Below are general tips intended to aid potential Certified Community Behavioral Health Clinics (CCBHC) in aligning organizational processes and services with the CCBHC model.
- Ensure the organization is ready to undertake the certification process. The process requires more than just submitting documents; it requires that the organization review its policies and procedures and make changes to ensure they align with the CCBHC model. Staff at all levels of the organization must also understand what a CCBHC is and how the organization will implement the model.
- Make documents searchable. The easier it is for reviewers to find relevant information, the more quickly documents can be reviewed and the certification process can be completed.
- It is most helpful to submit the CCBHC checklist, with a crosswalk that indicates which documents the reviewer should check and a short narrative (approximately 1 paragraph) as to how/why the documents submitted fulfill the criteria.
- It is also useful to mark the relevant sections in submitted documents, so the reviewer can quickly find the sections intended to fulfill a specific criterion.
- Engage all staff in the process early. This will allow for everyone to develop an understanding of the CCBHC model early on, how the organization will implement it and allows for ideas about workflows and processes to come from all levels of the organization.
- Engaging staff early will ensure that they are competent and can readily engage HHSC reviewers during the staff interview portions of the certification process.
- Do not approach the process as a “checklist.” The CCBHC model may, and most likely will, require the organization to change some aspects of how it operates or the organizations workflow.
- Additionally, each section of the CCBHC reviewer checklist will be built upon by subsequent sections. For example: the needs assessment in section one will inform the staffing plan, service hours and partner organizations in the following sections.
All CCHBCs are required to have a needs assessment process that is updated, at minimum, every three years. The needs assessment should be targeted at the community the organization serves. Efforts should be made to determine who lives in the service area (age, gender, race/ethnicity, etc.); what, if any, special challenges they face (e.g. transportation); what, if any, special needs they have (e.g. language services); and any other information that will be important to consider when determining services, hours, staffing, or other needs the organization can fill.
It is important to understand the population that the organization is currently serving and identify discrepancies between the organization’s client population and the community. Additionally, gaps in the services the organization provides compared to identified needs in the community should be highlighted in the needs assessment.
Centers must 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. CCBHCs should have a process which determines staffing levels based on a community needs assessment. This process is continuously influenced by the changing needs of the populations that are served.
Availability and Accessibility of Services
CCBHCs should be able to identify how services are delivered, regardless of payment source, ability to pay or the individual's home. Centers also must identify processes for coordination efforts with other service providers.
Centers should have formal contacts with other organizations that may work with the same clients. CCBHCs typically 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, individual providers, and others.
Scope of Services
To assure a level of consistency across CCBHCs, a list of evidence-based practices (EBPs) that reflected statewide needs assessment findings and supported other Texas program initiatives were developed. 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 certification process include:
- 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
Centers must address continuous quality improvement and reporting components of the CCBHC model. Two key components of continuous quality improvement are:
Creation of a Continuous Quality Improvement Plan
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. 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.