As part of the pilot certification process, Texas Health and Human Services Certified Community Behavioral Health Clinics staff identified barriers and gaps to effectively meet certification criteria. Impacts across the 8 sites included identifying components of the criteria that needed additional clarification and technical assistance, as well as key organizational changes needed at the agency level.
Below are general tips intended to aid potential CCBHCs in aligning organizational processes and services with the CCBHC model.
Centers should have staffing levels that reflect the needs of the community that they serve. Communities grow and change over time, and staff and center locations should be able to reflect such changes. Centers that are working towards certification as a CCBHC should have a process which determines staffing levels based on a community needs assessment, and is continuously influenced by the changing needs of the populations that are served.
Availability and Accessibility of Services
Centers that are working toward certification as a CCBHC should be able to identify how services are delivered, regardless of payment source, ability to pay or the individual's home. Centers also should be able to identify processes for coordination efforts with other service providers.
Centers should have formal contacts with other organizations that may work with the same clients. Many CCBHCs have chosen to incorporate memorandums of understanding (MOUs) with community partners to establish a network of community supports for clients. These partners include primary care providers, local veterans' services organizations, school districts and individual providers.
Scope of Services
To assure a level of consistency across CCBHCs, HHS and the pilot centers developed a list of evidence-based practices (EBPs) that reflected statewide needs assessment findings and supported other Texas program initiatives. These practices were selected as minimum standards; however, the EBPs that a center chooses to employ should be appropriate to the needs of the population being served. The EBPs selected for the initial certification process included:
- Adult Specific EBPs:
- SAMHSA Assertive Community Treatment (ACT)
- Cognitive Behavioral Therapy (CBT) and Cognitive Processing Therapy (CPT)
- SAMHSA Illness Management and Recovery (IMR)
- SAMHSA Integrated Treatment for Co-occurring Disorders
- SAMHSA Supported Employment and Permanent Supportive Housing
- Child/Adolescent Specific EBPs:
- Nurturing Parent Training
- Trauma Focused CBT
- Case Management using the NWIC Wraparound model, when indicated
- Applicable to all populations:
- Screening, Brief Intervention, and Referral to Treatment (SBIRT) model
- Motivational Interviewing
- Person-Centered Recovery Planning
- Seeking Safety
Quality and Other Reporting
Throughout the planning process, centers were faced with changing traditional modes of doing business in order to address continuous quality improvement and reporting components of the CCBHC model. Two key components are:
Creation of a Continuous Quality Improvement Plan
As centers work towards the CCBHC model, a written continuous quality improvement (CQI) plan should include the establishment of fidelity checkpoints for overall CCBHC adherence to CCBHC criteria, as well as adherence to EBP protocols. This plan also should identify dedicated quality staff and processes to address quality findings. Centers are expected to build consumer participation into the CQI process that will include consumers in a meaningful way as remediation strategies are developed.
Creation of a Charge Master
Centers should be able to identify or create a charge master detailing the actual cost of providing a service to assist in tracking and managing overall costs. Throughout the CCBHC project, most centers tracked cost based on what a payer reimbursed. However, by moving to an all-payer cost reporting format, centers are better able to examine their true cost of care and compare themselves with others in the market.
Organizational Authority, Governance and Accreditation
Organizations must include meaningful consumer participation in governing bodies of the organization. If a center has a governing board membership that is dictated by a local or county government, it is recommended that an alternative advisory board with more than 50 percent consumer participation is created to implement a continual feedback loop of service quality and delivery. This should be representative of the diversity of populations served, as well as include consumer (adult and youth) and family input.