Written by Mary Givens, CCBHC Program Manager
The complexities and challenges of launching Certified Community Behavioral Health Clinic (CCBHC) programs and services within your agency can be broken down into achievable parts and manageable parts, that help you plan for success. Qualifacts subject matter experts, partnering with customer leaders have created the “Supporting the Five Stages of the CCBHC Experience” to guide you.
This six-part series begins with this installment – the definition of each stage and an overview of each.
Subsequent installments will provide detailed discussions and insights into each stage.
Stage 1: “Contemplation and Planning” | Supporting the Five Stages of the CCBHC Experience
The “Contemplation and Planning Stage” is about research and assessing your readiness to be a CCBHC. Take the time to do research on the CCBHC treatment model before leaping in and committing to it – including clinical requirements, reporting requirements, and compliance rules. Qualifacts recommends these preparatory steps:
- Thoroughly review each of the CCBHC criteria available from the SAMHSA website.
- Here is the 2022 version of the “State Impact Report: Transforming State Behavioral Health Systems,” from the National Council for Mental Wellbeing, which provides data on Demonstration CCBHC Treatment Model successes to date. Read through it to see where others are realizing success. Check their website for updates
- Complete a readiness assessment for becoming a CCBHC, using a hired third party or by creating an in-house team. This will be a required component of your Substance Abuse and Mental Health Services Administration (SAMHSA) grant application and can be used for planning and success check-ins. Thoroughness is critical so that the artifact can guide your strategic planning to move to the CCBHC treatment model. More details on this will be shared in the next article.
Stage 2: “Funding and Launch” | Supporting the Five Stages of the CCBHC Experience
This stage is about procuring the finances to start up your CCBHC. There are several streams of funding available, depending on federal and state actions.
- The signing into law of the “Bipartisan Safer Communities Act” (June 2022), will add 10 additional states to the SAMHSA Demonstration Project CCBHC model every two years, starting July 1, 2024. If your state gains entry to the expanding demonstration model, you gain the possibility of applying for and certifying with your state to become a CCBHC. The model opens access to cost-based reimbursement through the Prospective Payment System (PPS), which can support and extend CBBHC sustainability through state funding after grant dollars expire. “PPS in its many variations provides a critical financial foundation across the safety net and deserves continued support from policymakers,” recommends The National Council for Mental Well Being, a longstanding CCBHC advocate.
- To learn more about the sections of the law that speak to the sustainability of the CCBHC model read my blog post on Bipartisan Safer Communities Act and download the free resource
- SAMHSA has offered repeated rounds of CCBHC expansion grants for agencies in an effort to grow the program beyond the original demonstration model CCBHCs, and extended funding timelines and added states.
- In some states that have a CCBHC demonstration project, state funding has been made available to agencies planning to make the CCBHC transformation.
- Some states have gained CMS approval for State Plan Amendments or Waiver dollars that support CCBHC offerings.
- I know a very small number of agencies that funded the creation of their CCBHC programs and services with funding from their own budgets.
Stage 3: “Certification and Data Collection” | Supporting the Five Stages of the CCBHC Experience
Preparing for certification includes committing to timelines for meeting CCBHC criteria.
- Being realistic when setting timelines includes understanding the complexity and scope of the clinical, financial, partnership, and community changes and resources you will be managing.
- Start collecting data toward clinical and operational outcomes as soon as possible to build in as much time as possible to adjust and adapt to your new workflows and processes. It is an iterative process – nobody gets it right the first time. Be prepared to revise and update your approaches.
- Ensure that your updated forms and workflows are as efficient as possible for the providers. The goal is to be able to capture outcomes data while minimizing the impact on interactions with clients. It will take a few live efforts before your new approaches are optimized.
- Starting your data collection as soon as possible gives you maximum runtime to establish a baseline for each measure. We will explore why this is important further in article four of this series.
Stage 4: “Reporting and Stabilization” | Supporting the Five Stages of the CCBHC Experience
Reporting is where the “rubber meets the road”. This is where you get to see if all of your planning, establishing processes, setting up and configuring your EHR, reworking workflows, and training staff really was effective. It now comes down to the data. How are you doing on these clinical and operational outcome measures that you will now start reporting? This is a great time to analyze your data (study) and determine if changes need to be made to the workflow, the forms, the processes, or (perhaps) training. Stabilization comes when you have cycled through this process enough times that you start to see forward movement on each outcome toward greater success. We will discuss the “how” to achieve stabilization in great detail in article five of this series.
Stage 5 “Continuous Quality Improvement” | Supporting the Five Stages of the CCBHC Experience
“Quality is not an act, it is a habit.” – Aristotle.
How do we establish a “habit” or new behavior? Consistency.
Continuous organizational improvement in general and enhancement of reportable clinical and operational outcomes, in particular, inform your decision making, as you assess your success on a regular basis. To gather this data and make it actionable, you must have an EHR that provides transparency into your performance – ideally with easy-to-use reporting and analytics tools and data visualizations including configurable charts and graphs
Once you know where you are starting, you can see where you are going, and manage to your goals. Actionable data, easy-to-use reporting, and analytics that are easily visualized can guide improvements to your workflows and processes as you gain insights into where you are successful and where you need to refocus your efforts.
When data is not collected consistently, which is a common problem, the gaps in your analytics will reveal opportunities for training or changes in configurations or forms.
- Generalize what is working across the workforce
- Tweak what needs adjusting, by adapting and training.
This process will continue until outcomes are mastered, and evidence-based data is widely available across your programs and services. As each outcome is mastered, you will add new, more challenging metrics, in a positive cycle of continuous quality improvement for your CCBHC and the clients you serve.
Conclusion | Supporting the Five Stages of the CCBHC Experience
Qualifacts believes that analyzing and discussing the CCBHC experience as five tangible stages will guide your CCBHC toward greater success sooner. We firmly believe the CCBHC treatment model is the way of the future. We are here to support you in making your move to this preferred model of treatment for people with behavioral health and substance use conditions. The remaining articles in this series will support you in your CCBHC transformation experience.
Mary Givens, MRA
CCBHC Program Manager
Mary Givens has been with Qualifacts for 13 years. She has a Masters in Rehabilitation Administration from the University of San Francisco. Before coming to Qualifacts, Mary was the CEO of a non-profit organization that served IDD, she was the Director of Client Services and a Director of Supported Employment for people with SPMI. Since coming to Qualifacts, she has been a Project Manager for Implementation and a Program Manager of Meaningful Use, and is currently the CCBHC Program Manager.