One of the building blocks of the mental health redesign in 2011 was the creation of a set of core services in the Iowa Code. Like many, you may be wondering what is a core service? And, why was that important?
Why fix the 99-county system?
When I began working on the system in Iowa, each of the 99 counties provides mental health services 99 different ways. Some had great services, others had almost none. Some used substance use treatment monies for services and others bought police cars so people could “sober up in the back.”
No one was happy about the inconsistencies across the state not the providers, or the funders, and especially not the clients and persons needing help.
We decided to add core services to create a unified approach to helping people with mental health needs.
1. What is a core service?
A core service is one mental health service that should be available to all Iowans in the state no matter where they live or their income level. By being labeled “core”, the State of Iowa expects the regions to provide these basic services thoughout the state.
A core service needs to be considered evidence-based. That means that research is available showing that the service is effective at treating the condition it seeks to treat.
Long gone are the days of providing convenient, traditional services that cost a lot of money but did not produce any growth or improvement. The cost of care increased. Funders needed to be shown that therapies work and are beneficial to justify ongoing payment.
2. Core Services in Iowa
In Iowa, we began with a basic set of core services. Those included:
- Assessment and Evaluation
- Mental health outpatient therapy
- Medication prescribing and management
- Mental health inpatient treatment
- Basic crisis response, including but not limited to the following:
- Twenty-four-hour access to crisis response
- Personal emergency response system
- Support for community living, including but not limited to the following:
- Home health aide
- Home and vehicle modification
- Supported community living
- Support for employment or for activities leading to employment providing an appropriate match with an individual’s abilities based upon informed, person-centered choices made from an array of options, including but not limited to all the following:
- Day habilitation
- Job development
- Supported employment
- Prevocational services
- Recovery services, including but not limited to all the following:
- Family support.
- Peer support.
- Service coordination including coordinating physical health and primary care, including but not limited to all the following:
- Case management
- Health Homes
For an initial list of services, this was very basic. For larger counties with histories of good services, this seemed too small, too easy. But for some smaller counties, it would be a huge leap forward in providing services to persons with needs.
3. How do core services help?
By creating this list, the State of Iowa created standards. Regions are expecteed to deliver services within so many minutes of a request and within so many miles of where a person lived. This decision revolutionized the system in Iowa.
No longer could providers only build services where it was convenient. Providers were given the responsibility to build across Iowa. This does happen overnight. And, we are still in process today. The state reviews the level of access in each region annually.
Since this basic list was formed, additional services have been added. We will look at those in another future post. We will also dive into the access standards and see where we are falling short in delivering these services as mandated by law.
What core service do you think needs more availability in Iowa?