Virtual workshop sessions

Description:

In this session, participants will learn about contingency management, an evidence-based approach to substance use disorder treatment. Participants will hear directly from subject matter experts on contingency management, as well as providers and program staff who have implemented these programs in a variety of settings. The presenters will also share the factors — existing research, billing, objectives/focus, population, etc. — they took into consideration in standing up the contingency management program in their particular settings and states. This session will also highlight the implications of billing Medicaid for contingency management services.

Presenters:

• Zackiya Grant-Knight, MPH, Program Officer, Center for Health Care Strategies
• Dr. Richard Rawson, Professor Emeritus, UCLA
• Diane Del Pozo, Registered Nurse, ACHCH
• Jovan Yglecias, Chief Program Officer, Bay Area Community Services

Description:

Healthcare organizations are increasingly contracting with community-based organizations, including networks of CBOs organized by a community care hub (CCH), to deliver social care services (such as CalAIM’s Community Supports) as part of a whole person care approach. Differences between the sectors can make the contracting and implementation of these partnerships challenging. This session will discuss the experiences of both health plans and CBO/CCHs in the contracting process and introduce a new four-part guide recently developed by the Partnership to Align Social Care for healthcare organizations seeking to contract with CBOs and CBO networks.

Presenters:

• Mark Humowiecki, Senior Director, Camden Coalition
• Beau Hennemann, RVP, Local Engagement and Plan Performance, Anthem
• Anwar Zoueihid, Vice President, Long term Services & Supports, Partners in Care Foundation

Live streamed from the conference to the virtual platform

Description:

Access to stable housing is a foundation for improvements in health and the effective use of medical services. Cambridge Health Alliance, a safety net health system, and Vinfen, a human services organization, have partnered to provide comprehensive housing support to a diverse community in Massachusetts through a MassHealth (the Massachusetts Medicaid program) Section 1115 Waiver.  By addressing the social drivers of health, the housing program works to reduce healthcare costs. The workshop will discuss the housing program design process and best practices in care delivery and cross-sector collaboration. An individual who has completed the housing program will share their lived experience with the program.

Presenters:

• Hallie Tosher, Manager, Population Health Program Development, Cambridge Health Alliance
• Laura Palmer, Flexible Services Program Coordinator, Cambridge Health Alliance
• Lisa Goldsmith, Vice President of Integrated Care, Vinfen
• Stefanie Gamse, Flexible Housing Program Manager, Vinfen

Description:

People who are currently spending or who have previously spent time in jails, youth correctional facilities, or prisons are at higher risk for injury and death than the general public, and the point of release from a correctional facility is an especially vulnerable time for these individuals. On January 26, 2023, California became the first state in the nation approved to offer a targeted set of Medicaid services to youth and adults in state prisons, county jails, and youth correctional facilities for up to 90 days prior to release. This workshop will provide an overview of California’s approved federal Medicaid demonstration waiver.

Presenters:

• Autumn Boylan, Deputy Director, CA Department of Health Care Services
• Sydney Armendariz, Chief, Justice-involved Reentry Services Branch, DHCS

Description:

Community responder programs position health professionals and staff as first responders to 911 and other emergency calls to provide community safety services in situations that don’t involve violence or serious crime. These civilian teams provide immediate assistance for people experiencing behavioral health crises, conduct wellness checks, help people with housing needs, and more. The expansion of these models will improve connections to social services and reduce the likelihood of use of force, injury, or arrest, improving individual health outcomes, enhancing the dignity for people experiencing crises or other disruptions, and reducing their reliance on emergency services.

Presenters:

• Anne Larsen, Program Manager, The Council of State Governments, Justice Center
• Earl Miller, Director of CRESS, Town of Amherst
• Melissa McKee, Policy Analyst, The Council of State Governments, Justice Center

Description:

Faith Health Advocates (FHA) /Community Health Workers (CHWs) are lay members of the community who work either for or in association with community health in both urban and rural environments. FHAs/CHWs usually share ethnicity, language, socioeconomic status, and lived experiences with the community members they serve.

Camden AHEC has been successful with structuring a model with Faith Based Organizations/ Faith Health Advocates to address the healthcare concerns of the community.

The strategy to get our community stakeholders and neighbors alike invested in better healthcare outcomes and mental health hygiene is essentially “Elevating behavioral health in whole-person care”.

Presenters:

• Martha Chavis, President & CEO, Camden AHEC

Description:

This session will outline how Landmark Health leveraged behavioral health collaborative care in a home-based geriatric medical practice to improve access to behavioral health care. The Landmark team applied a treat to target approach that included brief behavioral health interventions, care management, and medication management when clinically indicated, leveraging a robust, interdisciplinary team working together to achieve improved outcomes for patients with complex healthcare needs.

Presenters:

• Tanni Bromley, Senior Director, Behavioral Health, Landmark Health, Optum Home and Community Care
• Dr. Christopher Dennis, Chief Behavioral Health Officer, Landmark Health

Description:

Two-generational, person-centered, and team-based care can holistically help address behavioral health issues and complex health-related social needs of children, youth, and their families. Presenters from the ADOBE program serving two clinics in Albuquerque, New Mexico will spotlight strategies for implementing wrap-around services and family navigator supports for juvenile justice-involved youths and their families. Staff from St. Christopher’s Collaborative Primary Care Clinic in Philadelphia, Pennsylvania will showcase how providers can effectively collaborate with social workers to administer social screeners and provide trauma-informed behavioral health referrals for youth and families. The presenters will address how these models were designed, implemented, tested, and funded.

Presenters:

• Armelle Casau, Senior Program Officer, Center for Health Care Strategies
• Dr. Andrew Hsi, Emeritus Director, Institute for Resilience, Health, and Justice; Emeritus Professor of Pediatrics and Family and Community Medicine, ADOBE Program, University of New Mexico Health Sciences Center
• Jennifer Daniels, Clinical Coordinator, ADOBE Program, University of New Mexico Health Sciences Center
• Ann Cushwa, Primary Social Worker, The Center for Collaborative Primary Care at St. Christopher’s Pediatrics

Description:

Walking through the lessons learned in building a CalAIM-based program, the presenters will discuss the journey from the dream to outcomes. Touchpoints will highlight the obstacles that surfaced and the problem solving needed to keep going, break down barriers, and build collaborative networks to address client needs through whole-person care. This includes the obstacle of staff recruitment/retention and the need for flexibility, support, training, and self-care.  With an emphasis on patient-centered, trauma-informed care using a strengths-based approach, presenters will discuss 6 domains of health highlighting the importance of behavioral health as a foundational need within the at-risk population.

Presenters:

• Kym Centaro, Program Director, Housing and Wellness Program of Community Support Network
• Dr. Carrie Lara, Clinical Director, Housing and Wellness Program of Community Support Network
• Erika Klohe, LCSW, Regional Director of Behavioral Health, Buckelew Programs

Description:

In 2015, a federally qualified health center in Oregon started a complex care program within primary care. This three-team-member program operated within the medical model, leaving behavioral and social needs unmet. In 2019, the Complex Care Team created a unique position that organizationally is under behavioral health but works entirely with the Complex Care Team. This position incorporates the best of several job titles, guided by the Camden Coalition’s complex care core competencies. This model has been largely successful, requiring learning and adaptations. We will share the strengths and challenges of the model, giving participants inspiration and guidance for their own adaptations.

Presenters:

• Jessyca Delephine, High Complexity Care Case Manager, Benton County Health Department
• Jennifer Micek, Complex care physician, Community Health Centers of Benton and Linn Counties
• Grace Robinson, Complex Care Consumer, Benton County Health

Description:

The Family Navigator Program at the University of Miami has been offering services to families living with disabilities, behavioral concerns, and complex medical and social needs in South Florida. This successful program serves a diverse population facing health inequities due to multiple factors. We will walk participants through our process and lessons learned, review barriers and solutions to connection with services, discuss the importance of lived experience of family navigators in supporting a person-centered healthcare system, and describe the ongoing project of bringing together family navigation programs to collectively learn from best practices.

Presenters:

• Nancy Torres, Program Director, University of Miami
• Maite Schenker, Faculty Lead and PI, University of Miami
• Paulina Wolff, Family Navigator, University of Miami
• Teronna Maddox, Family Navigator, University of Miami

Description:

There is a lack of data about the preferences and specific needs of individuals dually eligible for Medicare and Medicaid who come from communities that are majority Black, Indigenous and people of color (BIPOC), and who need home- and community-based care (HCBS). The session will focus on a pilot study in CA that took intentional steps to establish relationships with three BIPOC organizations and dually eligible individuals from BIPOC communities to co-create a set of questions that more accurately and consistently capture what matters most to these individuals as they engage with the HCBS system.

Presenters:

• Leena Sharma, MPP, Deputy Director, Center for Community Engagement in Health Innovation, Community Catalyst
• Marc Cohen, PhD, Research Director/Co-Director, LeadingAge LTSS Center @UMass

Description:

This presentation will discuss how an interprofessional social work-led team was able to integrate evidence-based group interventions for chronic condition management, pain management, cancer survivorship, emotional wellness, and fall prevention into community-based organizations, health clinics, and behavioral health and wellness centers, utilizing community health workers and individuals from the community with lived experience as facilitators of these interventions. The presentation utilizes case studies, problem solving activities, and small group discussion to practice the strategies outlined. Overall, the presentation will demonstrate how implementing these impactful interventions through these strategies has proven to be effective and empowering for both participants and trained facilitators.

Presenters:

• Padraic Stanley, Program Manager of Community Integration, RUSH University Medical Center
• Yessenia Cervantes-Vazquez, Lead Community Health Worker, RUSH University Medical Center

Description:

This presentation describes the Queen’s Care Coalition (QCC) and our program model that increases patients’ sense of mauli ola (whole-self wellness) by focusing on pilina (building strong relationships), using hospital- and community-based patient navigators, social workers, and clinical staff. Navigators address social determinants of health and connect patients with existing community resources to reduce hospital utilization and improve access to primary care and behavioral health services. Priority is given to Native Hawaiians. Compared to pre-intervention, QCC patients had decreased ED visits by 60% and there was an 82% decrease in 30-day hospital readmissions. Case studies are shared highlighting our model of care.

Presenters:

• Martha Boyd, CHW, Patient Community Navigator/Community Health Worker, The Queen’s Medical Center
• Robert Naniole, Patient Community Navigator, The Queen’s Medical Center
• Ana-Melissa Kea-Scott, Patient Community Navigator, The Queen’s Medical Center