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A Picture of Recovery: TBI Waiver Gives Elliott Philips Hope for Future

Elliot Philips works out

TBI Waiver participant Elliott Phillips works out as part of his recovery journey.

A traumatic brain injury (TBI) sustained after he was thrown from a truck bed in 2014 changed Elliot Phillips’ life and filled it with struggles. Now, since enrolling in the NC TBI Waiver operated by Alliance Health in April 2020, Elliot has been on a journey toward healing with hope for the future.

“It has made my life better in so many ways it’s hard to count,” Elliot said.

Elliot’s accident caused multiple injuries in addition to the TBI, including right hemiparesis, dysphagia and communication deficits. Elliot’s injuries caused decreased balance, endurance and pain, cognitive deficits, and severe depression

He received very little rehabilitation after the accident because, without the TBI Waiver, Medicaid has strict limits and eligibility requirements. As a result, Elliott lived a mostly immobile life for 6 years.

Before his TBI, Elliot felt that life was good. He enjoyed exercising and hanging out with friends and did not struggle with mental health. After his accident, Elliot turned to substances to deal with his mental health, which led him down a path with very little quality of life. Elliot had lived in the Oxford House, but continued to struggle with polysubstance abuse, mental health issues, and pain from his injury.

When Elliot began on the TBI Waiver he was living with his father, who also struggles with substance abuse, and the dynamic made it very difficult for Elliot to recover. Elliot continued to struggle with substance abuse but made consistent progress.

Before he went “live” on the waiver, Elliot had a hospital stay for mental health/suicide attempt, but he eagerly began services after discharge.
He received Community Support Team (CST) services at Southlight when he began on the waiver, and continues to work with a peer support specialist. His cognitive deficits have improved due to specialized consultative services, life skills training and community networking services.

TBI care coordination was able to find a pain clinic that could treat his pain and support his recovery. Elliot’s work with specialized consultative services (occupational therapy, physical therapy, and speech-language pathologist therapy) has increased his independence from not being able to stand in the shower to walking, going to the gym, stretching, going out in the community and more. Hanger, a provider of orthotics and prosthetics, assisted with splints for Elliott’s right foot drop and right-hand contracture. These services plus a TENS unit funded by the waiver have greatly reduced Elliot’s pain.

Elliot has had two additional hospital stays for mental health and suicide attempts, however, these were always triggered by his living situation or something TBI care coordination with staff could pinpoint. He then became open to changing his living situation to an unlicensed alternative family living home, funded by residential supports on the waiver. He was also motivated to go to Alcoholics Anonymous (AA), and he now attends meetings five days a week.

During his recovery, Elliot has developed a stronger relationship with his mother and a healthier relationship with his father. His specialized consultative staff has also introduced him to a coffee club where he can relate to others.

Elliot recently received his 90-day chip in AA and has also abstained from heroin for almost a year. In addition to gaining more independence, he has developed the skills to maintain boundaries and effective communication with his family. The TBI Waiver has given him hope that he can work toward living independently.

Despite mild health concerns through this journey, Elliot has owned his healthcare, making his own appointments, setting up transportation, and making sure all needs are addressed. Because of his mild cognitive deficits, this progress has come slowly, but each time Elliot has had a challenge he jumps right back into services. He has learned not to see himself as a failure, but notice his progress over perfection.

“Elliot is truly a picture of recovery of TBI,” said Alliance TBI Care Coordinator Kate Hughes. “He truly understands the endurance, persistence, and commitment of TBI and substance abuse/mental health recovery.”

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Reminder: Feedback Needed on Alliance Provider Search

Alliance Health is committed to continuing to improve the usefulness of our web-based clinician and provider search tool, and to help ensure that the search tool is understandable to prospective and current members as well as other stakeholders. This anonymous survey will provide us with information to help us identify any areas of difficulty in using the search tool.  We appreciate your time and feedback in completing this survey by February 12, 2021.

Care in Focus: Communication is Key in Crisis

Tammy ramirez

Alliance Health Care Coordinator Tammy Ramirez

When an Alliance member with intellectual or developmental disabilities (IDD) ends up in in the emergency department (ED) or crisis facility, timely communication can often be key in getting them home quickly or making sure they get a timely and appropriate placement if hospitalization is necessary. Alliance Health Care Coordinator Tammy Ramirez is one of the people there to make sure that crucial communication happens quickly.

Ramirez has been working at Alliance since 2012 and serving as a crisis liaison in Wake County since 2014. She works with UNC WakeBrook’s Facility Based Crisis and WakeMed, focusing on members with IDD. Before her employment at Alliance, she had worked with the Wake County LME and has a background of working with people dually diagnosed with IDD and mental health or substance use disorders.

“If one of our folks goes in the ED, it’s a priority to get information to the staff as quickly as possible about the services and supports that are in place so they have all the contact info they need, as well as a psychological evaluation,” Ramirez said. “We want to make sure that the first thing they do when a person comes in is medically look at them and see if it’s a medical issue or if it’s truly a behavioral issue, or if the medical is playing into the behavioral issue.”

She then reaches out to all the players involved in the members’ care, including Alliance Internal staff. “I try to be mindful, if there are a lot of players involved who are already connected with the family, to not be one more person from Alliance that they have to get a phone call from,” she said. “If they are actively involved with a care navigator, a school-based care coordinator or a mental health care coordinator, I try to make sure that they remain the primary contact with the family so they (the family) are not confused or overburdened.”

Ramirez said that she and her fellow liaisons make it easier for ED or crisis facility staff to do their work with complete knowledge of a member’s history and supports, which in a crisis situation may not be easy to obtain from the member or their family.

“We really try to be an assist to our members first and foremost, but we are also an assist to our partners, such as WakeMed and UNC Wakebrook,” she said.

“Every day is different. It’s fascinating work and I know it’s definitely needed, and I just enjoy being able to help any way I can,” Ramirez said.

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Feedback Needed on Alliance Provider Search

Alliance Health is committed to continuing to improve the usefulness of our web-based clinician and provider search tool, and to help ensure that the search tool is understandable to prospective and current members as well as other stakeholders. This anonymous survey will provide us with information to help us identify any areas of difficulty in using the search tool.  We appreciate your time and feedback in completing this survey by February 12, 2021.

Liaisons Ensure Continuity Of Care In Crisis

Many people in a mental health or substance use crisis seek help in a hospital emergency department (ED), where that crisis may be seen as a distinct episode with little continuity or communication about the person’s past or what happens after they leave. Because of this, Alliance Health’s care management team has a robust ED liaison system designed to ensure continuity of care, improve outcomes and possibly reduce repeat ED visits for the people we serve.

Six Alliance care coordinators currently serve as ED liaisons, coordinating and communicating between the EDs and other care coordinators and community-based services, including two Wake County school-based care coordinators who offer assistance to Wake County Public School system (WCPSS) students and their families.

Whether the member is discharged and connected to community supports or referred to an inpatient program, the goal is to establish continuity of care. “Our job is really a lot of communication, collaboration and brainstorming.” Said Adam Shields who serves as the ED liaison at Wake Med’s main ED in Raleigh, and backup for Ashley Marrow, who works with Rex and Duke Raleigh as well as the five other Wake Med EDs. Marrow also serves as backup for Shields.

Senitra Pryor works in Durham with Duke University and Duke Regional hospitals, including the inpatient psychiatry wards at each, and Melinda Short covers Cape Fear Valley Medical Center and its behavioral health center.

As part of Alliance’s School Based Team (SBT) partnership with WCPSS, school-based care coordinators Catherine Lilly and Christopher Toller monitor ED and crisis facility admissions to identify WCPSS students and link them to appropriate behavioral health and community resources to support them in their transition back to school after a crisis episode.

The ED liaisons have an app that allows them to see the facilities’ daily admissions and review the behavioral health cases. Then they partner and collaborate with the hospital social workers, providers and other community resources to get people diverted out of the ED if appropriate, or work on a discharge and continuity plan if someone has been admitted for observation. If the member has a care coordinator they are alerted, if not a care coordinator is assigned to ensure the member maintains connection to care after the crisis.

“We are making sure no one falls through the cracks and that care coordinators know when their members are there.” Short said. “A lot of times people in crisis don’t know their provider’s information or when their last date of service was, so we can make sure the social worker has the information they need at the time.”

For WCPSS students, the liaisons reach out to a child’s parent to see if they are interested in having additional support. If so, they get a signed consent and assign a school-based liaison who coordinates with the school, notifying them that a student is in the hospital. “The main goal is to support the student as they transition back to school after the hospitalization,” Lilly said. “This involves tailoring the child’s support to their specific circumstances,” she said.

The support goes beyond healthcare to addressing what are commonly called the social determinants of health, so the liaisons have a conversation with members about their needs. “Many people have a lack of resources including food insecurities or lack of transportation, so we try to ensure that they have that before they leave,” Pryor said.

The COVID-19 pandemic has multiplied some of the stressors that may push people into crisis, adding new pressures to school students. “There’s already the pressure and anxieties that come with that age and then on top of that you have virtual learning and feeling disconnected from peers,” Toller said. “The routine has changed so drastically, plus you have the pressures of parents and children all trying to work at home.”

Economic pressures may also increase the amount of stress in the household, multiplied for families who are facing homelessness. The liaisons can connect members and families with housing resources, which for Wake students includes the McKinney-Vento program, which addresses the needs of children and youth experiencing homelessness. Last summer the SBT liaisons were able to get Independent Living Initiative (ILI) funding for the family of a child with medical issues, which allowed them to move into a home. Another family of several Wake children were staying in a motel, but internet access issues made it difficult to register the kids for schools so Toller coordinated with a social worker to get the kids registered.

“I think of how hard it is for so many adults to adjust, and it’s something that no one could have prepared any young person for,” Toller said.

To learn more about crisis alternatives to the ED, visit the Alliance website.

Learn more about the Alliance School Based Team in its 2019-2020 annual report.

Alliance Telehealth Survey Finds High Satisfaction Among Members, Providers

The COVID-19 pandemic has dramatically changed the delivery of and access to healthcare across the US. Fear of exposure and evolving local and state restrictions caused cancellation or deferral of many in-person healthcare encounters. Because of this, as well as temporary flexibilities allowed by Centers for Medicare & Medicaid Services, many Alliance Health providers have expanded telemedicine visits to serve our members.

To better understand the impact of these changes on services, Alliance conducted member and provider surveys to identify barriers, benefits, and gaps related to telehealth services. Overall, the satisfaction reported with telehealth services was near the level of reported satisfaction with In-person services.

“Our providers deserve a lot of credit for the amazing, almost overnight pivot that they made to provide telehealth,” said Sean Schreiber, Alliance Executive Vice President—Network and Community Health. “Our ability to support providers in their transition to telehealth has allowed us to maintain our members’ access to the services they need despite the difficulties imposed by the pandemic.”

The survey, conducted in June and July 2020, sampled Alliance providers via an online form, and members via telephone interviews by Alliance staff. Of the respondents, 64 providers reported providing and 202 members reported receiving telehealth services between March and July 2020. The number of members served via telehealth increased significantly during the COVID-19 pandemic. Of members that received telehealth eligible services between March and August, 62% received at least one telehealth service.

Of the member respondents that received telehealth services, 88% rated their service good or very good, which is only slightly below the 91% favorable rating for in-person services. Member satisfaction data was compared across demographic subgroups, including race, age, county, ethnicity, disability group, language, funding, service, provider, telehealth platform, provider training, and provider experience and were found to be proportional across all subgroups with at least 40 responses.

From the providers’ perspective, 78% believe their members are satisfied, 58% report improved show rates, and 66% report the same or increased member engagement as compared to in-person visits.

Some services appear to be better suited for telehealth than others. More than half of providers rated enhanced services (which include Multisystemic Therapy, Intensive In-Home, Family Centered Treatment, Community Support Team, Psychosocial Rehabilitation, Day Treatment, Substance Abuse Intensive Outpatient Program, Substance Abuse Comprehensive Outpatient Treatment, and Assertive Community Treatment Team) as more difficult to deliver via telehealth. Only 34% of providers rated outpatient services as harder to provide via telehealth than in person.

In addition to the ability to safely serve members during the pandemic, telehealth presents other benefits over in-person services. Members ad providers reported reduced transportation difficulties and travel expenses, which are known to be significant barriers to in-person appointments. Telehealth also provides flexibility and engagement advantages, reduces the need for childcare, and may allow providers some insight into a members’ home environment.

There are some disadvantages, however. One barrier may be lack of technology or the knowledge to use it. Providers may need to invest in upgraded equipment or broadband access, and some members may not have a computer, smart phone, or tablet with internet access. Despite this hurdle, 80% of providers reported that most members had no challenges with platform. Telehealth may not be suitable for all ages or diagnoses. Members’ home environments may not provide privacy from family members or present distractions from children in the household. And many members may have difficulties completing paperwork or co-payments electronically.

One survey limitation is that members without valid phone numbers in the system were excluded from the sample. In addition, there were low numbers of responses within subpopulations and claims lag may have meant several weeks passed between the members’ service and survey.

“This survey provides a starting point for continued examination of how telehealth may serve members going forward,” said Wes Knepper, Alliance Senior Director of Quality Management. Ideas for future inquiry include:

  • Leveraging stakeholder insight and digging deeper into claims data to identify populations whose needs are not being met.
  • Continuing to assess ongoing and long-term outcomes of the shift to telehealth for members and providers.
  • Developing strategy to support providers with transitioning to HIPAA compliant telehealth platforms
  • Assessing provider training needs, best practices, and training options.

The survey summary presentation may be found here.

Alliance Expands Partnerships to Care for Communities

Alliance Community Health and Well-Being (CHWB) staff have expanded efforts to improve well-being in our communities during the COVID-19 pandemic through strategic partnerships to reach people in areas of highest unmet social needs.

Factors such as income, employment, education, food security and housing are known to affect health and well-being, and all have been impacted by the COVID-19 pandemic. “When you’re out there in it you realize that the TV does not do it justice,” said Ann Oshel Alliance Senior Vice President—CHWB. “People are really struggling and suffering.”

To reach these people and let them know where to turn for help, Alliance has teamed up with providers and community organizations in new ways.

In one initiative, funded through the CARES Act, outreach teams from Southlight Healthcare and Renew Counseling Center are canvassing in neighborhoods with high rates of COVID-19 infections. The canvassers visit businesses and homes in these areas and offer emotional support and information about accessing helping resources, including the Hope4NC helpline.

“We’re in some neighborhoods where they have a 60% positive rate,” Oshel said. “We know that just about everywhere we’re going somebody knows somebody or has been personally affected,” she said.

Food is a major area of increased need caused by the pandemic, so Alliance has partnered with NC Cooperative Extension Wake County Center and Wake County Public School System (WCPSS) as part of their food insecurity response. “It is huge what they’re doing, and it’s a terrific opportunity to make sure people know where to get help,” Oshel said.

Alliance staff have participated in food distribution events almost weekly, giving out packets that include information about Hope4NC, Alliance Health, and crisis services. At a recent drive-up food distribution at First United Methodist Church Cary, Oshel passed info to people in more than 400 cars that lined up for a Thanksgiving meal, groceries and gift cards. “They are in line for food, which is indicative of some kind of struggle, and everyone just wants to talk about how hard this has been,” she said.

In addition, people in each car scanned a QR code that led to a community outreach survey asking about specific needs each family may have. Those who indicate they are interested in mental health counseling and support are referred to Alliance for follow-up as part of Hope4NC outreach efforts.

Alliance staff will also be participating in upcoming events in partnership with WCPSS and the InterFaith Food Shuttle to deliver food to families currently housed in hotels, with mental health and Hope4NC information included in each box.

Another initiative Alliance has joined is the effort by WCPSS to address students who have not engaged in virtual learning. Alliance staff are analyzing school system data to see if we are already doing outreach into the neighborhoods with a high number of absentees and to help WCPSS determine what interventions and resources can help engage the missing students.

“It’s tens of thousands of kids” who have either never connected to the classroom or engaged only episodically, Oshel said. “The school system is concerned that there might be something more significant going on with the families, and they have asked us to provide some resources,” she said.

“It has evolved from the school system asking us to provide information and join them at events to asking us to work with together with them to make sure the families and students they are really concerned about have somebody to talk to,” Oshel said.

North Carolinians experiencing stress during this trying time can get free crisis counseling from Hope4NC by calling  1-855-587-346;3.

Alliance Launches Hope4NC #HealthyHoliday campaign

Hope4NC #HealthyHoliday social media message

One of the Hope4NC #HealthyHoliday social media messages.

Alliance’s Community Health and Well-Being department has launched the #HealthyHoliday campaign to promote mental health awareness and get the word out about Hope4NC.

To spread the word about Hope4NC, Alliance staff are being innovative to reach those who need hope and help during this holiday season. Throughout this holiday season interactive messaging, interviews, daily words of affirmation and videos will be posted on Alliance’s social media platforms: Facebook, Twitter and LinkedIn.

The Federal Emergency Management Agency originally created Hope4NC after the devastation of Hurricane Matthew to provide emotional support and referrals to community resources to help disaster survivors manage their stress. Hope4NC now offers a 24/7 helpline that provides free crisis counseling for North Carolinians who have been affected by COVID-19 physically, mentally or financially.

Anyone in North Carolina’s 100 counties can call 1-855-587-3463 to be connected to immediate crisis counseling services.

“Hope4NC provides a safe space for you to share your struggles, concerns, and needs by providing confidential crisis counseling and a variety of other resources to improve overall mental health,” said JaMonica Thompson, Alliance’s Hope4NC program manager. “Help us help you, stop the stigma, it’s OK to reach out.”

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New TBI Group Home Opens in Durham

Moretz Manor

Moretz Manor ribbon cutting

Top: Moretz Manor; bottom: Alliance Health Network Program Manager Kate Peterson (right) helped cut the ribbon for the opening of Moretz Manor, a new group home for adults with traumatic brain injury.

Moretz Manor, a new group home in Durham serving adults with traumatic brain injury (TBI), celebrated its grand opening in October.

Alliance Health funded Moretz Manor’s start up and is working closely with Lutheran Services Carolinas on the facility’s development. The home will offer a specialized residential program to people receiving services through the North Carolina TBI Waiver. The program will also be open to adult Innovations Waiver members who sustained a TBI. Lutheran will also be accepting workers compensation and other forms of payment.

The home, located in a quiet Durham neighborhood, has six single-occupancy bedrooms and two full bathrooms, one of which is wheelchair accessible. The home also features a large living room, dining room and kitchen, an outdoor patio, and internet, cable and all amenities.

“Moretz Manor is a welcome addition to the spectrum of community-based care available to adult participants in the TBI Waiver and Innovations Waiver program,” said Cristina Phillips, Alliance Provider TBI/IDD Long Term Supports Supervisor. “The home provides an alternative to a skilled nursing facility or institutional setting.”

The home provides 24-hour supervision, with trained staff assisting residents with activities of daily living, educational and recreational opportunities and skill building. Staff include a program manager and a nurse, and participants will receive psychological and medical services, including speech therapy, occupational therapy, and physical therapy.

About North Carolina’s TBI Waiver program

The TBI Waiver provides an array of home and community-based services, through a three-year Medicaid waiver pilot, in Alliance’s four-county region. The waiver is designed to provide an alternative to nursing facility care or specialty rehabilitation hospital care for eligible individuals with a traumatic brain injury.

TBI Waiver services may be available to residents of Durham, Wake, Cumberland and Johnston counties who experienced a severe TBI which occurred on or after the age of 22, resulted in effects that are likely to continue for a very long time, resulted in significant challenges in completing daily activities, and caused the person to need more than one type of rehabilitative service and supports. Individuals must apply for and be eligible for Medicaid to receive TBI Waiver Services. Alliance staff can assist with the application process. To get started, call the Alliance Health Access and Information Center at 800-510-9132 and ask to speak to a TBI access specialist. Learn more at the Alliance Health TBI Waiver page.

LME/MCOs Preserve Behavioral Healthcare Access During COVID-19

The following op-ed piece was authored by all seven North Carolina LME/MCOs and is being submitted to various publications across the state.

Like nothing before it, COVID-19 threatened access to behavioral healthcare. It led many people to put off or cancel necessary care. It created grave challenges for many healthcare professionals who provide that care to individuals who receive mental health, intellectual/developmental disability (IDD), and substance use disorder (SUD) services. The negative health impacts of this pandemic will extend far beyond the immediate effects of the virus, particularly for those who are either uninsured or on Medicaid and have social and environmental factors impacting their overall health.

Aggressive action was needed to sustain our state’s behavioral health and IDD system so that these individuals have uninterrupted access to care throughout the COVID emergency and beyond. Thanks to the support of the North Carolina General Assembly, Governor Cooper, and the NC Department of Health and Human Services, North Carolina’s Local Management Entity/Managed Care Organizations (LME/MCOs) have been able to meet this challenge by sustaining and adapting the availability of local services and supports across our state.

North Carolina’s seven LME/MCOs are responsible for managing Medicaid and other public behavioral health and IDD funds for millions of North Carolinians in all 100 counties who are uninsured or covered by Medicaid. Working closely with our behavioral health providers, the LME/MCOs have invested more than $150 million over the last six months to help our members, families, and communities weather the pandemic and prepare for challenges in the months and years ahead.

LME/MCOs made significant investments to ensure the availability of local services and supports. We sustained our front-line providers, the healthcare professionals who ensure members receive crucial treatments and care. We made financial stability payments that helped keep their doors open, quickly jump-start telehealth services, and serve individuals virtually.

People can and do recover from mental illness and SUDs–provided they can access the proper treatment. That is why telehealth service delivery has become essential during the pandemic. LME/MCOs utilized funding to purchase mobile phones and data plans for members who did not otherwise have these resources but needed to continue receiving services. By maintaining access to services through telehealth, we can help avoid emergency department visits and unnecessary hospital admissions, thereby relieving pressure on the state’s hospitals and healthcare system. And, we know that positive outcomes for individuals with IDD hinge on promoting stability and helping them stay in their homes and communities of their choice.

We are grateful to North Carolina policymakers for supporting our efforts to maintain access to behavioral health and IDD services for North Carolinians during the COVID-19 pandemic and helping us protect our members, their families, and providers. Because of this support, we have promptly responded to the unique needs of our communities during this crisis. Moreover, we commend our providers for adapting under extraordinary circumstances to serve members and we recognize them for their outstanding courage and dedication to others. The LME/MCOs are committed to continuing to work together with policymakers and providers to successfully serve our members and their families through the pandemic and beyond.

North Carolina’s LME/MCOs:

  • Alliance Health
  • Cardinal Innovations Healthcare
  • Eastpointe
  • Partners Health Management
  • Sandhills Center
  • Trillium Health Resources
  • Vaya Health