Report: CCBHC Model Enables Clinics to Hire More Staff, Serve More People and Reduce ER Visits

Amidst widespread staffing shortages and other workforce challenges across the mental health and substance use treatment system, new data released by the National Council for Mental Wellbeing found the Certified Community Behavioral Health Clinic (CCBHC) model enables clinics to hire more staff to respond to surging demand for services, in addition to expanding access to treatment and reducing emergency department visits. The data reflects outcomes in the eight original demonstration states following the 2017 launch of the innovative health care delivery model.

These data are the first to consider the full scope and lifetime of the eight-state demonstration program from 2017-2021. This is a key metric when evaluating the model’s effectiveness, as clinics typically spend much of the first year putting new infrastructure into place to meet program requirements. It also comes on the heels of a recent Government Accountability Office (GAO) report that found CCBHCs are proven to increase the number of individuals receiving care and provide an increased array of services in their communities.

“State officials in the demonstration program credit the CCBHC model and its funding for allowing them to build the system capacity and infrastructure required to meet rising levels of need. These data further reinforce that CCBHCs work – they expand access, reduce emergency department visits, enable clinics to hire more staff and reduce the burden of response for law enforcement,” said Chuck Ingoglia, president and CEO of the National Council for Mental Wellbeing.

“But right now, not every organization that wants to adopt the model has the option to do so. This must change. Every community deserves access to high-quality care and the expanded services CCBHCs uniquely provide, and every clinic that wants to become a CCBHC deserves the chance to adopt the model. We urge Congress to include the bipartisan Excellence in Mental Health and Addiction Treatment Act of 2021 in the reconciliation package. The legislation would allow any state the option to apply to join the CCBHC demonstration program and establish a payment rate that covers the real cost of expanding access.”

Key highlights from the National Council’s survey of state CCBHC officials:

• The CCBHC demonstration increased access to mental health and substance use care, largely due to increased availability of same-day appointments, expanded hours of operation facilitated by increased hiring and concerted efforts to conduct outreach to underserved groups.
• States reported reductions in emergency department and hospital visits among CCBHC clients, leading to cost offsets.
• The CCBHC demonstration helped states mitigate the effects of the mental health and substance use service workforce shortage by enabling clinics to hire and retain vital staff.
• The CCBHC demonstration increased access to a comprehensive, evidence-based services to curb the opioid crisis, including medication-assisted treatment (MAT), the gold standard of care.
• The CCBHC demonstration resulted in improved integration of physical care with mental health and substance use treatment, with CCBHC sites in some states exceeding program requirements to offer onsite primary care services.

The findings in this report were primarily based on semi-structured interviews with state officials from the eight states participating in the CCBHC demonstration; review of reports, program data and other documents shared by state officials; and review of other publicly available evaluation reports on the CCBHC program.

Oklahoma Highlights

In 2017, the Substance Abuse and Mental Health Agency (SAMHSA) selected eight states to participate in the Certified Community Behavioral Health Clinics (CCBHC) demonstration. Oklahoma was one of them and three Oklahoma nonprofit mental heath providers became CCBHCs including Family & Children’s Services, Red Rock Behavioral Heath Services and Grand Lake Mental Health Center.

Oklahoma is highlighted in the following new reports released by the National Council of Mental Wellbeing of which the Alliance of Mental Heath Providers is a member. They include, but are not limited to:

• Oklahoma’s CCBHC demonstration sites helped curb the opioid crisis, including medication-assisted treatment (MAT). Oklahoma had very few individuals receiving MAT prior to the CCBHC demonstration. State officials reported a 700 percent growth in this service from the year prior to the CCBHC demonstration to the fourth demonstration year.
• Oklahoma reported notable decreases in the percent of individuals admitted to inpatient care and treated in an emergency department. The three CCBHCs generally showed a decline in the percentage of clients treated at the emergency department (an 18-47% reduction across the three clinics) and admitted to the hospital (a 20-69% reduction) from the period prior to CCBHC implementation to the fourth year of the program.
• Oklahoma reported the percentage of clients accessing peer supports increased from 40 percent in 2016, prior to the CCBHC
  demonstration, to nearly 57 percent by 2019.
• One of the biggest impacts of the CCBHC program in Oklahoma was establishment of urgent recovery centers, which operate 24 hours per day, seven days per week and function as an outpatient unit where a person can receive up to 23 hours and 59 minutes of care to stabilize an emerging crisis with no appointment needed. Two of the three CCBHCs in Oklahoma have urgent recovery centers and the third is in the process of opening one. Oklahoma also increased mobile crisis response teams through the CCBHC demonstration, as some rural areas did not have a crisis team nearby.
• In Oklahoma, all CCBHCs have issued electronic tablets (iPads) to law enforcement agencies. The tablets are equipped with a function that immediately connects law enforcement officers to treatment providers at local CCBHCs – 24 hours a day, seven days a week – for an assessment determining what level of care might be needed for individuals experiencing a mental health or substance use crisis. Other effective coordination and outreach strategies implemented by CCBHCs in Oklahoma include: 1. Designating liaisons who regularly visit the local crisis centers and inpatient units to engage with individuals prior to
  discharge, and 2. Establishing an outreach team that regularly visits the local homeless camps, day centers, etc., to connect with individuals in need.
• Oklahoma reported the CCBHC demonstration greatly improved treatment for suicidality; this included suicide care pathways built into CCBHCs’ EHRs and designated “touchpoints” for outreach and engagement following the Zero Suicide Framework. CCBHCs can immediately assess in their EHRs who is at risk for suicide and whether an individual might need a more intensive level of care. CCBHCs in Oklahoma regularly use Collaborative Assessment and Management of Suicidality (CAMS) and according to state officials, it is “just what [CCBHCs] do now with a suicide screen.”