PCPA and Behavioral HealthChoices

PCPA Paper Highlights Success of Behavioral Health Managed Care

PCPA has published Continuing the Success of Pennsylvania’s Behavioral Health Managed Care Program. The primary purpose of the paper is to keep legislators, state and county officials, and other stakeholders apprised of the important and successful commonwealth program, Behavioral HealthChoices. The paper was written on behalf of members to highlight the success of the behavioral health managed care program and support continuation of this model. It has been the overwhelming experience of community providers, consumers, and many others in the field that the Behavioral HealthChoices model of specialty managed care offers a structure of accountability that assures access to quality care, implementation of evidence-based treatment, and sound fiscal control. PCPA believes strongly that the model should continue. All members are encouraged to forward the paper to local officials and other stakeholders whenever possible.

Apple and Accessibility – Reaching All Learners

Marian Community Hospital Closing

Marian Community Hospital Closing

Wayne County Office of Mental Health/Mental Retardation/Early Intervention would like to inform the community and other partners that the Marian Community Hospital closing has necessitated changes in the delivery of Wayne County Mental Health Crisis Intervention Services, effective Friday, February 17th at 7:00 am.

Wayne County Office of Mental Health continues to maintain a contract with Northwestern Human Services (NHS) to provide these services. With the closure of Marian, these crisis services will now be provided at Mid-Valley Hospital. This should provide a relatively transparent change, as all other service provisions, with the exception of the change in hospital location, will remain the same.

Crisis Services may be accessed by calling Northwestern Human Services Honesdale Office at (570)253-0321 or Carbondale Office at (570)282-1732. These numbers are available 24/7. As always, in the case of a life threatening emergency, call 911 ñrst.

Should you experience any difficulties with this change or with mental health crisis services, please feel free to contact our office so we can address these difficulties and work towards continuing to improve our services.

Bipolar Disorder in Young People: Can Research Diffuse Controversy?

Dr. Mark Olfson, author of "Bipolar Disorder in Young People"

Dr. Mark Olfson, TeenScreen National Center’s scientific advisor, is professor of clinical psychiatry and a mental health services researcher and research psychiatrist at Columbia University and the New York State Psychiatric Institute.

He is a leading expert on the impact of increased diagnoses and prescribing of antipsychotic medications on our youth – concerns that have generated serious discussion within the mental health and medical communities. Improving diagnosis and treatment of bipolar disorder in young people will be the focus of our February 29 webinar, Bipolar Disorder in Adolescents: What Primary Care Providers Need to Know, which we are co-hosting with the American Academy of Pediatrics.

Here, Dr. Olfson shares his thoughts on the controversy and discusses how new research findings may help settle it.

Over the past several years, an increasing number of children and adolescents in the U.S. have been diagnosed and treated for bipolar disorder1,2. As part of their treatment, a majority receive psychotropic medications, often a mood stabilizer and an antipsychotic medication. A recent meta-analysis suggests that antipsychotic medications may be more effective than mood stabilizers for the treatment of manic symptoms in bipolar youth3. Yet weight gain and other adverse metabolic side effects associated with antipsychotic medications4 pose important considerations. As compared with

adults, children and adolescents may be more vulnerable to antipsychotic-induced weight gain5 and perhaps even to antipsychotic-associated diabetes6,7.

When the diagnosis is clear, than the benefits of these medications often far outweigh the risks. However, there is growing concern over the accuracy of some of these diagnoses8, 9. Symptoms of increased irritability – often interpreted as symptoms of bipolar — also occur in ADHD and disruptive behavior disorders, and may contribute to a tendency among some clinicians to overdiagnose bipolar disorder10. Even among child and adolescent psychiatrists, there is variation in the clinical criteria used to make a bipolar diagnosis. Many are either uncertain or reject the concept that a child must have the primary DSM-IV criterion for a manic episode (at least one week of elevated, expansive, or irritable mood) to receive bipolar disorder diagnosis8.

Concern over high rates of community bipolar disorder diagnosis in young patients has led the DSM-5 Task Force to propose a new diagnosis: disruptive mood dysregulation disorder. This disorder includes youth with recurrent temper

outbursts that are out of proportion – both in duration and intensity — to the stressor that provoked them and that are not connected to an existing mood or psychotic disorder. Although the effects of this new disorder on medical practice remain unknown, epidemiological data suggest that disruptive mood dysregulation disorder occurs in approximately 3.3% of children and adolescents11.

Despite substantial progress in combining psychosocial therapies for adults with bipolar disorder, much less research has focused on child and adolescent bipolar patients. Recently, however, family-focused therapy, which emphasizes communication and problem-solving skills training to enhance family functioning, in combination with pharmacotherapy, has been found to contribute to more rapid and complete remission of depression symptoms than a combination of brief psychoeducation and pharmacotherapy12. Support also exists for multifamily group psychoeducational therapy for children with bipolar disorder in reducing mood symptoms13.

Uncertainty and controversy often surround the diagnostic boundaries of bipolar disorder for children and adolescents. In this clinical context, it is important that mental health professionals apply the DSM criteria in a standard and consistent manner, approach pharmacotherapy with an understanding of its efficacy and risks, and seek to take advantage of emerging evidence that interventions that work on family communication and functioning may play an important supporting role in improving the course and outcome of children and adolescents with bipolar disorder.


References

1. Olfson M, Blanco C, Liu L, Moreno C, Laje G: National trends in the outpatient treatment of children and adolescents with antipsychotics. Arch Gen Psychiatry 2006;63:679-685.

2. Blader JC: Acute inpatient care for psychiatric disorders in the United States, 1996 through 2007. Arch Gen Psychiatry 2011; doi:10.1001/archgenpsychiatry.2011.84

3. Correll CU, Sheridan EM, DelBello MP: Antipsychotic and mood stabilizer efficacy and tolerability in pediatric and adult patients with bipolar 1 mania: a comparative analysis of acute, randomized, placebo-controlled trials. Bipolar Disorders 2010;12:116-141.

4. De Hert M, Dobbelaere M, Sheridan EM, Cohen D, Correll CU: Metabolic and endocrine adverse effects of second-generation antipsychotics in children and adolescents: a systematic review of randomized, placebo controlled trials and guidelines for clinical practice. Eur Psychiatry 2011;26:144-158.

5. Correll CU, Lencz T, Malhotra AK: Antipsychotic drugs and obesity. Trends Molec Med 2011;17 (2):97-107.

6. Hammerman A, Dreiher J, Klang SH, Munitz H, et al.: Antipsychotics and diabetes: an age-related association. Ann Pharmacother 2008;42:1316-1322.

7. Andrade SE, Lo JC, Fouayzi H, Connor DR, Penfold RB, Chandra M, Reed G, Gurwitz JH: Antipsychotic medication use among children and risk of diabetes mellitus. Pediatrics 2011;128:1135-1141.

8. Galanter CA, Pagar DL, Oberg PP, Wong C, Davies M, Jensen PS: Symptoms leading to a bipolar diagnosis: a phone survey of child and adolescent psychiatrists. J Child Adolesc Psychopharmacol 2009;19:641-647.

9. Pogge DL, Wayland-Smith D, Zaccario M, Borgaro S, Stokes J, Harvey PD. Diagnosis of manic episodes in adolescent inpatients: structured diagnostic procedures compared to clinical chart diagnoses. Psychiatry Res. Feb 14 2001;101(1):47-54.

10. McClellan J, Kowatch R, Findling RL. 2007. Practice parameter for the assessment and treatment of children and adolescents with bipolar disorder. J Am Acad Child Adolesc. Psychiatry 46(1):107–25

11. Brotman MA, Schmajuk BA, Dickstein DP, et al.: Prevalence, clinical correlates, and longitudinal course of severe mood dysregulation in children. Biol Psychiatry 2006; 991-997.

12. Miklowitz DJ, Axelson DA, Birmaher B, George EL, Taylor DO, Schneck CD, et al. Family-focused treatment for adolescents with bipolar disorder: results of a 2-year randomized trial. Arch Gen Psychiatry 2008;65(9):1053–61.

13. Fristad MA, Verducci JS, Walters K, Young ME. Impact of multifamily psychoeducational psychotherapy in treating children aged 8 to 12 years with mood disorders. Arch Gen Psychiatry 2009;66(9):1013-21

PCPA Legislative Alert: Visit Legislators and Advocate for Community Services!

Governor Corbett will present his proposed 2012/13 state budget on February 7 and it is anticipated that the Department of Public Welfare budget may be cut. The budget will not be finalized until much later, usually by the end of June. There is significant opportunity to impact the final budget numbers by strong and effective advocacy in the districts. In the current economic climate it is more crucial than ever that community providers reach out to local legislators to educate them regarding the importance of maintaining the community safety net for constituents in need of mental health, intellectual disability, or substance use disorder services.

It is imperative that members contact legislators in their district offices to urge them to support funding mental health, intellectual disability, and substance use disorder services at a level that enables community agencies to continue to provide quality services. Visits are most effective if framed by:

  • educating legislators about your agency and the important role it plays in his or her district as both an employer and as a resource for constituents in need of services;
  • advocating for the key role of community services as a more effective and less costly modality for the provision of mental health, intellectual disability, and substance use disorder services; and
  • most importantly, how possible budget cuts impact your agency and, consequently, their constituents.

For supporting material, please review the talking points document referred to below.

Important information to highlight concerning your role as an employer includes the following.

  • The number of consumers/persons your organization serves annually.
  • The number of individuals employed by your organization. Remember that you are an employer – besides salaries, consider other rising costs (for example, increasing health care costs) at your organization. Be specific.
  • Remember that you are a business and purchaser of services – think about the amount spent on utilities (including vehicles, gasoline, phones, computers, furniture, food, postage, supplies, training, etc.). Make it clear to your legislator that your organization is vital to your community’s economy.

When contacting legislators the following materials should be shared:

It is important to note that PCPA members agree with the necessity of a balanced state budget, but not on the backs of individuals served. If services to Pennsylvanians in need of mental health, intellectual disability, autism, or addiction care are to remain accessible and effective, funding must be preserved and Pennsylvania’s safety net must be protected.  To avoid the implementation of cuts to community services, it is crucially important that members take action.

Questions and comments may be directed to George Kimes (george@paproviders.org) or Anne Leisure (anne@paproviders.org).

 

Advocacy Alliance Client Testimonial – Helena Marques

Helena Marques went through a hardship after she lost her job. Originally from Perth Amboy, New Jersey she came to Scranton, Pennsylvania because of their resources for the homeless.

Facing mental health challenges from an early age, Helena turned to the Advocacy Alliance for help.

At the Recovery Center, Helena found assistance and hope. In addition to helping her find food and shelter, The Advocacy Alliance was able to expedite the waiting process and get Helena the counseling services she needed.

Watch the video below to hear Helena’s story in her own words.

“Wendy’s Wisdom” Signing with Author Sherry Skramstad

Wendy's Wisdom Cover

Author Signing: 
Wendy’s Wisdom: The Challenges and Accomplishments of a Woman with Down Syndrome

Join author Sherry Skramstad in her recollection of Wendy’s lifelong journey as she relates the many lessons she herself learned from the simplicity but profundity of Wendy’s Wisdom.

When:
03/21/2012 – 07:00 PM 

Where:
Barnes & Noble Booksellers
Wilkes-Barre
The Arena Hub
421 Arena Hub Plaza
Wilkes-Barre, PA 18702
570-829-4210

September Implementation of Act 22 Co-Payments

Act 22 of 2011 provides the Department of Public Welfare (DPW) the authority to address current fiscal challenges and budgetary limitations by imposing a co-payment on services for certain children enrolled in the Medical Assistance (MA) program. The Office of Medical Assistance Programs (OMAP) has announced that this co-payment for services will be implemented in September. It will affect approximately 38,000 children with disabilities living in a family with income in excess of 200 percent of the federal poverty level. OMAP is in the process of finalizing plans. Notices will be sent to affected families 30 days prior to implementation.

Providers will be responsible for collection of co-payments and may do so at the time of service or set other arrangements for payment. The yearly cost of co-payments for service may not exceed five percent of the family’s income and may not be in excess of 20 percent of the cost of the service. The MA claims processing system will be used to regulate the family income cap so that the ceiling of five percent on a monthly or quarterly basis is not exceeded. Co-payments will not be applied to school-based services, preventative services, and other items or services that are currently excluded from MA co-payment. It is unclear whether providers will be required to provide services if the co-payment is not paid. MA representatives have stated that the law does not establish an exception process for co-payments.

PCPA will continue to update members as new information is received.

Voices of Hope

In 1955, a new organization, founded in Lackawanna County, provided a voice for persons with mental illness. Since its humble beginnings, that organization, now known as The Advocacy Alliance, has expanded to serve persons with mental illness and persons with mental retardation in fifteen counties through Northeastern and Eastern Pennsylvania.

Take a few minutes to view “Voices of Hope”, an inspirational story that parallels changes in the way mental health and mental retardation services were delivered through the 50s, 60s, 70s, 80s, and 90s and the hope that accompanies the dawn of the 21st century.

The journey begins in the mid-1950s when persons with mental illness expected to be socially isolated and stigmatized, and continues to the 21st Century when due to the efforts of many, including The Advocacy Alliance, persons with mental illness and persons with mental retardation are living in communities participating in life decisions, and exercising their right to be heard.

A New Approach to Mental Health: Improving Outcomes for All

A new approach to mental health
From both a wellbeing and economic perspective, there is no doubt that mental health issues need to be addressed with the same urgency and vigour that physical health problems receive. For many people, recovery from mental illness is closely linked with other social factors such as income, housing, education, employment and social care and support.

The new health and wellbeing boards will have a key role in integrating more effective commissioning so that it includes a social model of recovery and not just clinical care. With the NHS having to find £20bn in efficiency savings, future commissioning in the NHS still shrouded in confusion, and leading mental health experts expressing concerns that mental health is still ‘largely invisible’, what does the future hold for mental healthcare?


Book Online

Confirmed to Speak:
Steve Shrubb
Director Mental Health Network,
NHS Confederation

Neil Deuchar
Co Chair
, The Joint Commissioning Panel for Mental Health
Paul Farmer
Chief Executive Officer
, Mind
Dr Ian McPherson
Chief Executive
, The Mental Health Providers Forum
Paul Jenkins
Chief Executive
, Rethink 
Andy Bell
Deputy Chief Executive
, Centre for Mental Health

View Full Programme

At A New Approach to Mental Health our expert speakers will explore the government’s vision and discuss how the mental health strategy can be implemented to best ensure outcomes are successful. Delegates will have the chance to challenge, discuss and debate the key issues and gain relevant insight applicable to their professional roles.

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