Howard County has begun a series of public meetings to discuss strategies for behavioral health integration, exploring ways to connect and integrate mental health and substance abuse services. The meetings, which three of which were held in March and with one more set for April (see below), are being hosted by a workgroup composed of members from the Howard County Health Department and the Howard County Mental Health Advisory (HCMHA), with the Board of Health, the Alcohol and Drug Abuse Advisory Board, the Mental Health Authority Board and various nonprofit organizations that operate in the county.
At the conclusion of the meetings, the workgroup will provide Howard County Executive Allan Kittleman with recommendations on an integration model.
The meetings mark the first formal step in forming a plan to meet the growing need for behavioral health services in Howard County, said Carl DeLorenzo, the county’s director of policy and programs.
“The county has taken a number of practical steps to integrate over the past few years, such as co-chairing workgroups and co-locating offices,” DeLorenzo said. “The workgroup’s task is to formally integrate our systems and develop a governance structure.”
By “systems,” DeLorenzo means the Core Service Agency (CSA), which oversees mental health; and the Local Addictions Authority (LAA), which oversees substance use disorders.

It’s Important
Systems integration is important from a service delivery standpoint, because research continues to show co-occurrence of mental health and substance use illnesses in individuals, DeLorenzo said. “The goal is to develop a systems integration model that achieves better health, increases care quality and reduces care costs for the individual.”
The workgroup is referring to this three-pronged goal as the “Triple Aim.” On a state level, Maryland began integrating its systems in 2013, and the Maryland General Assembly continues to monitor local jurisdictions’ efforts to follow suit.
Joan Webb Scornaienchi, executive director of HC DrugFree and chair of the Howard County Alcohol and Drug Abuse Advisory Board, said both entities she represents fully support integrating substance use disorder services and mental health services. “However,” she said, “we don’t yet know exactly what that integration will look like for Howard County.”
In numerous ways, HC DrugFree has been providing integrated behavioral health services for years, because substance use and mental health challenges, far too often, go hand-in-hand, said Scornaienchi.
“In our programs and through HC DrugFree resources, we routinely include topics that concern how to help youth and adults cope with stress; the dangers of self-medicating with legal or illegal drugs instead of receiving proper mental health treatment; and as youth tell us in focus groups, how to address the desire by many people in today’s busy world to escape for a while and just feel numb.”

Focused Agenda
The focus of the workgroup is twofold, said Dr. Maura Rossman, Howard County health officer: to select and recommend a behavioral health integration model for Howard County and to develop that model’s governance structure.
Rossman listed the following items as issues that will be discussed in the public meetings: rationale for integration, functions of the local authorities, the integration spectrum, integration options, which option best supports the desired functions, and model selection and governance structure.
To summarize, DeLorenzo said the group will discuss how integration can improve individuals’ access to care and quality of care received.
“We will analyze the work our local systems are currently doing and how merging those systems can improve outcomes for individuals,” he said. “We will review existing integration models, and fit our desired functions into them to determine which model best supports the principles we are trying to achieve.”
The group’s guiding principles include, among others, population health, disease prevention and health promotion — patient-centered and measurement/evidence-based, DeLorenzo said.

Integration Timeline
Currently, the LAA and the HCMHA are separate agencies that collaborate on common business and already work together to address identified behavioral health needs, said HCMHA Director Madeline Morey.
“The LAA is part of the health department, a state agency, and the HCMHA is a quasi-public entity known as the CSA, and is established in county code,” Morey said. “The HCMHA is currently working on its strategic plan as well, which will help inform the process underway for integration.”
In 2013, the Maryland Department of Health and Mental Hygiene issued a report providing Maryland jurisdictions with a model for integrating their mental health and substance abuse services. The state of Maryland has encouraged localities to move toward this integration, and it owes the legislature a report on the status of integration by November 2017.
Howard County is prepared to integrate these services, said Scornaienchi. “Integration of services is the way of the future, and counties across Maryland have moved or are moving in that direction,” she said. “We in Howard County knew this was coming for several years. We have watched other counties integrate, and we have been preparing.”

The last of four public meetings to discuss strategies for behavioral health integration is scheduled for Wednesday, April 26, from 5 to 7 p.m., at the Health Department, 8930 Stanford Boulevard, Barton Room, Columbia. For more information, contact Carl DeLorenzo at 410-313-2172 or email cdelorenzo@howardcountymd.gov.