Report Type: Assessment Funding Recommendations
CABQ BernCo Behavioral Health Systems Gap Analysis
YEAR
2021
AUTHOR / ORGANIZATION
Via Positiva
GEOGRAPHIC SCOPE
Bernalillo County, City/County Joint
What is this?
This is a system gap analysis commissioned jointly by the City of Albuquerque and Bernalillo County to evaluate the behavioral health service delivery system and identify gaps preventing effective care for residents experiencing mental health conditions, substance use disorders, and homelessness. The report was prepared by Via Positiva, LLC, a local Albuquerque consulting firm, and delivered in June 2021. The methodology combined extensive document review of prior reports and strategic plans, qualitative research through focus groups and key informant interviews with stakeholders including community members, providers, City/County officials, state officials, MCO leaders, and national behavioral health system experts, as well as quantitative analysis of funding streams, service utilization, and demographic data. The analysis was grounded in trauma-informed principles and the Adverse Childhood Experiences framework, with the authors explicitly noting their longtime Albuquerque residency and decades of local social services experience while striving for impartiality.
Summary
The Via Positiva analysis reveals that while Bernalillo County and the City of Albuquerque have developed substantial behavioral health infrastructure—including the CARE Campus, Crisis Intervention Teams, Mobile Crisis Teams, and multiple housing and treatment programs—these services operate without unified coordination, leaving community members unable to navigate the system effectively. The report identifies six overarching priorities: establishing structured intergovernmental collaboration with a single strategic plan; developing unified communication strategies; conducting systematic walk-throughs of service delivery from the client perspective; implementing independent quality reviews; hiring visionary leadership skilled in both clinical pathways and behavioral health business; and increasing Medicaid utilization (currently only 27% despite 50% of the state’s Medicaid population residing in the county). Key service gaps include permanent supportive housing, crisis triage capacity, children’s services, mental health assessment capacity, and workforce shortages. The analysis strongly recommends creating a Human Services Coordinating Center as a single point of access, implementing Mental Health First Aid community-wide, expanding Community Health Worker programs, and developing trauma-informed principles throughout all services. The fundamental recommendation is transforming disparate programs into a unified “movement” led by charismatic, community-connected leadership that prioritizes empathy and warm handoffs between services.
BH Systems Change Recommendations
The report contains explicit behavioral health systems change recommendations: 1. Create a Structured Intergovernmental Collaborative Body Operating from One Comprehensive, Unified, Detailed Strategic Plan - Establish single coordinated governance structure for City and County behavioral health services - Hire executive leader skilled in the business of behavioral health - Include consistent meaningful community input - Address duplication of services and underutilization 2. Create a Human Services Coordinating Center & Provider Relations Hub - Establish single point of contact for citizens seeking services - Develop warm handoff protocols between all service levels - Create provider relations function for technical assistance and coordination 3. Implement "Full Court Press" Education and Communications Campaign - Develop simple, singular communication strategy to the public - Move beyond electronic-only outreach to reach Medicaid population - Create unified messaging about available services 4. Expand Crisis Triage Services - Complete Crisis Stabilization Unit opening - Develop Crisis Triage Center with UNM - Establish alternatives to emergency room presentations 5. Expand Behavioral Health Workforce - Address chronic provider shortages - Increase providers who speak native languages of residents - Expand community-based service delivery models 6. Engage the Greater Community - Implement Mental Health First Aid training community-wide - Expand Community Health Workers program - Develop street outreach capacity - Train citizens, families, providers, advocates in trauma-informed principles 7. Expand Permanent Supportive Housing - Address critical housing gap for behavioral health population - Connect housing to treatment services with warm handoffs 8. Establish Strategic Partner Business Learning Collaborative - Provide training and technical assistance for providers - Support diversification into more complex reimbursement structures - Increase Medicaid utilization from current 27% to appropriate levels 9. Develop Sobering Center - Provide alternative to law enforcement involvement for public intoxication 10. Implement NIATx Walk-Through Process - Conduct physical walk-throughs of delivery systems from patient/family perspective - Identify bottlenecks and breakdowns at every step - Use University of Wisconsin Madison Network for Improvement of Addiction Treatment model 11. Conduct Independent Quality Reviews - Retain independent analysts for on-site provider chart reviews - Review client satisfaction surveys - Perform client interviews for recent service users - Assess fidelity to evidence-based practices 12. Require Cultural and Linguistic Access Standards (National CLAS Standards) in all contracting 13. Shift from Output to Outcome Measures in all contracts and program evaluations
How to Use for Systems Planning
What this report IS useful for in systems planning: - Understanding the historical development of behavioral health governance structures in Bernalillo County since the 2014 GRT vote - Identifying specific coordination failures between City and County that create barriers to care - Documenting community and stakeholder perceptions of system accessibility and effectiveness - Providing a framework for unified strategic planning across jurisdictions - Understanding funding landscape including GRT revenues, Medicaid, and other sources - Identifying specific service gaps in crisis care, housing, workforce, and children's services - Justifying investments in care coordination infrastructure and single points of access - Supporting arguments for outcome-based rather than output-based contracting - Documenting the need for alternatives to law enforcement response for behavioral health crises What this report DOES NOT provide: - Current service inventory with contact information or capacity data - Quantitative analysis of service utilization, wait times, or outcomes by program - Cost-benefit analysis of existing or proposed programs - Detailed implementation timelines or budgets for recommendations - Provider-level performance data or quality metrics - Analysis of specific Medicaid reimbursement rates or policy barriers - Comparison to peer communities or national benchmarks - Post-pandemic assessment (report completed during early pandemic period)
Key Facts & Data Points
- Bernalillo County population: approximately 680,000 individuals - Behavioral Health Gross Receipts Tax (1/8th of 1%): Approved by 69% of voters in 2014, generating approximately $22 million annually (started at $19.9 million in first year) - Combined annual behavioral health funding: Over $100 million across all sources - New Mexico Medicaid coverage: Over 772,000 citizens (approximately 38% of state population) - Bernalillo County Medicaid utilization gap: Contains 50%+ of state Medicaid population but only 27% of behavioral health service utilization - Mental health disorder prevalence: Approximately 20% of US population; 50% show symptoms before age 21; 75% show symptoms before age 24 - Managing entities: At least 15 different managed care, state, and local agencies without a single strategic plan - Major ethnic groups comprising 53.43% of Bernalillo County: White (Hispanic), Other (Hispanic), American Indian and Alaska Native, and Asian - Prior reports: At least seven expert reports or community task forces since 2014 have issued similar recommendations - National recognition: Bernalillo County Department of Behavioral Health Services received the National Council 2020 Innovation at Work Award - Programs launched: 23 programs, $20 million invested in behavioral health industry, $70+ million committed to projects, 50,000+ people helped through County initiatives - Current Centennial Care MCOs: Blue Cross Blue Shield of NM, Presbyterian Health Plan, Western Sky Community Care
Priority Services & Findings
**SUD Organizations** - CARE Campus (Comprehensive Assessment and Recovery through Excellence): Continuum of services for substance use and co-occurring disorders including Public Inebriate Intervention Program (PIIP), Detox, and Supportive Aftercare Community Program (6-month continuum at no charge to clients) - Metropolitan Detention Center: Among first nationally to provide Medication Assisted Treatment for Opioid Use Disorder during incarceration (Methadone, with Buprenorphine planned) - DUI Councils providing substance use services - City-funded substance use treatment voucher system serving ASAM levels 0.5, Level I, and Level II - Two youth substance use treatment programs - Recovery Oriented Medication Assisted Treatment recommended for expansion **Mental Health / Crisis Care** - Crisis Stabilization Unit on CARE Campus (delayed opening due to pandemic) - Mobile Crisis Teams (MCT) - evaluation underway - Crisis Intervention Team (CIT) trained officers - New Mexico Crisis and Access Line (statewide) - National Suicide Prevention Lifeline access - 988 hotline planning for suicide prevention - Community Engagement Teams providing 24-hour peer-driven outreach and in-home services - Peer Drop-in programs - Peer Case Management programs (evaluation underway) - Suicide Prevention programs (evaluation underway) - Crisis Triage Center development with UNM (delayed) - Psychiatric Replacement Hospital planning with UNM **Integrated Primary Care** - Three Assertive Community Treatment (ACT) teams funded by the City providing comprehensive behavioral health services including medication management in community settings ("hospital without walls" model) - Centennial Care 2.0 Medicaid Managed Care requiring MCOs to address physical health, behavioral health, and social determinants of health - UNM Project Echo providing healthcare improvement and technical assistance - Telehealth services expanded during pandemic **School-Based / Youth Services** - Youth Transitional Living programs - Two youth substance use treatment programs - ACES Prevention programs (evaluation underway) - Albuquerque Public Schools partnership (significantly disrupted by pandemic) - Youth and family programs through Department of Family Community Services - Violence and gang prevention programs
Immediate Actions for Systems Planners
-Convene joint City/County leadership meeting to formally commit to developing a single unified strategic plan for behavioral health services, with timeline and accountability structure. -Issue RFP for executive-level behavioral health system leader position with expertise in both clinical pathways and behavioral health business operations to coordinate across all funding streams and agencies. -Contract for NIATx-model walk-through assessment of current service delivery from client perspective across homelessness, criminal justice, and behavioral health systems within 90 days. -Establish formal coordination structure with Centennial Care MCOs (Blue Cross Blue Shield NM, Presbyterian, Western Sky) to address the 27% utilization gap for Medicaid behavioral health services. -Create single telephone access point and conduct community awareness campaign to publicize available services, moving beyond electronic-only communication methods. -Conduct independent chart review and client satisfaction assessment of CARE Campus and major contracted providers to understand gap between administrative reports and community experience. -Require National CLAS Standards compliance in all new and renewed behavioral health contracts. -Revise contract templates to include outcome measures (not just outputs) with data feedback loops to providers. -Resume Mental Health First Aid training (paused during pandemic) with expanded community reach. -Review and remove exclusionary criteria (such as bench warrants) that prevent individuals from accessing services designed to help them.
Key Contacts
**/ - Albuquerque BernCo Government Commission (ABCGC) = - Albuquerque Police Dept = - BernCo Criminal Justice Coordinating Council (CJCC) = - BernCo Dept of Behavioral Health Services (DBHS) = - BernCo Sheriff's Dept = - Centennial Care MCOs: Blue Cross Blue Shield of NM, Presbyterian Health Plan, Western Sky Community Care = **/ - City of Albuquerque Dept of Family & Community Services = - City of Albuquerque Community Safety Dept (ACS) = - City of Albuquerque Office of Equity & Inclusion (OEI) = - Coalition for a Safer Albuquerque = - NAMI NM & NAMI Albuquerque = - NM Behavioral Health Collaborative **/ - NM Behavioral Health Services Division (BHSD) = - NM Children, Youth & Families Dept (CYFD) = - NM Human Services Dept (HSD) = - Metropolitan Detention Center = - McCune Foundation = - UNM Evaluation Lab = - UNM Institute for Social Research