The Center for Health Innovation (CHI) is the NM Public Health Agency and serves as the lead agency for the HRSA Rural Network Development grant. Susan Wilger and I developed the proposal which was funded by HRSA as a planning grant and Joan Goldsworthy Appel and I have led the planning process with four NM counties and three state partners. A fourth state partner has just been added.
The partnerships involved in the grant include four rural counties in different parts of the state The four rural counties represent diverse models of County – Behavioral Health Agency (BHA) collaboration to address behavioral health needs. The four counties include: Rio Arriba, Sierra, Luna and Grant Counties.
The partnership models include a fully integrated Rio Arriba County HHS Department which provides a range of outpatient behavioral health services directly and more intensive services through partnerships with area providers. They bill Medicaid and work with a behavioral health network of community partners, including FQHCs, BHAs, law enforcement and other organizations. Their work is funded through a large mix of state and federal grants and contracts and Medicaid.
Another model exists in Sierra County, a more rural county with a smaller county government that has developed a highly delegated model of behavioral health, working with OliveTree, the BHA and behavioral health hub. The county provides leadership, grantwriting and financial back office support. Sierra County’s inmates are housed at the jail in Luna County and come up to the Sierra County Detention Center for court appearances and services. Sierra has multiple grants and contracts. They contract with OliveTree BHA for behavioral health services. OliveTree has formed a behavioral health network with agencies, therapists, MCOs, law enforcement and other organizations.
Luna County provides an extensive amount of programming and services, as the county government is one of the few resources in that county with a low, highly dispersed rural population. These include promotora programs, partnerships with the local FQHC and domestic violence shelter. They are interested in developing the Certified Community Behavioral Health Clinic (CCBHC model), which exists in many states and provides more reimbursement for more community-based services than the traditional Medicaid reimbursement for CCSS services which now exists in New Mexico.
Grant County has just developed a Health and Human Services Dept., to oversee, coordinate and align different HHS initiatives. Behavioral Health is a priority for Grant County. The county government is developing a behavioral health planning council which is comprised of key BHAs, to develop a coordinated network of providers working closely with the county.
All four counties have active Health Councils. All have FQHCs and BHAs, the majority of which are active in county networks and collaboratives. The partnership has discussed and analyzed:
- The different types of County – BHA partnerships which exist in the partnership;
- Types of services that are provided to clients, and how they fit within the sequential intercept model (SIM);
- Systemic, policy and funding barriers that exist; and
- Strategies to support network development that involve services, network structure, policy and funding.