Spotlight on the States: South Dakota Change Agents
The Spotlight on the States is a quarterly series designed to highlight valuable resources that have been developed by states to further the integration of mental health and substance abuse systems and services. States highlighted in this series were a part of a SAMHSA-supported learning collaborative and agreed to share their experiences, resources and lessons learned.
South Dakota's Use of Change Agents
South Dakota recruited "Change Agents" to help guide and sustain its Statewide effort to improve services for people with co-occurring disorders. More than 150 Change Agents — including every community mental health center and 90 percent of substance abuse treatment providers — meet quarterly to review the State's progress under its Co-Occurring State Incentive Grant (COSIG) and recommend improvements to policies and programs.
"In South Dakota, our providers are valuable partners in improving services for people with co-occurring disorders," says Kay Ermish, M.S.W., LCSW, Project Coordinator with the Black Hills Special Services Cooperative and lead consultant to the South Dakota Division of Community Behavioral Health in implementing its COSIG. "We really believe that meaningful change needs to involve not any one of us, but all of us — and that has become the guiding philosophy for our change efforts."
The collaboration of Change Agents is coordinated by an executive team of State-level leaders and evaluators. Transformation at the state-level is guided by a steering committee — called Partners in Transformation — that includes consumers, Change Agents, supervisors, directors and administrators from a range of service systems, including the Division of Community Behavioral Health, the Human Services Center, the Division of Child Protective Services, The Division of Developmental Disabilities, Special Education from the DOE, Unified Judicial Services (both juvenile and adult court services), and the Department of Corrections.
Like many rural States, South Dakota is challenged by geography to provide access to services and also to convene stakeholders face-to-face. To help bridge the distance and the time between in-person meetings, South Dakota used regular conference calls, video conferencing, Webinars, and an online "wiki space" to share information and ideas among Change Agents. The State also provided mini-grants to participating agencies across the state to help defray time, travel, and administrative costs of participation in the transformation effort.
South Dakota has implemented a number of policy changes in response to recommendations from Change Agents. For example, the State adopted a flexible billing structure that allows addiction treatment specialists to bill for basic mental health interventions, and mental health providers to bill for alcohol and drug interventions. In addition, the State now includes expectations related to co-occurring capability in provider contracts. Beginning this year, the State will develop and revise policies describing expectations for providers related to integrated care in screening, assessment, and treatment.
A Scope of Practice Workgroup of providers, collaborating with State licensing boards, developed guidelines based on the philosophy that all clinicians should work toward co-occurring disorder capability. In addition, providers agreed to take a number of steps to conduct annual assessments of their co-occurring capabilities using a standardized tool, COMPASS-EZ. They also agreed to evaluate clinical skill levels using CODECAT-EZ, and to update Quality Improvement plans every six months.
"The outcomes of this collaboration so far have been far reaching," says Shawna Fullerton, Director of the Division of the Division of Community Behavioral Health. "We have been working with communities across the state to develop a more integrated system of care of both adults and youth, and they've really stepped up to the challenges of expanding access and offering services to individuals and families at the right place, at the right time, with the right approach to keep people engaged," she adds.
Screening and tracking for co-occurring disorders increased across the State, and nearly every agency now maintains data on the State's management information system on the number of individuals screened and assessed for co-occurring disorders." In addition, two-thirds of provider agencies have developed integrated treatment plans, and virtually all agencies (97 percent) have implemented "welcoming" policies to ensure that everyone who presents for treatment is engaged.
For more information please contact Kay Ermish at kermish@tie.net.
