Candidate Success Spotlight: Advantage Behavioral Health Systems
A conversation with Advantage Behavioral Health Systems leaders about their efforts to prepare for CCBHC certification
What has preparing for certification been like so far?
Tamara: It has been exciting to see the benefits and positive outcomes from our clients through Care Coordination partnerships with local hospitals. Our clients have easy access to physical health screening, monitoring, and follow-up of medical issues while addressing their behavioral health concerns. Also, we collect data through assessments in our electronic health record that show our clients are getting better as a result of treatment by tracking the reduction of their symptoms.
Shannon: It has really been a team effort across the agency and a notable enhancement of Advantage’s services for the community. The move to a CCBHC model has allowed us to re-imagine our system of care to ensure that the services that we provide are of the highest quality and meet the needs of our community.
Our certification process began with a review of the CCBHC guidelines and identifying areas where we needed to implement new workflows or services, amend policies or procedures, establish or formalize community partnerships, and collect data for quality metrics. We created a tracking process, a set of files to house our evidence and a timeline for completing activities. For us, the areas that required concentrated focus were developing an integrated primary and behavioral healthcare system, developing care coordination infrastructure, enhancing staff competencies in trauma-specific treatments, and developing a measurement-based system of care.
We are lucky at Advantage to have a talented and dedicated team of staff who are excited about the opportunities in the CCBHC model and who helped us implement the Advantage vision of CCBHC. Because we were SAMHSA grantees in 2021, our initial implementation occurred during four months that autumn, and we attested at the end of December 2021. It was a whirlwind, but also exciting to see so many important changes happening for the agency and our clients and staff. Our preparation for certification for CCBHC with DBHDD has been less rushed, thankfully, but we have maintained our original trajectory: establish a team, set the vision, identify the operational changes and data tracking needed, develop a specific plan and timeline, and then do it!
As you prepare, what are some of the notable changes you have seen?
Tamara: Staff are trained in evidence-based practices that focus on trauma-informed care, understanding military culture to serve veterans, cultural competency, and access to primary care services through coordination of integrated health services for individuals we serve.
Shannon: The move to CCBHC for Advantage has been transformational on so many levels, but there are three areas that were significantly impactful for us.
First, the implementation of care coordination and integrated health services at Advantage has been one of the most successful changes to date. As safety net behavioral health providers, we know that our patient population has a high incidence of medical comorbidities, experiences difficulty accessing consistent medical care, and struggles with the management of chronic health conditions – all of which impact behavioral health concerns. For the subset of our population that is the most psychiatrically acute, the barriers to accessing consistent medical care are even more significant.
At Advantage, the development of the Integrated Health Service line included establishing relationships with both local medical hospitals for data sharing, which means that we have the ability to electronically access and share health information with our clients’ other medical providers. This type of collaboration between providers automatically improves care both with Advantage and with non-Advantage providers. For clients who need more support in accessing physical health care needs, the care coordination team has been successful in streamlining referrals to outside providers and helping to ensure that clients are keeping up with appointments, accessing needed specialist services, and addressing barriers such as transportation, to ensure that care is received. We were also able to add health education programming and on-site primary care at our largest clinic in order to ensure that clients without medical insurance could receive needed medical care alongside behavioral healthcare.
Second, the ability to focus on clinical training and competency of our staff meant that we could provide training and ongoing consultation/support for our staff to learn evidence-based practices. We focused on trauma-specific treatments initially and are scheduled to expand offerings to include family- and youth-focused treatments in the next year. Prior to CCBHC, the clinical staff were offered minimal opportunities for professional development during the work week, because in a fee-for-service environment, the focus is on the volume of clients seen rather than on the quality of care provided.
This focus on quality over volume is really the game-changer with CCBHC and I am so grateful and excited that Georgia has chosen to embrace this model of care. Enhanced education and competency activities improve the care we provide to clients, but they also improve the environment for the direct service staff. It allows them time to breathe, think about and plan the care they are providing, consult with one another on difficult situations, and really assess whether the interventions they have provided are effective. All of this translates to meaningful care and to a collaborative and professionally fulfilling environment for our staff.
Finally, the ability to rely on quality metrics rather than on counting metrics to evaluate our system is one of the biggest and most impactful changes that CCBHC brought for Advantage. Evaluating based on whether our care is effective and whether we are providing evidence-based interventions is a completely different way of thinking about care than being evaluated based on things like how many clients were seen or how often clients missed appointments. In a system that is providing care to people, measurement should be meaningful. In order to be meaningful it has to have a focus and tell you a clear story about your care system such that you can easily identify where changes or improvements need to be made.
Advantage’s shift to quality measurement has been significant for this reason and has allowed us to begin to use clinical measures data with staff at the program level. At this point, we are starting to have staff ask us for quality data so that they can evaluate whether they are providing effective care. Every time that happens, I get an excited phone call or an email from our outcomes team about how they were able to assist in answering a question that will help a client receive better care. It doesn’t get better than that!
What tips would you offer to others who are preparing for certification?
Tamara: Establish an implementation team immediately, create a crosswalk that includes each criteria and the evidence that demonstrates each criteria is met, and utilize information provided from community needs assessment to address service gaps. Regularly evaluate progress and areas that need more attention.
Shannon: 1. Think about your data collection needs alongside your workflow and documentation changes. Your workflow is your data collection mechanism and it’s important to ensure that it is efficient for the staff so that required elements don’t get missed or ignored.
2. Get your agency on board with the CCBHC vision from the start and keep it in the conversation. We had better success when staff understood how CCBHC would change the service environment and bring improvements for both them and their clients.
3. Stay organized and don’t wait until the last minute to collect evidence. There are a lot of documents and other materials that you need in order to demonstrate that you meet certification requirements. It’s easier to establish the system for how you will store the evidence at the beginning and then add things as they are completed.
What will certification mean for your community?
Tamara: Certification will help provide targeted outreach to underserved communities, improving access to care, and reducing health disparities in the communities we serve.
Shannon: Very simply, it means better care for the clients that receive treatment from us. I think it also means better relationships and collaboration with other providers, which allows behavioral healthcare to become more embedded in the larger healthcare system. It is my hope, too, that the development of CCBHC will mean that there is increased access to quality integrated care that will reduce crisis encounters and help mitigate the current burden on the state’s crisis system. Overall, I believe that CCBHC will enhance the continuum of care for our clients and create a trusted, reliable behavioral health center that is more than a safety net.
