Alliance Announces New Clinical Leadership

(Durham, NC) – Alliance Behavioral Healthcare has named two additions to the leadership of its Care Management Division. Dr. Beth Melcher, who has been serving as interim Executive Vice President for Clinical Operations for the past several months, has assumed that position on a permanent basis, and Dr. Katherine Hobbs Knutson is Alliance’s new Chief Medical Officer.

Before assuming her interim role, Dr. Melcher was Chief of Network Development and Evaluation at Alliance. Prior to coming to Alliance she served as Assistant Secretary for MH/DD/SA Services Development and then Chief Deputy Secretary for Health Services for the North Carolina Department of Health and Human Services. Her distinguished career also includes stints as President/CEO of Recovery Innovations North Carolina, Clinical Director for The Durham Center, and Executive Director of NAMI North Carolina. She received her Ph.D. in Counseling Psychology from the University of Pittsburgh.

Dr. Hobbs Knutson comes to Alliance from the Duke University School of Medicine Department of Psychiatry, where she practiced in emergency and outpatient settings. She is an adult and child psychiatrist with extensive clinical experience in underserved community settings treating children and adolescents with emotional and behavioral disorders that are significantly impacted by the social determinants of health.  Dr. Hobbs Knutson also has conducted health services research focused on innovative state programs to improve identification of and access to care for youth with behavioral health disorders.

“Based on my clinical and research experiences, I believe that prevention of and early targeted intervention for pediatric mental health problems would substantially improve health outcomes and lower costs across the multiple public systems serving children,” she said. “At Alliance I plan to use my roles as a clinician and administrator to fuel these changes.”

Prior to her position at Duke, Dr. Hobbs Knutson was the Director of Community Psychiatry at the Children’s National Health System in Washington, DC, and in 2014 served as Associate Medical Director for Psychiatry for the Massachusetts state Medicaid program. She is a 2007 graduate of the University of North Carolina at Chapel Hill School of Medicine, where she received the George C. Thrasher Jr. Award for outstanding performance and ability in psychiatry.

“Under the leadership of Dr. Melcher and Dr. Hobbs Knutson I have no doubt that Alliance will only enhance its reputation for clinical excellence in the management of behavioral healthcare in North Carolina,” said Alliance CEO Rob Robinson. “Their experience and expertise are critical to our commitment to population health management to address health and well-being among the people we serve, as we shift toward proactive approaches for promoting prevention, wellness, early identification and tailored intervention programs.”

Alliance Takes National Awards for Documentary

(Durham, NC) – Alliance Behavioral Healthcare’s BECOMING Initiative has won two national Excellence in Community Communication and Outreach (ECCO) Awards for its short-form documentary called Breaking the Cycle, the story of the challenges and successes of some of the young people served by BECOMING. It can be accessed at

Alliance is the managed care organization for publicly-funded behavioral healthcare services for the people of Durham, Wake, Cumberland and Johnston counties. Alliance works with a network of almost 2200 private providers to serve the needs of 471,000 Medicaid-eligible and uninsured individuals within a total population of 1.8 million.

BECOMING was a six-year, SAMHSA-funded program that concluded in October of 2016. It targeted high-risk 16-21 year olds in Durham County who had mental health challenges and were disconnected from services and supports that would normally assist them in transitioning to adulthood. Through partnerships within the community, BECOMING connected these youth with literacy support services, coordination of clinical care, employment services, positive recreational opportunities and leadership training, with a goal of helping make these transitions more successful. By the time the grant ended the program had served over 300 young people.

The awards for Breaking the Cycle were presented during a live webcast earlier this month in a competition that included over 60 entries from across the country. The ECCO (Excellence in Community Communication and Outreach) Recognition Program is sponsored by the U.S. Substance Abuse and Mental Health Services Administration’s Caring for Every Child’s Mental Health Campaign of the Comprehensive Community Mental Health Services for Children and Their Families Program.

The Recognition Program showcases and celebrates outstanding achievements in social marketing and communications by system of care grantees. It showcases and celebrates the talents, strengths and successes of community-based programs that incorporate systems of care for children and youth with serious mental health needs and their families.

These most recent awards are part of seven national awards captured by BECOMING for communications and outreach during the six-year run of the program, including the prestigious People’s Choice Award in 2015.

Public Input Sought on DHHS Design for Medicaid Managed Care

The Department of Health and Human Services has released a detailed proposed program design for transforming the state Medicaid and NC Health Choice programs to managed care. DHHS issued its proposed program design to ensure stakeholders have an opportunity to comment on managed care specifics. Comments are being accepted through Sept. 8, 2017. Learn more.

Alliance Teams with CASA to Increase Affordable Housing

(Durham, NC) – Alliance Behavioral Healthcare has continued its history of working collaboratively with its public, private and non-profit partners to increase affordable housing capacity for people with mental health issues by providing $250,000 in financing to a local non-profit developer.

Alliance is the managed care organization for publicly-funded behavioral healthcare services for the people of Durham, Wake, Cumberland and Johnston counties. Alliance works with a network of almost 2200 private providers to serve the needs of 471,000 Medicaid-eligible and uninsured individuals within a total population of 1.8 million, and is the first MCO in the state to contribute funds to the purchase of property for people living with mental health challenges.

Alliance knows that investing in supportive housing promotes an improved quality of life and better treatment outcomes for these individuals. This investment goes beyond simply paying someone’s rent – it takes a holistic view ranging from honoring where someone chooses to live, to maintaining their housing after rental assistance ends. Like other “social determinants of health” – the conditions in which people are born, grow, live, work and age – safe, stable housing provides a critical foundation for recovery.

“Our investment recognizes the importance of creating greater access to permanent, affordable housing for people with mental health conditions,” said Ann Oshel, head of Community Relations at Alliance. “This helps make it possible for a group of people who are often vulnerable to homelessness to live successfully in their communities.”

The contribution was made to CASA, a non-profit housing developer and property manager, in support of its largest acquisition of housing units to date – 44 units at Underwood Apartments on Underwood Avenue and the 35-unit Maplewood Apartments on West Chapel Hill Road, both in Durham. Thirteen of the apartments will be reserved for individuals receiving services managed by Alliance, with an additional eight units reserved for veterans. CASA plans to make improvements at both properties, including fencing, landscaping, parking lot repairs, and replacement of aging staircases and balconies. This brings CASA’s inventory of affordable apartment homes to 490 units in Durham, Wake and Orange counties.
The apartments will primarily target people earning 50 percent of the area median income or less, which is $25,700 for one person. Leases for current tenants will be honored, and measures are in place to ensure that the units remain affordable over time.

“These homes will continue to serve Durham renters with limited incomes for many more years to come,” said CASA CEO Debra King. “This acquisition allows us to preserve the Underwood and Maplewood apartments as affordable rental housing in Durham and gives the current tenants assurance that their rent will remain affordable.”

Others partnering with Alliance and CASA in the purchase of these 79 apartments include North State Bank, BB&T, North Carolina Housing Finance Agency, Federal Home Loan Bank of Atlanta, and the City of Durham.

In addition to this investment, in 2016 Alliance provided over $682,000 in rental assistance to 425 individuals and families, moving them out of homelessness and helping them avoid eviction. Individuals who are receiving services managed by Alliance can access housing assistance through their provider.

Alliance Board Vacancies

There are currently five open positions on the Alliance Board of Directors, two each for Wake and Cumberland County residents and one for a Johnston County resident. Candidates for Board membership must be residents of the county they would be representing and at least 18 years of age. Employees or family member of employees or volunteers of provider agencies or vendors contracted with Alliance, or persons with a financial interest or ownership in any such agency or vendor, are not eligible to serve. Learn more about the Alliance Board and how to apply for membership.

Wake Teen Diversion Program Shows Promising Results

(Raleigh, NC) – At the end of its first year the Wake Teen Diversion Program is showing promising results in keeping teens faced with school-related nonviolent misdemeanors out of the Wake County adult court system. The program is administered by Alliance Behavioral Healthcare, the managed care organization (MCO) for public behavioral healthcare for the citizens of Durham, Wake, Cumberland and Johnston counties. It is part of Alliance’s School-Based Care Coordination initiative, in which Care Coordinators use a “wraparound” model to improve student connections with the services they need to reduce the severity of their behavioral health symptoms. In turn, student absences are reduced and academic performance improves.

The Wake Teen Diversion program works with youth ages 16 to 18 by diverting them from adult criminal court to alternatives like Teen Court and mediation if they adhere to a diversion plan, which also addresses behavioral health needs. Students who successfully complete the program do not face criminal charges or have an arrest record. Once in the system, kids face increasing barriers to education, employment, and housing, ultimately hurting their chances to become a productive member of society, a problem known as the “school to prison pipeline.”

The program is administered by Alliance Behavioral Healthcare, the managed care organization (MCO) for public behavioral healthcare for the citizens of Durham, Wake, Cumberland and Johnston counties. It is part of Alliance’s School-Based Care Coordination initiative, in which Care Coordinators use a “wraparound” model to improve student connections with the services they need to reduce the severity of their behavioral health symptoms. In turn, student absences are reduced and academic performance improves.

“The School-Based Care Coordination initiative is just one example of Alliance’s efforts to reach into our communities to the places where we can be proactive in identifying people who are at risk of the negative impact of behavioral health challenges,” said Dr. Beth Melcher, EVP of Alliance’s Care Management Division. “That allows us to intervene with treatment and support to help ensure they can avoid serious consequences and continue living satisfying lives.”

Alliance is the only North Carolina MCO with a pre-charge, school-based diversion program. During the 2016-17 school year the program received 143 referrals with 84 youth active or waiting for an intake in the program. To date 22 students have successfully completed the program. Included in that number are two kids who were able to keep their college scholarships by successfully completing their diversion plan.

North Carolina is the only state that treats teenagers as young as 16 as adults regardless of the severity of the offense. As a result, every year thousands of North Carolina youth enter the criminal system for first time, low-level offenses. Over 400 Wake County students were referred to the adult criminal justice system during the 2014-15 school year with students of color making up the majority of suspensions and arrests.

The Wake program has received widespread support from school, court, mental health, law enforcement and social justice leaders. “The biggest benefit of this diversion program, which is unique to the other diversion programs we have, is that these children undergo a thorough assessment to identify underlying issues that give rise to criminal behavior and allow those needs to be addressed,” said Wake County District Attorney Lorrin Freeman. “This should prevent further criminal activity by these individuals and play a big role in building them into successful members of our community.”

The diversion program is limited to school-based offenses and holds students accountable for their criminal conduct, identifying programs and services that give them the help they need. Students complete the diversion in six months without court contact, allowing them to chance to “make things right” without the negative effects a pending criminal case has on college and work opportunities.

The program also ensures minor criminal offenses committed at school are handled consistently across the county, providing consistency and predictability for school staff, students, and parents because they know what to expect when a case arises. School Resource Officers can refer cases to Alliance without leaving campus and avoid spending time in court.

“Court time is being used for more serious cases, instead of processing low level diversion cases,” said Katherine Edmiston, Wake County assistant district attorney. “Any increased efficiencies in court resources benefit all of us in Wake County.”

The Wake Teen Diversion Program is the result of a community collaborative between Alliance, Wake County Public Schools, and representatives from the Wake County Sheriff’s Office, the Raleigh and Cary Police Departments, Wake County Legal Aid and Wake County Public Defenders. Key support for the program came from Judge Vince Rozier, District Attorney Lorrin Freeman, Wake Public Schools Assistant Superintendent Brenda Elliott, and School Board member Christine Kusher.

“WCPSS is pleased to work with our various partners on this initiative,” said Elliott. “The district was seeking restorative ways to address low level criminal offenses that happened in schools and instituting a diversion program that provided support and not just consequences to students and their families just made good sense.”

Stemming the Tide of a National Epidemic

by Rob Robinson, Alliance Chief Executive Officer
(from the Raleigh News and Observer)

We’ve lost 13,000 of our fellow North Carolinians to unnecessary deaths from unintentional opioid overdoses since 1999. 1 in 4 people receiving prescription opioids long-term from their primary care doctor struggles with addiction. Addiction to heroin and other illegal opioids as well as misuse of prescription pain medications is a national crisis, with devastating effects on the lives of the people it touches.

Alliance Behavioral Healthcare applauds DHHS Secretary Mandy Cohen’s appeal to clinicians across North Carolina to join the fight against opioid addiction in our state. We also support bipartisan discussions in the North Carolina General Assembly aimed at addressing this epidemic, and encourage expanded State funding for the treatments and supports desperately needed by people experiencing a whole range of substance use disorders.

Over the past year at Alliance, when our data analytics and our internal medical and clinical staff identified a pattern of risky prescribing of benzodiazepines and opioids, we began to design and implement a set of tiered responses that aligns closely with what the State is doing to reduce prescription drug abuse.

We offer ongoing technical assistance for clinicians and service providers in our network and share education on best practice prescribing guidelines and how to assess and effectively treat opioid use disorders. We’ve increased reimbursement rates to providers who implement medication-assisted treatment, an evidence-based program that uses buprenorphine, which has been found to be effective in treatment of opioid use disorders.

We extend beyond our provider network to help local pharmacists better understand opioid addiction as a chronic, preventable and treatable disease, and to increase awareness of the risk of opioids and possible drug interactions. We also engage with them about offering naloxone to people identified as high-risk for opioid overdose. Naloxone is a medication used to quickly block the effects of opioids and to save the life of a person who has overdosed.

Working in partnership with the NC Harm Reduction Coalition, Alliance allocated $100,000 to supply naloxone free of charge to community providers as well as consumers with known addictions and their families, along with education on how to administer it. We made this potentially life-saving medication available to the Wake County Sheriff’s Office and to TASC, a program in Cumberland County that works with people whose substance use or mental health problems have put them at risk for chronic involvement with the justice system.

And we’re including instruction in the use of naloxone in our Crisis Intervention Team training, an innovative program that teaches law enforcement officers and other first responders to respond appropriately to people in behavioral health crisis.

While we remain mindful of the 1,500 accidental overdoses in North Carolina last year, we can share the good news that for the first time, there have been more overdose reversals in our state from naloxone than deaths from opioids. That’s encouraging, but there is still so much to be done.

Alliance’s Crisis and Assessment Centers are often ground-zero in our response to people in trouble with addiction and overdose. These facilities, including WakeBrook in Raleigh and the Durham Recovery Response Center, are community-based alternatives to hospital emergency departments that help stabilize those in crisis and ensure they are connected to appropriate follow-up care.

That’s why our plan to invest $41 million over the next three years to better meet the behavioral healthcare needs of our communities includes a big commitment to enhancing our crisis capacity. Planning is underway for a new crisis center in Wake County, as well as a facility to meet the unique needs of children and adolescents in crisis.

And we’re proud of our partnerships across our service region to combat this public health crisis at the grassroots level, including with the Wake County Drug Overdose Prevention Coalition, Durham County Public Health, and the Cumberland County Opioid Abuse and Awareness Task Force.

Addiction is a chronic disease that cuts across the social fabric of socioeconomic status, ethnicity and race, gender and geography. It will take a concerted and combined commitment from federal, state and local government, community providers, clinicians and pharmacists, law enforcement, and community stakeholders across the spectrum to make a difference.

I pledge Alliance Behavioral Healthcare to the fight.

Hope4NC and Alliance Support Cumberland County Citizens Affected by Hurricane Matthew

(Fayetteville, NC) – Seven months after Hurricane Matthew slammed into Cumberland County, many families are still displaced from their homes and waiting for repairs to be completed. Through a partnership with the Substance Abuse and Mental Health Services Administration (SAMSHA) and the Federal Emergency Management Agency (FEMA), Alliance Behavioral Healthcare is providing five crisis outreach teams to canvas neighborhoods, hotels, rentals and shelters to provide disaster crisis counseling to those affected by the flood.

The Crisis Counseling Assistance and Training Program, also known as Hope4NC, offers short-term interventions that include the coping strategies and emotional support disaster survivors need to help manage the stress of their current situations. While the program doesn’t provide home repairs, it can refer citizens to a variety of helping resources in the community that are essential to putting their lives and homes back together.

The crisis counselors that staff Hope4NC understand that many households are in various stages of repair. “It can be devastating to lose everything and still have the daily struggle of living outside your home seven months later,” says Disaster Recovery Coordinator Laressa Witt. “Added to the financial burden of starting all over, it can be very stressful for families.”  Witt points out the importance of the confidential place the program provides for people to talk about their struggles and hardships. “It’s amazing how therapeutic it can be to have someone listen and empathize with you.”

According to FEMA there are four emotional stages of disaster, moving from the heroic phase to the honeymoon phase to the disillusionment phase and finally to the reconstruction phase. Witt says that many in Cumberland County are in the disillusionment phase due to the length of time it has taken to recover from the October weather. “Many folks say they had no idea it would take this long to return to their homes, and this has added to their emotional fatigue. Most tell us that they are simply ‘tired.’”

Cumberland County citizens still displaced from their homes or still experiencing the emotional effects of the storm call the Hope4NC Hotline at (919) 407-2942.

Alliance and WakeMed Health and Hospitals Offer Mental Health First Aid Training to Elected Officials in Wake County

Alliance is partnering with WakeMed Health and Hospitals, Duke Raleigh Hospital, UNC REX, and the UNC-CH School of Social Work to train elected officials in Wake County in Mental Health First Aid. The 8-hour training will be held on May 19 at WakeMed North Hospital in Raleigh.

1 in 5 Americans has a mental illness, but many are reluctant to seek help or might not know where to turn for care. Unlike physical conditions, symptoms of mental health and substance use problems can be difficult to detect. For friends and family members, it can be hard to know when and how to step in. As a result, those in need of mental health services often do not get them until it is too late.

Just as knowing CPR helps even those without clinical training assist an individual having a heart attack, Mental Health First Aid training allows members of the public to better identify, understand and respond to signs of mental illnesses. Trainees learn a 5-step action plan that guides them through the process of reaching out and offering appropriate support.

In just ten years, the Mental Health First Aid program has certified over 1,000,000 people nationally, including over 36,000 in North Carolina, most in the Southeast and #6 in the country. During the past year alone Alliance trained 824 individuals in Adult Mental Health First Aid, and 84 in Youth Mental Health First Aid, a specialized version of the training for adults who come in frequent contact with young people.

Among those scheduled to participate in this week’s training are members of state and local government and executive leadership from WakeMed Health and Hospitals, UNC REX and Duke Raleigh Hospital.


Alliance Teams with Duke to Keep Kids at Home

Alliance Behavioral Healthcare has partnered with researchers in the Duke Division of Child and Family Mental Health and Developmental Neuroscience and Ben Goldstein, PhD of the Duke Division of Biostatistics and Bioinformatics on a project designed to use early intervention with mental health services to help young people avoid the need for intensive care in out-of-home settings. The project is funded in part by a grant from the Duke Institute for Health Innovations.

As the managed care organization (MCO) for public behavioral health services for the citizens of Durham, Wake, Cumberland and Johnston counties, Alliance serves a total population of over 1.8 million people. Ensuring mental health treatment for youth in their communities – and supporting them to live at home with their families of origin – is a priority for Alliance reflected in its plan to invest $41 million in Medicaid savings over three years in innovative, evidence-based solutions to the behavioral health needs of its communities.

The project will develop a model of statistical analysis of health insurance claims to generate real-time identification of youth at risk for needing treatment in therapeutic foster care, or in emergency departments at a point when psychiatric treatment in an out-of-home setting is the only option. While therapeutic foster care is an effective model of care that provides children with a combination of the best elements of traditional foster care and residential treatment centers, earlier identification of high-risk kids can allow them to remain with their families and in their communities while receiving mental health treatment, a less intensive and costly alternative. Alliance and Duke will team to provide them with care coordination and clinical services. The resulting predictive model and associated data analysis will be re-used in a number of applications that will help identify and intervene with youth at risk for needing out-of-home treatment.

“This partnership with Duke is consistent with our comprehensive population health approach in delivering a data-informed, collaborative care model that identifies and addresses the full range of medical, functional, social, emotional and environmental needs across all the populations we serve,” said Rob Robinson, Alliance CEO. “Our goal is to improve health outcomes by focusing on wellness, prevention and person-directed care.”