Camille Harding leads the Community Behavioral Health Division in the Colorado Department of Human Services, Office of Behavioral Health. Her team oversees the public behavioral health system, which includes statewide crisis services, prevention programs, and substance use and mental health treatment and recovery services across the state.
Ascent: What is your vision for expanding and supporting behavioral health services across Colorado?
Harding: We are undertaking a Population in Need Study to get a good understanding of services around the state and help our office prioritize efforts and financing for behavioral health services. We are looking at behavioral health data sets and convening community experts to identify and target areas of focus for the next several years.
Within our Colorado Crisis System, we are prioritizing mobile response teams that go to where people are in the community—at home, at the library or at the coffee shop--rather than requiring clients to travel to a treatment setting when they are in crisis. We are interested in expanding this system to ensure statewide coverage. We are also looking at ways to support expansion within the crisis system by leveraging community-based co-responder models where a social worker is paired with emergency responders so individuals in a behavioral health emergency can be better served by a behavioral health team instead of law enforcement.
We’re also looking at trauma-informed systems and thinking about an early trajectory for engaging children and their families, based on the Adverse Childhood Experiences study. We want to make sure children and families have the support they need, and that may include social determinants of health. Some of that falls into the traditional behavioral health area, but some is case management and making sure families are supported with wraparound services and all their developmental milestones are met.
Ascent: What has surprised you most in the implementation of the Regional Accountable Care entities (RAEs), which are focused on providing integrated behavioral health and primary care for Medicaid beneficiaries?
Harding: Since we work so much in the specialty behavioral health space, I haven’t had a lot of recent interaction with primary care providers and how behavioral health screening is increasing demand for behavioral health services. In general, I think the RAE system expands access and allows providers to treat individuals in the primary care setting. I used to work in a primary care practice and provided behavioral health services in the primary care setting. This supports families in addressing behavioral health issues more immediately. Addressing parenting questions, developmental issues, managing case management needs and addressing social determinants of health is a huge opportunity to support clients.
From a systems perspective, I’m hearing most about shifting contractual relationships, and the implications for substance use treatment providers and community mental health centers. Our providers are having to think differently about how they deliver services, because payments are different now under the RAE. What we’re focusing on is how we can make sure we have sufficient resources for those intensive services within communities.
Ascent: What's next in terms of advancing behavioral and whole-person health in Colorado?
Harding: We’re looking at how we can leverage health information exchange for whole-person care, so behavioral health providers have access to the patient’s longitudinal record—emergency room visits, hospital stays, etc.—that occur in primary care settings. Even from the criminal justice side, we’re trying to leverage health information exchange so that when a person is incarcerated, a health care provider in a criminal justice setting can support continuity of care and maintain treatments—particularly in terms of medications.
Our health information exchanges in Colorado are in the process of implementing patient consent management modules, so, if patients consent, they can update it when needed and share the record. That will be key to allow the behavioral health providers to use health information exchanges.
We’ve also been running some interesting pilots with federal grants (a combined $45 million since 2017) to combat opioid addiction. Primary care providers have been trained to use medication-assisted treatment with buprenorphine, and we’re scaling up some of those best practices to ensure folks have access to those services across the state. We’ve worked closely with Health First Colorado (the state’s Medicaid program) and the University of Colorado Department of Family Medicine to fund technical assistance with the IT MATTTRs initiative. We’ve increased the number of primary care providers who are trained and approved to offer medication-assisted opioid dependency treatment by almost 500 providers.