Show Summary:
Behavioral Health Division - children's services grants
The North Dakota Health and Human Services (HHS) Behavioral Health Division has announced the availability of Children's Behavioral Health Service Grants through the System of Care initiative, aimed at supporting the development and implementation of community-based, culturally responsive services for children, adolescents, and young adults with behavioral health conditions and their families.
Tanner Mosser, 21-year-old ND High School Varsity head coach
Tanner Mosser is the girls basketball coach for South Prairie-Max and led his young team to an improbable appearance in the Class A State Championship game Saturday night in Minot. Tanner is just 21-years old, one of the youngest coaches in the history of North Dakota prep basketball.
NOTE:
To learn more about the System of Care grant discussed today, please visit our website at: https://www.hhs.nd.gov/behavioral-health/system-of-care or contact Katie Houle directly, khoule@nd.gov.
For additional information about the Behavioral Health Division programs and initiatives:
- https://www.hhs.nd.gov/behavioral-health
- Mental Health Directory: https://www.hhs.nd.gov/behavioral-health/directory
If you or someone you know is struggling or in crisis, help is available. Call or Text 988 or chat 988lifeline.org.
The interview with Katie Houle, a licensed master social worker and clinical administrator for the System of Care in the North Dakota Health and Human Services Behavioral Health Division, covered the availability of behavioral health services grants aimed at improving mental health and substance use conditions across all age groups in North Dakota. Key highlights include:
- The importance of understanding behavioral health as a crucial aspect of overall health, emphasizing mental health and substance use conditions affecting individuals and families.
- The System of Care initiative, stemming from a 2018 study by the Human Services Research Institute, focuses on developing a comprehensive system of care for children with complex behavioral health needs, addressing system gaps and strategic goals.
- The initiative aims to create a broad and robust continuum of services, from prevention and education to meaningful treatment services, ensuring accessibility across the state, particularly in underserved areas.
- North Dakota received a federal grant of $3 million per year for four years from the Substance Abuse and Mental Health Services Administration (SAMHSA) to fund the System of Care initiative, focusing initially on two geographic areas: the Greater Bismarck-Mandan region and the Greater Devils Lake region.
- The System of Care Children's Behavioral Health Service Grants aim to direct federal funding into these regions to support entities and providers currently serving or interested in expanding youth-specific services, emphasizing community-based, youth and family-driven, and culturally responsive services.
- The grant application process has been simplified to encourage more providers to apply, aiming to make funding opportunities more accessible to entities with varying capacities.
- The initiative's success will be measured by increased service provision to children, adolescents, and young adults, with a long-term vision of improving systemic outcomes such as higher graduation rates, reduced emergency department visits, and lower juvenile justice involvement.
- Sustainability is a key focus, with emphasis on leveraging the grant to support the implementation and expansion of home and community-based services that are reimbursable under state Medicaid plans and federal sources, aiming for a lasting impact beyond the grant period.
Transcript
Youth Behavioral Health Grants
Main Street
Katie Houle is a licensed master social worker, clinical administrator, system of care in the North Dakota Health and Human Services Behavioral Health Division. That's a long title, Katie, but welcome to Main Street.
Katie Houle, ND HSS
Thank you. It's great to be here, Curt.
Main Street
You have announced that some behavioral health services grants are available, Katie, and we want to really get into that today to let our listeners know that there may be people listening that have never heard of these opportunities before. Maybe get down in the weeds a little bit to really tell people what is available and how this money can be used and how it can help the community. Give us an overview of the grant program.
Katie Houle, ND HSS
Absolutely. Well, I think that the first thing that I would love listeners to know is a little bit of history. So the Behavioral Health Division within Department of Health and Human Services, we're really looking at how are we thinking about programs and policies that impact those with behavioral health conditions across the lifespan.
Main Street
Can I ask you a quick question? Absolutely. What does that mean?
What are behavioral health conditions?
Katie Houle, ND HSS
Absolutely. When we think about behavioral health, first of all, one of our really key components that pushes our work is behavioral health is health. So when we talk about behavioral health, we're thinking about what are mental health or substance use conditions that impact children, adolescents, young adults, adults and family systems across the state.
And so similar to other health conditions, we're thinking about how do we provide programs and services and really education and prevention programs across the state that really help people know what is behavioral health and what are those conditions, signs and symptoms to be watching out for themselves within themselves and other people, especially their loved ones and those within their lives. But also, how can we be getting better treatment into our communities and making sure that children, adolescents and adults have access to really meaningful treatment services and supports close to home.
Main Street
And we'll get into a little bit later where those services potentially can be. But essentially, it's not just a Fargo thing. It's not just a Bismarck thing that we're talking about today.
Katie Houle, ND HSS
When we think about the system of care initiative, it really comes from a study that happened back in 2018. For listeners to know, the Human Services Research Institute put out a study, a behavioral health study that really talked about where are we doing a really good job and where are those opportunities for us to fill system gaps. And one of those strategic goals was for us to be thinking really meaningfully about how do we develop a system of care for children that have complex behavioral health needs.
Main Street
When we say us, you mean the state of North Dakota?
Katie Houle, ND HSS
Us, yes, as the state of North Dakota. And that is a really big, broad initiative. But when we talk about a system of care, what we're thinking and talking about is how do we have a really broad and robust continuum of services from mental health promotion and prevention work, right?
How do we make sure everyone knows about conditions that can impact young children, even prenatally with mothers and all the way up into transitional age youth? But how do we also think about the service continuum when we start seeing signs of impacts of mental health or substance use within children and adolescents and young adults? And so the system of care initiative really has two goals, is how do we develop a much more comprehensive children's behavioral health service array?
So what is that menu of services that we need across the state and within our local regions? And then how do we develop the infrastructure to really sustain those service systems, right? How do we ensure that we have cross-system partnerships and how do we ensure that we have those funding structures in place?
Because there are certain service gaps, depending on your insurance status, depending on where you live in the state and your ability to really overcome some of those barriers, right? We have to think about geography. We have to think about our challenges and workforce shortage and our challenges and really ensuring that there is, we're thinking really thoughtfully about access in all really corners of North Dakota.
The first milestone of that strategic plan of creating a system of care was for us to get funding. And so we applied and we were one of six states to receive a system of care grant from Substance Abuse and Mental Health Services Administration or SAMHSA. So this is a federal grant.
This is a federally funded grant. How much? It's three million dollars per year for four years.
And of course we have to apply year to year, but it was a really important milestone for us to have that federal funding opportunity for us to be thinking about how do we develop that service array and how do we develop the infrastructure to sustain it.
Main Street
The quick question would be, three million seems maybe like a lot of money to some, but this is a big state. Are you in a position yet to know if it's enough money?
Katie Houle, ND HSS
What we did is, when we think about system of care, I want listeners to be thinking about how are we going to do it statewide. But for the first four years, we have decided to focus on two geographic areas. And those regions are the Greater Bismarck-Mandan region or the region that's served by West Central Human Service Center.
And that includes shared geography with Standing Rock as well as MHA Nation. And then also the region served by Lake Region Human Service Center and the Greater Devils Lake region, including shared geography with Spirit Lake and Turtle Mountain. And so that was a grant requirement for us to be thinking about not only statewide infrastructure, but what do we need to be thinking about regionally and locally in order for us to be meeting the needs of children with those complex behavioral health needs as close to home as possible.
And so that brings me to why we have released, we recently released System of Care Children's Behavioral Health Service Grants. And this is really our opportunity for us to release some of this federal funding directly into those regions to really hopefully impact how child serving entities. So those could be for-profit organizations like private behavioral health care providers.
It could be family-run organizations, non-profit agencies, people that are already serving children within those regions or organizations that are really interested in expanding into youth-specific services in those regions. And so the goal is for us to utilize this funding so that we can really allow those entities and that current infrastructure and really the people that are currently doing this work and really being champions in their local communities, the ability to expand services that directly serve this target population.
Main Street
Katie, sometimes some of the organizations that you talked about generally are better geared to reach out, obtain grants, and then use the grants to supplement their service goals. And other entities may not have the manpower to do that. What do you suggest to those folks and how can you make sure that what you're doing is really inclusive to maybe some folks who've never went down this road of getting a grant to do that which they want to do?
Katie Houle, ND HSS
I think that that's a really important question, Craig. And we were actually really mindful about capacity and what we are already asking our health care providers and behavioral health providers and those serving children to do, right? We are asking providers to be serving children, adolescents, and families.
And it is often beyond levels of expertise and capacity to think about how do I have time to apply for funding? How do I apply for funding and think meaningfully about how to sustain it? How do I build and create all of those funding structures that are going to ensure that I'm able to provide accessible services in my community?
And so one of the things that we did with this service grant application is really did simplify it, right? We do not have a specific application or formatting structure. We really have a set of about 10 questions that we are asking these local providers to answer to really paint a picture of how they envision creating opportunities to better serve children that they may already be serving or expanding into service areas that they've been really dreaming of doing.
We have really invested over the last year in a lot of grassroots community level engagement. And so we've had the opportunity myself is to sit with some of these providers and say, looking at this, does this seem like something that's for you, right? And sometimes we get that feedback of how can we create these funding opportunities to be a little bit more accessible.
But I do think the service application we have right now is really simplified in a way that our hope is that it isn't going to take too much capacity to be thinking about. I think our goal with this service application really was to make the application as simple and accessible as possible so that we can really honor the skills of those providers and those serving children in our community right now.
Main Street
I'm going to ask you now, Katie, to tell folks where they can get more information. And I'll ask you again at the end of the interview, but for maybe someone who's not stepping all the way through this, what should they do today if this is something that's very exciting for them?
Katie Houle, ND HSS
So if you're listening and you are in a role, whether you're an educator, you are someone that's serving children with behavioral health conditions clinically or in any other capacity and are really interested in working together and collaborating with us on how we can create more services for this target population, I would really love for you to reach out to me. Reach out to me via my email. Navigate to our System of Care grant page, which is under Department of Health and Human Services, Behavioral Health Division, and my direct contact is there as well.
This service grant application does end on March 8th, but we do anticipate, Craig, having other funding opportunities that are going to be coming down the line, and I want to make sure that I'm staying in good touch with people that would be really interested in working together to serve children, adolescents, and families, especially with complex behavioral health needs. If you are a listener, you may be a parent or a caregiver or a grandparent or a loved one of a child or adolescent or young adult that is really struggling with a behavioral health condition, and so what I would like to share with you is we are really working hard, especially in these two regions, to think about how do we listen to your needs and ensure that all of this work is really driven by what you would like to see, the services you would most need to access.
Main Street
Katie, will this grant prioritize certain types of services or can you go into more detail about what services specifically you envision?
Katie Houle, ND HSS
Absolutely. System of Care is really a set of values and philosophies, and what we know is that in order for us to create really value-based services that are community-based, youth and family-driven, and culturally responsive, we know that we have to look at our service continuum, especially our more intensive home and community-based services. One of the things that we're seeing within our system is that we are utilizing inpatient hospitalizations, our psychiatric residential facilities, sometimes corrective settings and group home settings.
Those levels of care are already always really critical, especially as it relates to medically necessary psychiatric care, but what we really want to focus on with System of Care is how do we create intensive home and community-based services that provide the level of intensity and frequency of services that are needed in home, in school, and in the community. What we often hear is maybe, especially depending on where a family might live in the state, is they may have some school-based mental health services or maybe accessing outpatient services, but there may be behaviors or conditions that that child has that they aren't responding positively to once a week or once every two week outpatient services. And those are the services that we're really targeting is what are those services that are evidence-based practices like more intensive home-based therapies or what are those more care coordination services that could really connect the dots and help our system more easy to navigate for children and families that really need more care than they're receiving right now.
Main Street
Enjoying our conversation with Katie Houle, she's a licensed master social worker, clinical administrator, System of Care in the North Dakota Health and Human Services Behavioral Health Division. How will you know that this grant money is being impactful in a positive way? How do you know that the money is well used?
Katie Houle, ND HSS
So I think a part of us releasing funding and developing partnerships with local community organizations is the first goal is that we want to increase the number of children that are being served, right? So we want to know that there are more children adolescents and young adults that are receiving adequate behavioral health services.
Main Street
Can I ask a quick question?
Katie Houle, ND HSS
Sure.
Main Street
Is it your view that more children are now needing those services or that the children have always been there they just haven't been identified?
Katie Houle, ND HSS
I think that's hard to answer. I think that we are in a time that we are seeing a higher prevalence of mental, emotional, and behavioral disorders and right now what we see in terms of data is anywhere from about 10 to 12 percent of just the general population of children tend to meet criteria for a diagnosable condition and when we think about a diagnosable condition it's really about level of functioning, right? One child may have diagnosed depression and another child might have a diagnosis of depression and what their individual presentation might be, what will be totally different and how that impacts their functioning, right?
And so a child with depression may really struggle to get out of bed, engage meaningfully with their peers, attend school, right? And so we're starting to see that it would be indicators to community-based providers that we certainly need treatment for depression but how do we work together with that family system, with that school system to create, you know, a more meaningful plan for that child. But we also know that there are children with depression that are functioning pretty well.
They're engaged in hockey, right? They're having positive relationship with peers and that's showing up in different ways in their lives, right? Maybe it's showing up at home.
Maybe there's some, you know, anger and challenges and conflict that comes up with parents or caregivers at home and so I think we know that the prevalence rates are about 10 to 12 percent but I think everything that we talk about within behavioral health is how do we create that service array so that we can really be individualizing because we know that the individual circumstances of each child within our state is really unique.
Main Street
Back to my original question then, how do you know that the money is being well used and providing successes?
Katie Houle, ND HSS
I think we have to think about it from a whole system perspective. I think we're going to have individual data. We're going to individually know that if we're providing adequate services that an individual child is self-reporting and has some of those functional outcomes that allows us to see that they're getting better over time.
But from a system perspective, Craig, one thing that we know is that 10 to 12 percent that meet criteria for a serious emotional disturbance, we know across the nation about 75 to 80 percent do not receive adequate treatment and where do we see those impacts is across our system. So we know that children that don't receive services have issues with attendance and academics. Our older adolescents and transitional age youth, it impacts employment.
We see a lot of challenges with health care, starting to see physical and chronic health care conditions. We see the starting of maybe higher risk substance use behavior and higher risk to having a substance use disorder later in life. So we see some of those poor life indicators.
And so the point I'm trying to make is that children with complex behavioral health needs have multi-systemic involvement. We can't only be thinking about this from a behavioral health perspective. We have to be thinking about what are those behavioral health outcomes, but also how can we be thinking about it from a school and academic perspective?
How can we be thinking about it from a juvenile justice and child welfare perspective? And how can we be thinking about it from a health and sort of social determinants of health perspective? And so to answer your question, it's really we are going to know that we're doing a good job when we see higher graduation rates for children with emotional disturbances.
We're going to know we're doing a good job when we see lower rates of children that are going into emergency departments and psychiatric residentials due to their conditions. We're going to know we're doing a good job when we are seeing lower rates of engagement and involvement in juvenile justice. We know that there's high prevalence of those that are in juvenile justice that have behavioral health conditions.
So how do we ensure that kids don't get to the point of engagement in those systems? How do we prevent getting there? And so it's hard to answer that question, right?
Main Street
And certainly the results aren't immediate by any means.
Katie Houle, ND HSS
Right. It's not immediate. It's going to be incremental.
But I think if we can think about this really as micro and locally as possible, my hope is if we have more providers and more services in those local communities, we're going to see and feel the reverberations of that within our family and community systems sooner than later. And then hopefully, seven to ten years from now, we're going to see those system-wide changes.
Main Street
Positive outcomes. Katie, you mentioned the word sustainability earlier. Right.
And so many times with grants, that's the big elephant in the room. Right. These services we've come to learn are good, needed, necessary.
The grant now runs out. What are your thoughts about that?
Katie Houle, ND HSS
There's three things that I think about. We have to be mindful about sustainability throughout this initiative. Two of our priorities within this specific service grant is for us to be targeting entities that are interested in implementing or expanding two types of services.
And those are those home and community-based services that fall under our 1915i state Medicaid plan. And those are reimbursable services under that state Medicaid plan. And system of care can really help bridge the gap.
It's hard to go from starting a, let's say, a community-based agency and becoming a billable, reimbursable provider. Could we use federal funds like system of care to help motivate, implement, and get to a point of being able to reimburse and sustain that? The other one that we are focusing on is our Title IV-E prevention programs.
And our Title IV-E prevention programs are another sustainable federal source. So these are our programs. They're evidence-based practices that have been selected by our state through Department of Health and Human Services, Children and Family Services, of specific services that we can be implementing really to prevent out-of-home placement.
So especially kids that need more intensive evidence-based services like functional family therapy, brief strategic family therapy, multisystemic therapy. These are all short-term, time-limited, but more intensive home-based service opportunities for children that meet eligibility. And so the purpose of that, just like 1915i, Craig, is how do we fill that gap, right?
How can we get people hired, get people trained and oriented, develop those community-based partnerships, and we can use system of care funding to help lift. Let's use this as a lifting mechanism to get us connected to those sustainability sources. So the third being our more classic fee-for-service models.
And there are limitations to that, right?
Main Street
Who has insurance? Who has a means to pay?
Katie Houle, ND HSS
Exactly. In a lot of our communities, there are pretty high rates of those that are insured or are on Medicaid. And some of our private behavioral health providers need a little bit of support to, similar to like I shared, is hiring a new psychologist, hiring a business manager, hiring a social worker that is going to help to reduce the barriers of transportation and other things that really limit maybe a community's ability to get the right children in the door.
And so I think of these system of care grants as really sort of implementation and lifting grants. But we are going to have to look. The services that children and families need across the state, not all of them are reimbursable.
Main Street
Katie, as we conclude today, one last time, how should people reach out to you?
Katie Houle, ND HSS
So I would really encourage listeners, any questions that you have about the Behavioral Health Division, we have so many services, programs, and opportunities really across the state and across the lifespan, right? From early childhood up into adulthood related to mental health conditions and substance use, visit our website. And also feel free to reach out to us anytime.
We do have a behavioral health navigator that can help navigate you to direct behavioral health services. And we also have a mental health directory. I know a lot of people come to us saying, you know, I'm just really looking for this type of service in my community.
And so we have a directory to help you with that.
Main Street
Katie Houle, she's a licensed master social worker, clinical administrator, system of care in the North Dakota Health and Human Services Behavioral Health Division. Katie, thanks for joining us on Main Street.
Katie Houle, ND HSS
Thank you so much.
NOTE: This transcript was generated using AI tools. The audio of the show is the official record.