The Provider Advisory Committee (PAC) of CBHNP meets at least quarterly to consider proposals for benefit inclusion of new technologies or the new application of existing technologies or behavioral health procedures. In 2003, a proposal was approved for an alternative behavioral strategy to treat Attention Deficit Hyperactivity Disorder. In 2004, a proposal was approved for the treatment of Reactive Attachment Disorder (RAD). Both programs are currently implemented. For more information on these programs, please contact your Provider Relations Representative.

In 2005, the available research, clinical efficacy, and models of service delivery of telepsychiatry were reviewed. Telepsychiatry was recommended to the Counties (health plan) to consider as part of potential benefit coverage under HealthChoices programming. Telepsychiatry is an expanding service delivery model across the United States and is seen as an important tool in improving access to psychiatry services. Videoconferencing from satellite offices is typically linked to remote psychiatrists, whose availability is heavily clustered in urban areas. This program is pending and not yet approved.

For 2006, PAC completed an assessment of Buprenorphine, which was approved by the FDA for opiate addiction in 2002. It is a safe, effective and well tolerated medication for treating patients in outpatient clinic or from the primary care office. It has the advantage of being dispensed on a monthly basis and makes it possible for the patients to maintain employment. Buprenorphine has a low abuse potential, good safety profile in overdose and is less likely to be diverted. There are remarkable community advantages for substitution medication treatment of opiate addiction including a decrease in overdoses, delinquencies, medical complications, and AIDS risk. Despite being available for four years with support from new federal laws, there are still system barriers to accessing this treatment in Pennsylvania and other states. The Committee recommended buprenorphine for possible reinvestment or other appropriate benefit approval processing.

In 2007, PAC completed a review of Assertive Community Treatment (ACT). ACT is one of the best studied, effective community based treatment models for SMI. It clearly reduces hospitalizations, improves housing stability, quality of life and moderately improves symptoms. The program is no more expensive than traditional care and is more satisfactory to consumers and families than standard care. The challenge is that it is not widely available to people who would benefit from it. PAC recommended ACT be considered as part of potential benefit coverage under HealthChoices programming under reinvestment or other appropriate benefit approval processing. A recommendation was also made that existing Community Treatment Teams consider pursue ACT certification.

In 2009, PAC completed an assessment of Seeking Safety. Seeking Safety is one of the best studied, most cost effective community based treatment models for Post Traumatic Stress Disorder and Substance Abuse Disorders. It is a safe, reliable, outcome oriented treatment option for Trauma Informed Care. There are no regulatory considerations that impede implementation and can be considered as an in-plan Outpatient Therapy service. Implementation of a pilot program in cooperation with the Dauphin County MH Jail Diversion program provided an opportunity to monitor treatment effectiveness and outcomes in a cost efficient manner.

In 2010 PAC research was reviewed to complete an assessment of Dialectical Behavior Treatment (DBT). The committee found DBT well validated, well researched and recommends DBT as a viable, safe and outcome oriented treatment modality. DBT is a behavioral therapy that focuses on present behavior and factors controlling that behavior. It is designed for treatment of severe and chronic, multiple diagnosis, difficult to serve and individuals with both Axis I and II behaviors. DBT treatment grew out of behavior therapy, cognitive therapy, and third wave therapies. The review of DBT was based on its use in Inpatient, Partial and Outpatient settings. The reviewers recommended consideration of DBT use with substance abuse, adolescents and disruptive behavior disorders.

In 2011 PAC assessment review focused on Behavior Imaging, a behavioral therapy that focuses on present behavior and factors controlling that behavior. Behavior Imaging captures and stores behavioral health events on video. This allows for clinicians to capture relevant behavioral information relating to antecedent, behaviors, and consequences. Videotaped information can also be shared with relevant stakeholders. Behaviors are captured in natural environments in many settings (home, school), and can be used to monitor progress. Recording therapy and testing sessions also provides the opportunity for supervisory review, and video can be annotated / organized in a video library. Behavior Imaging processes include collecting, uploading and organizing, providing the opportunity to capture behaviors as they occur, including events and behaviors leading to undesired behaviors. Additional elements include a training library and administrative functions. It allows for more immediate, relevant, and cost effective supervision, which can also positively impact care; provides more structure and support to caregivers (e.g., parents; guardians; teachers) than current practices allow (e.g., can discuss various video vignettes; parent video library; interventions can be taped) and allows more measurable outcomes as well as a vehicle to assess treatment fidelity. Information sharing (including data sharing) with other providers and treatment team members is also beneficial. The committee recommended adoption of Behavior Imaging as a special / pilot project to test areas of strengths, weaknesses, unexpected situations, and/or difficulties in implementation. In addition, a pilot allows for an opportunity to measure outcomes, effectiveness and implementation strategies. PAC also recommended that implementation be initially limited to a specific provider and/or level of care (example CRR-HH), as well as application to specific populations.