In Bernalillo County, a series of high-profile behavioral health-related challenges led to an allocated $17 million per year for the county to spend on providing high-risk populations with targeted behavioral health services.
With help from the GPL, the county developed a strategic procurement system to most effectively spend the newly allocated dollars, which included identifying behavioral health service needs, best practices, and priority populations. The County’s first initiative will provide over 10,000 children with a variety of behavioral health interventions that aim to prevent adverse childhood experiences.
The county developed a problem-based procurement template that minimizes prescriptiveness and focuses on specific outcomes; which it continues to use to expand its behavioral health service array. This includes the provision of new youth transitional living services, community engagement teams, and mobile crisis teams.
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On March 16th, 2014, Albuquerque Police officers fatally shot James Boyd, a schizophrenic man camping in the hills outside the city. This incident brought a long-standing challenge – providing adequate behavioral health care services – to the forefront of the public sphere. Like many jurisdictions across the U.S., Bernalillo County’s approach to dealing with high-risk individuals with behavioral health challenges was largely remedial (the county jail is the largest regional provider of behavioral health services, providing addiction treatment, discharge planning, etc.). In response, the voters of Bernalillo County and the County Commission approved a 1/8th percent gross receipts tax increase in late 2014 to fund behavioral health services. This resulted in an additional $17 million per year for the county to spend on providing high-risk populations with targeted behavioral health services.
The GPL worked with Bernalillo County and several project partners to develop comprehensive systems for identifying and procuring for a variety of behavioral health services. This included identifying behavioral health service needs, best practices, and priority populations as well as developing and implementing a problem-based procurement. Major project components included:
Determining how to spend the tax allocation most effectively. Bernalillo County developed an interim governing structure around the gross receipts tax allocation, which included four community based sub-committees working through a joint city / county governing structure. Each committee is staffed by a city or county employee, but is chaired, co-chaired, and comprised of various members from the community.
Targeting adverse childhood experiences through a problem-based procurement. The county’s first initiative was an RFP for preventative behavioral health interventions aimed at at-risk children, with an annual budget of $3 million. The county issued a problem-based RFP using the issue of “Adverse Childhood Experiences” (ACEs) as its motivating framework. Respondents were asked how they would 1) prevent adverse childhood experiences, 2) reduce the likelihood of future adverse childhood experiences, and/or 3) address the link between adverse childhood experiences and long-term negative health and well-being outcomes. The response to the RFP was one of the largest the county had ever seen, with twenty-four service providers submitting applications. Eight providers were ultimately selected, and contracts were structured as two-year “pilot projects” with the option to renew, adjust, or re-procure after the pilot phase. The new interventions will reach over 10,000 children and adolescents each year through a variety of preventative programs. Programs include: systematically screening at-risk children for ACEs and social determinants of health, providing case coordination and parent-child skills courses to at risk or neglected children and their families, and working with adolescents re-entering or being diverted from juvenile detention.
Moving forward to expand other identified behavioral health services. Following the ACEs RFP, the county issued three additional RFPs for behavioral health programs: Youth Transitional Living Services ($650k), Community Engagement Teams (up to $1mm), and Mobile Crisis Teams ($1mm). Each procurement has used a problem-based and outcomes-oriented approach, minimizing prescriptiveness and focusing on specific outcomes. For the Mobile Crisis Teams initiative, the city and county entered in to a cooperative procurement in order to develop and ensure consistency across behavioral health treatment services.
The Bernalillo County project provides an example of how governments can use procurement opportunities as a transformative management tool to identify key challenges, collaborate with the community to pilot solutions, and continuously iterate to improve service delivery. In particular, the project has:
Reformed procurement practices to ensure the right services are reaching the right people. The ACE’s RFP established a new problems-based approach to procurement that is now being adopted more broadly throughout the county government. These procurements start by identifying gaps in the current behavioral health continuum service array, and are focused on working collaboratively with community stakeholders and service providers to identify and pilot innovative solutions.
Spurred active collaboration with providers to use real time data to improve service delivery. The county is facilitating monthly stakeholder meetings, performing data inventories, and conducting site visits in order to actively collaborate with providers to improve service delivery. The ACEs contracts lay out requirements for tracking performance measures and for frequent active contract management meetings to ensure sustained collaboration. In the current framework, providers share updated performance data one week before their monthly meeting with the county. Then through collaborative, in-person meetings, the county and the providers can adopt continuous, real-time improvements such as enhanced service coordination, more targeted service delivery, and quick resolution of unexpected challenges.
Incorporated evaluations to improve programs and inform future funding decisions. As part of an innovative partnership with the University of New Mexico Institute for Social Research, each program selected through the ACEs RFP will receive a structured program evaluation. This will be a key component in the county’s decisions about how to continue the ACEs program. These initial process evaluations may also help to lay the ground work for more extensive impact evaluations down the road.
Shifted the focus from remedial to preventative behavioral health spending. In 2018, more than 10,000 children will be provided critical services that they would not otherwise have had access to. For many of the providers, this program represents the first time they can focus their services on prevention, and for all providers the new funding is helping fill the gap in behavioral health services.