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Center for Mental Health Services
National Advisory Council
Washington, D.C.

DIRECTOR'S REPORT
September 1998

As the Center for Mental Health Services (CMHS) approaches the close of its fifth year leading the Federal Government's efforts to support and advance mental health service delivery systems throughout the country, it reports numerous achievements. CMHS programs continue to shed light on the best ways to create appropriate, consumer-oriented, community-based systems of mental health care. The following report highlights some of these activities.

CMHS has been especially active since the CMHS National Advisory Council met in May. Chief among those activities are a proposal for a far-reaching program to address the psychosocial aftermath of terrorist attacks, the ongoing efforts on the Surgeon General's Report on Mental Health, and a number of innovative programs to increase consumer involvement in developing mental health service delivery systems that truly meet their wants and needs.

As a result of the bombing of the U.S. Embassy in Nairobi, Kenya, Brian W. Flynn, Ed.D., Director of the CMHS Division of Program Development, Special Populations and Projects, will be in Nairobi, September 1-15, 1998. He has been asked to gather information, provide guidance for immediate local actions, and provide a report with recommendations for both long- and short-term intervention, training, and education in the psychological sequelae of this event. Dr. Flynn, who is well-recognized internationally in the field of disaster and emergency mental health, goes to Nairobi at the behest of the U.S. Agency for International Development (USAID)/Office of Foreign Disaster Assistance (OFDA). The Kenya Medical Association requested that the OFDA provide a consultant with recognized expertise in this area.

Even before the almost-simultaneous terrorist attacks on the U.S. embassies in the African cities of Nairobi and Dar es Salaam, CMHS recognized the need to address the psychosocial sequelae of terrorist attacks. Terrorist use of a biologic or chemical weapon is likely to affect the mental health of communities in a manner far greater and substantially different than that seen even in Oklahoma City. As a result, work is underway at CMHS to develop programs that will create response plans to address the fear, panic, and disabling anxiety syndromes in the immediate aftermath of terrorist attacks.

Programs to investigate the likelihood and extent of such responses have been proposed, as well as programs to explore interventions that would mitigate the long-term behavioral mental health consequences. In addition, a training program in behavioral and psychosocial principles for first responders would strengthen the linkages between the mental health components of community, regional, and national medical networks and improve their ability to respond to the consequences of terrorist incidents involving weapons of mass destruction.

CMHS has been designated as the lead agency by the Secretary of the Department of Health and Human Services to develop the Surgeon General's Report on Mental Health. This honor presents CMHS with an extraordinary opportunity to focus public attention on promoting mental health; ending the stigma associated with mental illness; encouraging early recognition and intervention for mental health problems; and promoting effective, appropriate service delivery systems that enhance mental health treatment for millions of Americans in their own communities.

In keeping with its mission to involve consumers and family members in the development of systems of mental health care, CMHS has engaged in a number of new projects. For example, the CMHS National Advisory Council resolved unanimously to form a subcommittee of consumer/survivor advocates. This subcommittee will provide Council with the necessary perspective to address properly the specific needs, issues, and concerns of consumer/survivors as it advises the CMHS Director.

CMHS also will administer grants to enhance knowledge about how consumer-operated self-help programs contribute to the rehabilitation and recovery of individuals with serious mental illness. Five million dollars will support three technical assistance centers under this program. This represents the largest Federal commitment to date on this important topic.

Under this program, two technical assistance centers will promote consumer/survivor self-help activities, and a third will assist supporters of consumers/survivors. These technical assistance centers will develop resources such as training materials, interactive communication opportunities, and highly developed approaches to recovery and empowerment.

Grants also are available to increase the capacity of statewide consumer/survivor and/or consumer supporter networks. These networks will strengthen organizational relationships among consumers, families, and advocates; foster leadership and management skills; and identify technical assistance needs for consumer/survivor and/or consumer supporter organizations.

LEGISLATIVE UPDATE

Reauthorization

Given the twin pressures members of Congress face to wrap up spending bills and to resolve the nonpartisan controversy over a formula fix for the performance partnership block grants, SAMHSA reauthorization is unlikely this legislative year. A formula fix for the performance partnership block grants would reallocate resources among States.

SAMHSA would like reauthorization for the formula grant programs, including the CMHS Projects for Assistance in Transition from Homelessness (PATH) program, the Comprehensive Community Mental Health Block Grant, and the Protection and Advocacy (P&A) program.

These programs include provisions for a smooth transition of the CMHS Block Grant programs into performance partnership grants. Performance partnership block grants would consolidate the 12 required State plan criteria for community mental health services into five criteria, and would reduce the number of mandatory requirements for substance abuse plans. Other discretionary CMHS grant authorities were proposed to be consolidated into one Knowledge Development and Application (KDA) program for mental health.

The KDA program redirects the focus of SAMHSA discretionary grant programs from supplementing and building services to a targeted approach to developing and applying knowledge in service systems at the State and local levels.

Appropriations

The proposed budget for fiscal year 1999, which begins October 1, 1998, must still go to conference between both chambers of Congress. Once they agree on funding levels, the spending bill will then either be vetoed or signed into law by the President.

Markups from both the House and Senate committees on appropriations overseeing the Department of Health and Human Resources are, respectively, as follows: $473 million (up $21.5 million) and $454.26 (up $3 million). The program increases, in millions of dollars, are:

House Senate
Performance Partnership Block Grant $13.4 no increase
Children's Mental Health Services $5.1 no increase
PATH $3.0 $2.0
Protection and Advocacy no increase $1.0


Center for Mental Health Services Proposed FY 1999 Budget

(Dollars in Millions)

FY 98 President's FY 99 Request House Markup Senate Markup
Knowledge Development
and Application
58 58 58 58
Children's Mental
Health Services
73 73 78 73
Protection and Advocacy 22 22 22 23
PATH 23 23 26 23
Mental Health performance
Partnership Block Grants
275 275 289 275
Total CMHS 451 451 473 454


Center Director's Activities

CMHS Director Bernard S. Arons, M.D., received a lifetime achievement award from the International Association of Psychosocial Rehabilitation Services. He was honored for his dedication to and leadership in improving the lives of people with mental illness.

Dr. Arons delivered a number of speeches at mental health conferences throughout the country. Among them were remarks to members of the American Psychiatric Association at their Annual Meeting in Toronto, Ontario, Canada in May; a speech at the Third Strategic Planning Retreat for the Comprehensive Community Health Services for Children and Their Families Program in Washington, D.C. in July; and a speech entitled "Audacious Imagination: Future of Mental Health Services" at the American Psychological Association's 106th Annual Meeting in San Francisco, California in August.

Dr. Arons also delivered opening remarks at the Training Institutes sponsored by the National Technical Assistance Center for Children's Mental Health, a CMHS technical assistance center, in Orlando, Florida, in June, and at the National Dialogue on Co-Occurring Mental Health and Substance Abuse Disorders, sponsored by the National Association of State Mental Health Program Directors and the National Association of State Drug Abuse Directors in Washington, D.C. in June.

In addition to participating in numerous public speaking engagements, Dr. Arons was interviewed for both live and print audiences. For example, Dr. Arons was the sole guest on the Armstrong Williams Show, a cable call-in program that reaches approximately 300,000 viewers in 40 States. The hour-long episode dealt with the cause and prevention of suicide. The high caliber of Dr. Arons' answers and the exceptional call-in response prompted Mr. Williams to invite Dr. Arons to return for another interview during Mental Health Awareness Week in October.

In the wake of the Capital Hill shootings, Dr. Arons was interviewed by U.S. News & World Report magazine (circulation 2.3 million) and the local CBS affiliate WUSA-TV 9. The interviews provided Dr. Arons with an opportunity to educate the public about paranoid schizophrenia and the links between mental illness and violence.

PROGRAM ACTIVITIES AND INITIATIVES


CMHS Office of the Director

Thomas H. Bornemann, Ed.D., Deputy Director, gave a presentation on the Surgeon General's Report on Mental Health at the 106th Annual Convention of the American Psychological Association in San Francisco, in August.

Associate Director for Medical Affairs

Melvyn R. Haas, M.D., Associate Director for Medical Affairs, and Paolo del Vecchio, Consumer Affairs Specialist, gave a presentation on the importance of dialogue between consumers and providers at The National Alliance on Mental Illness's annual meeting in Washington, D.C., in July.

The HIV/AIDS Steering Committee met in Washington, D.C., in July. Officers from the 11 sites, representatives of partner agencies, and other attendees addressed the HIV/AIDS Mental Health Services Demonstration Program and mental health needs of people living with and affected by HIV/AIDS.

Over the next several months, the HIV/AIDS Mental Health Services Demonstration Program will formally begin to disseminate findings about the mental health needs of people living with or affected by HIV/AIDS. This knowledge will shed new light on approaches to providing integrated care to persons with HIV/AIDS. Policy makers, health care providers, and others who serve this population will be able to learn from the experiences of the 11 grantees involved in the program and replicate the most promising approaches in their own communities.

The Medical Affairs Office in October will convene a group of psychiatrists to look at the implementation and effects of downsizing in psychiatry residency training programs.

Office of Managed Care

The Office of Managed Care initiated several new projects. These include the following:

  • Design and Costs of Mental Health/Substance Abuse (MH/SA) Benefits Under the State Children's Health Insurance Program

    This project will examine the professional literature, analyze options, and provide recommendations to States on the design and implementation of mental health and substance abuse benefits within the new State Children's Health Insurance Program (SCHIP). The analytic report will discuss the most effective methods, settings, and treatment modalities for reaching these children and for ensuring continuity of care; provide a framework for estimating costs associated with specific benefits, including rate setting methodology and case rates; and recommend strategies for adequate coverage of MH/SA services under SCHIP.

  • Managed Care Issues in Involuntary Treatment and School-based Mental Health Care

    This project will provide two independent policy analyses related to coverage under Medicaid managed care. Project One, "Court-Ordered or Involuntary Treatment Under Managed Care," will explore the consequences of including or excluding court-ordered mental health and substance abuse treatment in the scope of services covered by contracts between managed care organizations (MCOs) and State Medicaid agencies. Project Two, "School-based/School-linked Mental Health Services Under Managed Care," will explore options and models for these mental health services within managed care, as well as financing and reimbursement issues which affect the viability and expansion of these services. The study will examine States that include school-based/school-linked mental health services in State managed care contracts and will explore issues in managed care for maintaining and expanding these types of services.

  • Managed Care and Benefits Reports

    Three reports will be produced under this project. The first will update an annotated bibliography of mental health and substance abuse (MH/SA) services offered in managed care plans. The second will present focus group results from employers who provide generous MH/SA benefits. The third will present focus group results from managed care organizations concerning managed care contracting.

  • National Association of State Mental Health Program Directors, Managed Care Liaison

    This project will identify and coordinate the ongoing work related to managed mental health care provided by State Mental Health Agencies, the National Association of State Mental Health Directors, and the CMHS Office of Managed Care at the State and Federal levels. A major purpose of this project will be to improve coordination of these activities with the National Association of State Alcohol and Drug Abuse Directors through an identical project that is being funded by the Center for Substance Abuse Treatment (CSAT).

In addition, CMHS and CSAT will release on September 15, 1998, the results of a major study of national expenditures for mental health, alcohol, and other drug abuse treatment. This study, which is the first major update of spending estimates since those published by Rice et al., in 1990, is the result of a collaboration between the managed care offices in the two centers. Estimates will be presented by payer and type of provider for 1996, and trends since 1986 will be identified. The study also provides estimates that allow direct comparison with those published by the the Centers for Medicare and Medicaid Services for all health care.

Major findings from the study will be published in the September/October issue of Health Affairs. A full report will be available from CSAT and CMHS in October. Unlike previous studies, CMHS and CSAT intend to update these estimates annually to ensure that information on national spending for MH/SA services remains current.

Jeffrey A. Buck, Ph.D., Director, addressed the third Annual Conference of the National Association of County Behavioral Health Directors in Portland, Oregon, in July.

Office of External Liaison

Curtis R. Austin, Office of External Liaison (OEL) Director, in July attended the National Association of Black Journalists Annual Convention in Washington, D.C.

To ensure that the media and the general public have access to and receive information on mental health and mental illness in a timely fashion, the CMHS OEL established a "beat" system. A personal public affairs specialist has been assigned to each program office. The public affairs specialist will stay abreast of major initiatives within his or her assigned office/division and take a proactive role in getting that information out to the media.

OEL also recently developed an electronic log system for media inquiries. This system will enhance OEL's ability to analyze the nature and number of incoming media requests.

From June through August, OEL coordinated several major media interviews. In June, Melvyn Haas, M.D., Associate Director for Medical Affairs, was interviewed on bipolar disorder by the Boston Phoenix. The Boston Phoenix has a circulation of approximately 218,000. In addition, Jeffrey A. Buck, Ph.D., Director of the CMHS Office of Managed Care, provided information to the Los Angeles Times on insurance parity. The Los Angeles Times has a daily circulation of 1.02 million readers.

The OEL Consumer Affairs Office in June sponsored its second Regional Consumer Meeting in Kansas City, Missouri. This meeting solicited grassroots consumers' views on pressing needs and on needed responses. Representatives from Iowa, Kansas, Missouri, and Nebraska identified the top concerns as being self-help/consumer operated services, employment/loss of benefits, housing, medications, external grievance procedures, consumer training/education, crisis/emergency services, and meaningful participation in State planning councils.

A cross-agency group established in March to address President Clinton's directive to implement the Consumer Bill of Rights submitted a work-plan in July to the Substance Abuse and Mental Health Services Administration (SAMHSA) Administrator, Nelba Chavez, Ph.D. The work-plan proposes four overarching goals, various objectives, and numerous activities to implement the Consumer Bill of Rights throughout SAMHSA programs and activities. The goals are to establish a joint strategy for implementation with internal and external substance abuse and mental health communities, ensure that SAMHSA staff and its constituent community have the information and understanding needed to execute it, establish policies and materials to promote compliance, and encourage SAMHSA grantees and contractors to comply. The group sought recommendations from more than 30 external constituents such as providers, consumers, national organizations, and State program directors.

Building upon the success of the 1997 "Consumers and Psychiatrists in Dialogue" conference, a similar meeting in August was sponsored among 20 consumer leaders and psychologists in Washington, D.C. These meetings are designed to foster partnerships between consumers and practitioners; to review what hinders and assists recovery; and to explore ways to improve both clinical practice and the overall mental health service delivery system. A full report will be available on this meeting.

In collaboration with the Bazelon Center for Mental Health Law, CMHS sponsored the first-ever meeting of older adult mental health consumers. The goals of this gathering were to determine the self-identified needs of older adults, to explore mechanisms to strengthen networks, and to improve ways of communicating these concerns. A complete report of this meeting also will soon be made available.

Office of Policy, Planning, and Administration

Anita Sweetman and Sue Stanley, who participated on SAMHSA's Administrative Team, received the Secretary's Award for Distinguished Service "in recognition of the team effort to reengineer and streamline SAMHSA's administrative processes and procedures." Donna E. Shalala, Secretary of the Department of Health and Human Services, thanked the members for their commitment, leadership, and contributions to the Department.

Division of Knowledge Development and Systems Change

Michael J. English, J.D., Director, received the Secretary's Award for Distinguished Service from Donna E. Shalala, Secretary, Department of Health and Human Services. He received this honor for "visionary and dynamic leadership in managing new knowledge development and application initiatives to improve services for adults with serious mental illnesses and children with serious emotional disturbances."

Child, Adolescent, and Family Branch

Grantees of the "Circles of Care" for American Indian/Alaska Native communities (either federally recognized tribes or urban Indian programs), will plan, design, and assess the feasibility of implementing a culturally appropriate model of mental health services for children with serious emotional disturbances. This 3-year project is a collaboration among CMHS; the Indian Health Service; and the Department of Justice, Office of Juvenile Justice and Delinquency Prevention. This program will also address the problem of this ethnic group's over-representation in the juvenile justice system, suicide attempts in jails, and gang activity. Approximately nine sites will be funded.

Judith Katz-Levy, M.Ed., Senior Policy Analyst, in June gave a presentation on "Children with Serious Emotional Disturbances/Substance Abuse" at a the Centers for Medicare and Medicaid Services seminar on children with disabilities in Baltimore, Maryland.

Community Support Programs Branch

The Evaluation Center at the Human Services Research Institute, a CMHS technical assistance center under this Division, has developed a number toolkits: "Toolkit for Performance Measurement Using the MHSIP Consumer-Oriented Report Card" and "Implementing Process and Outcome Evaluations." The Evaluation Center also has conducted nearly 100 consultations on topics including performance measurement, outcomes instrument selection, research design, managed care evaluation, statistical analysis, and evaluation use.

In addition, the publication Outlook, which is published jointly by the Evaluation Center and the National Association of State Mental Health Program Directors Research Institute, has been distributed to nearly 3,000 users. The 15-page summer issue was on performance measurement systems.

The National GAINS Center for Individuals with Co-Occurring Disorders in the Criminal Justice System, a CMHS technical assistance center, has sponsored three topical meetings during the last quarter. The meetings addressed: adolescent girls in the juvenile justice system; a regional forum for localities developing targeted women's services in jails; and a meeting co-sponsored by the GAINS Center and the Soros Foundation on "The Implications of Managed Behavioral Health Care for Persons with Co-Occurring Disorders in the Justice System." Reports generated by each meeting will be available shortly through the GAINS Center.

Division of Program Development, Special Populations, and Projects

Division Director Brian Flynn, Ed.D., an internationally recognized authority in the field of disaster and emergency mental health, will be in Nairobi, Kenya, September 1-15, 1998. In the aftermath of the bombing of the U.S. Embassy in Nairobi, Dr. Flynn has been asked to gather information, provide guidance for immediate local actions, and provide a report with recommendations for both long- and short-term intervention, training, and education in the psychological sequelae of this event.

In another arena, CMHS is providing technical and material assistance to the Suicide Prevention Advocacy Network (SPAN). SPAN is a grassroots, nonprofit organization that is sponsoring the Suicide Prevention Conference in Reno, Nevada, in October. Robert DeMartino, M.D., Associate Director for the CMHS Program in Trauma, Terrorism, and Systems Consultation, sits as liaison on the conference steering committee. Among the conference's supporters are Surgeon General David Satcher, M.D., who will provide closing remarks at the conference, and Senator Harry Reid (D-NV), who was instrumental in the passage of Senate Resolution 84 which recognized suicide as a national problem and declared suicide prevention a national priority.

Material support from CMHS will allow State and county mental health officials to attend the conference. It also will help to produce and disseminate guidelines and other instructional materials resulting from the conference, as well as to develop a best practices synthesis regarding the prevention of youth suicide.

Emergency Services and Disaster Relief Branch

This CMHS Branch continues to be involved in multiple disaster crisis counseling programs in Colorado, Florida, Guam, Iowa, New York, North Dakota, Ohio, Pennsylvania, South Dakota, and West Virginia. A number of CMHS disaster mental health publications are under major revision. This Branch also coordinates its activities with numerous components of the Department of Health and Human Services, the Departments of Justice and Education, and The American Red Cross.

Collaboration with the Federal Emergency Management Agency on a stress management program for disaster relief workers continues, and a refresher training program was held in August at the Emergency Management Institute.

Special Programs Development Branch

Elzbieta Gozdziak, Ph.D., Public Health Advisor, and John Tuskan, R.N., participated in the Iraqi Refugee Initiative Meeting in Michigan in May. The meeting's goals were to provide a venue for Iraqi refugees to share their resettlement experiences, explore ways to improve cultural orientation and resettlement processes, and build on the strengths of this community and plan for the future.

Mr. Tuskan also gave a keynote presentation on "Refugees and Refugee Mental Health: The Spiritual Dimension" at the second International Islamic Unity Conference in Washington, D.C., in August.

Dr. Gozdziak and Mr. Tuskan also will present a paper entitled "Violence as a Political Instrument: A Public Health Perspective" at the annual meeting of the American Anthropological Association in Philadelphia, December 2-6. Dr. Gozdziak and Mr. Tuskan will use torture victims as a case example to demonstrate the effects of violence-both immediate and long-term-on individual victims, their families and community members, and on society at large. They also will briefly discuss approaches to assessment and treatment of torture survivors to help demonstrate the costs (both human suffering and financial) of this form of violence.

At this same meeting, Dr. Gozdziak will present the paper "Violence, Racism, and Population Dynamics." This paper will examine the increasingly prominent role of anthropology and public health in providing alternative insights into the area of violence. Various kinds of violence-including physical, structural, and political-both within the U.S. and in international communities will be examined. Some of the topics included in this discussion will be interethnic violence, the interplay between population dynamics and group identity with collective violence, the impact of gun-detection technologies on community and police relations, and the fragile balance between residents' desire for a safe community and personal freedom and civil rights. Program and policy recommendations, as well as suggestions for further research, will be provided.

Division of State and Community Systems Development
Protection and Advocacy Branch

This Branch in May helped sponsor the 21st Annual Conference of the Advocacy and Client Assistance Program Training in Washington, D.C. Representatives from Protection and Advocacy programs across the country gained valuable tools to help them improve the quality of their services.

In addition, CMHS plans to design and produce a poster to help end stigma against mental illness and people who have mental illnesses. To that end, a focus group of consumers of mental health services was convened in August. The focus group provided their perspective on what the message of the poster should be and how that message should be presented.

State Planning and Systems Development Branch

To fulfill its mission, CMHS must attend, not only to today's immediate mental health services needs, it must also look at emerging trends to determine, anticipate, and plan for future services needs. This Branch funded the Project on the Future of Mental Health Services, which is designed to bring together some of the most forward-thinking mental health policy makers, researchers, providers, consumers, and advocates in the country today. They gathered to identify the emerging environmental, political, legal, treatment, social, cultural, healthcare, and economic trends in the mental health service delivery system. A discussion of a preliminary report on this project is an agenda item for this Advisory Council meeting.

Survey and Analysis Branch

A new edition of the statistical guide, Mental Health, United States, 1998, will be available in late fall. Divided into six sections-current context, assessment of outcomes, assessment of performance, key factors in managed care, population bases analysis, and national statistics-this much-demanded resource sheds light on the essential components of the public health model, as well as the increasing complexity of the mental health field in an era of managed behavioral healthcare.

Ten policy papers on issues confronting the behavioral healthcare field with suggestions for future directions have been accepted for publication in a late 1998 special issue of the journal of the Washington Academy of Sciences. The papers address consumer, family, and provider issues; service integration for children and adults; the relationship between State Medicaid and State Mental Health Agencies; purchasing of mental health services by the public sector; and issues surrounding clinical practice guidelines, outcomes, and report cards.

Ronald Manderscheid, Ph.D., Branch Chief, gave a number of keynote speeches, participated in and chaired panel discussions, and convened various workshops. Among his activities are a keynote address at the Annual Meeting of the CMHS Systems in Kansas City, Kansas, in May; presenting a paper to the American Public Welfare Association's Annual Meeting on "Essential Quality Tools for Children," in Washington, D.C., in July; another keynote address at the Annual Rural Mental Health Conference, in Lexington, Kentucky, in June; chairmanship of the CMHS "Activities on Quality Tools Panel" at The National Alliance on Mental Illness Annual Meeting in Washington, D.C., also in July; a workshop on the "Automation of the Human Services Record," in San Diego, California in August; and remarks at the "Mental Health Component of the National Disability Survey, National Center for Health Statistics Disability Rollout, Annual Meeting on Disability Statistics in Washington, D.C.

In addition, Marilyn Henderson, M.Sc., Supervisory Survey Statistician, in June convened a focus group on clinical practice guidelines in Washington, D.C.

Memoranda of Understanding Between Agencies

CMHS, the Center for Substance Abuse Treatment (CSAT), and the Center for Substance Abuse Prevention (CSAP) have entered into a "Cooperative Agreement to Study Women with Alcohol, Drug Abuse, and Mental Health (ADM) Disorders Who Have Histories of Violence." This initiative is designed to study the complex interaction of violence, substance abuse, and mental health disorders on women who are victims of violence and the children they rear. Phase One of this two-phase study will develop an integrated system of care with services intervention models, implement the qualitative phase one evaluation, and develop evaluation protocols for Phase Two.

This cooperative agreement is based, in large part, on a number of meetings CMHS sponsored over the last six months. Among those meetings were "Mothers with Psychiatric Disabilities," "Awakening from Silence: Self-inflicted Injury in the Lives of Women and Girls," and "Responding to the Behavioral Health Care Issues of Persons with Histories of Physical and Sexual Abuse: A National Experts Meeting."

ORGANIZATIONAL/PERSONNEL UPDATES

Office of the Director

Christine L. Guthrie, M.Ph., Special Assistant to the Deputy Director, assists in analyzing health and related data, interpreting policy and providing guidance on a range of personnel activities, preparing reports of findings, and conducting special studies.

As an officer in the Public Health Service commissioned Corps, she has analyzed the mental health and substance abuse provisions of State Child Health Insurance Program plans to determine breadth of coverage, flexibility, family orientation, and to propose outreach strategies.

During graduate school at the University of North Carolina, Ms. Guthrie was part of a team to develop and implement suggestions for evaluating the quality of health components of the "Smart Start" program, a county-based intervention to prepare young children for success in school. Ms. Guthrie also has worked as a school counselor, a medical social worker, and a coordinator and trainer for a suicide prevention education program. She is fluent in Spanish.

Office of Managed Care

Tiffany Ho, M.D., joins CMHS as a senior medical policy advisor with expertise on insurance benefit design, as well as medical and psychiatric issues related to managed care. Dr. Ho received her medical degree from the University of Pennsylvania School of Medicine and complete her residency in psychiatry at the University of California, San Francisco. She has served as a Health Policy Fellow on the House Ways and Means Subcommittee, working on the staff of Representative Pete Stark (D-CA).

Dr. Ho has provided outpatient psychiatric treatment and consultation, supervised residential, inpatient, and emergency facilities, and participated in a fact-finding mission organized by the American Psychiatric Association to study mental health system of South Africa. In addition, she has been an active member of the American Psychiatric Association's Joint Commission of Government Relations and the council on International Affairs. Dr. Ho also has participated in medical missions in Vietnam, Honduras, the Dominican Republic, and Jamaica.

Child, Adolescent, and Family Branch

In April and May 1998, three new staff members joined this Branch:

Elizabeth Sweet (Liz), M. Ed. Ms. Sweet's primary responsibility is to serve as Program Director for the Statewide Family Network Grants. Formerly she was the Executive Director of the North Dakota Federation of Families For Children's Mental Health. Ms. Sweet's expertise comes from her experience as the mother of three children with special needs, and one son who came to live with Ms. Sweet and her husband at the age of eight from institutional care. Ms. Sweet's background includes a B.A. in social work and an M.A. in guidance and counseling. She is licensed as an addiction counselor in North Dakota and is also a licensed professional counselor. She worked for three years as a case manager for adults with developmental disabilities. Ms. Sweet then worked for seven years with adolescents and their families as an addiction counselor in a private inpatient facility. She then held responsibilities for the women's addiction program in that same facility. Ms. Sweet's commitment to her family and this work make her an asset to the team in the Child, Adolescent and Family Branch. She also gives voice to the concern of parents at the Federal level within the Comprehensive Community Mental Health Services Program for Children and Their Families.

Louise M. Peloquin, Ph.D., serves as the program director for the communications campaign. This national campaign, which was transferred from the Office of External Liaison in November 1997, assists the 31 grantee sites in the full range of community outreach programs including social marketing, spokesperson training, product development, and media relations. Dr. Peloquin brings a unique combination of education and experience to this position.

Her doctorate is in education/psychology. She also holds masters degrees in education/counseling and clinical-administration social work. Over the past 20 years, she has served as a researcher, trainer, and public health advisor to government agencies and nonprofit organizations such as Planned Parenthood of Metropolitan Washington, Lamaze Childbirth Association, and the March of Dimes Birth Defects Foundation.

For the past seven years Dr. Peloquin served as a senior project director with an international consulting firm and was responsible for collaborating with researchers, physicians, nurses, mental health providers, and allied health professionals in developing appropriate training and technical assistance in prevention, early identification and treatment of substance abuse. Her duties included developing, conducting, and coordinating educational activities, such as social marketing and dissemination approaches, under a contract sponsored by the Center for Substance Abuse Prevention. The focus of this work was to integrate prevention and treatment initiatives in mental health and disease prevention for special populations. Dr. Peloquin's background combines working with children, families, and community-based programs as a licensed clinical social worker, as well as developing social marketing and health communication programs.

Ms. Roslyn Holliday Moore serves as the program director for the urban grantee sites and the National Resource Network at the Washington Business Group on Health. Ms. Moore received her B.S., in speech-language pathology, and an M.S., in speech-language pathology from Columbia University. Ms. Moore's 22 years of experience combines providing direct services as a speech-language pathologist in a State operated children's psychiatric facility with administrative responsibilities as an inpatient program coordinator. Before joining the Child, Adolescent, and Family Branch she served for three years as the director of FRIENDS (Families Reaching in Ever New Directions) initiative.

In this position she directed all activities related to the implementation of a community-based system of care program funded through CMHS. This included developing and implementing transition management plans in inpatient and outpatient mental health settings, coordinating community division programs with main campus operations of a children's psychiatric center, maintaining Division budgets and monitoring program expenditures, and eliciting support from borough providers and the NYC Department of Mental Health to increase consumer participation in policy development and political decisions. This combination of education and experience has provided Ms. Moore with an in-depth overview of the principles and program requirements for grantee sites in the Child, Adolescent, and Family Branch.

Homeless Programs Branch

Bruce DeForge, Ph.D., will join the Branch on Sept. 14, 1998, and will serve as the associate director of evaluation. Dr. DeForge comes to CMHS from the Department of Family Medicine at the University of Maryland, Baltimore, where he served as the director of research. He also was adjunct faculty in the School of Social Work at the university. Prior to his employment there, he served as the lead data analyst/manager of a research demonstration funded by NIMH. This project investigated the effectiveness of linking housing and treatments for homeless individuals with serious mental illnesses. Dr. DeForge will help create in-house data bases from CMHS knowledge development initiatives that allow the Center to continue to explore knowledge application opportunities. In addition, he will assume project officer responsibilities related to his areas of expertise.

Protection and Advocacy Branch

Carlotta F. Donehue is a Presidential Management Intern within the Department of Human Health Services and serves as a Project Officer/Public Health Advisor for the CMHS Protection and Advocacy for Individuals with Mental Illness Office.

Ms. Donehue holds an M.A. in Rehabilitation from South Carolina State University in Orangeburg. She completed a six-month internship in the in the psychology department of the Federal Correctional Institution in Estill, SC, where she focused on the linkage between substance abuse/ mental health and abuse/neglect within the corrections system. As an undergraduate, she worked in a juvenile correctional residential facility advocating for the rights of children. During her tenure as the director of the facility, Ms. Donehue gained expertise in community based programming, behavioral management models, and legal advocacy. In addition, Ms. Donehue has served as a public school teacher working with children who have special needs, both physical disabilities and serious emotional disturbances.

Ms. Donehue has extensive experience in mental health, public health, human service, and legal advocacy issues. As a PAIMI Project Officer, Ms. Donehue draws on her experience and skills to perform policy and planning development activities and provide national direction as well as technical assistance to the designated P&A systems in the 50 states, six territories, and the District of Columbia.

Special Programs Development Branch

In September, Nancy Davis, Ph.D., joins this CMHS Branch. Dr. Davis is a licensed psychologist and received her doctorate from Harvard University in counseling and consulting psychology. While in the Boston area, she was the director of post doctoral training at the Danielsen Institute at Boston University and the director of psychiatric and substance abuse programs at the Charles River Hospital. Most recently, Dr. Davis has been working in private practice and on the integration of psychological and medical services in Chattanooga, Tennessee. Other areas of specialization include addictive behaviors, domestic violence, wellness, and cardiac rehabilitation.

Titles of her published articles include, Treating the Substance Abusing Trauma Survivor; Medical and Emotional Issues of Perimenopause and Menopause; The Psychologist's Role in the Campaign Against Domestic Violence; and Transitions in the Lives of Women. She has written two text books on human development and the psychology of the human life cycle. Dr. Davis will assume the lead in the Branch on women's issues and will assist in CMHS initiatives on resilience.

State Planning and Systems Development Branch

Albert Byrd, M.S.W., has over 30 years experience at the State and Federal levels. As a career employee within the Department of Health and Human Services, Mr. Byrd currently works with the Assistant Secretary on Aging. He participated in the Mini White House Conference on Mental Health and Aging where he was instrumental in developing recommendations for knowledge development and application.

Mr. Byrd has worked on quality control issues, service guidelines and practice assessment initiatives, formula block and discretionary grant programs, health program analysis, and policy and program activities in a number of DHHS agencies. In addition, Mr. Byrd has extensive experience working collaboratively with business and voluntary sectors, as well as with congressional committees on matters related to public health, housing, employment, transportation, welfare, and services integration.

His direct involvement in the implementation of White House Executive Orders and Directives to the Secretary of Health and Human Services positions him well in the formulation and implementation of policy and practices related to working with States in building comprehensive coordinated community-based systems of services for people at risk. He also has played a pivotal role in developing National, State, and community level initiatives to prevent substance and prescription drug misuse and mental illness.

Addendum

In addition to the projects previously described, the Division of Knowledge Development and Systems Change as well as the Division of State and Community Systems Development report the following activities:

Division of Knowledge Development and Systems Change

  • Delivered five papers that identify lessons-learned from a decade of research and service delivery experience to an expert consensus meeting on exemplary service delivery for homeless persons. These papers discussed outreach/engagement, case management, clinical services, transition of homeless persons to mainstream providers, and responsiveness to emerging policy issues. This meeting was held with representatives from the Health Resources and Services Administration's Healthcare for the Homeless Program and the Assistant Secretary of Planning and Evaluation, Department of Health and Human Services.
  • Completed Phase I of the Housing Initiative in which each grantee evaluated and documented the availability of two different housing models and the capacity to recruit residents for an adequate research study.
  • Recruited consumers for the fourth and final cohort of interviews in the Access to Community Care and Effective Services and Supports (ACCESS) study. These interviews will help determine whether or not the improved outcomes observed in the 12-month follow-up of cohorts one and two are maintained.
  • Developed and adopted a multi-tiered framework for viewing services for co-occurring disorders using a severity matrix. The matrix allows locus of responsibility, financing streams, and coordination mechanisms to be mapped against client populations defined in terms of severity of the problems rather than discrete diagnostic categories or rigid functional definitions. This framework is the result of a meeting, sponsored by CMHS and the Center for Substance Abuse Treatment, to define and highlight opportunities for improving services for persons with co-occurring mental health and substance abuse disorders. The meeting was conducted by the National Association of State Mental Health Program Directors and the National Association of State Alcohol and Drug Administration Directors.
  • Analyzed findings from evaluations of the Children's Services Grants conducted from 1993 to 1998. These findings indicate significant improvements in school attendance, grades, law enforcement contacts, and placement stability for children with serious emotional disturbances. This information was included in the annual report to Congress on the Comprehensive Community Mental Health Services Program for Children and Their Families.
  • Received findings from the Managed Care Impacts on Children Study, conducted at the University of Pittsburgh. These findings indicate that 1) participants in managed care organizations are one-third as likely to use specialty mental health services compared to those whose insurance provides fee-for-service benefits; 2) African-American adolescents and teens enrolled in managed care organizations are half as likely to use specialty mental health services as European-American adolescents and teens whose insurance provides fee-for-service benefits; 3) children with psychiatric inpatient stays are less likely to join a managed care organization and tend to disenroll at a higher rate; 4) participants in managed care organizations are more likely to experience delays in care; 5) families are likely to join managed care organizations for benefits such as dental and eye care, and no co-pay for prescription drugs; and 6) parents are likely to join a managed care organization for general healthcare yet enroll their children in fee-for-service plans to receive more flexible mental health benefits for their children.

Division of State and Community Systems Development
  • Streamlined and refined the Mental Health Performance Partnership Block Grant application process. These revisions allow a choice between submitting a consolidated five-criteria plan or the traditional 12-criteria plan. Using either format, a State can submit a 1-, 2-, or 3-year plan.
  • Embarked on a project to explore how new models of health care reform affect service organization and delivery; the implications of these changes for the evolution of system guidelines for services delivery; and the large-scale modifications necessary in data systems to accommodate and monitor these changes. This work will be coordinated with parallel Federal entities involved in health, substance abuse, and long-term care, and their associated national organizations.
  • Approved a data collection project to help understand the effects of managed care, as well as expand the number of States for which Medicaid data are analyzed and the number of private plans covered. Analyses will show major findings on utilization costs under Medicaid, Medicare, and private insurance programs. The project will provide CMHS with updated information from States that have entered Medicaid managed care for comparison with previous results, as well as information to managed care plans. This project continues and builds on previous work by CMHS.
  • Initiated an interagency agreement with the Bureau of Justice Assistance at the U.S. Department of Justice to conduct a 1-year feasibility study to establish a comprehensive tribal mental health and substance abuse prevention and treatment facility in Alaska for children with co-occurring mental health and substance abuse disorders and their families. This study will be a collaborative undertaking involving the CMHS Child, Adolescent, and Family Branch, the Center for Substance Abuse Treatment, the Center for Substance Abuse Prevention, the Indian Health Service, and local tribal organizations.
  • Launched an initiative to assess the effectiveness of the community Mental Health Services Block in meeting the mental health needs of underserved populations. These populations include, but are not limited to, persons in the juvenile and criminal justice systems, the elderly, and individuals with co-occurring mental health and substance abuse disorders. This initiative is a collaborative effort with the National Association of State Mental Health Program Directors, the National Mental Health Association, the Federation of Families for Children's Mental Health, the Bazelon Center for Mental Health Law, Families U.S.A. Foundation, and the University of Colorado's Division of American Indian and Alaska Natives Programs.

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