Healthy Minds, Healthy Bodies: What you should know about the Georgia Crisis & Access Line

Suicide is third leading cause of death among 10-24 year olds in Georgia. In order to combat this growing issue Governor Deal and the state legislature included an additional $21.4 million in the FY2019 state budget to improve and expand children’s behavioral health services. Out of that appropriation, $1,092,000 was directed to suicide prevention efforts, which will in part go towards expanding the capacity of the Georgia Crisis and Access Line (GCAL). GCAL provides 24/7 online and telephone support for Georgians who are seeking services for or in crisis as a result of developmental disabilities, mental health, or substance use conditions.

GCAL connects callers with trained professionals and clinicians who screen and assess the severity of callers’ need for service. The GCAL operators then provide the appropriate assistance, referrals to necessary services, or dispatch crisis services when needed. The call center can:

  • Provide telephonic crisis intervention services,
  • Dispatch mobile crisis teams or emergency services when needed,
  • Assist individuals in finding an open crisis or detox bed across the state,
  • Link individuals with urgent appointment services,
  • Help individuals find a mental health, substance use treatment, or developmental disability provider in their area in a non-emergency; and
  • Connect families and individuals with community-based support services.

GCAL also provides language assistance for people with limited English proficiency.

Even though GCAL’s name includes the word “crisis,” consumers do not need to be in crisis to call or visit the website. As mentioned above. GCAL provides non-emergency or crisis services. Call center staff are available to answer routine questions about behavioral health and provide callers with a choice of providers and assistance in scheduling appointments for service.

Georgia consumers can call 1-800-715-4225 or visit mygcal.com if they or someone they care for is facing a behavioral health crisis or in need of services. For more on how GCAL is making a difference in the lives of individuals and their families, check out this video from Voices for Georgia’s Children.

 


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Healthy Minds, Healthy Bodies: Getting to know the Georgia Apex Program

Georgia currently ranks 51st in children’s mental health services but an infusion of dollars into Georgia’s system of care is expected to have a positive impact around the state. Governor Deal and the state legislature included an additional $21.4 million in the FY2019 state budget to improve and expand children’s behavioral health services. Of that allotment, $4.3 million are dedicated to fund 13 additional grants for the Georgia Apex Program, a school-based mental health program that improves early identification, access to and coordination of needed behavioral health (BH) services for children with behavioral health needs.

Nearly one in ten Georgia children ages 2 to 17 years have one or more diagnosed emotional, behavioral, or developmental conditions and these conditions become more prevalent as children hit adolescence. Behavioral health issues can manifest in chronic absenteeism, classroom disruption, discipline issues, or other adverse behaviors at school, which can prevent young people from being academically successful.

To address the behavioral health needs of Georgia’s students, the Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD) launched the Georgia Apex Program in 2015 to “[create] partnerships between community-based mental health providers and local schools to provide school-based mental health services.” The three main goals of the Apex Program are:

  1. To increase access to mental health services for children and youth;
  2. To provide early detection of child and adolescent mental health needs; and
  3. To increase coordination between community-based mental health providers and the local schools and districts they serve.

The Apex Program places mental health providers in schools to provide services like screening, assessment, counseling and therapy, and referrals to community support services like youth club houses. The program began with 29 community health providers in 104 Georgia schools, and as of February 2018, the program had expanded to 320 schools. Over the first two years of the program, more than 5000 students who had not previously received mental health services were screened and provided with the appropriate services and supports for their needs.

More than three quarters (76%) of the schools served by the Apex Program are located in rural areas where behavioral health services are more limited, and almost half (46.6%) are located in elementary schools so that services are available to younger students, when behavioral health conditions are often less severe and more treatable.

In addition to increasing access to care for students in need, the program has demonstrated success by integrating into a variety of school settings and improving coordination and communication between providers and school staff. Further, providers are able to bill for 75-90% of the students served each month, indicating the model may be financially sustainable.

The Georgia Apex Program is a promising model that brings mental health care services to Georgia children, reducing barriers to health care and improving their chances for academic success.  

To learn more about the Georgia Apex Program:  

  • Visit the Georgia Department of Behavioral Health & Developmental Disabilities’ Office of Children, Young Adults and Families or email georgia.apex@dbhdd.ga.gov
  • Read the resources available at Georgia State University’s Center of Excellence for Children’s Behavioral Health at the Georgia Health Policy Center.
  • Watch the video below from the Georgia Department of Behavioral Health & Developmental Disabilities and see how the Georgia Apex Program is making a difference in the lives of children and their families.

 


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GHF hosts educational forum about children’s behavioral health

Georgians for a Healthy Future hosted an educational forum titled Strong Foundations: Building a System of Care to Address the Behavioral Health Needs of Georgia Children on Tuesday, May 15. The forum explored the behavioral health needs of Georgia children and youth, Georgia’s publicly-supported behavioral health landscape, and successes and opportunities in the current system of care. The event also raised awareness about Georgia’s system of care in an effort to improve access to behavioral health services for children and youth.

The event began with Respect Institute speaker Tammie Harrison, who shared her experiences navigating the behavioral health care system and getting to a place of recovery.

Because many of the event attendees were new to the topic of children’s behavioral health (BH), GHF’s Executive Director Laura Colbert provided some foundational information about the prevalence of children’s BH conditions, contributors to poor BH, and the pathways to BH care and supports for young Georgians. You can find Laura’s PowerPoint slides here. She also debuted GHF’s new behavioral health fact sheet.

Dante McKay, Director of the Office of Children, Young Adults, & Families at the Georgia Department of Behavioral Health & Developmental Disabilities (DBHDD) provided attendees with an overview of DBHDD’s work, the 2017 System of Care state plan, and how the recently signed FY19 budget would impact the department’s ability to serve Georgia children and youth.

Dr. Erica Fener-Sitkoff, Executive Director of Voices for Georgia’s Children moderated a panel discussion of BH service providers, which included Wendy Farmer of Behavioral Health Link, Laura Lucas of Project LAUNCH (DBHDD), and Monica McGannon of CHRIS 180. The panelists discussed barriers to accessing BH services, which they said include continued stigma, lack of trained workforce, and transportation. The panel also identified innovative efforts, like Project LAUNCH and mobile crisis services, to bring BH services closer to consumers when and where they need it. When asked how Georgia’s next Governor could continue to make progress in the area of children’s behavioral health, panelists suggested a focus on workforce development, increasing access to community-based substance use treatment for teens, and prevention and early intervention.

 

If you missed the event, a recording of the webcast is available here.

To see photos, review materials, and read more about our Strong Foundations event, please visit the event page.


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Healthy Minds, Healthy Bodies: FY2019 budget and children’s mental health

Despite several missed opportunities to address consumer health concerns during this year’s state legislative session, the FY2019 budget includes several impactful investments. Last week, Governor Nathan Deal traveled through Georgia and held budget signing ceremonies in Atlanta, Acworth, Blue Ridge, Statesboro, and Tifton for the $26 billion spending plan which will begin on July 1 of this year through June 30, 2019. The infusion of dollars into children’s mental health is especially noteworthy and exciting because of the impact it is expected to have across the state.

Governor Deal has recently made children’s behavioral health one of his top health care priorities and this year included in his proposed budget $20.6 million to fund recommendations from the Governor’s Commission on Children’s Mental Health. During its consideration of the state budget, he legislature ultimately increased the funding dedicated to these recommendations to $21.4 million.

These funded recommendations include behavioral health crisis services, supported employment and education for young adults with behavioral health needs, provider training and telehealth, and opioid abuse prevention for youth. Funding for suicide prevention will in part go towards expanding the capacity of GCAL, the Georgia Crisis and Access Line, which provides 24/7 online and telephone support for people who are seeking services for developmental disabilities, mental health, or substance use issues. Some of the additional funding is also dedicated to the Georgia Apex Program, a school-based mental health program that improves early identification, access to and coordination of needed behavioral health (BH) services for children with BH needs..

In the coming months, we will break down the Commission’s funded priorities and their impact on young Georgians. Look for our Healthy Minds, Healthy Bodies blog mini-series.

Looking for more information on this topic? Georgians for a Healthy Future will be hosting an educational forum later this month during which we will explore the behavioral health needs of Georgia children and youth, Georgia’s publicly-supported behavioral health landscape, and successes and opportunities in the current system of care. Join us in person or via webcast for this exciting and important event!


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New tool available to Georgia health care providers to address the opioid crisis

Laura Colbert, MPH, MCHES

 

Every day four Georgians die from opioid overdose and recent data from the Centers for Disease Control and Prevention confirm that the epidemic shows no signs of slowing. Health care providers, public health professionals, community leaders, and families are all searching for effective strategies to slow and stop this growing public health crisis. Some initial steps have been taken by Georgia policy makers and others to increase access to life-saving drugs like naloxone, improve and expand the prescription drug monitoring program (PDMP) to prevent over-prescribing, and raise public awareness about the risks of opioids and other substances, but more is needed. Solutions must include evidence-based strategies that emphasize prevention and early intervention, as well as timely treatment and support for recovery.

An exciting development within Georgia’s Medicaid program gives health care providers an additional tool to aid in the fight against substance use disorders, especially among adolescents and young adults. Georgia’s Medicaid agency has activated the reimbursement codes for a tool called SBIRT, which stands for Screening, Brief Intervention and Referral to Treatment. SBIRT is a set of tools that identifies people who use alcohol or other drugs at harmful levels and guides follow-up counseling and referral to treatment before serious long-term consequences occur.

Ninety percent of adults who meet the medical criteria for addiction started smoking, drinking, or using other drugs before they were 18 years old. Because Medicaid and PeachCare for Kids cover half of all Georgia children, the activation of the Medicaid reimbursement codes for SBIRT is a powerful opportunity to identify youth substance use and intervene early. Studies show that simply asking young people about drugs and alcohol use can lead to positive behavior changes and that brief interventions reduce the frequency and amount of alcohol or other drug use by adolescents.

This policy change was the product of a sustained advocacy effort by Georgians for a Healthy Future (GHF) and the Georgia Council on Substance Abuse (GCSA). We anticipate it will lead to the screening of an estimated 145,000 Georgia youth annually and that 36,000 of those youth will present substance use behaviors that prompt a brief intervention with a health care provider. Initial data from Georgia’s Medicaid agency demonstrates that some providers are already making use of the SBIRT codes in their practices.

Notwithstanding these exciting results, we have committed to continue our efforts to improve access to screening, early intervention, and recovery services and supports for young people across Georgia. While the Medicaid reimbursement codes allow physicians, physician extenders, and advanced practice registered nurses to provide SBIRT services, we recognize that RNs, LPNs, licensed clinical social workers, and certified peer counselors can and should be able to provide SBIRT to youth and adults. Further, the codes allow SBIRT to be provided primarily in health care settings, but that excludes schools and other community-based settings where most young people spend their time.

We invite you to join our efforts to prevent substance use among young Georgians. Spread the word by giving our new fact sheet to the providers in your clinic, public health department, or hospital. If you are a health care provider, attend a training to develop the skills to implement SBIRT with the people that you care for. Join our on-going advocacy efforts to activate the reimbursement codes for more practitioner levels (including RNs and LPNs) and more settings by contacting us to let us know you are interested.

The opioid and substance use crisis that is sweeping Georgia and impacting communities nationwide will require a full spectrum of solutions that leverage the expertise of health care providers, public and private resources, and community and family supports. SBIRT is an evidence-based tool that can play a significant role in our collective efforts to reduce substance use and create a healthier Georgia for all of us.

To learn more, visit our Keeping Youth on a Healthy Path page.

For health care providers: download our new fact sheet here.

 

 

 


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Sine Die

Thats a wrap for the 2018 Georgia legislative session!

The Georgia General Assembly completed the 2018 legislative session in the early morning hours on Friday. A flurry of significant bills passed in the final days of the session. We are disappointed that agreement could not be reached to protect consumers from surprise out of network medical bills, but are heartened that other legislation passed to improve access to health care for consumers across the state. Check out our summary of the more notable bills below and find a full list of health care related legislation at GHF’s legislative tracker.

 


Everything you need to know about the 2018 legislative session

Georgians for a Healthy Future and the Georgia Budget and Policy Institute will be presenting “Changes in Health Care and Policy in the 2018 Legislative Session” on Thursday, April 19th at 10:00 AM. Make sure to join GHF and GBPI to hear an overview about the bills, resolutions, and budgets that were passed and that will affect Georgia’s health care system and consumers. Tune in to this webinar to find out how this session’s legislation may affect your work, your health care, or your coverage.


 

WHAT HAPPENED LAST WEEK
HB 683: Amended FY2018 Budget | PASSED

HB 683 makes adjustments to the state budget for the current fiscal year which runs through June 30, 2018. The FY2018 supplementary budget (also called the “little budget”), makes necessary, mid-year adjustments to the current state budget. Governor Deal signed signed the $25.4 billion amended budget on March 9, 2018 at a ceremony in Polk County. The budget included $1.2 million for hospitals to offset costs due to the high number of flu cases.


HB 684: FY2019 Budget | PASSED 

HB 684 is the budget document for the coming state fiscal year which will run from July 1, 2018 to June 30, 2019. The budget, which totals $26.2 billion, includes several new investments in children’s mental health per the recommendations of the Governor’s Commission on Children’s Mental Health, and fully funds and the Maternal Mortality Review Committee’s (MMRC) recommendations at $2 million. For more information on the health care highlights in the proposed FY2019 budget, read the Community Health and Behavioral Health budget overviews from the Georgia Budget & Policy Institute.


HB 314: Surprise billing legislation | DID NOT PASS

Legislators failed to reach an agreement about how to best resolve the problem of surprise out of network billing for Georgia consumers. HB 314 (formerly SB 359) would have prevented consumers from receiving balance bills when they unexpectedly receive care from providers that are not in their insurance plan networks during emergencies. Surprise out-of-network medical bills can be hundreds of thousands of dollars and are more common when insurance plan provider networks are very narrow and restrictive. Georgia’s provider networks are the narrowest in the nation.


SB 357: Legislation to establish Health Coordination and Innovation Council | PASSED

SB 357 establishes the Health Coordination and Innovation Council and an advisory board to the Council. The Council will act as a statewide coordinating platform, bringing together all of health care’s major stakeholders. It’s members will include the Commissioners of several state agencies as well as a primary care physician, a pharmacist, a dentist, and representatives from the academic community, but there are no specifications about who will serve on the Council’s advisory body. The legislation sunsets in 2022 and will have to be reauthorized in order to operate past July 1st of that year.


HB 769: Recommendations from the Rural House Development | PASSED

HB 769 is the result of the 2017 House Rural Development Council’s work. The bill included a number of provisions, most prominently of which was the creation of a Rural Center for Health Care Innovation and Sustainability within the existing State Office of Rural Health. The bill also increases the rural hospital tax credit to 100%, directed the Department of Community Health to streamline and create efficiencies within the state medical plan, allows for the establishment of micro-hospitals, sets up an incentive program for physicians practicing in rural areas, and redefines “rural county”.


HB 827: Rural hospitals tax credit increase | DID NOT PASS

HB 827, introduced by Rep. Trey Kelley, would have expanded the rural hospital tax credit program from a 90% credit to a 100% credit. The tax credit program went into effect last year and has resulted in the donation of about $10 million to rural hospitals thus far. The legislation was tabled late in the legislative session because the tax credit language was included in HB 769.


HB 740: Education legislation impacting behavioral needs of young students | PASSED

HB 740, which requires schools to provide a multi-tiered system of supports for a student in pre-school through third grade prior to expelling or suspending the student for five or more days was passed by the Senate last week. The legislation provides increased opportunities for schools to screen students for a variety of academic and behavioral health needs, and connect them to the appropriate health and other services.


SB 325: Interstate Medical Licensure Compact Act & Step therapy | DID NOT PASS

SB 325 would have allowed Georgia to enter the “Interstate Medical Licensure Compact Act” which allows health care providers to more easily obtain licenses to practice in multiple states. It would also have granted states easier access to investigative and disciplinary information about providers. All of the bill’s original language was removed and substituted with new legislative language that, among other provisions, limits step therapy and sets up a process for physicians to request exceptions (previously HB 519). Step therapy is a requirement by some insurers that patients try a series of lower-cost treatments before the insurer will cover the treatment prescribed by a patient’s physician.


SB 351: Changes for APRNs | DID NOT PASS

SB 351 would have expanded from four to eight the number of advanced practice registered nurses a physician is allowed to supervise and would allow APRNs to order radiographic imaging for patients if their supervising physician delegated the authority. The legislation was significantly diminished from the original proposal which would have granted APRNs a greater scope of practice.


SB 352: Legislation to establish Commission on Substance Abuse & Recovery | DID NOT PASS

SB 352 establishes a Commission on Substance Abuse & Recovery, headed by a director and charged with coordinating data among relevant government entities; informing strategies to combat the opioid crisis within the Departments of Public Health and Education, the Attorney General’s Office, and other state entities; consulting with the Governor’s office on a potential Medicaid waiver related to opioid abuse; and developing and informing other efforts to expand access to prevention, treatment, and recovery support services across the state.


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Keeping up the Drumbeat for Youth Substance Use Prevention

Neil SUD 2016Georgians for a Healthy Future was excited to meet and engage colleagues in rich discussions around policy, grassroots organizing and coalition-building to make prevention counseling more widely available for young people. This June, we joined advocates from other states in Philadelphia for the Community Catalyst Substance Use Disorders Advocacy Convening. The three-day conference gave us valuable insight for the next phase of our advocacy and policy efforts to expand the use of Screening, Brief Intervention and Referral to Treatment (SBIRT) through the activation of Medicaid codes for youth. Activating Medicaid codes would allow providers to be reimbursed for the time they spend conducting SBIRT and would encourage greater use of the tool.

 

Over the past three years, in partnership with the Georgia Council on Substance Abuse, GHF has advocated for turning on SBIRT codes and raised up youth substance use disorders as a critical public health issue that can no longer be overlooked in Georgia. We will publish a white paper on the potential benefits for turning on the Medicaid codes for youth SBIRT services in Georgia in the coming months. Check out our website to find out more about our Somebody Finally Asked Me campaign, additional resources on youth substance use prevention, and how you can get involved.


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GHF In The News
Aug 3, 2018
Ruling allows for purchase of cheaper insurance
Andy Miller

Less expensive coverage comes with more risks “The administration’s rule change is dangerous for Georgia consumers,’’ said Laura Colbert of Georgians for a Healthy Future

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