Then, we have some key stakeholders that have some different goals and incentives, and one of the previous questions brought up to participate and also role. So, just a quick review of those. For behavioral health and medical care providers, expanding capacity, integrating primary care and specialty care, integrating community care with justice-based services, expanding their own capacity to enroll clients in Medicaid and insurance because certainly there are going to people who come not enrolled, improving treatment through the use of evidence-based practices, and then cultivating partnerships with new stakeholders.
County government officials, we were talking about their incentives to minimize cost and litigation risk is related to health care issues in jails. Their option is to maximize diversion and effective re-entry services to reduce future demands for incarceration and reduce current demands for incarceration. That’s the diversion side. It important I think for them to assess the potential risks and benefits. They have the capacity to convene local planning processes to develop local action plans and also to help work the questions of the governmental food chain to bring the Medicaid folks to the table, to bring the insurance folks to the table, to bring the bring the Department of Public Health folks to the table, and to investigate reallocation of funding from county corrections to community health services if that’s something they want to pursue.
For state Medicaid directors, the criminal justice system presents a great opportunity to enroll a lot of people in a timely and efficient manner. It does require some modification, possibly of how they’re thinking about doing it right now, but the numbers of people in the criminal justice system who are going to be a part of the newly eligible group are going to be so large that you’re going to get their attention if you bring the numbers to them.
So, collaborating with criminal justice and behavioral health and medical treatment providers to reduce coverage barriers, expediting enrollment, and also to facilitate strategic planning of the capacity expansion and again with special attention to rural or underserved communities.
State insurance directors are going to be operating health insurance exchanges, and there are going to be people most likely on probation who are, through family income or some job they hold, may not be eligible, may not be below that 133% poverty level but will be eligible for insurance subsidy through the exchange. So, we want there to be continuity of access, continuity of coverage plans so, for example, one of my clients who, today, makes no legitimate income but gets a job once they’re in recovery, I don’t want them to be suddenly priced out of ongoing substance abuse care and our services.
So, that’s the value of establishing this continuity from my perspective. I think from the criminal justice system perspective it’s just that writ across many hundreds of thousands of people want. Also, proper integration of this population into managed care.
For criminal justice officials in jails, corrections, probation, and parole, partnering in systems integration efforts is really important, maximizing Medicaid and insurance enrollment is important, and partnering in diversion efforts will also make a big difference.
I don’t know if we have any judges on the phone, but judges, in particular, have a very strong role in convening groups of different stakeholders to try to bring this conversation into focus. We work a lot with our judges to try to do this thing. They create a neutral framework, and they create some clarity about what the stakes are what’s needed. It can be very helpful. So, we certainly encourage them to be involved.
That was the slide in the presentation. Here are some resources that you may want to take a look at. The links may not appear so well on the slide, but you’ll be able to see them more clearly when the presentation is available.
There was a national conference, the Community-oriented Correctional Health Services Conference Coaches. We submitted a paper for that conference. It was sponsored by the Robert Wood Foundation, and all of those conference papers may be of some interest to you. There was a presentation form the Substance Abuse and Mental Health Services Administration thinking about this from the provider and treatment center perspective that was just given in July. It was excellent. I encourage you to look at that. The Council for State Governments also has a frequently asked questions document on health care reform.
So, those are the three things I wanted to suggest for folks who want to dig a little deeper into this. Certainly, I’m available for e-mail and phone if want to talk further about this. We’re doing a lot of national and local advocacy planning, and the whole thing’s unfolding day by day. So, it’s a very interesting time.
So, Monica, we have a few more minutes if people want to ask more question.
Okay, I have a question here from Herb. Let me put unmute your line. I can’t unmute his line. Let me unmute Colleen’s line. Okay, Colleen?
Can you hear me?
Yes. Hello, my question has to do with, I’m aware of the shortage of clinicians especially chemical dependency professionals, but are there any incentives coming down the pike with regards to raising the rate of pay or anything like that? I know quite a lot of people who would like to be in the field, but they’ve done the research to find out the rates of pay overtime and have really chosen not to go into the field because of it. Is there anything that we’re looking at as far as that goes?
Well, that is certainly a persistent problem in our field, and it’s trying to take grant dollars and make them stretch as far as you possibly can, I think, is one of the mechanisms by which pay rates for services and pay rates for people have been suppressed in that one. So, I think that the natural market mechanism of demand will have an impact or raising prices in the more capitalist way. The other way this will get worked out in terms of rates for services is it’s going to be all negotiated at the state level. So, I would encourage you or through your provider organization to really take a look at how you all can influence that conversation.
We’re not quite there yet, but it’s a good time to start asking questions about when and where those decisions are going to be made and how to influence them.
Okay. It just seems that some of these folks in this planet are being taken care of by some of those who get some of the lower rates of pay in the human services industry. So, just curious about that.
Yeah. I have about 299 colleagues in this agency who couldn’t agree with you more.
Yeah. Thank you for that.
We’ll go to our last question, and let’s see. Herb?
Yeah, hi. Thanks for taking my call. Do you hear my now? Okay. I guess I was just wondering and I left a couple of times. I had a couple of things I had to attend to. So, forgive me if you covered this, but is there any return on investment information on any of this in terms of primary prevention or prevention in terms of insuring that our clients and their family as well might be in better shape healthwise.
What I’m thinking is this. For instance, I walk outside, and there’s always a handful or more of our clients smoking cigarettes. We’re all paying for this high price, and I’m wondering is there anything down to that specificity on programs that might work and what the return on investment might be, something like that or other specific ways.
Well, the work that I’m familiar with on a more aggregate level is when you expand substance abuse and mental health service benefits, and this research has been done in both Medicaid and in private insurance. What you see in terms of the reduction in health cost in the same program year and let alone down the road, that data is very encouraging, and it comes from the reduction of emergency room visits and a reduction in accidents, all those things we all see our clients go through and that stuff stops when somebody stops using or at least is significantly reduced.
So, there is actual read data that supports that, and if you want to send me a follow up e-mail, I’ll send you the annotated bibliography I have on that that I got from [01:52:36].
What is it? What is your e-mail?
I put it on the presentation. You’ll get it on the presentation.
Oh, okay. Fine. One other thing. One of the things that I think is really troubling is not just that my clients and our clients here have significant substance abuse issues, but a significant number of them, while they’re out of control with drugs and alcohol and are trying to get it together, end up getting pregnant and having a child. Then, there’s the whole thing with custody. Is there a safe environment in their home or not? Is there anything being done to try to stem what I think is almost like a tide because you just multiple the problems with economic problems as well as with other types of problems when folks are out of control themselves and then they can’t be expected, when they’re out of control, to provide a healthy and safe household in which to be raised.
You’re exactly right on the one really big benefit of this broad scale effort to deal with untreated addiction and psychiatric disorders is the impact on families and the impact on community. I think you’re absolutely right that we pay in so many ways and our clients pay in so many ways and their children pay in so many ways, whether it’s children of people who are incarcerated and everything that they go through or whether it’s children who have an active drug or alcohol using parents.
So, our ability to intervene with that much more comprehensively, think has more of huge payoff for children, and I think it would be interesting to think about what would be a model intervention within a substance abuse treatment program that helps prevent that and intervene more thoughtfully and more directly with that issue.
Also, I think there will be a benefit from the much broader access, and we have a program where we work with parents who have lost custody of their children and are involved in the child welfare system because of their substance abuse. A lot of those folks don’t get their children back, but we are able to get them sober. Then, their subsequent children are born drug-free. So, that’s actually one of our goals in that program is how many drug and alcohol-free births do we have even if reunification is impossible?
So, I really do see what you’re talking about, and I think we need to think about how to take advantage of these expansion of resources to create that kind of outcome for families and for children.
That’ll be the last question. For those of you who have your hands up, I will provide Maureen’s e-mail on the follow-up e-mail I’ll be sending out.
I just want to thank Maureen. Thank you again for your presentation today. For all of you who participated today, I know two hours is a long time, but thank you so much for joining us. I just want to make a mention that during the webinar Maureen mentioned several practices such as evidence-based practices, trauma-informed care, Medicaid assisted treatment. Great Lakes ATTC will be hosting future webinars on those topics because we’re turning [01:56:23] into families, more on re-entry.
At the end of the month, we’re hosting two recovery-oriented systems of care, webinars on theory and practice. I’ll send out that information, and we’re also hosting a two-day regional re-entry conference October 25th and the 26th. Day one is in Chicago, and day two literally is in the correctional center. If you’re interested in attending any workshops or stopping by at any of our exhibit tables at Large Conferences in the state of Illinois, Ohio, Michigan, and Indiana, you can contact me directly at email@example.com.
For those of you who are not in our four state region, I encourage you to visit our national website which is www.attcnetwork.org. I’ll also send this information, but thank you all. Thank you, Maureen, and if you have any questions just let us know.
Thank you. Thank you for hosting this, Monica.
Oh, you’re welcome. Okay. Buh bye.