When core services were added to the Iowa code in 2012, there was a second list called “Additional core services” that were named “Core plus” by the providers.
Why a Road Map?
My goal in setting up the regional system was that there would be a complete set of services in the Iowa code. Not all could be implemented at once, but that it would be a roadmap of where we wanted to go in the future. As the mental heath redesign passed, there were several bigger counties who wanted more in the base of the system.
They had been providing more services and believed that the starting point was too low. To address this concern, additional services were added. The code said that if you already did the initial core and had funds available regions could provide additional services. As we talked about in a previous post, some smaller counties did not even provide the basics.
To add a huge list of mandates services up front, seemed too daunting of a task to them. State leaders were concerned that some smaller regions would fail if the bar was set too high out of the gate. The idea was to set a reasonable core and then add to it over time as region got up to speed. Regions would report on availability of each service. And would be encouraged to continue to build new services if they had additional funding.
Additional Core Services “Core Plus”
The additional core services in the original law included the following:
- Comprehensive crisis services, including but not limited to all the following:
- Twenty-four-hour crisis hotline
- Mobile Response
- Twenty-three-hour crisis observation and holding.
- Crisis stabilization facility and community-based services
- Crisis residential services
- Subacute services provided in facility and community-based settings
- Justice involved services including but not limited to all the following:
- Jail diversion
- Crisis intervention training
- Civil commitment prescreening
- Advances in the use of evidence-based treatment, including but not limited to all the following:
- Positive Behavior Support
- Assertive Community Treatment
- Peer Support Services
In 2012, the list above included services that were available in some areas of the state. All were evidence-based meaning that they had been researched and shown effective in helping people with mental health issues. And, they each had fidelity standards meaning that data could be collected moving forward to prove effectiveness and measure progress.
One of the greatest challenges facing the mental health discussion in Iowa up to this point was the lack of data. Having been a 99-county system, there was little ability to track people using services. Many people were double counted on multiple waiting lists.
Creating services that could show outcome data would be key in the funding discussions moving forward. In 2012, counties were given the mandate to regionalize, to set up the initial core service system and given the flexibility to provide these additional “core plus” services if they had the funding to do so.
As you will see in future posts, some regions moved more quickly to these services than others. Some regions still do not have complete coverage. Challenges include workforce shortages, reimbursement rates and unknown need.
What Core plus service did you think was most important? What other would you have added?