If you are currently a Community Behavioral Health Clinic (CCBHC) and you are looking to enhance, improve, or expand your CCBHC, you likely already know about the Certified Community Behavioral Health Clinic Improvement and Advancement Grant which is available now to all those who are eligible.
The anticipated total available in CCBHC funding is $61,800,000 for an anticipated 62 awards of up to $1,000,000 per year, per award for up to four years with the application due date as May 22, 2023.
The purpose of the CCBHC-IA grant is:
- To strengthen and increase the effectiveness of CCBHCs that meet the CCBHC Certification Criteria.
- To provide a comprehensive range of outreach, screening, assessment, treatment, care coordination, and recovery supports based on a needs assessment with fidelity to the CCBHC Certification Criteria.
- To support recovery from mental illness and/or substance use disorders by providing access to high-quality mental health and substance use services, regardless of an individual’s ability to pay.
While the application process is rigorous, as a CCBHC, you know the benefits to the people you serve, the community, and the agency itself. The application process can be daunting, as it is comprehensive, and the rules for submitting the application are very concise. Here are ten tips to help ease the process:
Tip #1: Understand And Begin Implementing the Updated 2023 SAMHSA CCBHC Criteria Now
Although the need to move to the updated version of the CCBHC criteria is not immediate, there is great value in understanding the changes to come and preparing for them sooner rather than later. The changes overall are positive in that they seek to lessen the administrative burden and clarify earlier criteria. The timelines for complying with the updated CCBHC criteria, depend on which type of CCBHC you are. The timelines are as follows:
- Section 223 CCBHC Demonstration programs beginning on or after July 1, 2024, will be expected to comply with the Updated Certification Criteria
- All SAMHSA CCBHC Expansion award recipients will be expected to meet the Updated Certification Criteria by July 1, 2024.
- Existing state Section 223 CCBHC Demonstration programs are expected to come into compliance with the Updated Certification Criteria by the start of the demonstration year beginning on or after July 1, 2024.
- Other state initiatives to support CCBHCs through mechanisms such as general funds, Medicaid state plan authorities, or Medicaid waivers are encouraged to adopt the Updated Certification Criteria by July 1, 2024
Recommendation: The clarity of the CCBHC criteria in the updated guidelines provides immediate benefits. As for the new criteria, we recommend starting a collection on the new BH Led CCBHC Clinical outcome measures now, before they are required. This will allow you to establish a baseline for the new measures (ISERV, SDOH, DEP-REM-6) as well as firm up your workflows allowing you to perform well on them from the start of the reporting period once they are required.
Tip #2: Update the Community Needs Assessment
As a grantee, you will be expected to conduct one or maybe two community needs assessments over the course of the project. Start with your current community needs assessment and use it as a template which you will then update.
Recommendation: The US Census Bureau has up-to-date stats on the make-up of your community members. This is a good place to start to document your understanding of the language and cultural needs of your community. This data will also be beneficial for your Diversity Impact Statement.
The Centers for Disease Control (CDC) has data on all types of national mental health issues including SUD, mental health in the workplace, and targeted topics like tobacco use (and cessation) specific to people with mental health conditions.
Along with these website resources, you will also want to conduct an updated community survey and look for changes since your original survey, assuming you did one. Including your CCBHC’s impact on the needs identified in your original community needs assessment is valuable content for your application narrative and a strong reflection of the quality of your services and your CCBHC’s impact.
Tip #3: Project the Number of Clients You Will Be Able to Serve
By now you know how accurate you were at initially predicting the number of clients you would be able to serve under the CCBHC umbrella each year. Use your past experience and the community needs assessment while considering your current resources in order to predict the number of clients you will serve each year of the project. Perhaps your CCBHC needs to hire more staff in order to serve more clients or improve your access to care.
Recommendation: Identify the person or write a job description for the person who will be the CCBHC Project Director immediately. If the right person is not yet on staff, designate an intermediary person so all the tasks required to complete the proposal are coordinated and tracked against a formal project plan.
Project Plans allow you to delegate tasks to responsible persons with target due dates and a place for status to ensure you meet the application submission deadline. We can provide you with a template for a project plan (excel format) if you need one. You will use the project plan after you are awarded the grant dollars to ensure you execute the plan you committed to in your proposal.
Tip #4: Create or Update the Project Plan
Ideally, you used some kind of project plan for assigning and tracking progress to all the tasks that needed completing for your initial CCBHC proposal and for the launch of your CCBHC. If so, this is the time to update this project plan. If you were able to accomplish the launch of your CCBHC without a project plan, well kudos! However, we strongly suggest you use one for this CCBHC-IA grant application. The project plan will take you into and through the execution of the commitments you make in the CCBHC-IA application.
Recommendation: Break the Notice of Funding Opportunity (NOFO) requirements down into tasks to be delegated out amongst the interdisciplinary CCBHC team you have assembled. Each task should include a brief description and a target completion date. Target completion dates are critical so you can move toward the application due date with less stress. The Project plan should be reviewed and updated at every meeting of the team. If you need a project plan template, email the Qualifacts CCBHC program coordinator, Mary Givens at mary.givens@qualifacts.com, to receive an Excel-based template.
Tip #5: Take a Hard Look at CCBHC Technology Needs
By now you have identified some gaps in your technology. Some of the most common ones are data reporting and interoperability; both key elements for a CCBHC. It is the right time to take a serious inventory of your technological needs. You need great transparency in clinical and operational data. You need to be able to easily share “rightfully consented” data about shared clients among the different entities such as the primary care provider or emergency department.
Recommendation: Allocate some of the grant funds to enhance your technology in these (or other areas) you have identified as lacking. Important to note is that “no more than 15 percent of the annual funding award may be used for infrastructure,” including technology but this need is not to be ignored.
Tip #6 Reach Out for Help in Developing your Sustainability Plan
The sustainability plan may be the most challenging of the deliverables required for the CCBHC-IA grant application. The requirement is that within one year of the award, you will need to develop and implement a sustainability plan to support the delivery of services once federal funding ends. The sustainability plan shall be updated annually.
Recommendation: Have a clear and concise understanding of your costs, including any growth you plan for the CCBHC. Take advantage of the CCBHC Technical Assistance Center to help you create a viable sustainability plan. These services are available at no cost to you.
Tip #7: Get Help – Participate in SAMHSA Technical Assistance Center Activities
Participate in SAMHSA-provided CCBHC Technical Assistance Center activities. CCBHC Technical Assistance will provide guidance to CCBHC-IA recipients to promote adherence to the CCBHC model, certification, sustainability, and the implementation of processes that support access to care and evidence-based practices. Resources include a library of written resources such as a “Care Pathways Toolkit,” “CCBHC Communication Kit,” and “CCBHC Criteria Checklist.” They also provide webinars and training events but most importantly, you can request one on one consultation. All of this is available at no cost to you.
Recommendation: When it comes to developing the more challenging pieces of your CCBHC-IA application (DIS, sustainability plan, etc.) don’t go it alone. Reach out and ask for help from the CCBHC Technical Assistance Center. The Center is also a great resource when your CCBHC is up and running. As challenges come up, turn to the technical assistance center, and leverage their many resources to support you.
Tip #8: Assess Your Current Evidence-Based Practices (EBPs) | Consider Changes or Additions
At the point of applying for the CCBHC-IA grant, assess the impact of the EBPs you have in place currently and determine if you need to make any changes or additions. Any success you have had with a specific EBP will be good to include in the application narrative. If you find that one of the EBPs is not resulting in much positive change, perhaps it is time to consider a different EBP or add an additional EBP. Of course, in order to assess the impact of the EBPs on specific populations, you will need accurate data from your EHR. A need to be considered when assessing the strength of your technology.
Recommendation: Visit the SAMHSA Evidence-Based Practice Resource Center and SAMHSA’s National Network to Eliminate Disparities in behavioral health (NNED) to identify evidence-informed and culturally appropriate mental illness and substance use prevention and treatment practices that can be implemented in your project. In terms of the EBPs, you will need to identify the evidence-based practice(s) and/or interventions that are evidence-informed and/or culturally promising that are appropriate or can be adapted to meet the needs of your specific population(s) of focus.
You must discuss the population(s) for which the practice(s) has (have) been shown to be effective and document that it is (they are) appropriate for your population(s) of focus. You must also address how these interventions will improve outcomes and address how you will monitor and ensure the fidelity of EBPs and other appropriate interventions. In situations where an EBP is appropriate but requires additional culturally-informed engagement practices, this should be discussed in the application.
Tip #9: Analyze Your Project Performance Measures & Make Changes
Data, data, and more data. As part of this application process, you will need to provide specific information about how you will collect the required data for this program and how such data will be utilized to manage, monitor, and enhance the program. In order to be able to do this for the future of the CCBHC, you need to assess where you stand currently. You need a snapshot of the health of your CCBHC. Knowing there is room for improvement, what changes will you make with this grant to improve the health and performance of the CCBHC?
Here are some of the possibilities.
- New or different EBPS
- Changes to access to care
- New outreach activities
- Additional providers
- Modified workflows
- Improved utilization of resources
Recommendation: In your snapshot of the health of your CCBHC, consider reporting on the following factors:
- Number of clients served versus committed to serving per project year
- Changes or improvements in your behavioral health clinical quality outcomes (changes in PHQ-9 scores, number of smoking cessation interventions per year, etc.)
- Performance on your SMART goals to date
- Number and types of service delivered year to year
- Diagnoses of people served
- Physical Health measurements collected
- Number of ED visits (decrease?) year to year
- Number of inpatient admissions (decrease?) year to year
- Change in mental health functioning outcomes
- SDOH statuses (housing, employment, food)
Tip #10: Update your Disparity Impact Statement (DIS)
Using the reporting capabilities of your EHR, how well does the population of the people you serve in your CCBHC reflect your community? Do you have adequate language and cultural support at your CCBHC to support the community as represented in the community assessment? How often do you look at this data and pivot to make improvements? All things to consider as you update your disparity impact statement.
Recommendation: Compare real-time data from the EHR to the findings and commitments made in your historical DIS and use that information to design a new and improved DIS.
The CCBHC-IA grant provides a great opportunity to improve and advance your current CCBHC, but first, you must have a clear snapshot of where you are today. Strong analytics and reporting from your EHR are key to meeting this need. As always, we are available to discuss anything CCBHC at your request. Please feel free to reach out to the Qualifacts CCBHC program manager mary.givens@qualifacts.com.
