Mental Health: Systems Transformation

NEW HAMPSHIRE

Grant Information

Name of Grantee

State of New Hampshire, Bureau of Behavioral Health (BBH)

Title of Grant

Statewide Implementation of Illness Management and Recovery (IMR) for Consumers with Severe Mental Illness (SMI)

Type of Grant

Mental Health: Systems Transformation

Amount of Grant

$300,000

Year Original Funding Received

2004

Contact Information

Norman Cordell, Project Co-Director
Office of Medicaid Business and Policy
603-271-4297
ncordell@dhhs.state.nh.us

Erik Riera, Project Director
Bureau of Behavioral Health (BBH)
105 Pleasant Street, Main Building
Concord, NH 03301
603-271-5000
eriera@dhhs.state.nh.us

Subcontractor(s)

Kim Mueser, Consultant/Training Director
NH-Dartmouth Psychiatric Research Center (PRC)
603-271-5226
Kim.T.Mueser@dartmouth.edu

Target Population(s)

Individuals with severe mental illness (SMI).

Goals

  • Implement Illness Management and Recovery (IMR) as an evidence-based practice (EBP) in a comprehensive manner throughout the Bureau of Behavioral Health (BBH) services structures to support consumers in their recovery process.
  • Involve consumers and family members formally in the evaluation of IMR services by incorporating consumers and family members in the fidelity teams assessing the IMR practice at the community mental health centers.
  • Develop an organizational structure that specifies IMR clinician specialist teams in each community health region to be responsible for delivering the services, as well as an IMR supervisor at each center and an IMR coordinator at BBH.
  • Develop a credentialing process for IMR providers, including staff at community mental health centers and state psychiatric facilities.
  • Explore the involvement of consumers in the provision of IMR to individuals receiving services at community mental health centers.

Activities

  • Establish a permanent state IMR team, including a permanent liaison coordinator at BBH, to oversee and implement the grant project and to become the advisory board for an IMR Center of Excellence.
  • Develop an IMR implementation plan, outcome measures, and a quality assurance plan.
  • Establish IMR clinician specialist teams to train regional providers in IMR foundation principles, IMR overview, and IMR skills.
  • Improve financial incentives for implementing IMR by restructuring Medicaid guidelines and by offsetting the cost of IMR training and supervision with grant funding.
  • Establish a benchmark for the attainment of critical IMR workforce skills-including participation in training, knowledge base, observable skills, and supervised practice experience-as a foundation for a credentialing process.
  • Establish an IMR Center of Excellence, to include partnerships with all stakeholders, that will become the State's focal point for providing technical assistance and training in IMR.

Abstract

The New Hampshire BBH will implement the EBP IMR program statewide to empower consumers to better manage their mental illness and reclaim their lives by supporting their pursuit of personal recovery goals. The critical ingredients of IMR are supported by multiple controlled studies and include psycho-education, strategies for improving medication adherence, developing a relapse prevention plan, and enhancing skills for coping with persistent symptoms.

Implementation analyses of the IMR program and other EBPs conducted in New Hampshire and across the country have identified barriers to accessing IMR, including lack of a coherent service structure for IMR, a mismatch between Medicaid-reimbursable procedures and some key components of evidence-based IMR interventions, lack of involvement of consumer providers, and the need for ongoing mechanisms to ensure access to training and to sustain high-quality services. The grant will be used to address these barriers to IMR in New Hampshire as follows: (1) establish a coherent service structure for delivering and monitoring IMR in every community mental health center/peer-support program region (and the two state-operated inpatient facilities) involving trained clinician IMR service providers at each site, a supervisor, and a state IMR coordinator; (2) provide training for IMR in each community mental health center/peer-support program region and state-run inpatient facilities, and consultation to center administrations; (3) develop recommendations for modifying Medicaid reimbursement guidelines to support provision of IMR services; (4) develop an IMR state team at the BBH level to lead, monitor, and continuously improve the system transformation; (5) develop credentialing procedures and standards to facilitate long-term Medicaid reimbursement capability; and (6) establish a Center of Excellence for IMR services that will provide training and consultation to both centers and the State to ensure sustainability of collaborative high-quality IMR services throughout New Hampshire.

BBH has already convened a multi-stakeholder EBP team comprising consumers, family members, community mental health providers, BBH, and NH-Dartmouth Psychiatric Research Center (PRC). This team has been meeting on a regular basis and has unanimously endorsed this IMR project.