not represent the ASU Center for Applied Behavioral Health Policy or Arizona State University. Printed locally in Phoenix, Arizona at Artcraft.

Summer Institute

COVID-19 magnified the depths of health care disparities for African Americans and Latinos. Protests over racial injustices reignited a call for civil rights, equity and justice for our African American community. Mercy Care is committed to advocating for racial justice and to ensuring our members have access to quality physical and behavioral health services. Because we care. www.MercyCareAZ.org

LET’S GET BETTER TOGETHER CONFERENCE 2020 Virtual Series A New Day to Stand In Our Truth: Building Allies and Strengthening Communities

Health

Welness

Here

Date

• LGBTQ+ and Gender 101 • LGBTQ-Inclusive Sex Education • Suicide Prevention • Self-Care Practices • Transgender Allies • Queering Mentorship • Homelessness

• Join us June 24 & 25, 2021 for the next conference!

• Visit letsgetbettertogetheraz.org for more information

Remaining 2020 conference virtual sessions

Speakers

August 10th

• T. Michael Trimm • Jace C. Ryden

August 12th

• Yvette M. Tucker, MAEd • Stephanie A Earl, MAEd/AET, MS PSY, CPLP

Title

Time

How to be a Trans Ally

11:00 AM

Self-Care Practices for a Healthy Mind, Body, Heart and Spirit

2:00 PM

Thank you to our 2020 conference sponsors! Avi Vieira Psy.D.

Oasis Psychological Services

Mercy Care stands with our LGBTQ community in continuing to advocate that everyone – regardless of sexual orientation, gender identity or race and ethnicity – is protected against discrimination. We celebrate the affirmation of the Civil Rights Act protecting gender identity and sexual orientation against discrimination in the workplace. We are committed to the fight for equal rights, to offering access to quality physical and behavioral health services and speaking up for those who can’t always advocate for themselves.

Because we care. www.MercyCareAZ.org

Mercy Care honors the frontline and essential workers who stepped up in service to our community during a time of crisis. Thank you. Because of you and your service, we are able to stay healthy, stay at home and stay connected. Because we care. www.MercyCareAZ.org

Letter from the Director

Reflecting on the Center Path

Natasha Mendoza, MSW, Ph.D. Director of the Center for Applied Behavioral Health Policy Over the past two years, as Director of the Center for Applied Behavioral Health Policy, I have come to understand the true meaning of the word “reward” and how it is inextricably intertwined with gratitude. At CABHP, I am awarded the opportunity to do good and meaningful work, and for this, I am immeasurably grateful.

With a talented group of staff, students, and faculty affiliates, we’ve made formidable strides in our mission to “Expand knowledge and improve quality of care.” I am proud of the way we have worked together to secure opportunities and funding so we can positively impact workforce development, create use-driven behavioral health research, and contribute to the community in which we are embedded.  To illustrate, I’d like to highlight a few of our projects. We developed specialized in-service training materials used by local firefighters, paramedics, and emergency medical service personnel to increase their knowledge and

Brave New World

[The premiere of ASU presents the Experts on MAT. L to R: Abby Henderson, Francesca Mia Gomez, Mike Chesworth, Christina Boudreau and Kevin Bushaw.]

skills when interacting with persons and families experiencing behavioral health emergencies. We produced a series of short films featuring interviews with medical experts and agency leaders helping Arizonans combat opioid use disorder. ASU presents the Experts on MAT fights stigma, encourages treatment, and addresses commonly held myths. With a grant from HHS’ Health Resources and Services Administration (HRSA) we are establishing the ASU Interdisciplinary Training Academy for Integrated Substance/Opioid-Use Disorder, Prevention, and Healthcare, where, just before entering the opioid workforce, ASU pre-professional students in nursing, social work, and psychology will train beginning with the 2020-2021 academic year. Through our research and evaluation capabilities, we are partnering with several community-based service providers in Pima County to pilot an innovative new approach to street outreach: An integrated care team comprised of a nurse practitioner, a behavioral health provider, and a formerly homeless peer, uses Screening, Brief Intervention and Referral to Treatment (SBIRT) and Motivational Interviewing (MI) techniques, followed by rapid rehousing using

Summer Institute

[Protesters rally against raciallymotivated violence in downtown Phoenix and across the world.]

the Housing First Model. And to help drive these and future efforts, we are engaging a new, reinvigorated Community Advisory Board. In sum, we have done a lot of great work, yet there is more work to do! As I write this message, Arizona is experiencing exponential growth in COVID-19 cases; over forty-three thousand confirmed cases and over twelve hundred deaths. Now the pandemic is colliding with profound social change via peaceful protests across the country and right outside our office windows in Downtown Phoenix. In their wake, I am called to action as a social worker, researcher, and educator. At the same time, like many of you, I am faced with the challenges of working at home, supporting my family, colleagues, and friends – at a distance – but with a renewed sense of hope about the world into which we will emerge. In a way, like butterflies, we are all undergoing a complete metamorphosis. Sonya Renee Taylor, author of The Body is Not an Apology, offers this:

[In a historic decision, on June 15, 2020 the U.S. Supreme Court ruled that the 1964 Civil Rights Act protects gay, lesbian, and transgender employees from discrimination based on sex.]

“We will not go back to normal. Normal never was. Our pre-corona existence was not normal other than greed, inequity, exhaustion, confusion, rage, hoarding, hate and lack. We should not long to return, my friends. We are being given the opportunity to stitch a new garment. One that fits all of humanity and nature.”  Just over the past month, the world has changed rapidly; it is shifting mercilessly all around us. Such resounding change has implications for our evolution as professionals invested in behavioral health. Consider the behavioral health impacts as we grieve collectively for black lives lost, for lives lost to inexcusable violence, and for lives lost to COVID-19. Consider that, even with a Supreme Court victory, we will continue to worry about the future of our Dreamers. Consider that, while LGBTQ+ workers have new Federal protections, there is still much to do to fight the oppression of LGBTQ+, Black, and brown people. Ultimately, we know, without question, that the collective behavioral health of the community is critical. It is the

binding thread that runs throughout all of the above and connects us in our humanity.  At our Center, we seek to embrace this Brave New World with a profound understanding of what it means to live healthfully and consciously in consideration of our neighbors. To that end, we ask you to join us as we begin to think about how we wish to emerge. We are excited to be with you over these next few months as we evolve together to be better professionals, better family members, better friends, and better communities. With gratitude,

Tasha Mendoza

Visit cabhp.asu.edu

Brave New World

Committed to serving the behavioral health community through a wide range of resources, specialized research centers and labs, including the Center for Applied Behavioral Health Policy, Center for Violence Prevention and Community Safety, Developmental Etiology of Externalizing Problems (DEEP) Lab, Global Center for Applied Health Research, Morrison Institute for Public Policy, and Southwest Interdisciplinary Research Center.

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Letter from the Dean Jonathan Koppell, Ph.D. Dean of the Watts College of Public Service and Community Solutions Welcome to the 21st Annual Summer Institute: Brave New World. Your presence at this conference over the next several months represents not only your dedication to your profession, but also your active leadership in strengthening the personal and professional communities with which you engage.

Summer Institute

Your choice of a behavioral health-focused profession represents an affirmative response to a call to service. Solutions to social problems, great and small, often begin with answering just such a call. We at ASU are grateful to have the opportunity to support you in your efforts. The grassroots protest movement that followed from the the killing of George Floyd has pushed civic engagement to the forefront of American life. As we each go about our daily lives, participating in all of our various communities, we are beckoned to fully engage with each other – to listen, to understand, and to make our contribution to change and to healing – even, paradoxically, as we find ourselves physically separated due to the pandemic.

As we each go about our daily lives, participating in all of our various communities, we are beckoned to fully engage with each other – to listen, to understand, and to make our contribution to change and to healing – even, paradoxically, as we find ourselves physically separated due to the pandemic. A few weeks ago, I was honored to speak on a panel at the Brookings Institution on the topic of Strengthening the Civil Fabric of our Nation. All the participants agreed that as a nation, and as a society, we could benefit from more practice around how to come together to solve problems. Afterall, dealing with conflict requires practice. Creating solutions also requires practice. Because our society has become so fractured, I believe the outpouring of activity, emotion, and engagement we have seen in this time of crisis in our country represents a watershed moment when something is possible.

and experience to discover enhanced means for stabilizing lives, addressing society’s divisions and inequities, expanding knowledge, and improving care. ASU’s Watts College of Public Service and Community Solutions, the umbrella under which the Center for Applied Behavioral Health Policy resides, sees itself as an instrument to that end. However, it is only an instrument. Those who pick up the tools to do the work are the real change makers whom our country so greatly needs.

To all of you who are attending this year’s conference, to all the nationally recognized experts, the local and federal government leaders, the educators, the researchers, the clinicians, the peer support specialists, the counselors, and the outreach providers – the more than 400 of you representing the private sector, state agencies, and nonprofits, all dedicated to making people and communities more prosperous, healthy, and resilient: Thank you for picking up these tools presented to you at the 21st Annual Summer Institute, and thank you for giving ASU the opportunity to practice our engagement with, and in support, of you.

Visit publicservice.asu.edu

Coming together to create understanding through interaction and engagement is what this long-standing and successful conference is about. With this year’s Brave New World theme, we seek to apply our collective expertise

Brave New World

Arizona State University

Medication-Assisted Treatment (MAT) ECHO

Let’s improve opioid use disorder treatment (MAT) in Arizona, and let’s do it fast. Medication-Assisted Treatment ECHO

Let’s improve opioid use disorder treatment in Arizona, and let’s do it fast. The model TheECHO ECHO model

Getting patients the right at right the right providers Getting patients the right care,care, at the time, time, from from providers that that they know and trust. The overarching goal of Project ECHO they isknow and trust. The overarching goal of Project ECHO is to democratize medical knowledge through the ongoing delivery to of democratize medical knowledge the ongoing delivery of continuing continuing medical education through (CME) aimed at increasing provider capacity medical education (CME) aimed increasing provider capacitysessions at the at the primary care level. This at is done via biweekly teleECHO that care connect a team withbiweekly primary care providers in rural that and primary level. This ofis experts done via teleECHO sessions underserved to discuss best-practice for theproviders target patient connect a team areas of experts with primary care in population. rural and Ultimately, this to allows patients to get thefor care need, whilepopulation. remaining underserved areas discuss best-practice thethey target patient close to home, from providers who best understand their unique needs. Ultimately, this allows patients to get the care they need, while remaining close to home, from providers who best understand their unique needs.

MAT ECHO mission

MAT ECHO mission ASU and Honor Health, with funding support from Blue Cross Blue Shield

Arizona the Arizona Healthsupport Care Cost Containment have ASUofand Honorand Health, with funding from Blue CrossSystem Blue Shield partnered to deliver a Medication-Assisted Treatment ECHO program of Arizona and the Arizona Health Care Cost Containment System have to establish a state-wide learning collaborative to scale evidence-based partnered to deliver a Medication-Assisted Treatment ECHO to education and practice in the management of patients withprogram opioid use disorder (OUD). This program is specifically designed to target establish a state-wide learning collaborative to scale evidence-based providers to increase and confidence education and throughout practice in Arizona the management of capacity patients with opioid use in effectively their buprenorphine waivers. This to program is disorder (OUD). utilizing This program is specifically designed target offered at no cost, and CME credit is provided. providers throughout Arizona to increase capacity and confidence in effectively utilizing their buprenorphine waivers. This program is Sign up today! offered at no cost, and CME credit is provided.

http://links.asu.edu/ASUECHOsignup chs.asu.edu

http://links.asu.edu/ASUECHOsignup

Adrienne White, MS

Director, ASU ECHO adrienne.r.white@asu.edu Adrienne White, MS Director, ASU ECHO adrienne.r.white@asu.edu Adrienne Lindsey,

MA, DBH Associate Director, Adrienne Lindsey, ASU Center for Applied MA, DBH Behavioral Health Policy,

Associate Director adrienne.lindsey@asu.edu Center for Applied Behavioral Health Policy, ASU adrienne.lindsey@asu.edu

Upcoming MAT ECHO Series Curriculum

Date

Topic

8/14/2020

Management of Pain in Patients with Opioid Use Disorder

8/28/2020

Harm Reduction Techniques

9/11/2020

Use of Drug Testing

9/25/2020

Treatment of Pregnant Women with Opioid Use Disorde

10/9/2020

MAT for Adolescents

10/23/2020

TBD - Group Determined Topic

11/6/2020

MAT Legal and Policy Issues

11/20/2020

Co-Occurring Physical and Mental Health Conditions

11/4/2020

Inclusion of Other SUDs in MAT Treatment Centers

12/18/2020

The Future of MAT

Note: all meetings take place from 12:00pm to 1:00pm on Zoom on the date scheduled above

Thank you to our sponsors:

Brave New

Program

ASU’s College of Health Solutions

Project ECHO

offers patients the right care from providers that they know and trust.

Project ECHO (Extension for Community Healthcare Outcomes), a revolution in medical education and care delivery, is now offered by ASU’s College of Health Solutions. This innovative model for improving health outcomes aims to increase capacity by sharing knowledge. Specialists at their “hub” site work with primary care providers in communities across the state to train them in the delivery of specialty care services. The program increases access to specialty treatment and care in rural and underserved areas.

Summer Institute

Project ECHO’s overarching mission is to democratize medical knowledge to get best-practice care to underserved people all over the world. The ECHO model is founded upon providing a platform for lifelong learning of guided practice to increase workforce capacity and provide best-practice care to rural and underserved populations all over the world. The driving force behind Project ECHO is the movement to de-monopolize knowledge and amplify local capacity to address the needs of the most vulnerable patients by equipping communities with the right knowledge, at the right place, at the right time. ASU ECHO Director Adrienne White grew up in Alberta, Canada, and moved to the United States in 2003, graduating from the University of Louisville with a degree in Human and Health Performance. “I swiftly put this degree in my back pocket and moved to Arizona to chase a career as an athlete playing professional golf for six years, competing on the LPGA tour before a careerending shoulder injury,” Adrienne remembers. “This abrupt change in career path ultimately led me to ASU’s College of Health Solutions where I obtained my Masters in Science in the Science of Health Care Delivery in 2014.” Adrienne has worked at ASU ever since. In fall of 2017, she had the opportunity to meet Project ECHO founder, Dr. Sanjeev Arora,

when he came to ASU to speak. He suggested that ASU become a replicating partner for ECHO programs. Adrienne described what the ECHO model means and how it succeeds for health care professionals. “Project ECHO (Extension for Community Health Care Outcomes) is all about getting patients the right care, at the right time, from providers that they know and trust,” she explained. “The overarching mission is to democratize medical knowledge to get best-practice care to underserved people all over the world. This low-cost, high impact intervention is done through the application of the ECHO learning loop linking interdisciplinary specialist teams with primary care providers through weekly or biweekly teleECHO sessions.” Specialist teams offer consultations and share their expertise across a virtual network via case-based learning. This increases the capacity of local providers to treat patients with complex conditions within their own communities. This model is distinctly different from telemedicine because it allows local providers to retain the management of patient care rather than passing that care to a remote

Brave New World

The MAT ECHO program was born. “We provide ongoing, biweekly consultation with an interdisciplinary team of experts to elevate provider capacity and confidence prescribing MAT," said Adrienne. "This program is best suited for clinicians of all types who are prescribing medications for opioid use disorder now or in the future, but lack the competencies or confidence to fully implement MAT into their practice.” In today’s COVID-19 environment there are proven results for the ECHO model and its success.

[Project ECHO founder Dr. Sanjeev Arora]

specialist. Patients get the care they need from providers who best understand their unique needs while remaining close to home. “The Medication-Assisted Treatment (MAT) ECHO was developed based upon one factor: a need in our community. Blue Cross Blue Shield of Arizona, the Arizona Healthcare Cost Containment System (AHCCCS), along with other community organizations, were undertaking immense efforts across the state to help medical providers obtain a waiver to prescribe buprenorphine (an opioid used to treat opioid use disorder, acute pain, and chronic pain) so they could medically treat patients within their clinics,” Adrienne said. “Despite these efforts, the results were not translating; only 3% of these providers were integrating MAT into their practice.”

Summer Institute

“We’re moving through an era in health care that no one could have predicted or prepared for —and that certainly includes us here within ASU ECHO. However, we did know that the ECHO model was scalable, resilient, and adaptable. In the face of COVID-19 it proved again to be all of these things,” Adrienne enthused. “As COVID-19 hit we saw an increase in enrollment in our ECHO programs, registering over 400 participants in 10 days. We launched entire programs on a week’s notice to help respond to the need for resources our health care workforce was seeking as the pandemic hit our community. The ECHO model holds in all times, but especially during COVID-19, with its immense power to disseminate rapidly changing and evolving policies and best-practices, and the ability to do it fast.”

To learn more about the MAT ECHO program or sign up, visit website at CHS.ASU.edu/Project-ECHO or contact us at ECHO@asu.edu to learn how to join the ECHO community of learners.

CMS Peer Support Specialists are available 24/7 to explore opioid use disorder treatment possibilities.

Call 24 hours a day, 7 days a week to reach a CMS Peer Support Specialist

(602) 338-1273

(602) 338-1182

Community Medical Services (CMS) is an opioid treatment program that provides

medication-assisted treatment (MAT) for opioid use disorder (OUD) using methadone, buprenorphine, and naltrexone, along with behavioral therapies and counseling.

Agencies we partner with: ✓ Hospitals and Emergency Departments ✓ Residential Treatment Programs ✓ First Responders & Crisis Response ✓ Criminal Justice Agencies ✓ Drug Courts

communitymedicalservices.org | info@cmsgiveshope.com

Keynote Spotlight

Change makers Brave New World

Rachele Espiritu and Suganya Sockalingam are founding co-partners at Change Matrix, assisting leaders to identify shifts in values, beliefs, and practices to adapt to change and promote equity to create positive change. Rachele’s background is in clinical psychology and culturally responsive and equitable evaluation work and in the field of children’s mental health and systems work for two decades. Suganya is a public health professional who started with working on cultural and linguistic competence and continued that work into cross-cultural communication. Now she’s working on equity inclusion and diversity issues. Suganya and Rachele discussed the creation of Change Matrix, and issues of bias, disparity and equity. Suganya Sockalingam: Change Matrix came together because we were passionate about wanting to change the system which is currently providing services under the rubric of children’s mental health services. It didn’t meet the needs of children and their families and youth in transition. We wanted to create a company that would be small, flexible, diverse, inclusive, and really value the concept of equity in everything we did. That’s why we started Change Matrix as a minority woman-owned small business. We’ve been grappling with the concept of implicit bias and structural racism; it’s becoming more of a public issue in the conversations that we have around service delivery and support to families. Rachele Espiritu: As a team we meet on a weekly basis, during time that we call “learning, being, and doing.” This is an opportunity to come together and explore issues around equity, leadership, and evaluation. Our equity work has allowed us to come to common ground on definitions of terms that are important to explore our own internal biases and to start thinking about how implicit bias comes up in terms of organizational policies,

programs, and structures. Equity has always been at the center of the work that we do. Suganya, I’m curious, what about our work about bias has surprised you? Suganya: I had not realized the impact of childhood conditioning and the experiences of being in a society where the media has such a capacity to inform our thoughts and beliefs. How am I sure that I don’t allow that to influence my interactions with people? It’s made me think about being really intentional as I’m working and communicating with people. Rachele: That’s the key thing about implicit bias: we all have them, and they don’t necessarily reflect what our belief systems are. We encourage people to stretch and go beyond their comfort zone in terms of people they interact with, or experiences that they seek to help them think about and learn about other groups and to help counter stereotypes. We hope that you’ll do this individual work and then bring that into your own organizations and look for opportunities for organizational change. Suganya: Although we have biases, they can be dislodged from our perspective, our beliefs, our values, and the way we think of the world and people around us. There’s a tendency to have a preference for people within our own group, and I think that we can stretch ourselves to really be able to embrace all people and learn about them.

Visit ChangeMatrix.org The views and perspectives expressed do not represent the ASU Center for Applied Behavioral Health Policy.

Brave New World

Using Virtual Reality to Promote Well-Being

by Nicole Janich, Ph.D, Garth Paine, Ph.D, Abby Henderson, MS

Summer Institute

One of the most unique aspects

of working at the Center for Applied Behavioral Health Policy (CABHP) is the way well-being is encouraged - even in the workplace. CABHP staff often have conversations about things that bring us joy, make us grateful, and help us grow. These conversations can be a space for creativity as well, as we brainstorm ways to improve quality of care and expand knowledge related to behavioral health. Two common themes in these discussions are nature and technology, which led to a partnership with the ASU Acoustic Ecology Lab (AEL) in 2019. The project began as a way to explore how nature and technology can work together to improve wellbeing. Many studies have already documented the positive effects nature has on issues such as stress and tension, blood pressure, pulse rate, attention, and recovery from medical procedures. The use of Virtual Reality (VR) has become an increasingly popular technology, and a great tool in studies of health and behavioral health. The AEL is led by Drs. Garth Paine and Sabine Feisst who have pioneered work in this area for years. Dr. Feisst is in the ASU School of Music, and Dr. Paine is in the ASU School of Arts, Media, and Engineering, as well as the School of Music. Acoustic Ecology as a discipline studies and documents the sounds of the environment. The AEL continues that work and explores the way people notice and react to the sounds of their environments. One of their projects is EcoRift, which came out of Dr. Paine’s field recording trips to national parks and creative exploration of the Oculus Rift technology since 2013. Working with communities in national parks across the American Southwest, each month

Brave New World

Environmental awareness and physical and mental well-being can foster greater connectedness with people’s natural surroundings, happiness and sustainability. he recorded the sounds at a series of sites to track how climate change sounds, and to develop environmental stewardship in those communities. Joined by Dr. Feisst in 2014, he started to build a growing, publicly accessible archive of geo-located and geo-tagged highquality field recordings. It soon became clear that VR captures of these places could also be made using 360-degree photography and ambisonic audio recording (360-degree spatial audio capture) and thus the EcoRift series of VR nature sojourns was launched. Staff from CABHP met Drs. Paine and Feisst at a local conference where they provided VR headsets for conference attendees to experience some of the EcoRift series. As a result, CABHP and AEL formed a collaboration on a study of VR and well-being with the hope that we can one day offer the experiences of nature to individuals who do not have the ability to travel. When asked about why this topic is important, Dr. Paine stated “Environmental awareness and physical and mental wellbeing can foster greater connectedness with people’s natural surroundings, happiness and sustainability. Cross-disciplinary research brings together the arts, engineering, health sciences, and it advances greater disciplinary and social benefits.”

Summer Institute

The collaboration between CABHP and AEL provides an opportunity to better explore how nature and technology can work together to offer improved behavioral health, regardless of someone’s ability to travel to a national park. This work has become even more pertinent in light of the COVID-19 pandemic, as many people have struggled with reduced opportunities to immerse themselves in national parks and natural environments. Ultimately, because we know that a connection between health and nature exists, we developed a study examining the impact of exposure to nature through VR on individual affect and cortisol levels (measured through saliva). Dr. Nicole Janich explained, "Our study is comparing differences in participant affect and salivary cortisol levels across individuals who are exposed to nature through a television and individuals exposed to nature through VR headsets." She continued, "VR has the potential to improve well-being for individuals living in urban environments who may not have the ability to travel due to physical, financial, or other constraints. Although our study is only a pilot study, we hope our work will lead to continued efforts to bring the benefits of nature to people and places that do not readily have access to these experiences."

We’re reshaping the future of behavioral health in Arizona, and we need students like you to lead the way. Ready to join us? ValleywiseHealth.org.

Focus on AHCCCS

Office of Individual & Family Affairs The State Medicaid system, AHCCCS, has always focused on quality health care for its members. In the spirit of continuing this effort, the AHCCCS Office of Individual & Family Affairs (OIFA) is working to further improve one of the vital aspects of behavioral health services for members (e.g., children, adults, youth in foster care, members with an intellectual disability, etc.).

Summer Institute

Join the OIFA Team on September 1 from 2:00 - 3:00pm for their remote Summer Institute presentation, focusing on a number of relevant topics, including: • What does Family Support Services look like in the current Medicaid system? How is it provided, what does the service look like, how is it utilized for members with an SMI, etc.

• How is the service delivery carried out in the current system? What is the process

for providers and members? What issues or barriers accompany this process?

• How can providers be shown the benefits of Family Support Services? What methods would work best? Is there anything currently in use that is successful?

• Releases of Information (ROI) and other barriers to getting services? Are ROIs, pay codes, reimbursements, and etc. creating barriers to receiving FSS?

• How to disentangle Peer Support and Family Support? Historically Family Support

Services (FSS)and Peer Support Services have been used interchangeably; however each is different and successful in its own right. What can be done to highlight and promote FSS as its own unique service?

Join the Summer Institute Scavenger Hunt! Access the Conference App, and then scan each QR Code in this book to enter to win a registration to the 2020 conference. [SCAN CODE 1]

Participants will be able to engage in a dialogue with panelists from varying life experiences and knowledge to learn about FSS with different populations. The discussions between participants will further identify and address issues, as well as work towards solutions. This session is for you if you believe Family Support Services are important, and want to help further the development of FSS for the future. The AHCCCS OIFA Team promotes recovery, resiliency, and wellness for individuals with mental health and substance use challenges. We build partnerships with individuals, families of choice, youth, communities, organizations and we collaborate with key leadership and community members in the decision making process at all levels of the behavioral health system.

Brave New World

The OIFA Team is: Susan Junck, Bureau Chief - Susan has been involved with the behavioral health community for over a decade serving as an advocate, manager of family support, human rights liaison, family psychoeducation facilitator, mother of a young man with a serious mental illness and active volunteer with NAMI (National Alliance on Mental illness). Susan is dedicated in ensuring that members', family members' and other stakeholders' voices are heard at all levels of our system. Susan has a degree in Psychology and Paralegal Studies. Chaz Longwell, Recovery & Resiliency Coordinator - Since 2012 Chaz has overseen the policies and procedures guiding Arizona’s Medicaid-Reimbursable peer support programs. He had previously been employed in public relations, event coordination and program development in the non-profit sector. Chaz is a graduate of Arizona State University with a degree in Sociology. Jamie Green, Healthcare Advocacy Coordinator - Jamie is a Certified Peer Support and Family Support Specialist with advanced training in Health & Wellness and Health Coaching and has extensive experience in navigating the public Behavioral Health System both professionally and personally. She has past experience in program development, implementation and facilitation of a Whole Health Wellness Program focused on self-activation, efficacy and resiliency. Jamie considers herself a self-proclaimed Subject Matter Expert (SME) in behavior change gained through her many years of lived experience in both her personal life and professional career.

Summer Institute

Steven Leibensperger, Foster Care Community Liaison - Steven has worked for AHCCCS since 2003 assisting members in the eligibility process, and working to grow and develop internal staff through training, facilitation, and eLearning design. He has been involved in the foster care system in Arizona since 2008 as a foster/adoptive parent and assisting local community organizations. He and his wife have fostered over 70 children and have adopted four. Steven has advocated for the rights and services of children in care. With a vast knowledge of AHCCCS programs and policy, the ability and skills to train and facilitate, and the passion for helping children in need, Steven brings a unique perspective to the OIFA Team as he works to make an impact on the children and adults in Arizona. Chi Isiogu, Administrative Assistant Chi believes that energy (chi) is at the heart of living and loves putting hers into helping others. She is a strong proponent of service and volunteers at JFCS, Salvation Army, Ballet AZ, Family Promise, and Temple Chai. Chi has held a breadth of careers spanning from cow milking, to accounting, to teaching art, to now working for OIFA at AHCCCS. She credits her BA in Human Resources for allowing her many opportunities, however, she owes most of her success to her lived experience in mental health.

Mercy Care is honored

to once again sponsor the ASU Center for Applied Behavioral Health Policy’s Summer Institute. Now more than ever, building understanding of the health issues facing Arizona is critical for the long-term well-being of our communities. Ongoing educational opportunities such as the ASU CABHP Summer Institute assist Mercy Care in fulfilling our vision for the people we serve to live their healthiest life and achieve their full potential. We are especially pleased to deliver this information as the new statewide health plan for children covered by the Comprehensive Medical and Dental Program (CMDP). We invite you to attend the sessions presented by nine of our own colleagues from Mercy Care, each of whom has direct expertise throughout the system of care.

Armando Peelman

Addiction and MedicationAssisted Treatment How can Medication-Assisted Treatment, also known as MAT, help individuals battling addiction? What are the benefits, how does it work and is it successful? Learn more about current efforts to increase access to care and evaluation of substance use treatment services.

Tuesday, September 22 2:00 P.M. Adonis Deniz Jr.

Together Housing Support and Employment Make a Difference Stable housing is fundamental. Housing and employment supports make a tangible difference in the success rate of people who would otherwise be at-risk of homelessness. Find out what these important services are and why they’re a critical piece of an effective housing strategy.

Lydia L’Esperance

Jennifer Page

Most people are one paycheck away from homelessness. Housing support is reserved for persons who experience chronic homelessness. We have identified an underserved population – the not chronically homeless individuals engaged in behavioral health who are at risk of becoming homeless due to financial challenges. We designed a program that pairs evidence-based practices with short-term financial support, which has proven effective in maintaining community tenure. This session will help your organization to identify strategies and evidence-based practices to support individuals in the community in maintaining self-sufficiency.

Tuesday, August 25 2:00 P.M.

Brave New World

Lisa Lucchesi

Nicole Khan

Identifying Human Trafficking and Accessing Immediate Treatment for Child Victims Human trafficking is the second largest criminal enterprise in the world. One-third of all runaway children will be lured into the sex trade within 48 hours of leaving home. Mercy Care and the Phoenix Police Department created the Phoenix Human Trafficking Collaborative, which gets young people into treatment and keeps them safe as they move through the recovery process. This program has a 93% retention rate and is a model for other programs across the country. Find out why it’s making a difference for young people right here in Arizona.

Thursday, September 10 2:00 P.M.

Janette Lopez

Adult with a Capital A: The Behavioral Health System from Child to Adult Transitioning from childhood to adulthood can be a bumpy road. For young people with behavioral health diagnoses or involvement with the child welfare system, the challenges are even greater. There are ways to plan for a successful transition. This session will cover the role of the Child and Family Team (CFT), transition planning, referrals for patients with general mental health and serious mental health considerations and much more.

Tuesday, September 15 2:00 P.M. Kyle Morris

Housing Connection Through a Behavioral Health Lens Jennifer Page

The Behavioral Health Coordinator is an innovative position through the Human Services Campus to meet the unique needs of individuals experiencing homelessness with a serious mental illness. This role is a bridge between behavioral health and homeless services and has been essential in connecting hundreds of individuals to appropriate housing resources since 2015. This presentation will share the high-level impact the BHC has on the homeless services and housing system as well as provide a personal lens on how this position interacts with members and the community to ensure rapid connection to safe and stable housing.

Tuesday, September 22 10:00 A.M. Andy Wambach

About Mercy Care

Join the Summer Institute Scavenger Hunt! Access the Conference App, and then scan each QR Code in this book to enter to win fun prizes! [SCAN CODE 2]

Mercy Care is a not-for-profit Medicaid managedcare health plan, serving AHCCCS members in Arizona since 1985. Mercy Care is a local company sponsored by Dignity Health and Ascension Health. Mercy Care provides access to physical and behavioral health care services for Medicaideligible families, children, seniors, and individuals with developmental/cognitive disabilities.

Learn more at MercyCareAZ.org

Brave New World

Strategic Partnerships Bringing Macro-Level Thought to Micro-Level Application by Justin Chase, LMSW, CPHQ, FACHE, President and CEO, Crisis Response Network

In today’s fast-paced integrated health and social services world, it is critical for crisis and social service organizations to build meaningful relationships with stakeholders across a broad spectrum of specializations and demands. To be most effective, organizations should be placed at the center of a vast network of services and resources as the connection point between disparate systems.

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Join the Summer Institute Scavenger Hunt! Access the Conference App, and then scan each QR Code in this book to enter to win a registration to the 2020 conference. [SCAN CODE 3]

To build winning strategic partnerships around them, organizations should actively use the following four key principles:

1. Focus and simplicity 2. Know your audience and perspective 3. Ability to adapt and be flexible 4. Inspire with your stories Organizations must work diligently to describe their work or program simply. Albert Einstein said, “If you can’t explain it simply, you don’t understand it well enough.” What is it exactly that your organization or program does and can you explain it in simple terms in 30-seconds or less? Take the time to hone your focus and simplicity, and realize that it can be hard work. Steve Jobs said, “That’s been one of my mantras – focus and simplicity. Simple can be harder than complex: You have to work hard to get your thinking clean to make it simple. But it’s worth it in the end because, once you get there, you can move mountains.” When an organization can simply define what they do, it is important to stay in that lane. In other words, do what you do best – not more or less than that. Our organization defines the purpose and processes of our contact center work as follows:

1. Safety – the prevention of harm 2. Organize and expedite the flow of individuals in need 3. Provide information and other support for providers and clinicians To be effective in any business, you need to know your audience and their perspective. It is crucial to understand who you’re selling to and what their motivations are. To more fully understand these elements, perspective can be gained by putting yourself in the shoes of your audience. For our contact center staff, that means getting in the trenches, such as: • Police – do a ride along • Mobile Team – do a ride along

• Emergency Department or Crisis Stabilization Unit – spend a peak volume shift observing • Callers – call your line anonymously • Staff – spend time with each type of employee • Call center staff • Administrative staff • Meet regularly with stakeholders • Look at other industries When staff have gained a better perspective on the people they are serving, encourage them to be transparent and share successes and challenges to learn from. As an organization, it is essential to adapt and be flexible. Change is not only inevitable, it is essential. George Bernard Shaw noted, “Progress is impossible without change, and those who cannot change their minds cannot change anything.” To stay ahead of the curve, organizations must innovate. Our contact center has sought to do so by: • Creating a proprietary system for billing health care for services • Creating a mobile disaster/tragedy support system • Partnering with the greater 2-1-1 continuum • Using social determinants of health to understand and respond to more of a client’s needs rather than just the one need they may be calling about • Partnerships with first responders • Partnerships with other crisis line programs When your organization is effectively serving its audience/clientele, it is important to keep that momentum going through the use of inspiring stories. Robert McKee taught that, “Stories are the creative conversion of life into a powerful, clearer, more meaningful experience. They are the currency of human contact.”

To make use of inspirational stories, you’ll need to gather and share them. Here are some ways to do both: Tips for gathering stories • Website survey • Satisfaction surveys • Directly from your employees • Expectation to share inspiring stories at meetings • Offer incentives for shared stories

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Tips for sharing stories • Social media • Marketing materials • Website(s) • Employee intranet For organizations to serve as the connecting link for a network of services and resources and as the connection point between disparate systems, some critical components to consider are alternative payment models, alternative business models, advocacy, education, technology and workforce development. With this framework in place to build winning strategic partnerships, the next step is to determine where and with whom to start building them. Here are some ideas: • Local Red Cross • Local Voluntary Organizations Active in Disaster (VOAD) • FEMA • Local first responders (fire, EMS and police) • Public health • Health plans • Hospitals and healthcare systems • State Medicaid leadership • National Suicide Prevention Lifeline • National Alliance on Mental Illness

• Local United Way • Local veteran groups • Veterans Administration • Local universities • Homelessness coalitions/Homeless Management Information Systems • 9-1-1 dispatchers • Food banks • Health information exchanges • Local news outlets (TV, print, radio) • Technology vendors (phone, internet, etc.) Strategic partnerships are essential for positioning organizations as the hub of a vast network of services and resources and as the connection point between disparate systems. Ultimately, an organization can only be as effective as the community services to which it can connect clients. By working passionately toward the difficult, but worthy, goal of making an impact, organizations can initiate and grow strategic partnerships through: focus and simplicity, knowing their audience and that audience’s perspective, maintaining the ability to adapt and be flexible and then inspiring with stories of success.

About the Author Justin is a nationally recognized subject matter expert in: crisis systems, recovery-oriented systems of care, peer integration, nonprofit organizational leadership and development, and developing sustainable, effective and efficient healthcare programs and systems. He has served as a behavioral health administrator, executive, network/program developer, direct practitioner and project manager within the public behavioral health and child welfare system for more than 15 years. Justin received his Bachelor's and Master's degrees in Social Work from Arizona State University and holds a Certificate in Nonprofit Management from Duke University. Justin is a Licensed Master Social Worker, Certified Professional in Healthcare Quality, Certified Crisis Interventionist by the American Academy of Experts in Traumatic Stress, a Fellow with the National Center for Crisis Management and a Fellow with the American College of Healthcare Executives.

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WE CONNECT YOU TO THE RESOURCES YOU NEED IF YOU AND YOUR FAMILY ARE IMPACTED BY COVID-19 2-1-1 Arizona links individuals and families to vital community services throughout Arizona. We are a trusted, local, nonprofit organization providing you with access to 35,000+ COMMUNITY RESOURCES.

JUST DIAL

If you’ve been impacted by COVID-19 and need assistance finding food, paying house bills, accessing free childcare, or other essential services, contact 2-1-1 Arizona today.

877.211.8661

211Arizona.org

We provide the HOPE you need during these uncertain and challenging times.

Crisis Response Network operates a crisis response hotline and a continuum of crisis services to anyone experiencing a mental health emergency. We have been Inspiring Hope in Arizona since 2007, and our experience covers a variety of personal issues, including: • Suicidal thoughts • Substance use • Depression, anxiety and/or panic attacks • Grief, stress due to work or unemployment • Family problems, physical and verbal abuse

CRISIS LINE 24 | 7 | 365

602.222.9444 CrisisNetwork.org

School-Based Behavioral Health Services

by Kimberly Egan, Erica Chavez and Lena Embry

Rural, Urban, Metropolitan (and everything in between) Integration is and has been the buzz word around behavioral health for over a decade, but isn’t there so much more of an individual to integrate besides their physical health and behavioral health? There is no question that education is where most of the time and attention should be for our youth. How can we not integrate their education with their emotional needs?

School-based services are here to stay! According to the National Institute of Mental Health, approximately 22% of adolescents had a severe mental health concern. Recent studies of teenagers during COVID indicates that 70% of teens are experiencing mental health concerns. It is vital that schools, families, and mental health providers forge connections to support youth in being able to better address behavioral health needs. This leads to increased communication, shared vision, and more impactful outcomes.

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Regardless of socio-economic status, payer, family structure, or history, kids are needing services where they are: school. Providers are trying hard to keep up with the demand. Execution of these services will differ between different communities based on need, but there are a few things that are important regardless of the community you are living in. Many schools provide these services as part of their staff or through partnerships with behavioral health agencies.

1. Create partnerships and collaborate Through needs assessments, schools and provider agencies can determine if there is a need for embedding behavioral health services onto the school campus and creating a partnership to address more significant social and emotional concerns. Develop a plan to integrate school based services into a tiered level of services for the school, agencies should work with the school to become familiar and do community outreach, and reduce stigma and barriers to care.

2. Engage in strategic planning Coordinate expectations, roles, responsibilities and needs between the school and the provider. A formal Memorandum of Understanding (MOU) should be created to address privacy concerns, logistics and shared space. Based on the need, you will identify space, times staff, and services. Where? When? How? How often? Who is going to pull the student from class? How are we going to make referrals? Who are the primary contacts at the school and the behavioral health agency? What are we hoping to accomplish?

3. Measure Develop outcome measures, track progress, and analyze for continuous quality improvement measures. Outcome measures could include academic performance, truancy, discipline referrals, attendance, healthy school behaviors and a myriad of other outcomes.

4. Coverage of service/ reimbursement The behavioral health agency has several options to be reimbursed for these services which could include AHCCCS, private pay, block grants and other funding. Many funding sources that are available in a behavioral health clinic are available to be used within a school setting by a behavioral health professional. Work with your payer to use the correct location modifiers when submitting claims. Payers prefer that services are provided in the client’s natural environment as much as possible, and sometimes reimburse at a higher rate to assist with travel, technology, and additional expenses acquired.

5. Keep evaluating and innovating Coordinate regular meetings and correspondence between school and agency administrators and contacts to evaluate those outcomes, improve processes, review barriers and determine solutions. Kimberly Egan, Erica Chavez and Lena Embry made their presentation Thursday, July 30. The recorded presentation is available on the ASU Events app. The views and perspectives expressed here do not represent the ASU Center for Applied Behavioral Health Policy.

Brave New World

Banner University Health Plans

The Future is Now: Are You Ready? James Stringham, CEO We live in worrisome times. Disease, natural disasters and social upheavals are testing everyone’s coping skills. We all have had to make many changes to our way of life. To meet these challenges, the healthcare field has had to embrace the use of technology at a furious pace. In this ‘Brave New World’ of COVID-19 and the subsequent quarantine, we are seeing a significant increase in symptoms of depression and anxiety.

The pandemic has only exacerbated already growing feelings of loneliness and isolation experienced by many . To combat these issues, we have partnered with mobile app innovators to harness smartphone technology to address in real time such feelings. This is just one of the many ways Banner – University Health Plans is dedicated to “making health care easier, so life can be better.”

Learn how B – UHP is using an innovative smart app to address issues of loneliness and social isolation among its members. Meet the B – UHP Summer Institute Team

A new tool in the fight against Loneliness and Social Isolation Loneliness and social isolation are big problems in healthcare. The financial costs are staggering. An AARP study in 2017 estimated that Medicare spent $6.7 billion annually to address the increased healthcare cost. This study noted that loneliness can increase the likelihood of chronic health conditions such as diabetes, heart disease and high blood pressure.

On top of these financial costs, there are other factors to consider. In 2018, Cigna conducted a national survey where nearly half of 20,000 U.S. adults surveyed reported “they sometimes or always feel alone” and forty percent also reported “they sometimes or always feel that their relationships are not meaningful and that they feel isolated.” Along with the negative effects on people’s physical and mental well-being, social isolation and loneliness have been found to significantly increase the risk for premature death. There is no price tag that can be placed on the loss of human life.

Can a mobile app combat loneliness and social isolation?

While loneliness and social isolation are big problems, it is not something people are often comfortable talking about. The traditional approach to identifying when these conditions are impacting people’s lives too often relies on screenings by medical providers and case managers. Until the age of the smartphone, there were limits to what type of interventions could occur and time delays preventing early interventions.

Meet the B – UHP Summer Institute Team

James “Jim” Stringham Vice President, Chief Executive Officer Banner – University Health Plans

Cindy Jordan Founder, Chief Executive Officer Pyx Health

Sandra Stein, M.D. Medical Director Banner – University Health Plans

Pyxir: A friend in need, is a friend indeed B – UHP has partnered with Pyx Health to provide our members with a unique opportunity to interact with their care providers. Pyx Health has created a whole new way for our members to interact with their support system. They have utilized advanced artificial intelligence technology to help our members connect with the resources and support they need when they need it the most. When opening the app for the first time, our members are introduced to Pyxir. According to Pyx Health founder Cindy Jordan, Pyxir is a “super funny, empathetic chatbot” that helps to “empower people to take control of their chronic loneliness through sustained behavioral changes.” She wants people to see Pyxir as a “friend in a coffee shop” whom they can warmly interact with. All while, slowly helping people to learn better self- management skills. The app also helps connect members to additional resources via links and outreach calls. In addition, members can reach a help center to speak to a live person and ask any questions they may have. If warning signs are found by screening tools or other interactions, the member’s “Pyx pals” can swing into immediate action. They can offer support and help address any concerns before they have time to develop. Sandra Stein, M.D., B – UHP Medical Director, explains how the process works:

“An individual who is utilizing the Pyx app can select individuals in the community who are closest to them, to be able to support them in real time. It’s a very different intervention than is used with other social media platforms or text.…When the individual is starting to have a hard time, the Pyx app can communicate with that support circle and give them an outreach to say, ‘Janet is having a hard time, maybe you want to reach out to her.’ It even gives that support circle some basic recommendations about how to intervene, and at the same time if they’re feeling anxious or socially isolated, it will give some recommendations and humor to interact with her, so she’s not feeling as lonely.”

Dr. Stein also noted that while the app is still in its early stages of use, initial studies found “very positive outcomes associated with reducing cost” by lowering hospitalizations by members using the app. It is too early to know of any long-term benefits, but the potential to increase the well-being of our members offers hope. Maybe, one day this technology can banish loneliness and social isolation as major challenges faced by some of the most vulnerable members of our society.

Preliminary Pyx Results

Banner – University Health Plans is a proud sponsor of the 21st Annual Summer Institute for Behavioral Health The future belongs to those who believe in delight of innovation and dream.

Banner University Health Plans www.BannerUHP.com www.facebook.com/BannerUHP

Health care made easier, so life can be better.

Healthcare from a Community Perspective At Arizona Complete Health, we are driven and united by a common purpose – transforming the health of the community, one person at a time. In a time when life seems uncertain and challenges insurmountable, what does that purpose look like?

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All of us at Arizona Complete Health are part of the communities we serve. As our communities have struggled, we have also struggled. We have grappled with the senseless murder of George Floyd and shared in the pain and suffering associated with the civil unrest driven by racial inequities that exist in our country. We have also shared in the anxiety brought on by the novel coronavirus that has plagued our communities and its heavy economic fallout that has devastated so many.

Personal Protective Equipment and other items for Community Partners and Providers

The amazing thing about being a missiondriven organization is that, in times of crisis, our purpose binds us together. We are socially distancing, working from home, and yet closer to our mission than ever before.

• Circle the City

20,000 surgical masks and 5,000 gowns to support PPE needs of community partners and providers: • Ronald McDonald House • St. Mary’s Food Bank • United Food Bank

We fully recognize our responsibility to be there for our community to lend support, caring, compassion, empathy and to be a voice for inclusion and acceptance. Our health depends upon our healing. Below are just a few of the ways we have tried to show our support for Arizona’s communities.

• Pinal County Emergency Operations

$285,000 in total COVID relief grants

First responder liaison team distributed individual spray hand sanitizers to system partners:

These grant dollars will go to 22 organizations across the state that include rural community hospitals, healthcare providers and nonprofits that are supporting Arizonans with social determinants of health.

• 363 for law enforcement, fire and EMS

Food Support Dollars and Gift Cards

• Hospitals: Banner, Tucson Medical Center, Mount Graham Regional, Holy Cross, Canyon Vista, Copper Queen, Yuma Regional, Benson, Northern Cochise, La Paz Regional, HonorHealth, and others

• $80,000 in direct funding that went to 34 food banks and rural food pantries across the state • $52,500 in Walmart gift cards that were distributed to nine tribal nations and a veterans’ organization. • $10,000 in Amazon gift cards that will be allocated to three Peer and Family Run organizations to support their clients.

• Interfaith Community Services • Community Food Bank of Southern Arizona • Boys and Girls Clubs • Healthcare providers

• 242 for crisis mobile team providers Over $15,000 in meals being provided to front line providers and community partners for their employees and clients:

• FQHCs: El Rio, Adelante, Sunset, Regional Center for Border Health, and others • Boys & Girls Clubs • Other large providers Hundreds of hygiene/toiletry kits for homeless shelters and congregate living centers in rural Southern Arizona.

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Childcare Support for Healthcare Workers • $20,000 in total funding to Boys and Girls Clubs of the Valley and Arizona and Boys and Girls Clubs of Tucson who opened their doors to provide childcare for front line health care workers.

Telehealth Support • Centene allocated $5 Million for FQHCs across the country to get set up with telehealth supports. • Distributing 350 cell phones to 3 large health systems to support telehealth options for their patients. • $500 to support Community Partners Integrated Health (CPIH) Assertive Community Treatment teams who had limited phone or data plan access that served as a barrier to accessing ongoing care during the pandemic, which allowed CPIH to: • Purchase 12 phones for members’ use • Increase members’ existing data plans to support telehealth.

Provider Support Launched a provider resource page where provider can access information, webinars and grant and loan application assistance. Other Community Supports • Supported an employee virtual blood drive with the Red Cross. • Launched a Suicide Prevention and awareness campaign. • Engaged in public education efforts around COVID-19 prevention and protections, including the importance of using a cloth face covering, washing hands and socially distancing.

Join the Summer Institute Scavenger Hunt! Access the Conference App, and then scan each QR Code in this book to enter to win prizes! [SCAN CODE 4]

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Brave New View

Addiction:

A Mother’s Perspective by Anonymous (at the son’s request because stigma exists) If I had picked up this publication six years ago, I would have flipped past this article thinking, “Not another familydeals-with-insert-substance-name-here story.” Was I some sort of behavioral health and Addiction snob who believed such things only happened to other people? No, my friend. I have been, and still am, right there with every one of those families, shoulder to shoulder, fighting the good fight. My frustration with those “mother’s perspective” stories was that they didn’t offer anything beyond the specifics of their experiences. I had grown tired of their “if it happened to us, it could happen to you” endings.

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Substance use disorders are diagnosed at three levels. Addiction coincides with the most serious level, Severe. Full-blown Addiction is the dysregulation of the neurotransmitters in the brain’s mesolimbic dopamine system (the “pleasure pathway”) resulting from a drug or alcohol. With SUD-Severe, just like any other extreme form of disease, the patient will eventually die if there is no medical and psychosocial intervention.

Realization #1: Addiction is the same as Substance Use DisorderSevere Today I understand all too well from my family’s experience, the first risk factor for the disease of Addiction is the prevalence of SUD. According to the U.S. Surgeon General, “1 in 7 people in the U.S. will develop a Substance Use Disorder at some point in their lives”. I didn’t know what an SUD was in 2014. I just wanted to read something that translated my teenage son’s substance misuse symptoms (today’s terminology) into healthcare terms

so I could help get him better. I needed instructive information, along the lines of “here’s what we dealt with, here’s what we learned, and here’s how what we learned might help you.” I found nothing of the kind. My frustrating search for information and help for my son was complicated by something I now understand all too well: SUD is rarely diagnosed in the healthcare settings with which most people are familiar -- the exam rooms of primary care providers, community clinics, urgent care, or the emergency department. Unless one has the good fortune of coming across an Addiction-trained medical or behavioral health professional, SUD Mild, Moderate, or Severe are typically overlooked. Incredibly, despite my son’s continual interactions with psychologists, psychiatrists, and therapists from 2014 to 2018, the possibility of his having an emergent substance use disorder never came up. In fact, I was the one – me, The Mom -- who identified his Opioid Use Disorder (OUD) in 2017 based on what I had learned from my research.

I believe my recognizing his medical condition saved his life.

Read more at cabhp.asu.edu/bravenewview Read the full article to learn more about: • The resources I consulted to acquire the necessary knowledge to save my son’s life. • How I met and worked with one of the nation’s top Addiction research scientists, Dr. Carlton K. Erickson of the University of Texas at Austin’s College of Pharmacy (*By the way, I capitalize the word “Addiction” because he does. He uses this grammatical construct to differentiate the medical disease of Addiction from the way the term “addiction” is used in popular culture, such as “addicted to shoes.”) The views and perspectives expressed do not represent the ASU Center for Applied Behavioral Health Policy.

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Brave New View

Coming Out of the Fog:

Adoption and Mental Health by Britany Luna, LMSW

Adoptees attempt suicide at a rate four times greater than the general population. They are more likely to be diagnosed with psychiatric disorders (e.g. MDD, GAD, BP, ADHD, BPD), and struggle with substance use. Adults who were adopted as children are less likely to have long-term intimate relationships, live with a partner, or be married. Despite evidence of strong correlation between adoption and poor mental health, the adoptee experience is too often ignored as a factor in treatment.

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Adoption is generally viewed as an ideal solution to infertility or unintended pregnancy, rather than a lifelong process initiated by separation from the family of origin. Clinicians working with adult adoptees must recognize and address core issues related to adoption including trauma of separation, abandonment, grief and loss, and development of identity.

Separation Trauma/ Abandonment Adoption is the only trauma for which the victim is expected to express gratitude. Separation from the natural mother is traumatic, no matter the age at which it occurs. Adopted people often develop maladaptive coping behaviors as a response to this devastating loss, and as adults find themselves in relationships which replicate their original abandonment experience, as they struggle to make sense of implicit memories of loss. They often avoid true connection due to fear of rejection and future abandonment. Adoptees may tend to isolate, intrinsically sensing that they are alone, apart, unable to trust, and rarely ask others for help.

Grief and loss If I told you I was orphaned shortly after birth due to a deadly fire which eliminated every member of my family, along with any trace of their identities, would you express sorrow, offer condolences and attempt to sympathize with my grief? What if I told you I was adopted?

Adoption almost always begins with unacknowledged loss for all members of the triad, leading to long-term disenfranchised grief. The adopted child loses their original family, their heritage, culture, and sense of identity. As adults, the adopted person often suffers from unresolved grief manifesting as depression. Women who relinquished their infants are portrayed as heroes by the multibillion adoption industry – assured that they “did the right thing,” mothers often become emotionally stuck at time of relinquishment, never allowed to acknowledge and grieve the loss of their child. Most adoptive parents have often not properly grieved for the loss of their dreamtfor biological children, thus are not prepared for the differences between their (idealized) imaginary child and the reality of their (traumatized) adopted child.

Identity How can you determine where you are going if you do not know where you came from? Adopted persons struggle to develop a sense of identity, as they were generally provided little, if any information regarding their origins. As children and adolescents, they lacked the benefit of genetic mirroring (seeing ourselves in others), which implicitly assures us that we belong. As adults, they are denied access to their family history and critical medical information. For decades adoptions were shrouded in secrecy, thus compounding the shame, feelings of negative self-worth, and lack of control experienced by adoptees. Maintaining secrecy implies that adults who were adopted as children should still feel shame related to the circumstances of their birth. Even as adults, adoptees are perpetual children in the eyes of the law – unable to enjoy the same rights and privileges as other citizens – including access to identifying documents. Shame will continue to be a central theme until harmful policies of the past are reversed and those adoptees who have been deprived of identifying information are made whole.

Brave New World

Search and Reunion

Empowerment

Later in life many adult adoptees go through a process they refer to as “coming out of the fog,” which involves reconciling the impact adoption has had on every aspect of their lives. They may recognize much of what they lost to adoption, leading them on a quest to regain what they can through search and reunion. Oftentimes the desire to search is suppressed or ignored out of feelings of guilt towards the adoptive parents, with the adoptee waiting until after their deaths to search. Clinicians should be prepared to provide support throughout the search and reunion process.

The overarching societal belief that adoption is a net positive entrenches shame and prevents healing, while invalidating and silencing the voices of those most affected. Many adult adopted people find purpose by participating in advocacy campaigns and connecting with fellow adoptees through local and online support groups.

The realization that adoption provided a different life, but not necessarily a “better life” provokes sudden recognition of what should have been, and all that was lost but never mourned. Even the most successful reunions are often derailed by unanticipated and overwhelming feelings of grief. Torn loyalties between the birth family and adoptive family often result in lifelong conflict for the adopted person.

Outdated adoption policies foster an environment ideal for exploitation. Accountability in private adoption is nearly nonexistent due to a complete lack of transparency and oversight. Sweeping policy reform is necessary to deter those who would take advantage of vulnerable women, children, and families. Five decades of research have clearly defined the psychological trauma caused by lack of identifying information, yet laws still read as though we are practicing adoption in the 1960s. Denying adult adoptees access to their adoption records and original birth certificates deprives them of a basic right every other American takes for granted — knowledge of their identity and heritage. Those with lived experience as adoptees must occupy a seat at the table when crafting public policies in the area of adoption.

About the Author Britany Luna, LMSW – is an adoptee, adoption search consultant/reunion facilitator, and passionate advocate for policies that promote honesty and transparency in adoption and reproductive technology. Contact her at BritanyLuna@HeritageArizona.org The views and perspectives expressed do not represent the ASU Center for Applied Behavioral Health Policy.

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“You need a degree of foolishness to cause disruptive change in healthcare. Dare to dream.” - Vinod Khosla

Daring to Dream At Magellan Complete Care of Arizona, we believe in the power of our members to live healthy and vibrant lives in their chosen communities. With more than 40 years of behavioral health expertise and 20 years of specialty health care administration, we are a committed member of the Arizona healthcare community and a dedicated partner to the Arizona Health Care Cost Containment System. Innovation drives us—it is always at the forefront, pushing us to ensure we achieve improved health outcomes for our membership.

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Our goals are simple: • Improve the quality of and access to care by partnering with our members, our providers and the communities we serve. • Facilitate enhanced integration of medical, behavioral, pharmacy, and most importantly community-based services, to drive whole person health outcomes to new levels of wellness. • Our foundation of excellence is driven by our “Quadruple aim”: − Improved health of populations − Improved patient experience and care − Reduced per capita cost of healthcare − Improved provider experience We understand each member’s ability to achieve and maintain a healthy and vibrant life is tied to multiple factors. Connection is the key. Individuals need to stay connected to their families, friends, neighbors and others in their communities to maintain independence and achieve optimal health and well-being. And, because our member-facing teams live in the same communities as the members they serve, they have established relationships with individuals, organizations and local resources they can call upon directly. Our teams are compiled of associates with wide ranging skillsets who are connected to and accountable to our members and each other, allowing them to be nimble and flexible as they work collaboratively to support each individual member on their health journey. Individualized Care Plans Magellan members benefit from personcentered care plans regarding the types of services they will receive and when they will be provided. Members (or designee) actively participate in the Individualized Care Plan (ICP) delivery and planning process that starts with the member’s goals and meaningful choices

of service alternatives. ICPs are holistic and based on a comprehensive needs assessment with opportunities for communitybased services and are updated as needed and at minimum once per year. Our member-facing teams are personcentered, and our work with members goes beyond care plans. Respect for member voice and choice lives in the training our teams receive and in every interaction with members. From care plan implementation, to motivational interviewing, to Intentional Peer Support, to military/veteran navigation, to training on suicide prevention, to the history of Peer and Family Run organizations in Arizona, our teams are offered and exposed to orientation that makes every conversation more authentic and fruitful and leading to member connections that feel right to them. Needs assessments, care plans, and care coordination are based on an infusion of person-centered focus throughout the organization from top to bottom. Innovation through Partnership We are not afraid to leverage the deep bench of passionate healthcare leaders in our community. Whether it is a partnership with a university-based community education program, a grassroots feet-on-the-street outreach organization, or an advocacy organization comprised of folks with their own lived experience, we fund, support, and build programs that go beyond a normal health plan provider network. Then, we work collaboratively alongside providers to truly innovate. Together. Connected. By working closely with providers to build unique and innovating programs and care delivery to better meet member’s health care needs, Magellan is “daring to dream” of improved health and wellness outcomes for all members.

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Member Outcomes With high-touch, individualized care plans and a strong collaborative partnership with provider partners, Magellan has seen significant improvement is member health outcomes during the first two years as an ACC plan for Arizona.

Sarah* had a history of involvement with the justice system and was about to be released when the COVID-19 epidemic began. Due to restrictions and video visitation system issues, Magellan’s Justice System Liaison (JSL) was unable to conduct the routine in-person visit with the member prior to her release. Committed to each member’s care, the JSL located the member and scheduled an initial PCP appointment within seven days of her release. When the JSL follow-up one week later to ensure Sarah was able to make the PCP appointment, Sarah informed the JSL that she had not. The JSL rescheduled the PCP appointment to one within walking distance of where Sarah was staying and confirmed that Sarah has bus passes to get there. The JSL followed-up again after the scheduled appointment date only to find out that Sarah had once again cancelled the appointment, this time due to an unpredictable work schedule and she no longer had bus passes. As the JSL tried to coordinate delivery of bus passes at Sarah’s work, working around COVID-19 restrictions,

Sarah shared that she had not been taking medication prescribed to her for diabetes and, as a result, was experiencing complications. The JSL rescheduled an appointment with a PCP again for two days later and coordinated transportation for Sarah to get there. The JSL followed-up after the scheduled appointment and Sarah shared that the coordinated transportation arrived on time and she made it to the PCP. When she got there, the PCP encouraged her to go to an ER immediately due to elevated glucose levels. Sarah shared that if it hadn’t been for the help she received from the JSL to coordinate her care and transportation, she likely would have experienced severe repercussions. She confirmed the PCP prescribed the diabetes medication and test strips and that she would be able to pick those up at her pharmacy upon discharge. The JSL continues to coordinate with Sarah to ensure that she receives the health care she needs, especially due to her diabetes diagnosis and the COVID-19 pandemic. *name changed to protect privacy

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Magellan Complete Care of Arizona A new choice for Medicaid Learn more at www.MCCofAZ.com.

Contract services are funded under contract with the State of Arizona.

Brave New Trend

Dialing into

Telehealth by Chiranjir (Ravi) Narine, MD 60

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Telehealth is the diagnosis and treatment of patients over the phone or internet. In this BRAVE NEW WORLD, virtual appointments have become a necessary means of providing quality care. Studies have consistently demonstrated telehealth patients show progress comparable to those treated face-to-face. Additionally, most patients, caregivers and families report similar levels of satisfaction with virtual care. Advantages of telehealth include the ability to obtain services from an expert, often at lower cost than an in-person visit; patients avoid travelling long distances; providers have the ability to reach a wide and diverse patient population and the opportunity to involve other professionals via group chat. While an advantageous solution for many, some patients may find telehealth to be impersonal; and there may be personal resistance to adopt a new system. Here are some tips for incorporating telehealth into your practice.

Plan for critical situations Protocols addressing the management of medical emergencies, criteria for hospitalization, use of crisis services, and the provider’s role within the continuum of services should be clearly defined.

Become familiar with licensing requirements Most states require telehealth providers to be licensed in both the state where the they are located and the state where the patient receives services.

Scheduling, recordkeeping, and administration. Develop procedures to coordinate equipment and services, schedule patients, maintain records across sites and train staff. Protocols should provide contingency plans for issues such as canceled appointments, closing of clinics and most importantly, specific steps to deal with equipment failure, you should always have a backup plan (Plan A, B and C).

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Create an environment conducive to establishing a relationship

Know how to use equipment While it would be best to have IT support for times of crisis, the provider must know how to troubleshoot minor problems. Equipment typically includes monitors, cameras, microphones, speakers, and computers with hardware and software to facilitate conferencing. There are no shortages of choice in this area currently (e.g.Skype, Zoom, Microsoft Teams, GotoMeetings, WebEx, etc). There are multiple technologies of varying costs available to establish a connection between sites, including analog telephone lines, digital point-to-point connections, and the Internet or a combination thereof.

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Ideally, services should be delivered with the highest resolution to approximate an in-person visit, but this may be financially prohibitive and high-speed internet may not be widely available. Due to rapid changes in telecommunications and the decreasing costs of the technology, it is important to consider the most current options when choosing equipment. The ATA’s website (https://www. americantelemed.org/) has further information on technology and vendors. The provider’s physical setting should be similar to that of a typical office. The environment at the patient’s location should provide appropriate privacy. The location of the room is important because microphones are sensitive to extraneous noises such as exhaust fans, voices in the hallway, or traffic noise outside. Microphone placement should consider the acoustics of the room; microphones should not be placed near the speakers because an echo will occur.

Take care to appear professional Lighting is crucial. Incandescent lighting provides a more natural appearance. Overhead lighting will cast shadows that may impact on the examination. Lighting that emanates from behind the camera, similar to a vanity table, is preferable and optimal. The visual image is also affected by clothing. Pastel colors optimize visual transmission, whereas white coats, dark colors, or very bright colors affect contrast while patterns such as horizontal stripes can distort the image. Webcam placement poses a problem that is not easily resolved. When mounted above the monitor, individuals appear to be looking downward. A camera placed below the monitor will make the individual seem to be looking upward. The provider should alternate their gaze from camera to monitor to provide sufficient eye contact. There are two potential strategies address this shortcoming. If a laptop is used, camera placement slightly behind the laptop, just above the center of the screen will approximate the appearance of

direct eye contact. New technology termed “telepresence” places a camera in the middle of a monitor surrounded by a series of reflecting surfaces to refocus gaze and better approximate eye contact. Virtual relationships depend on screen presence which, in turn, depends on the provider’s appearance on the monitor, and rapport conveyed through the camera. The image of a newscaster is a prime example. A comfortable viewing distance from the monitor with the camera set to show the provider from the waist up is optimal. It is important to arrange the monitor and camera at both sites to achieve direct eyeto-eye contact.

One very important lesson learned since the recent explosion of videoconferencing is to always wear pants.

About the Author Chiranjir (Ravi) Narine, MD is a Board Certified Child and Adolescent Psychiatrist and is available for consultations. Contact him at rnarine@gmail.com For a list of references for this article, visit cabhp.asu.edu/telehealth The views and perspectives expressed here do not represent the ASU Center for Applied Behavioral Health Policy.

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The Importance of Laughter Laughing yoga benefits the mind, body and spirit. by EJ Scott

In the mental health field we have always heard about crisis and have even personally experienced crisis firsthand. 2020 has been the bearer of even more challenges in our world, and now more than ever a hearty dose of laughter is so important that it is required. In March of 1995, a western trained physician from Mumbai, Dr. Madan Kataria, was writing an article for a medical journal on “Laughter— The Best Medicine.” While researching the topic he was inspired by numerous individuals. Norman Cousins, who was diagnosed with a chronic disease, described how he discovered that humor and other positive emotions provided pain-free sleep and cured his illness in his book "Anatomy of an Illness." Dr. William Fry, a psychiatrist from Stanford University, examined the effects of laughter in the late 1960’s and demonstrated that twenty seconds of intense laughter can double the heart rate for three to five minutes, an accomplishment that would take three minutes of strenuous rowing exercise. The major body systems are stimulated by mirthful laughter which provides good physical exercise that can decrease chances of respiratory infections. Dr. Patch Adams showed how fun and laughter put into practice the idea that “healing should be a loving human interchange, not a business transaction.” Dr. Kataria decided to field test these ideas, and on March 13, 1995, started

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a laughter club which further developed into what is known as Laughter Yoga (the yoga comes from Pranayama Yoga, which involves deep breathing). Members do not tell jokes or rely on outside stimuli to laugh. Without judging whether something is funny or not, the laughers soon share genuine laughter. A lot happens when we laugh! Laughter can give us an emotional joy, which eases the endocrine system. It lowers blood pressure, epinephrine and glucose levels. Laughter creates a joyful cocktail of dopamine, serotonin, and oxytocin, decreasing stress hormones and improving mood. When we laugh, carbon dioxide and other gases are expelled from the lungs, which allows for fresh oxygen to fill them, and to enter the bloodstream, improving circulation. Every day, as well as in this pandemic, when stress is

Twenty seconds of intense laughter can double the heart rate for three to five minutes, an accomplishment that would take three minutes of strenuous rowing exercise elevated, the immune system is depressed, and can lead to disease.. When stress is decreased, the immune system is boosted, and physical health is supported. Laughter can shake loose blocked or suppressed emotions that are stored in the body. These emotions can cause physical, mental and emotional problems, and their release can provide life-changing results. Social interactions improve as shared laughter allows hormones and neuropeptides to flow through the bloodstream, further reducing stress and creating happiness from inner cellular joy. Human connection and interaction improve and feelings of isolation dissolve. We begin to laugh for no reason with others, not at others. So how can one laugh for absolutely no reason? How can a person giggle at the troubles and trials facing them, or even laugh at painful consequences from addiction? Studies done by Dr. Lee Berk at Loma Linda University in California have been conducted and it is confirmed that the body does not know the difference between fake laughter and real laughter. The more one laughs, the more reasons one finds to laugh and enjoy life. Life becomes more at ease than at dis-ease. Dr. Madan Kataria, a medical doctor and founder of Laughter Yoga (Hasya Yoga), states “if laughter cannot solve your problems, it will definitely dissolve your problems, so you can think clearly what to do about them.” You don’t need a sense of humor to laugh. With a sense of humor, the brain judges if a

situation is funny or not. A sense of humor is conditional. Children don’t laugh because they have a sense of humor — they laugh because it is in their nature to be joyful. Dr. Kataria observes that “we acquire this judgmental skill as our mental abilities develop during mid and late childhood, as we are programmed from joyful to conditional laughter. If a person does not feel like laughing it is important to note that if you bring the body, the laughter will follow.” Once natural laughter is released, it is hard to stop. It is said that whatever happens to the mind happens to the body. For example, notice that sad or depressed people exhibit depression and sadness in their bodily actions. Even speech and movement are visibly slowed. Dr. Kataria’s father always told him, “Whenever you are sad, don’t sit idle. Keep your body busy, engage in physical activity, go for a walk or jog and you will definitely feel better”. When unhappy, even behaving or acting happy will bring the mind to a state of happiness. Children are excellent examples of this as they laugh an average of 500 to 400 times per day. Adults laugh an average of 15 times per day. Laughter allows us all to chuckle from within and provides an aerobic exercise as we guffaw — one minute of good belly laughter is the equivalent of 10 minutes of jogging or rowing, and it is a lot more fun! The good news is one can self-train to laugh by simply doing laughter. For some it is easier to begin solo by engaging in one minute of laughter, and expanding with additional time spent laughing. Many prefer laughing

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in groups, where eye contact is made — it is difficult to not laugh when the person next to you is laughing! There are now 16,000 Laughter Yoga Clubs in the world in over 100 countries, and Laughter Yoga is available online and on the telephone worldwide. It is the mission of Laughter Yoga to bring about health, happiness, and peace in the world. It begins with each of us as we release, breathe, and laugh for the health of it, creating a joyful and brave new world. When everything seems so serious, COVID-19, protests and unrest, financial problems, housing, family issues, addiction, depression, anxiety, and trauma, we need to add to our list laughter — it is free and it is seriously needed in daily doses.

The views and perspectives expressed here do not represent the ASU Center for Applied Behavioral Health Policy.

What happens in a Laughter Yoga Session? • Yogic breathing (with longer exhalation which promotes relaxation) • Clapping (which stimulates the energy centers in the body) • Playfulness (brings about childlike joy and delight) • Laughter exercises (Laughers are encouraged to get out of their mind and let the laughter flow!) • Laughter meditation (Laughers are 100% present doing what they are doing and forget the whole world. Laughter meditation brings the individual back to relaxation after a hardy aerobic workout.) • Laughter Yoga helps to connect at the heart level with oneself and others, and helps us to not take ourselves so seriously, while gaining significant physical, mental, emotional and spiritual benefits.

About the Author E.J. Scott, MS, LISAC, is the Substance Abuse Counselor for the Yavapai-Prescott Indian Tribe, and received her certifications as Laughter Yoga Leader and Teacher with Jeffery Briar and Dr. Madan Kataria. She will resume facilitating the Laughter Club at the Adult Center in Prescott, AZ, once the Adult Center reopens after the pandemic. She can be contacted at 928-420-0399 or ejlaff4joy@yahoo.com to schedule presentations, laughter coaching, and teaching.

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Brave New World

2020 Arizona Behavioral Health Awards For twenty years the Center for Applied Behavioral Health Policy has recognized the top contributors to Arizona’s behavioral health community. Each one of this year’s recipients brings more than their insight, expertise and knowledge from their field to their position; they offer their own special wisdom, compassion, and understanding about humanity and others’ needs to the table making their vocation more than “just a job.” It’s a calling. And they do this every single day. We are proud to recognize them this year at CABHP’s 21st Annual Summer Institute for Behavioral Health. They help make a “Brave New World” a place for everyone. Watch the awardees' acceptance speeches at youtube.com/cabhpasu

Susie Huhn CEO, Casa de Los Niños Legacy

The Legacy Award recognizes the career of a behavioral health leader. Susie Huhn is the CEO of Casa de Los Niños in Tucson, Arizona. For over 40 years they have been a voice for change and advocacy providing vital resources for

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children and their families promoting child wellbeing and family stability. With the support of community leaders, volunteers, and donors, Casa de Los Niños helps prevent child abuse

Brave New World

2020 Arizona Behavioral Health Awards

and helps families to stay together. At the shelter children get loving attention and care, all at no charge to their families. Children can see medical specialists, therapists, get whatever treatment they need. It’s the only shelter in Arizona that can give children 24-hour medical care. In addition, Casa de los Niños forms vital partnerships with families so every child can be raised in a healthy home. A deeprooted community connection acts as a guiding force for the organization’s vision to increase the number of children and families living safe and healthy lives. They deliver a continuum of services; evidence-based and best practice models meld together prevention, intervention, and treatment strategies to effectively address the needs of at-risk children and their families. By focusing on the whole family, Casa de los Niños helps everyone become stronger, more resilient, and able to thrive.

volunteering for Big Brothers Big Sisters of America where she saw firsthand how difficult it was to be raised by a system rather than by a family. She vowed then that, as a community, more could be done to help children. She also lobbied for a White House Conference on Children and Youth. Working with members of Congress, Huhn helped introduce a bill to convene a new conference on children. Since then she has spent many years working to improve the lives of Arizona’s children. Susie also serves on many Boards and committees, including The Board of the National Council for Health and Human Service Providers. In 2017 she was honored as a Champion for Children by the Children’s Action Alliance in recognition of her many years of advocacy on behalf of children in Arizona. Susie is a tireless and instrumental voice helping everyone in her community understand, “What is family? For a country as rich in resources as we are, we could do better for children,” she said.

“Casa is a magical place in the community,” Susie said. “You take it one family at a time; how do you improve the life of that one child and that one parent today?” Susie has grown her agency to be one of the premier child serving agencies in Arizona, helping change lives for generations. She is a tireless advocate for children and their families, particularly those who have interfaces with the Department of Child Safety. Last fiscal year their programs served over 6,000 kids and over 4,000 families. Susie was inspired to dedicate her life to helping children by an experience she had

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Katy Welty

Manager, Peer Support Programs at West Yavapai Guidance Clinic Peer Leadership

The Peer Leadership Award recognizes an individual with lived experience whose advocacy and service contribute to breaking stigma and improving the lives of those navigating the behavioral health service continuum. Katy has been a Peer Support Specialist in Northern Arizona since 2002 and currently she’s the Manager of Peer Support Programs at West Yavapai Guidance Clinic. Some of her job duties at WYGC include providing individual peer support, teaching recovery skills and developing and supervising their extensive peer program. “My vision is that Peer Support Specialists will come to be utilized in every aspect of behavioral health service delivery,” she believes. Peer Support assistant Kimberly Schroeder attested that she had her life changed by Katy Welty’s guidance. “Katy allowed me to take charge of a program at WYGC called ‘Thrive.’ I’ve attempted to follow her lead in how to work and manage others, learning more how to bring out the best in peer staff,” Kimberly attests. “I have been stigmatized in my community as a Transsexual Female. I spent 10 months homeless believing I was of low worth when Katy gave me a chance. She assessed my potential and I felt like I was being measured for my abilities, not how my presence was affected by the optics of an employer,” Kimberly continued. “With her

guidance my Thrive program more than doubled in population since I was allowed to direct this service.” Katy has advocated for peer support at the Clinic since 2002, addressing provider stigma, training behavioral health practitioners. She is dedicated to bringing the peer experience to other agencies and has created a number of unique services. She pioneered the principle of having a peer supporter supervise peer teams. She personally manages a large peer staff with her commitment to place them in the best ways to utilize their skills. She is dedicated to providing training based on recovery principles and leads by example using the strength of the peer support recovery model. In addition to being a mental health advocate, Certified Peer Support Provider, Katy is also a proud Mom, and friend to bunny rabbits everywhere.

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2020 Arizona Behavioral Health Awards

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Dr. Jane Abucha DNP, ANCP-BC Innovative Health Clinic Excellence in Integrated Care

The Excellence in Integrated Care Award recognizes and individual or organization that seamlessly integrates behavioral and medical care. As someone who was displaced by the Second Sudanese Civil War, Jane Abucha refuses to dwell on her past and uses her experience as a tool to be successful. While in the United States, Jane saw the gap in health services in the Sudanese and African communities and decided it was her duty to break the chain. She’s been a champion and an advocate for bringing awareness to health issues deemed taboo or with stigmas and forbidden to speak of in the Sudanese and African communities. Jane has not only excelled in becoming a doctor, she also encourages other young women in her community to follow their dreams. For Jane, it doesn’t matter how long it takes you to make your dreams come true. Just be focused and remain persistent on it until you reach your goal.

Since 2014 Innovative Health Clinic has been providing a wide range of health and medical services to Arizona communities. Lead by Dr. Jane Abucha, Innovative Health Clinic has used a community approach in treating patients. Jane has brought her cultural and traditional values, providing every patient the treatment they deserve. Her identity as a South Sudanese allowed her to see the importance of addressing health and wellbeing of men, women, wellness and health in as an important piece of all human needs. Jane’s memoir, "From Start to Finish: How to be Successful," published in 2016, highlights her life in more than three countries. Jane Abucha expands on how she chose to live her best life while never forgetting the less fortunate.

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Kimberly Craig CEO, CHEEERS Leadership in Services

The Leadership in Services Award recognizes an individual who has excelled in the provision of behavioral health services. Kimberly Craig has set the standard in the peer-run organizations in the Valley. She has dedicated the last four years to CHEEERS Recovery Center by recreating how peer supports assist members living with severe mental illness and substance use disorders, so they can succeed in their recovery and in their community. CHEEERS Recovery Center is a nonprofit community service agency serving adults with behavioral health challenges providing Recovery Support Services through classes, groups, events, and oneon-one support, all given by state-certified CHEEERS Peer Support Specialists. Their goal is is to help everyone achieve a healthy and meaningful life through— the Three “E’s”— Empowerment, Education, and Employment. During the coronavirus pandemic, Kimberly has been able to keep all of her employees working, helped establish a number of different teleheath platforms such as the

CHEEERS Health and Wellness app, and Go to Meetings for participants to remain connected, overcome barriers and maintain their mental health wellness. Kimberly also ensured that members were able to obtain food boxes, cleaning supplies and hygiene items during this crisis. As they continue to make changes and adapt to the new normal, CHEEERS has expanded it’s campus to assist with maintaining social distancing when participants are able to return to campus for groups along with a number of other safety precautions like providing masks to members, hand washing and sanitizing stations throughout the campus. Renee Medunic, CHEEERS Assistant Center Director says, “Kimberly is a strong, innovative, and positive leader who takes care of her staff and participants as if they were her own family. CHEEERS is an amazing place to work and I am in awe of the things Kimberly is able to do on a daily basis.”

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2020 Arizona Behavioral Health Awards

Damon Polk Red Circle Lodge Cultural Heritage The Cultural Heritage Award recognizes an individual or agency that has brought cultural distinction to the behavioral health field. Damon Polk is a certified Substance Abuse Counselor (CADC II). He was born to the Quechan Indian Nation and grew up on the Quechan Indian Nation in Southern California. He is an enrolled member of the San Carlos Apache Tribe. Damon is the co-founder and Cultural Director of the Red Circle Lodge, a residential youth treatment program open to all adolescents who wish to heal through therapeutic practices and Native American philosophies. Located in southwestern Utah, they offer a structured living environment for boys and girls 12–17-years-old struggling with substance abuse, depression, suicidal ideation, family and relationship problems, oppositional defiance, deviant behaviors, delinquency, mental health disorders, sexual promiscuity, and other destructive and addictive behaviors. Red Circle Lodge uses proven therapeutic models in conjunction with cultural and spiritual practices to reach youth on a deeper level, help them develop healthy coping skills, and strengthen their ability to succeed. Their approach works with struggling adolescents who need holistic healing methods of treatment that address the whole person including physical, emotional,

mental, and spiritual elements of self. Adolescents develop a greater sense of self and a foundation of trust that gives them the courage to risk change. Christopher Sharp, Director and Clinical Professor Office of American Indian Projects in the School of Social Work at the Watts College of Public Service and Community Solutions said, “I have know Damon for many years, and I have had the opportunity to reconnect with him at different occasions and hear about the Red Circle Lodge, which is accredited by the Joint Commission. It is especially important to have quality while delivering culturally appropriate services to AI/AN youth; many communities they don’t have the services so young people must be sent away. This disconnects them from their natural support systems and cultures. Red Circle Lodge fills a critical need for a combination of quality and cultural empowerment for our Native Youth.” Damon offers a thoughtful philosophy to help promote inner-growth for the youth they serve, and others: “Become the person you hold in high regard. Politely emulate the words, gestures, and the walk. Recall why you strive to protect and preserve the image. Humbly add your strengths: refine, grow and make them your own. Recognize those around you, taking nothing for granted. In balance you can do this and remain focused on the task at hand. Smile and hum often. Breathe and enjoy. The Creator must love us so much for this day is both comforting and challenging.”

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2020 Arizona Behavioral Health Awards

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Jami Snyder and the AHCCCS COVID-19 Response Team Leadership in Policy The Leadership in Policy Award recognizes an elected official who has helped strengthen allocation from behavioral health services. No one is more deserving in these extraordinary times to be recognized for their work to ensure the healthcare provider community can continue to serve this vulnerable population than Director Jamie Snyder and her AHCCCS Team. Together, they did an amazing job of responding to the myriad of issues surrounding the COVID-19 crisis in Arizona. During this time when the world continues to learn how to cope with the global pandemic, Director Snyder and her team have supported the behavioral health providers in significant ways, including waived premiums and copays, and coverage for COVID-19 testing. The AHCCCS Team’s Communication with the providers during the

pandemic has been outstanding. Staying connected with community stakeholders has been exceptional, including meetings with the Arizona Council of Human Service Providers, Tribal Consultations, Behavioral Health and Crisis Task Forces, the State Medicaid Advisory Committee, addressing housing and homelessness, and more. Under Jami’s leadership, her AHCCCS Team focused new attention on social determinants of health, such as housing, employment, education and food insecurity, sought to increase for housing for individuals with serious mental illness, and pursued the integration of physical and behavioral health services allowing patients to access the full continuum of services. They’ve supported the development of a statewide, system-wide health Information Exchange Health Current to improve coordination of care. Congratulations and thank you to Director Snyder and her Team for all you do to support the health of Arizona citizens.

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2020 Arizona Behavioral Health Awards The Leadership in Advocacy Award recognizes an individual who has championed policies that enhance behavioral health services in Arizona. After reading "Twenty Years at Hull House," the memoir of Nobel prize winner, early 20th century social reformer an activist Jane Addams, Bahney has always considered herself honored to be a Social Worker walking in the very large footsteps of the founder of one of the first settlement houses in North America which provided child care, practical and cultural training and education, and other services to a largely immigrant population of its Chicago neighborhood. She received her Bachelor’s degree in Applied Behavioral Sciences with an emphasis in Direct Practice and Women’s Studies from George Williams College, Master’s degree in Sociology with a minor in Anthropology from Texas Tech University, and postgraduate certificate in Social Work practice from the University of Denver. Bahney is always on top of any significant issue in our state and the "go to" person for not only behavioral health issues but also child welfare, licensing, social justice, parity, domestic violence and so much more. Her direct, yet kind and thoughtful approach always promotes collaboration to solve major system challenges and barriers to care. She has been at the Arizona Council of Human Services Providers since 2013 as the Policy Analyst. Currently she is the Deputy Director. “We are a member association and we provide over 100 member mental health

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services all across the state including all the public sector medical agencies and the Arizona Department of Child Safety. We also serve low income and vulnerable populations and contract with private insurance to provide health services—not to just Medicaid families but pretty much all families,” Bahney describes the Council’s mission. “We operate over 700 facilities and serve over one million clients every year. We employ about 32,000 staff in every county and congressional district in Arizona. We help in advocacy over a broad range of issues which change nearly every year.” One of Banhey’s many talents is her aptitude for coordination—including CEOs, legislators/ politicians and State Agency Directors— challenging people by asking the right questions during discussions in such a way that ensures everyone has an opportunity to speak, yet keeping them focused on the issue at hand so that solutions can be collectively found. Bahney’s work experience runs the gamut from direct practice to systems advocacy to program management and supervision. Much of her early experience was in the domestic violence field working in shelter programs in a variety of capacities. Moving to Arizona in 1996, she became the Director of Public Policy at the Arizona Coalition Against Domestic Violence leading the advocacy efforts of the Coalition. Catholic Charities was Bahney’s next challenge, supervising a small satellite office in El Mirage providing community services, counseling, domestic violence advocacy, and emergency and transitional housing services. Then, she joined the team at Fresh Start Women’s Resource Center as Operations Manager and worked as a Mobile Crisis Therapist for LaFrontera EMPACT-SPC. In between, and in her spare time, she taught Policy, Practice, Diversity, and Human Behavior classes in the School of Social Work at ASU. Bahney currently serves on the Board of Directors of NASW-AZ and is co-chair of their Policy Committee. Bahney’s greatest accomplishment, however, is raising four wonderful children to adulthood and she will brag on them and her five grandchildren at a moment’s notice.

Bahney Dedolph

Arizona Council of Human Service Providers

Policy Analyst and Deputy Director Leadership in Advocacy Brave New World

Center for Applied Behavioral Health Policy’s

Cross-Collaboration with National Research Centers

Benefits Gulf Coast Communities

by Abby Henderson, MS

ASU is the world’s most innovative university for the fifth year running according to the U.S. News and World Report. One of the key elements of that innovation is crosscollaboration between sectors that normally operate in silos. These efforts to work across disciplines offer opportunities to address issues in the community that otherwise may have disconnected approaches. Our community embeddedness and cross-collaboration allows for a unique ability to address

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community issues and explore solutions.

...this project hopes to empower homeowners to make better decisions in regards to preparing for floods and other severe weather.

One such crosscollaboration that exists is between the Center for Applied Behavioral Health Policy (CABHP) and the Center for Emergency Management and Homeland Security (CEMHS). These two centers are so committed to collaboration that a CABHP staff member recently transitioned to a dual appointment between CABHP and CEMHS. This allows for an integration and collaboration that few research centers are able to experience. The National Academy of Sciences Gulf Research Program is a current project the two centers are engaged in and a great example of how cross-collaboration can benefit communities. The research area for this program is the Gulf Coast of the United States. CEMHS and CABHP got involved because of Dr. Melanie Gall, a Director of CEMHS who has worked extensively in Gulf communities. Dr. Gall sees homes as a first line of defense against flood damage, and this project hopes to empower homeowners to make better decisions in regards to preparing for floods and other severe weather. The ultimate goal of the project is to build an interactive website in which homeowners, renters, and community members can explore the properties in their area and determine the how vulnerable to flooding various properties are. The website will also include mitigation options and costs, in addition to costs of potential flood damage and other factors. There are many viewpoints to consider while building the website including the impact of risk information on the mental and emotional health of individuals. For instance, does realizing the home you want to purchase is in a high risk area with only expensive mitigation options impact your mental and emotional response to that home? If so, do those responses have an impact on your decision to purchase or not purchase that home? In order

to better understand those questions, CABHP staff are working on a survey with researchers from RAND, University of South Carolina, University of Central Florida, and Louisiana State University. The survey will explore how individuals understand risk information related to flooding, how individuals weigh costs and benefits of various housing options when choosing what to purchase, and how those choices have an impact on the mental or emotional well-being of respondents. This survey is one portion of the Gulf Research Program and will be used in conjunction with focus groups, community development, legal analysis, cost analysis, and the development of the actual interactive website. The ability to work across sectors with so many partners around the country sets this project apart. It is just one example of innovation happening at ASU.

Visit cemhs.asu.edu The views and perspectives expressed here do not represent the ASU Center for Applied Behavioral Health Policy.

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Secure Residential and Supported Housing for the Chronically Severely Mentally Ill Improves Arizona’s Behavioral Health System

by Laurie Goldstein Arizona is about to add a new level of care to its public behavioral health continuum: secure residential treatment. The Association for the Chronically Mentally Ill (ACMI) is a self-funded, non-profit family advocacy group who coalesced to identify, advocate for, and implement this new housing and treatment option. ACMI identified gaps in the current services and engaged with government, provider agencies, managed care companies, law enforcement, and the legislature to augment Arizona’s public behavioral health delivery system. ACMI will help achieve two new levels of care in Arizona’s public behavioral health system: Lighthouse-like residences and secure residential housing. These solutions lessen the burden on family and community. This innovative model stresses the importance of family members, volunteers and professionals representing individuals living with serious mental illness working free of conflicted or vested interests to address care gaps.

Experience-based Philosophical Commitment Arizona’s public behavioral health system underserves or inappropriately serves our most vulnerable, non-institutionalized, seriously mentally ill citizens. Our community-based “continuum of care” is flawed in the way it approaches, fails to adequately embrace and

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serve these individuals. The atrocities of 20th-century asylums gave way to increased incarceration, homelessness, and violence by and against individuals living with chronic, serious mental illness (SMI). Despite the fact that people living with SMI have a biological disease—not a failure of character— the existing community-based system remains clinically inappropriate. Society’s new asylums are our shelters, jails and prisons, and, of course, our streets. Law enforcement bears the brunt of performing frontline mental health work despite a public behavioral health industry that spends $2.5 billion on only 40,000 people. ACMI aims to make targeted improvements in services for those with “no place to go.”

Caught in a Tangle ACMI embraces the term “chronically seriously mentally ill” to denote the sliver of the SMI population who are treatment non-adherent and at high risk of homelessness and becoming

enmeshed with the justice system. ACMI analyzed the most notable ways that most people with mental illness successfully navigate the public behavioral health system. AMCI “drilled-down” on the ways the chronically seriously mentally ill struggle to accomplish this. This is because many individuals have fluctuating periods of impairment and lucidity, spending time in and out of hospitals, residential placements, jails, and homelessness because current social services simply has no place for them. ACMI targets these individuals who repeatedly fail housing placements and treatment in existing services and housing options through Arizona’s Regional Behavioral Health Authorities(RBHA) contracted providers, augmenting what the system offers to housing with 24-hour supervision in a community setting (referred to as “Lighthouse-like”), and secure residential for individuals who will not stay in available residential placement.

Expanding Treatment and Housing Options ACMI is determined to prioritize the promotion of Lighthouse-like residences as more clinically appropriate and cost-effective. Individuals living in these facilities had fewer hospitalizations, fewer encounters with law enforcement, fewer emergency admissions to screening agencies, and fewer inpatient hospital days. They led dignified lives with employment, hobbies, and involvement with their families and friends. Controversy aside, secure residential must be clinically appropriate, ordered after a judicial process that assures due process, and remain under periodic review by the courts. The goal of secure residential treatment is to provide safety and stability for effective treatment. The residential program is personcentered with oversight conducted by psychiatrists, behavioral health professionals who provide evidence-based treatment plans.

Secure residential treatment focuses individuals who are not effectively served in other treatment and housing modalities where the they may decide to leave regardless of clinical stability. Housing is critical to start and stabilize the road to recovery. People need to be appropriately housed according to their clinical needs. Lighthouselike community homes help reduce the endless cycle of hospitalization, homelessness, and incarceration. ACMI sees the need for an additional level of care to alleviate the tangle into which those with chronic serious mental illness fall. We’ve seen the model work. We know it works. We promote it.

Presenters Laurie Goldstein - Engineer, Advocate and Vice President of ACMI Joshua Mozell - Attorney, Advocate and President of ACMI Holly Gieszl - Attorney, Advocate and Founding Board Member of ACMI Attend their presentation via Zoom on Thursday, September 10 The views and perspectives expressed here are those of ACMI and do not represent the ASU Center for Applied Behavioral Health Policy.

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Reframing Reentry A quiet revolution is happening right under our noses... by Fred Nelson

We’re at an inflection point. It’s time to change the narrative about reentry—to reframe the problem and sketch out a practical solution. Every year, more than 600,000 people are released from state prisons across the country with Arizona accounting for roughly 18,000 of them. Nearly every one of these returning citizens steps into a reentry landscape that

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is unmapped, fragmented, uncoordinated, ineffective, inefficient, and plagued by the twin systemic evils of invisibility and isolation. Because of poor communication, constantly changing service providers, and out-of-date or incomplete information, most returning citizens can’t see the path to the help that is out there. At the same time, life-changing programs go undersubscribed, job-training classes operate at half-capacity, halfway houses have unfilled beds, and ministries are being shut down because service providers lack an effective way to communicate and connect with returning citizens in real time.

The current “system” serves very few stakeholders, leading to widespread dissatisfaction and discouragement for returning citizens and the service providers who are looking to work with them. The problem is isolation and invisibility. People are disconnected. What’s needed is an effective, efficient reentry marketplace to connect them. And now for the good news: The key building blocks for just this kind of reentry marketplace are already at hand. All we need is the vision and commitment to combine and engage them.

Building Block #1 is a more reentry-centric department of corrections. I’m in touch with a number of departments of corrections and witnessed an unmistakable and accelerating movement in this direction. I’ve seen a desire to partner meaningfully with outside organizations, a community corrections mindset that balances public safety with a renewed emphasis on case management, a commitment to supply inmates with tablet computers, and development of innovative DOC-run reentry centers.

Building Block #2 is the presence of large-scale urban hub-and-spoke reentry centers. Organizations such as Pacific Garden Mission in Chicago, Central Arizona Services Shelter in Phoenix, and Gospel Rescue Mission in Tucson are sufficiently large and wellmanaged to be able to address key needs of returning citizens. These larger players function as de facto reentry ecosystems, with a number of service providers networking to provide additional services. Their defining strength, centralization, is also their weakness. This points us to the next building block in an emerging reentry marketplace.

Building Block #3 is the decentralized network of regional and country reentry coalitions. While the big urban reentry centers capture the imagination and news headlines, the truth is that they connect with only a fraction of returning citizens. Most returning citizens will eventually look for help closer to home, in their neighborhoods, and this is where the myriad on-the-ground reentry coalitions and networks do their best work. These coalitions engage in disruptive networking by breaking down organizational silos by communicating with one another and coordinating their efforts. Nevertheless, the next steps toward true cooperation and collaboration have remained elusive for these groups.

Building Block #4 is the emergence of an online multisided platform for reentry. The introduction of a scalable and reproducible multisided platform brings the potential (as yet unrealized in the reentry sector) for significant network effects, including improved wellness and health outcomes for those struggling with substance abuse issues. The Inside Out Network’s website works like a dating site for reentry, helping returning citizens search for the help they need when and where they need it, and helping service providers reach out personally and proactively in real time to inmates on their tablets and returning citizens on their smartphones.

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So what happens next? It’s not enough to have four parallel building blocks. The benefits of a robust reentry marketplace come from bringing them together to work in concert. What’s needed now is buy-in at the top levels of leadership of each of these key stakeholders to (a) creatively imagine what a reentry marketplace could look like, (b) lift up networking as a preferred approach, and (c) support an ongoing commitment to breaking down stubborn organizational silos at all levels of their organizations.

and the entire ecosystem can be incentivized in positive ways. Building an effective reentry marketplace is a reality at our fingertips. It promises to bless and transform the lives of countless returning citizens, their families, and their neighborhoods. We owe it to them—and ourselves—to make this happen.

The strategic bet is that by creating a just and democratic reentry marketplace, significant new value can be added for every stakeholder

The views and perspectives expressed here do not represent the ASU Center for Applied Behavioral Health Policy.

Fred Nelson will be presenting on September 15 at 10 a.m. Arizona Time

About the Author Fred Nelson is the founder and executive director of the Inside Out Network, dedicated to crafting innovative solutions to connect returning citizens with service providers, churches, and ministries, as well as those serving on the inside in prison ministry with those outside who are working on reentry challenges. He can be reached at Fred@InsideOutNetwork.net

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Creating Value with Digital Touch in Healthcare by Don Fowls and Sean Gunderson Many of us have been to a healthcare provider in the recent past. It is not always the easiest thing to do: getting there, waiting, waiting some more, finally the visit, then the return home. Often, the visit itself goes well enough as most healthcare providers want to help their patients. But before and after can be another matter. When you arrive home, you may have a question about what the provider said may be going on, or you are not sure how and when to take a medication and what it may or may not interact with. Trying to recontact the provider can prove very difficult.

But when several providers are involved, it can be very difficult to know who is in charge of what and what the directions are. Nurses and others may try but they too may not have the full picture, and you are left with this gnawing uncertainty about what is going on and needs to be done.

If you have been hospitalized recently, many things about the stay may have gone well.

If you have several medical problems, all this can be compounded. You may have several

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specialty providers and several treatments that alone may be okay but together may not. Trying to get all these providers together to communicate and develop an integrated treatment plan that you can understand may be more difficult than, say, getting an act thru Congress. You may be one of the fortunate ones who has a family member who steps in and serves as a case manager who helps navigate or coordinate with these providers and gets it all straight, but not everyone is so fortunate. A key dynamic among these scenarios is that our healthcare system and its providers have relied on traditional ways of communicating and doing things that all too often do not work well. It is not that these people are illintended; many of them are in fact very well intended and want to do good especially for their patients. And many of them work and try really hard. The problem is the old ways are no longer very effective. The outcome can be a lot of frustration and bad feelings among patients and providers who are all basically good people and well-intended otherwise. Technology is not the only answer but can provide much help to address these problems and produce significantly better outcomes for these scenarios. There are many types of technology in healthcare, and ones that we are particularly interested and believe can help a lot are platforms that engage members. These platforms not only help members in their efforts to achieve better health outcomes but also facilitate the patient-provider relationship and enable providers to communicate and work better with each other and their patients. They do not replace the need for human beings in healthcare, but they do help connect them and facilitate the things they are trying to do.

To understand how patient member engagement platforms (PEPs) can help, we should take a closer look at the problems they seek to address. We have been very interested in how people access care, what helps them obtain the

care and outcomes they want, and what gets in the way. We have also been very interested in providers and how they connect with patients and each other. What we have found is that patients have significant difficulty navigating the healthcare world, connecting with different providers, adhering to their treatment plans or understanding their illnesses, conditions, or potential for health and wellness. Providers can have difficulty following their patients over time, connecting and communicating with other providers, or knowing objectively how they are responding to treatment. At the root of these problems are two different dynamics that have been around a long time and are fundamental to making healthcare work: the need for people to know and understand, and their need to connect and engage with each other in truly meaningful ways to make things work. Examining these problems more closely, one finds that patients may initially access care but then are not always clear on what they should do to implement the plans of treatment their providers have developed for (and sometimes with) them. It becomes more problematic when patients transition from one level of care to another, eg, hospital to outpatient care, especially when multiple outpatient providers are involved. It is very difficult for patients to know what to do, and they can become more confused when the directions from different providers conflict or are unclear. Education and information are usually either piecemeal or overwhelming leading to more doubt and anxiety. The expense of all this, eg traveling back and forth, lost time at work, can make matters worse, not to mention just keeping track of appointments, prescriptions, labs, etc. Providers may do an excellent job in providing care for the patient in front of them but can only do so much. They may not have sufficient time to adequately inform and educate patients about their problems or treatments. They also may not communicate well with each other in part because the means of communication have made it difficult up until now. It is unusual for several providers caring for the same patient to meet as a team with the patient to develop a treatment plan, but this is exactly what good treatment requires especially for patients with multiple co-morbid medical and behavioral health conditions. Further obstructing communication is the current, manual process for obtaining informed consent. Finally, it has also been difficult for providers to objectively know whether the treatment they provide is

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effective as there have not been relatively easy ways to measure and track outcomes. Data has been incomplete, inconsistent, and too often delayed. Technology, especially PEPs, can help address these problems. These are solutions that can be readily used on one’s phone, pad, or laptop. Ideally, they should be built with the patient and provider clearly in mind and account for real life processes and how people access and provide care today. Technologies superimposed on basic workflows that do not adequately account for these considerations produce less than satisfactory results. Technology can also leapfrog current practices in good ways that help. As an example, the current process for performing assessments is often manual and can be duplicative and unnecessary to the point of exasperation. It is common for patients to be asked the same questions multiple times by different providers, and the focus has become more on completing the assessment form itself rather than using the information to determine what is causing a patient’s problems. Technology can dramatically improve this process by making information already captured available to subsequent providers and enabling them to focus on accurate assessing problems, not just gathering information. The key word in PEPs is engagement: it must connect and engage with patients in the ways they connect and engage. Simple technology alone will not suffice. It can be argued that patient engagement is the single most important factor in achieving good results in healthcare. There are obviously many things that are very important as well, but if the patient is not engaged with his or her own treatment, it is much less likely success will ensue. PEPs can help in many ways. For example, treatment planning can be greatly enhanced by PEPs as ithey provide a shared platform to gather information, create goals and plans, and then track and communicate about them. They can greatly enhance adherence to treatment when the technology is used by both patients and providers and increases the patient’s probability of “owning” the treatment plan. In some respects, it is understandable

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the treatment plans sometimes fail. If patients have not been involved in developing and then having direct access to them, they become passive bystanders and wait for providers to do something for them. But if patients have participated in developing the plans, believe in them and have easy ways to access them, they become more active and involved in treatment and motivated to make it work. Information and education about can be provided on digital platforms in individualized ways that resonate with the specific patients, increasing the likelihood they will gain better understanding of their healthcare, how to prevent problems and improve wellness. Success in treatment becomes more likely as patients can track their progress, communicate with multiple providers as a team at the same time, and electronically sign informed consents so providers can communicate with each other. These types of platforms often utilize telemedicine so that patients can be seen where they are at much reduced transportation and other costs. As we face the COVID crisis, PEPs that educate patients, keep them in tune with their treatment plan and team, and make care readily available via telemedicine are even more important now than ever before. As effective as patient engagement platforms are for patients, they help providers. They enable providers to track response to treatment and communicate in real time between office visits as needed. Simple adjustments can be made this way, obviating the need to visit the office or clinic. Small problems can be kept small by the ability to assess and treatment via telemedicine on the platform They also help providers connect and communicate with each other, reducing the likelihood of conflicts in treatment and ensuring all are using the same plan. Barriers to communication caused by privacy can be addressed thru electronic signatures for informed consent. Financially for providers these platforms generate additional revenue by adding new services such as screenings and case management. They also allow for extra time with the patient and reduce no show rates substantially. They can save on expenses as well, particularly on the administrative side of providing care.

About the Authors Sean Gunderson is a founding partner of iTether Technologies, Inc. a leading digital health company, located in Phoenix, Arizona, that has developed an innovative care coordination platform with a focus on improving quality of care through the delivery of digital health services for patients and the collection of evidence-based outcomes for service provider organizations in the behavioral health, physical health, social health, and justice domains. iTether partners with leading health and justice organizations to deliver a mobile-enabled care coordination platform that improves member engagement with personalized care plans, health literacy content, telehealth access to clinicians, access to social determinants of health (SDOH), and tracking of progress toward recovery and wellbeing. At iTether, we have the quadruple aim of improving the quality of care, driving down the cost of care, delivering care to a larger population, and for a longer period of time. A focus on quality, cost, and patient outcomes–across the entire care continuum is more important than ever. Sean has a twenty-year track record of creating business value through the management and application of technology and business intelligence solutions for national and international organizations and has completed multi-million-dollar business development projects from the vision stage through business implementation, sales cycle, and operation for national and international firms.

Don Fowls, MD is a nationally known psychiatrist and health care consultant who works with organizations across the country to develop solutions for the many challenges they face today, including integration, value-based reimbursement, managing complex, special populations, and strategic partnerships. Dr Fowls has helped several national and regional health plans and health systems integrate behavioral and physical health and develop value-based payment models to support this. Dr Fowls previously served as Chief Medical Officer and Executive Vice President of Business Development for Value Options and its parent company FHC Health Systems for eleven years. He also worked at Schaller Anderson Inc. as Executive Vice President, Business Development, and President and CEO of its behavioral health subsidiary. In Arizona he recently served as Chief Medical Officer for Mercy Maricopa Integrated Care as well as the behavioral health advisor to the Practice Innovation Institute in Phoenix, one of the CMS Transforming Clinical Practice Initiative grant awardees to transform the practices of health care providers. As part of this process he co-led the Behavioral Health Affinity Group nationally. Dr Fowls is Chairman of the Board of Copa Health, an AZ based community provider of services for behavioral health and intellectual and developmental disorders. He is also President of the Arizona Psychiatric Society and a Fellow in the American Psychiatric Association. The views and perspectives expressed here are those of the authors and do not represent the ASU Center for Applied Behavioral Health Policy.

Brave New World

Brave New

Program

Street Triage Crisis Support Training (CST) yields empathy for community members and self-care for first responders by Denise Beagley, M.Sc.

Chandler Fire Department was awarded an Innovation Grant by both the Vitalyst Health and Arizona Community Foundations. In 2017, a partnership was formed between Arizona State University’s Center for Applied Behavioral Health Policy and the Chandler Fire Department to develop and deliver innovative training to firefighters. The product of this partnership was the Crisis Support Training (CST) curriculum. The goal was to provide the tools necessary to engage community members who are experiencing addiction, mental or behavioral health crises.

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Since the inception of this CST curriculum, the program has trained nearly 6,000 first responders throughout Arizona. Interest was further expanded from the original platform when CST was presented at the Arizona Fire Chief Conference, the Arizona State Fire School, and other local fire departments. An urgent need for this type of training prompted ASU to adapt and broaden the curriculum to instruct other first responders including police, 911 dispatchers, probation officers, crisis workers, social workers, and emergency medical service professionals. The training has generated increased exposure and desire for its use. The program’s content has also provided opportunities outside of Arizona. Historically, firefighters have been trained in Fire Science and lifesaving skills. As modernday firefighters, these first responders encounter an increasing number of individuals with behavioral health needs. This training was designed to increase the knowledge, confidence, and awareness of firefighters when working calls with community members who have common behavioral health needs,

with emphasis on mental illness and/or substance use disorders. The resulting effects for first responders have been an increase in their feelings of preparedness when approaching community members on scene as well as personal feelings of enhanced health, personal welfare, and ability to respond to a diverse range of situations. Firefighters now perform their duties beyond the extent originally thought possible. This merited the expansion to include other fire departments of neighboring municipalities as well as other first responders. The project’s results showed that the CST curriculum reduced the stigma of mental illness, improved first responder interactions, and helped navigate community members to the most appropriate emergency care. An unanticipated benefit to the Chandler Fire Department was the myriad of anecdotal stories about how practicing emergency mental healthcare deepened empathy and compassion, which in turn, dovetailed back to the first responders. The training made strong positive impressions on these representative first responders, who had these observations:

“You can definitely see that the line personnel are identifying mental health differently now. They're asking questions, taking extra time on a call, and learning a little bit more of the story. They are identifying the behavioral health needs that go beyond a standard medical call. Some pivotal moments for the firefighters were when they experienced the ‘Hearing Voices’ simulation that was hands on [with specially designed ear equipment used to simulate the experience of the mental condition] that gave the firefighters a perspective they’ve never had before. I think the CST training was profoundly impactful [it] gave them a better understanding and more knowledge. They are not threatened with what historically has been an uncomfortable situation.”

Battalion Chief Blas Minor, CEP

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“As a Peer Team Services member within our department and nationally through Firestrong, I feel the CST helped our crews start to breakdown the stigma of mental illness and start to look at it as part of their health… it is just as important as our physical health. We don’t always see the wounds of someone with a mental illness, but we want to help get them to the right place. This training helped us increase our awareness and laid a good foundation. We receive extensive and intense training on Fire Science and life-saving skills, but the CST classes were the first comprehensive training to address mental health concerns.”

Engineer Kyle Seigel, CEP “Three things stand out… One – the firefighters have more confidence in behavioral health-related calls… due to feeling better prepared and knowledgeable of resources; Two – they allow themselves to slow down… to take a look at the situation … not everyone needs to go to the emergency room; and Three – they have the willingness to listen and recognize that what the patients are saying is valid and true.”

Crisis Intervention Coordinator, Jessica Westmiller, MSW “Motivational Interviewing and effective communication skills helped us with these mental health calls to take a step back and look at the bigger picture. We can verbally de-escalate a situation and, in turn, give better care. As first responders, we always want to help. We train for months in the academy on how to put out fires, and how to address medical calls… but we’ve received minimal training on behavioral health until now. The CST Awareness class helped us understand that ‘As firefighters, our goal is to get the person to safety.’ It is also important to slow things down and to give the person time to share their story. It is important to the person we are helping that they are listened to. We are all working together toward a common goal of getting them to the right service.”

Battalion Captain Charles Griffiths, CEP

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“We have been able to deepen empathy and understanding for those individuals, living with mental health disorders. CST Awareness acted as an equalizer training course for our department. It helped reduce the stigma of mental health and substance use disorders. In the past, we treated these calls like our physical injury calls; but it was difficult for us to see the mental health calls the same way. If we didn’t see a physical injury or outward symptoms, it was more difficult for us to find appropriate, definitive care. We would generally refer the patient to another resource or take them to the Emergency Department. We now have additional tools to assist these individuals on scene, to take a few extra minutes to ask if there is anything else, they might need. Now, with the awareness class, we end up providing even better care to our community.”

Captain Brandt Lange, RN, CEP

About the Author Denise Beagley, M.Sc. works full-time as the Manager of Clinical Initiatives & Training for Arizona State University’s Center for Applied Behavioral Health Policy and part-time as a Crisis Intervention Specialist for Chandler Fire Department. She has worked within the behavioral health system since 2002. Before working in Arizona, she completed her master’s degree in Counseling Psychology at Trinity College Dublin. Over the past 20 years, her work has predominately intersected at Psychology and Public Safety and serves as a Subject Matter Expert (SME) to internal and external ASU departments and provider companies.

For more information about Crisis Support Training (CST) contact Denise.Beagley@asu.edu

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Crisis Support

Training

Crisis Support Training (CST) was designed for firefighters and emergency medical professionals to help develop efficacy in engaging individuals in behavioral health crises.

Trained in CST: 5,000 First Responders 2,700 were Firefighters

500 Post Training Surveys, 26 Follow-Up Surveys

is the most important “Thistraining I’ve had in years.” “Partnering Firefighters with Police Depts.” identified as the most useful training topic*

100%

Crisis Response Teams

2,129 Calls in 2018 said they were likely to use 77% Crisis Response post-CST

of respondents would recommend CST to other firefighters. *

*In Follow-Up Survey

Chandler Fire Department was awarded an Innovation Grant from Vitalyst Health Foundation and Arizona Community Foundation and they selected ASU’s Center for Applied Behavioral Health Policy as their partner to create, deliver, and evaluate a Crisis Support Training (CST) curriculum specifically designed for firefighters and emergency medical professionals. The project collaborates with community partners and organizations to help firefighters develop efficacy in their knowledge of serious mental illnesses and how to appropriately engage individuals in behavioral health crises. The impact of this project will help reduce the stigma of mental illness, improve patient outcomes, and increase access to appropriate care.

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We Keep the Human in Healthcare iTetherTech.com

Thank you to all the staff, volunteers and contributors who helped make this publication possible, from the Arizona State University Center for Applied Behavioral Health Policy. Printed locally in Phoenix, Arizona at Artcraft.

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