Structure of Criteria

The Certified Community Behavioral Health Clinic (CCBHC) program Is designed to work within the scope of state Medicaid Plans and to apply specifically to individuals who are Medicaid enrollees, the statute also requires the CCBHCs not to refuse service to any individual on the basis of either ability to pay or place of residence for inclusive service.

The criteria are intended to extend quality and to improve outcomes of the behavioral health care system within the authorities of state regulations, statutes and state Medicaid Plan.

Behavioral health is a general term used to refer to both mental health and substance abuse.

Care Coordination is defined as “deliberately organizing consumer care activities and sharing information among all of the participants concerned with a consumer’s care to achieve safer and more effective care. This means the patient’s needs and preferences are known ahead of time and communicated at the right time to the right people, and that this information is used to provide safe, appropriate, and effective care to the patient”.

Family-centered Care recognizes families are the ultimate decision-makers for their children, with children gradually taking on more and more of this decision-making themselves.

This includes individuals who do not speak English as their primary language or who have a limited ability to read, write, speak, or understand English and who may be eligible to receive language assistance with respect to the particular service, benefit, or encounter.

A peer provider (e.g., peer support specialist, recovery coach) is a person who uses their lived experience of recovery from mental or substance use disorders or as a family member of such a person, plus skills learned in formal training, to deliver services in behavioral health settings to promote recovery and resiliency. In states where Peer Support Services are covered through the state Medicaid Plans, the title of “certified peer specialist” often is used. SAMHSA recognizes states use different terminology for these providers.

Recovery is defined as “a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.” The 10 guiding principles of recovery are: hope; person driven; many pathways; holistic; peer support; relational; culture; addresses trauma; strengths/responsibility; and respect.

Health (abstinence, “making informed healthy choices that support physical and emotional wellbeing”); Home (safe, stable housing); Purpose (“meaningful daily activities … and the independence, income and resources to participate in society”); and Community (“relationships and social networks that provide support, friendship, love, and hope”)

(Substance Abuse and Mental Health Services Administration [2012]).

Recovery-oriented care is oriented toward promoting and sustaining a person’s recovery from a behavioral health condition. Care providers identify and build upon each individual’s assets, strengths, and areas of health and competence to support the person in managing their condition while regaining a meaningful, constructive sense of membership in the broader community. (Substance Abuse and Mental Health Services Administration [2015]).

A trauma-informed approach to care realizes the widespread impact of trauma and understands potential paths for recovery; recognizes the signs and symptoms of trauma in clients, families, staff, and others involved in the system; and responds by fully integrating knowledge about trauma into policies, procedures, and practices, and seeks to actively resist retraumatization.” The six key principles of a trauma-informed approach include: safety-trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice and choice; and cultural, historical and gender issues. (Substance Abuse and Mental Health Services Administration [2014]).