New SAMHSA CCBHC Criteria Will Foster Innovation in Crisis Services Continuum

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CRISIS CONNECTIONS

Recently, the Substance Abuse and Mental Health Services Administration (SAMHSA) updated its Certified Community Behavioral Health Clinics (CCBHCs) criteria to better align with its National Guidelines for Behavioral Health Crisis Care.¹

SAMHSA recognized that, with the implementation of 988, the varying availability of crisis services, and the growing opioid epidemic, the criteria needed to be updated to increase flexibility and provide greater clarity around standards for behavioral health clinicians.

Background

In 2015, the US Department of Health and Human Services (HHS) established the original CCBHC Demonstration with a set of uniform standards for clinicians across the country with the goal of transforming systems by providing comprehensive, coordinated, trauma-informed, and recovery-oriented care for mental health and substance use disorders (SUDs).² These standards were used by the original 8 states in the Section 223 CCBHC Demonstration that certified the first set of 67 CCBHCs in 2017.³

Since then, the CCBHC Section 223 CCBHC Demonstration has expanded to 2 additional states, HHS has supported the development of the program through an expansion grant program that was established in 2018, and states have supported the development of CCBHCs separately from the Section 223 CCBHC Demonstration. Today, there are more than 500 CCBHCs across 48 US states, territories, and the District of Columbia.⁴

Since the original demonstration, a lot has been learned about the implementation of the CCBHC model. Further, developments and advancements in the mental health and SUD fields have created a need to update the criteria to reflect advances and ensure that communities are set up to build a sustainable crisis system based on community needs assessments.

Many states are still in the very early stages of developing their crisis systems. Some counties and municipalities are developing crisis innovations ahead of statewide solutions, and CCBHCs have voiced difficulty in providing crisis services.

Additionally, the 2022 Bipartisan Safer Communities Act expanded CCBHCs by allowing any state or territory the opportunity to apply to participate in the current demonstration program, while allocating additional planning grant monies for states to develop proposals to participate.¹

New Criteria

The new criteria drive significant advances in the provision of crisis services and require CCBHCs to provide crisis receiving/stabilization services. Services can be provided by the CCBHC or through an agreement with a designated collaborating organization (DCO). This requirement will especially benefit high-acuity individuals (those presenting with suicidal behaviors, acute agitation, or substance intoxication) who need high-intensity, facility-based crisis services.

For individuals who need a higher level of care and treatment, facility-based crisis stabilization clinicians can serve as a safe and therapeutic alternative to hospital emergency departments, unnecessary inpatient psychiatric admissions, and jails.

However, these programs vary widely in scope, capability, and populations served, and often are not designed to meet the psychiatric needs of individuals who are experiencing acute mental health or substance use crises. Without a viable option for these high-acuity individuals, the crisis system is incomplete, and the individuals who need specialty crisis care the most will continue to be routed to emergency rooms and jails.

The new standards encourage CCBHCs to provide crisis receiving/stabilization services in accordance with the SAMHSA National Guidelines for Behavioral Health Crisis Care. To fully achieve this mandate, CCBHCs should explore partnerships with experienced specialty clinicians through a DCO agreement. DCO contracting for crisis specialty services will enable CCBHCs to fully benefit from and participate in the development of a comprehensive continuum of community safety-net crisis systems, as well as the ongoing advances in the field.

Concluding Thoughts

Connections Health Solutions, the leading and largest provider of facility-based acute crisis care, applauds SAMHSA for continuing to move the industry forward, and we look forward to the impact it will have on creating a sustainable crisis system of care. The updated criteria will guide existing and future CCBHCs, ensuring that individuals who seek CCBHC services can expect the same quality, comprehensive, and coordinated care regardless of where they reside.

Mr Santarsiero is the vice president of government affairs at Connections Health Solutions. A strategic leader of the growth and development team, he develops and executes federal and state policy outcomes that drive market access, innovative value-based care models, thought leadership, and new business opportunities. At Connections, Mr Santarsiero advocates for the value of its medically integrated care model that serves the highest acuity crisis patients presenting with suicidal behaviors, acute agitation, and substance intoxication. He has 24 years of experience in growth, market access, and profitability-driven government relations, contract procurement, and consulting.

References

1. Certified Community Behavioral Health Clinic (CCBHC) certification criteria. Substance Abuse and Mental Health Services Administration. Updated March 2023. Accessed March 27, 2023. https://www.samhsa.gov/sites/default/files/ccbhc-criteria-2023.pdf

2. HHS funds $22.9 million in state planning grants for new certified community BH clinics. New York Association of Psychiatric Rehabilitation Services Inc. News release. October 18, 2015. Accessed March 27, 2023. https://www.nyaprs.org/e-news-bulletins/2015/hhs-funds-22-9-million-in-state-planning-grants-for-new-certified-community-bh-clinics

3. Certified Community Behavioral Health Clinics Demonstration Program: report to Congress, 2017. Substance Abuse and Mental Health Services Administration. 2017. Accessed March 27, 2023. https://www.samhsa.gov/sites/default/files/ccbh_clinicdemonstrationprogram_081018.pdf

4. CCBHC: Section 223 Demonstration Program for Certified Community Behavioral Clinics. Substance Abuse and Mental Health Services Administration. Updated April 6, 2023. Accessed March 27, 2023. https://www.samhsa.gov/certified-community-behavioral-health-clinics/section-223