• DBHDS should be considering Medicaid 1115 waiver initiatives for the in-home provision of support services and crisis care training for family providers of those adults over the age of 26 with serious mental illness in their own homes in coordinating effectively with ACT teams and crisis intervention services in the community..  Experience-Based Co-Design is an evidence-based form of shared decision making that involves nominated family members, consenting adults with SMI, adult peer specialists, medical practitioners, and other nominated "carers" on an equal basis in the co-design of care plans and care coordination consistent with CCBHC standards of care.  EBCD is recognized as an international standard of care, for example, in the United Kingdom and Australia where its use is widespread.  EBCD is commonly used in care coordination of other complex medical disorders, such as Post ICU Syndrome cases.  It is a cost-effective means to help transition adults with SMIs over the age of 26 who are frequently home bound to evidence- based care and long-term independent living in the community.   Unaccountedly, EBCD is seldom used in the US despite advocacy by IHI and other healthcare organizations.  Medicaid Waiver funding should reimburse the costs of training for family members to share on a co-equal basis in the long-term care and transition to independent living of their consenting adult family members over the age of 26 in coordination with ACT and FACT teams.  Enhancements under this evidence-based care model approach includes video taping of critical incidents with role plays, enhanced knowledge and skills to develop medication support, discharge planning, inpatient and outpatient crisis plans,, psychiatric advance directives, and crisis support skills ,   Family members are recognized by SAMSHA as family "peers" working in concert with other adult peer "specialists". and are well placed fo provide reimbursable support for their often chronically disabled family members within their own homes.  Care initiatives for this frequently home-bound "at risk" population should be funded on a par comparable to that afforded under the ARTS Program funding for SUDS and Co-occurring Disorders.   Funding parity for the SMI has been repeatedly promised for years yet little in the way of actual funding has been appropriated in Virginia Medicaid Waiver Extension requests..  

Edmund W. Creekmore, Jr., MS, Ph.D., LCP, National Shattering the Silence Coalition