To be determ
Tuesday, October 11
Session A • 10:30 am – 12:00 pm
PART I: Competing for Quality: Strategies for Becoming a Top Talent Magnet
Presenter(s): Ed Krow, SPHR, CCP, SHRM-SCP, Ed Krow, LLC
Dr. Paul Newton, Expert Author Publishing
Track(s): BO, HR
It’s all about reaching and influencing the candidates wherever they are in whatever they read, hear, or see. To be successful in today’s marketplace, we must adapt key talent management strategies to changing workforce demographics. We will look at effective recruiting strategies across generations, the new recruiting framework in today’s economy, and 11 key strategies to revamp your recruiting message. To be competitive, organizations must ensure current employees are employment brand ambassadors as well, and we’ll talk about what that means and how the marketplace plays a role. You’ll hear how compensation is impacting the recruiting process and onboarding of new employees. We will look at considerations when designing a pay structure, key retention and motivation drivers, and why plans fail.
Creating the Playbook on the Fly: Lessons Learned from the COVID-19 Pandemic That Will Endure as We Navigate to the “New” Normal
Presenter(s): Woody Rosenbach, MBA, COMHAR
LaMar Brooks, MHS, COMHAR
Track(s): BO, EL, FM, HR, LD
March 2020: Philadelphia, Pennsylvania and the country announced a “2-week pause” that turned into a 2+ year pandemic. Through the lens of COMHAR, hear the firsthand account of how the agency rallied to not only survive but thrive during the most challenging time in its 45-year history. COMHAR leaders will walk you through the strategies and tactics employed to navigate through these unprecedented and uncharted waters. Lessons learned will cover the full docket from reimagined service delivery, staffing challenges, financial management, and IT infrastructure to overall health/safety considerations. Importantly, this session will provide you with the roadmap to be a stronger and more resilient agency as we enter the post-pandemic “new” normal world. Key lessons learned will include: you never do the PLAN the way you PLAN to do the PLAN; mission delivery serves as the North Star; build a team tailored to meet the unique needs; communicate early and often using a wide range of tools; educate with both the information and misinformation; we’re all leaders in the top, middle, and bottom; dash for cash; fully employed, fully engaged; you can’t overcome staff resistance to vaccination mandates, or can you?; it’s a marathon, not a sprint; and seize the future, but do NOT try to recapture the past. Importantly, the lessons learned will include anecdotes, measures, insights, and tangible outcomes that all audience members will be able to relate to.
Reducing Obstacles to Care: Low-Barrier Access to Buprenorphine and Other Life-Saving Treatments
Presenter(s): Mark G. Fuller, MD, Center for Recovery Medicine, Allegheny Health Network
Stuart Fisk, CRNP MSN, Center for Inclusion Health, Allegheny Health Network
Track(s): DA
Overdose deaths have been rising steadily in the US. In the most recent 12 month period reported, deaths exceeded 100,000 for the first time in US history. Traditional treatment methods are not reaching enough people and have too many obstacles for accessing high quality evidence-based services. Research has demonstrated that the majority of individuals with opioid use disorders are not receiving any of the medications for opioid use disorder (MOUD), which have been proven to decrease overdose deaths and increase engagement in treatment. This presentation will provide a review of the scientific evidence for the effectiveness of MOUD along with statistics demonstrating how vastly underutilized they are. We will then move to presenting three different models for removing barriers to care and connecting people with these life-saving medications within a harm reduction framework.
Reviewing Data Together: The Impact of the COVID Crises on Children’s Services Outcomes
Presenter(s): Dan Warner, PhD, Community Data Roundtable
Track(s): CH, EL, MH
Community Data Roundtable is a nonprofit organization collecting data in Pennsylvania’s child serving system since 2013. We believe it is only through shared data review that we will craft a truly transformative system. In this presentation, we will highlight the impact the multiple ‘COVID-19 crises’ (sheltering in place, worker shortages, etc.) have had on clinical outcomes for children on the autism spectrum and with serious emotional disturbances. This presentation is for anyone who likes to know the facts about the big picture, and is meant to be clear and engaging to everyone, from family members to system planners. Topics covered include an introduction to Community Data Rountable and how we collect clinical data; explaining the CANS tool; public facing dashboards; overall trends in the Pennsylvania child serving system before and since the COVID-19 crisis, and more. A special discussion on children with autism spectrum disorder will also take place.
Healing-Centered Supervision: Lessons from Peer Support
Presenter(s): Emily Ferris, CPS, Magellan Behavioral Health of Pennsylvania
Dana Lombardi, LPC, Magellan Behavioral Health of Pennsylvania
Track(s): MH
This workshop reviews important concepts in work wellness, drawing from peer support supervision practices to promote discussion on strategies to create a healing environment for participants and staff. There will be an overview of important definitions (healing-centered peer support, vicarious trauma, moral injury). We will discuss trauma stewardship as a philosophy and options to operationalize trauma stewardship for staff members as a proactive and restorative approach to managing burnout. Options for creating healing-centered environments for staff and participants will be discussed. We will also discuss the importance of boundaries and the fallacies of common approaches to self care. Lastly, we will brainstorm strategies for individual and group supervision.
One Hospital Diversion VBP Project: The Good, The Bad, and The Ugly
Presenter(s): Lisa M. May, PhD, LPC, UPMC Western Behavioral Health at Safe Harbor
Mandy Fauble, PhD, LCSW, UPMC Western Behavioral Health at Safe Harbor
Track(s): VBP/R
Outcome data will be presented on a hospital diversion value-based purchasing project that is in the second year of data collection. The methods used to track data will be reviewed, as well as the roles of staff in the completion of the project. We will also describe the challanges in completion, what unexpected factors impacted the outcomes, and solutions we found to have a positive impact with those unexpected factors.
Technologies Needed to Be Successful in Health care Reform for Mental Health, Substance Use, Developmental Disabilities, and Human Service Organizations
Presenter(s): Michael R. Lardieri, MSW, LCSW, Core Solutions,
Track(s): BO, CH, CO, DA, EL, FM, HRF, IDD, MH, PDA, TH
Participants will discuss the changing health care environment, including movement to managed care and value-based payments; continued success and improved quality by high performing CCBHCs, ACOs, PCMHs, and CCOs; the need for care collaboration/coordination and data sharing; post-pandemic access and use of telehealth; and SDoH data capture and intervention. Other topics covered will include common technology themes in these settings, such as clinical outcomes; evidence-based practices; benchmarking and dashboards; data sharing with partners and HIEs; integrated telehealth solutions; and robust data analytics.
Supporting Children with Medically Complex Conditions – Overview of Medical Support Needs
Presenter(s): Gregory Cherpes MD, NADD-CC, Department of Human Services,
Office of Developmental Programs
Rhonda Gengler RN, BSN, Department of Human Services,
Office of Developmental Programs
Track(s): CH, IDD
The presentation will discuss why supporting children with medically complex care needs is important to the development of children and the focus areas of the TSM services. A review of the TSM eligibility criteria for children with medically complex conditions will be included, as well as a discussion on the process for transitioning a child with MCC from a residential facility to a home. A review of educational resources that are available for providers and staff to utilize to increase their basic knowledge of medically complex conditions will be provided. In addition, attendees will review a case study of a child who successfully transitioned home from a pediatric facility and the challenges that were successfully addressed.
Tuesday, October 11
Session B • 1:15 pm – 2:45 pm
Employment Strategies for Those With Prader Willi Syndrome
Presenter(s): Lisa Svidron, MA, CESP, Mainstay Life Services
Jennifer Dayton, Mainstay Life Services
Track(s): IDD, VR
This interactive presentation will include activities, videos of individuals with Prader Willi working, and literature related to Prader Willi. Attendees will learn about the syndrome, the genetics behind the syndrome, and the reason why they have been considered unemployable in the past. They will participate in a job development with the presenter and talk through each job as to why it would fit and what safety strategies would need to be put into place. Attendees will become a part of the job development process and interactively point out negative aspects of a job. Attendees will understand that those with Prader Willi Syndrome can work with the proper safety techniques in place. Tips from this presentation can be used for other syndromes that may impede an individual from working according to the community.
PART II: Competing for Quality: Strategies for Becoming a Top Talent Magnet
Presenter(s): Ed Krow, SPHR, CCP, SHRM-SCP, Ed Krow, LLC
Dr. Paul Newton, Expert Author Publishing
Track(s): BO, HR
It’s all about reaching and influencing the candidates wherever they are in whatever they read, hear, or see. To be successful in today’s marketplace, we must adapt key talent management strategies to changing workforce demographics. We will look at effective recruiting strategies across generations, the new recruiting framework in today’s economy, and 11 key strategies to revamp your recruiting message. To be competitive, organizations must ensure current employees are employment brand ambassadors as well, and we’ll talk about what that means and how the marketplace plays a role. You’ll hear how compensation is impacting the recruiting process and onboarding of new employees. We will look at considerations when designing a pay structure, key retention and motivation drivers, and why plans fail.
TCV Community Services and Devereux Advanced Behavioral Health — A Case Study in Effective Affiliation
Presenter(s): Carl E. Clark II, Devereux Advanced Behavioral Health
Fran Sheedy Bost, Devereux Advanced Behavioral Health
Robert Dunne
Track(s): BO, CO, EL, LD
This presentation will be split into three areas to address the stated learning objectives: a discussion of mergers and acquisitions and affiliation models; a case study of the successful partnership between TCV and Devereux; and a chance for Q&A and lessons learned with regard to the affiliation decision and subsequent partnership. In Part 1, Devereux President and CEO Carl E. Clark II will discuss the models Devereux considers for affiliation agreements, which will lead into Part 2 and a discussion of the case study. In Part 2, TCV Executive Director Fran Sheedy Bost (who was with the organization prior to the affiliation and remains its executive director) will describe what she was looking for in a partner. Carl and Fran will discuss the affiliation journey all the way through TCV’s integration with Devereux’s systems. In Part 3, the group will share the top lessons learned throughout the process and provide an opportunity for Q&A with audience members.
Implementing Trauma-Informed Care in Children’s Mental Health Residential Treatment in Pennsylvania
Presenter(s): Gordon R. Hodas, MD, PA Office of Mental Health & Substance Abuse Services
Caren L. Rosser-Morris, PhD, PA Office of Mental Health & Substance Abuse Services
Track(s): CH, LD, MH
This presentation describes the current plan by the Office of Mental Health and Substance Abuse Services (OMHSAS) to implement trauma-informed care (TIC) in mental health residential treatment facilities (RTFs) for children and adolescents. These child and adolescent mental health treatment RTFs all receive Medicaid funding and are also known as OMHSAS-certified child and adolescent RTFs. The initiative to help OMHSAS-certified RTFs become trauma-informed is a multi-year process. It began in 2020, guided by the four phases of TIC identified in the document “Trauma-Informed Pennsylvania (TIPA).” The goal in 2021 was for OMHSAS to designate children’s mental health RTFs as Trauma-Aware. The current OMHSAS goal is to designate these same facilities as Trauma-Sensitive. In this presentation, clinical TIC consultants to OMHSAS will describe the TIC initiative for children’s mental health residential treatment facilities. The goal is to provide participants with an overview of the vision, progress to date, and steps taking place at the present time.
Preparing for a Value-Based Payment (VBP) Future in Substance Use Treatment in PA: Using the Centers of Excellence (COE) as an Example
Presenter(s): David Loveland, PhD, Community Care Behavioral Health
Track(s): DA, FM, VBP/R
Participants will be guided through the planning and implementation processes of moving an FFS payment to a VBP using the COE program. Participants will be asked to design the steps in the VBP based on existing quality metrics and potential savings and increase costs with various strategies. The presentation will include five sections, including: identifying the challenges of moving toward a VBP within organizations funded through FFS; highlighting the quality metrics needed to increase engagement and retention in the COE (data slides include actual COEs with dummy coded names); examining costs associated with low retention in the COE and cost savings associated with retention; exploring best practices to improve COE with alternative payment options; and providing an overview of how Community Care is using data to calculate a VBP for the 50+ COE locations in PA.
Managing Unique Challenges for Clients in the Workplace
Presenter(s): Thomas G. Tirney, CFA, CMT, ChSNC, Arlington Heritage Group
Track(s): EL, FM, VR
This guide for employment will review the case for increased employment in I/DD, shifting the mindset to promote employment, challenges & key considerations for providers, and income thresholds with regards to benefits.
Do Private Equity-Funded Start-ups and Services Have an Advantage Over Legacy Nonprofit Provider Organizations?
Presenter(s): Stacy DiStefano, MC, Consulting for Human Services
Track(s): DA, EL, IDD, MH, VBP/R
Presenter will use her experience advising PE firms and share their strategies and innovations. She will introduce in detail the top 10 newcomers across SUD, IDD, and BH, as well as show the attendees a way to develop a simple and targeted SWOT analysis to better compete.
Ethical Considerations of Guardianship
Presenter(s): Lesley Mehalick, JD, LLM, McAndrews, Mehalick, Connolly, Hulse and Ryan, PC
Track(s): ET, FM, IDD, MH
This seminar will fully discuss guardianship, including when guardianship is appropriate, its alternatives, an overview of the process for obtaining guardianship, the responsibilities of guardianship, whether a guardianship can be terminated, and when and how a guardian can be removed. We will review how the guardianship process might differ in cases of mental health illness and the complications that can arise in those cases. We will review the limits of guardianship and will discuss specific potential scenarios as to whether a guardian has the authority to make complex decisions. Examples such as estate planning, sterilization, voting, and end-of-life decisions for the incapacitated person will be discussed. Current topics will include the ability of a guardian to access the electronic records of an incapacitated person.
ined
To be determin
Wednesday, October 12
Session C • 10:45 am – 12:15 pm
Value-Based Care: Provider-Payer Partnership and Prioritization of Member Experience to Get to Value-Based Contracts
Presenter(s): Charlotte Chew, MSEd, Pyramid Health care
Monica Collins, MA, MBA, Magellan Behavioral Health care of Pennsylvania
Track(s): BO, DA, MH, VBP/R
The urgent need to restructure health care delivery persists and was compounded tremendously throughout the COVID-19 pandemic, which has increased access and capacity issues for behavioral health care. With access to services at the forefront of every provider and payer’s mind, the continued focus on addressing rising costs by delivering high value care does not have to take a back seat. Presenters include Pyramid Health care, a national Drug and Alcohol Provider, and Magellan Health care, a national and local Pennsylvania BH-MCO, who will engage the audience to recognize how, through partnership and collaboration, they developed a value-based care model during the COVID pandemic by focusing on the member journey. We will demonstrate how the partnership between our organizations was developed through the use of data and two-way education about each organization’s goals, objectives and needs; how we identified the key components of the client experience and developed a value-based care model framework around the client experience; the development of the care model; the metamorphasis providers and BH-MCOss must go through to begin a value-based care model; and the development of the payment model.
Protecting Those in Our Care — Devereux’s Response to a Significant Media Event
Presenter(s): Rhea Fernandes, PsyD, Devereux Advanced Behavioral Health
Leah Yaw, Devereux Advanced Behavioral Health
Track(s): BO, CH, CO, EL, LD
This presentation will broadly cover Devereux’s risk management, external crisis response, and business practices in response to media events that originally occurred in August 2020. Devereux’s senior executives that are presenting personally led the response, and as such are the ideal individuals to lead others in the field to prepare — both operationally and administratively — for such an event. First, the team will review Devereux’s comprehensive safety and quality report, which is a broad culmination of all of the work that Devereux has done to ensure that those in our care are safe. Next, the team will discuss the timeline of events from August 2020, including the engagement of an external consulting firm to directly address the allegations in the article series. Finally, attendees will leave with a variety of tips for what can be done in preparation for such a media crisis as well as how to manage organizational change as a result. Devereux uses project management as a framework for organizational change, which allows for broad strategic plans to be implemented in a granular way. These methodologies can be applied to any situation but were particularly important for showing follow through on a crisis.
Supporting Challenging Individuals: Bridging the Service Gap in an Outpatient Setting
Presenter(s): Ricky Jones, MS, LPC, Berks Counseling Center
Bonnie Triebig, MS, Berks Counseling Center
Track(s): CO, DA, HRF, MH
This workshop will address the benefits and lessons learned from the process of developing a Team-Based approach to treating high-risk patients, developing an assessment to help identify these high-risk patients, and implementing treatment with defined outcome measures. As health care providers, we are aware of gaps in available services that exclude patients from receiving the level of care required for effective treatment. The presentation will review why Berks Counseling Center identified a need for a high-risk team, the steps taken to develop it, the process of developing and testing a risk assessment, and lessons learned in implementation. Additionally, the presentation will highlight Berks Counseling Center’s experience and the processes that were developed to ensure maximum value while maintaining an integrated team approach to care. The presenters will explore the essential requirements of an effective high-risk team and ancillary services to maximize outcomes. Also addressed will be issues as they relate to staffing, data collection and reporting, and care coordination. We will share resources we used during implementation, as well as samples of the high-risk assessment.
Trauma-Informed Leadership: Critical in a Post-Pandemic World
Presenter(s): Angela Chew, LCSW, Dickinson Center, Inc.
Track(s): EL, HR, LD, MH
The presenter will define trauma-informed care and how it is translated into leadership roles and the actions of leaders. The presenter will use an activity to reflect the importance of trauma-informed care in leadership and decision-making, which demonstrates how easily the trauma-informed lens can get away from us. Participants will learn aspects of trauma-informed supervison, which are modified for leadership roles and how decisions are made and then shared with the program or agency staff. The presenter will use a video to demonstrate the challenges of making decisions that require a change in staff behaviors/mentality. Participants will learn and make use of the 5 areas of safety and the SELF circle in preparing for any decision or change. Participants will practice using trauma-informed care leadership to communicate changes to the staff whom they serve.
SkillUp™ PA: A No-Cost Online Learning System for Rehabilitation and Community Providers
Presenter(s): Barbara Vierlink,
Stephanie Perry, MSS, LSW, PA Department of Labor and Industry-Bureau of Workforce
Partnership and Operations
Kerry Twomey, MSc, 0
Track(s): BO, HR, LD, VR
Come learn about SkillUp™ PA. SkillUp™ PA offers over 6,000 online learning modules and over 130 career pathways for any PA resident to take online, at no cost, with only a PA CareerLink® Online registration required.
The Five Introductions: Sharing Your Story With Everyone from Family to Lawmakers
Presenter(s): Christopher Kush, MPP, Soapbox Consulting
Track(s): BI, CH, EL, IDD, LD, MR, MH, PDA, TH, VR
This will be an interactive session where Christopher Kush, MPP, author of The One-Hour Activsit and Grassroots Games, helps participants introduce themselves in a variety of ways. These introductions form the predictable core of many imporant interactions in the community, from family to lawmakers, to other professionals. Participants will learn how to share their personal experiences, focus on and comunicate important statistics, counter misconceptions, and pursue goals with a unified voice.
Developing Recovery Supports for Young Adults with Autism and Serious Mental Illness
Presenter(s): Chris Wolf, I Am Boundless, Inc.
Dr. Patrick Maynard, PhD, I Am Boundless and Boundless Health and Affiliates, Inc.
Jennifer Riha, MAC, LSS-GB
Track(s): CH, EL, IDD, MH
An intensive multi-system youth program developed by Boundless includes residential, applied behavioral analysis (ABA), mental health treatment, and education services by braiding funding from multiple systems of care. This has been replicated across the state of Ohio, resulting in new state-developed funding models in the Medicaid program. The panel will discuss the program models and the process used to bring together funders and stakeholders from separate systems to create a sustainable program model to meet the needs of these highest acuity youth and their families.
Wednesday, October 12
Session D • 1:45 pm – 3:15 pm
Introduction to Measurement-Based Care and Addressing Its Most Frequently Asked Questions
Presenter(s): Dr. Elizabeth Connors, PhD, Yale University
Jesse Hayman, Greenspace Health
Track(s): CH, CO, DEI, DA, EL, IDD, LD, MH
Dr. Elizabeth Connors (Yale Measurment-Based Care Collaborative, Assistant Professior of Psychiatry, Yale University) and Jesse Hayman (Greenspace Health) will deliver an engaging Q&A disucssion-style presentation, where Dr. Connors will share her vast experience within MBC, share the benefits of it, and discuss her experiences throughout her career dedicated to its implementation. Dr Connors will share her research, as well as others’, including her colleagues’ research from the Yale Measurement-Based Care Collaborative. Based on research, clinical, school, and group implmentations, we will share the key success factors of MBC and learnings to be applied across different settings. Examples of this content include how to introduce MBC to youth and adult clients, how to include caregivers within an MBC process, how to discuss significant symptom changes with clients, how MBC helps improve therapeutic alliances, how to set up a culture of learning around MBC within a clinic, how MBC can further engage clients in their care process, and how MBC can help to inform care/treatment decisions.
Implementing a County/Agency System to Improve Outcomes for Individuals, Agencies, and Systems of Care by Identifying and Modifying Treatment for Individuals with Fetal Alcohol Spectrum Disorders (FASD)
Presenter(s): Dan Dubovsky, MSW
Joe Kloss, BS, Luzerne-Wyoming Counties System of Care
Summer Krochta, LCSW
Jessica Sachs, Children’s Service Center
Track(s): CH, EL, LD, MH
Individuals with an FASD often fail in typical treatment settings when not recognized, resulting in repeated treatment failures, frustrating staff and increasing costs of intensive services. With an estimated 640,000 Pennsylvanians with an FASD, this is a significant issue for our programs throughout the state. This presentation presents a cooperative project between Luzerne-Wyoming Counties, Children’s Service Center, and the Pennsylvania FASD Task Force to train professionals and families about FASD, to identify youth with a probable FASD, and to implement an intervention approach to work with youth and families to address challenging behaviors and improve outcomes. This presentation will begin with information on the prevalence of FASD and the importance of recognizing FASD in individuals in all systems of care. The presentation then focuses on the development and implementation of this collaborative project. We will present examples of how the project is working along with data collected thus far and how this approach can enhance the success of agencies in improving outcomes for those they serve and potentially reduce the need for long term intensive services.
Providing Trauma-Informed Supports to Direct Support Professionals (DSPs) During Tragic Events
Presenter(s): Robin VanEerden, MS, LPC, NADD-DDS, CC, Merakey
Michael Benjamin May, EdD, BCBA, LPC, LBS, NADD-CC, Merakey
Track(s): CH, IDD, LD, MH, PD&A
This presentation will describe the critical role of implementing supports provided to Direct Support Professionals (DSPs) who work with individuals with special needs, as well as demonstrating evidence-based supervisory-directed interventions that prompt DSPs’ wellbeing.
Language Matters
Presenter(s): Marian Baldini, MS, MBA, KenCrest
Track(s): LD
As leaders we depend on language for both our everyday work and our strategic success. This session is a skill-building opportunity for leaders who want tools and techniques to inspire, align and energize our work. The session will be both light hearted and serious in its design. Frameworks from four distinguished leadership voices will be used to demonstrate effective communication. Leaders will walk away with resources to improve the way we use words to drive our accomplishments.
PART I: Risk Management in Telehealth: Guidance to Providers
Presenter(s): Cynthia Haines, Esq., Post & Schell
Track(s): BO, CO, TH
Cyberattacks targeting small businesses and the healthcare sector have surged because of the COVID-19 pandemic and the resulting rush to remote delivery of healthcare services. Security vendors and researchers tracking the industry have reported a major increase in phishing attacks, ransomware, web application attacks, and other threats targeting healthcare providers. Attendees will learn about the biggest cyber risks in 2022, including ransomware, cloud vulnerabilities, web application attacks, increased fishing, and human error. Participants will also hear about how to protect the organization’s confidential data, using tools such as network security, data backup plan, anti-malware programs, hipaa security best practices, cloud security assurances, application developers assurances, education and training, and vendor contracting.
Improving Peer Workforce Recruitment and Retention from Multiple Stakeholder Perspectives
Presenter(s): Jamie Edwards, MSW, LCSW, Community Care Behavioral Health Organization
Tracy Carney, CPS, CPSS, Community Care Behavioral Health Organization
Track(s): DA, MH, VR
This workshop presents findings from a qualitative assessment of over 30 certified peer and recovery specialist programs across Pennsylvania. This data is used to define the current peer workforce, recruitment, and retention challenges. Building off these findings, presenters will lead a discussion of strategies to address needs in three domains that emerged from qualitative findings: system-level challenges (e.g., certification, training, skill development process, limited peer career pathways, supervision requirements); program challenges (e.g., training needs, peer strengths, compensation); and managed care organization challenges (e.g., billing requirements, reimbursement rates, value-based payments). Attendees will benefit from group learning and discussion of peer and other programs with similar workforce challenges that have proven successful. Attendees will be able to apply these strategies for personal career development as well as within their organizations. There will be time allotted for questions at the end.
Before I Put My Hands Behind My Back, Can We Talk About This? — Philadelphia Police Department Co-Responder Program
Presenter(s): Megan L. Johnson, MA, LPC, Elwyn
John Muehsam, PhD, MSW, LSW, CAADC, CPRP, Elwyn
Track(s): MH
This presentation is intended to share with conference attendees insight into a collaborative and robust crisis care continuum. Philadelphia has taken significant steps to increase access to mental health services for community members while working to decrease inappropriate use of our justice system and emergency departments. Presenters will provide information on the steps that Philadelphia has taken as well as what other communities across the country are doing to address these same concerns. The presentation will begin with a general introduction to the role crisis programs have played in communities in which Elwyn has developed them, including our overall vision for crisis services going back to 2013. We will then discuss the ways in which co-responder programs have developed and operated on a national scale. Finally, the presenters will discuss the recent developments of the co-responder programs in Philadelphia as part of Philadelphia’s strategic initiatives to upgrade the city’s crisis services system across all levels of the crisis continuum.
Wednesday, October 12
Session E • 3:30 pm – 5:00 pm
Building a Strong School-Based Outpatient Therapy Program: Providing Quality Services and Enhancing Community Partnerships
Presenter(s): Amanda Katchur, PsyD, Community Services Group
Track(s): CH, LD, MH
This program is targeted for individuals who are managing, supervising, or working within a school-based outpatient therapy program. The primary focus of this presentation is on how to increase the quality of services being delivered to clients as well as how to improve relationships with our partners in the community. Areas that will be covered include identifying unique strengths and challenges of working within a school-based model and how to best work with this information. Supervision and a model of supervision specific to school-based therapists as well as a model for communication and problem-solving with our community partners and schools will be discussed. This will be accomplished through real-life examples and discussion, as well as through a Powerpoint presentation. This program will also discuss experiences in these roles and modifcations made due to the Covid-19 pandemic in order to continue providing quality supervision and care.
ATLAS®: A Tool for Connecting Your Community to Evidence-Based, High-Quality Addiction Treatment
Presenter(s): Angad Buttar, MS, Shatterproof
Kim Coleman, Pennsylvania Department of Drug and Alcohol Programns
Track(s): DA
In the United States, the use of evidence-based addiction treatment practices varies substantially. While some facilities use the most current science to ensure patient success, others may use outdated, ineffective, or even harmful practices. Because of this lack of standardization, it can be difficult for patients and family members to navigate to the care that is most appropriate for them and that follows effective treatment methods. In July 2020, Shatterproof launched ATLAS®, the Addiction Treatment Locator, Assessment, and Standards platform. This session will explore the unique characteristics of ATLAS in assisting communities in finding high-quality addiction treatment. Presenters will highlight the benefits that ATLAS brings to the treatment landscape both in searching for quality treatment and driving high-level change. The session will explore the role of treatment facility surveys, claims-based data, and patient feedback in developing facility profiles on the platform. During its most recent round of survey completions, ATLAS collected data from over 65% of treatment facilities within the state of Pennsylvania. Presenters will focus specifically on how this data is displayed in password-protected portals, teaching the audience how to use ATLAS data when analyzing and comparing facilities based on quality metrics. Attendees will learn the importance of submitting data to ATLAS and how to leverage this data to support high-level quality improvement within the addiction field.
PART II: Risk Management in Telehealth: Guidance to Providers
Presenter(s): Cynthia Haines, Esq., Post & Schell
Track(s): BO, CO, TH
Cyberattacks targeting small businesses and the healthcare sector have surged because of the COVID-19 pandemic and the resulting rush to remote delivery of healthcare services. Security vendors and researchers tracking the industry have reported a major increase in phishing attacks, ransomware, web application attacks, and other threats targeting healthcare providers. Attendees will learn about the biggest cyber risks in 2022, including ransomware, cloud vulnerabilities, web application attacks, increased fishing, and human error. Participants will also hear about how to protect the organization’s confidential data, using tools such as network security, data backup plan, anti-malware programs, hipaa security best practices, cloud security assurances, application developers assurances, education and training, and vendor contracting.
Expert Panel on Recruiting and Retaining Behavioral Health Staff During Challenging Times
Presenter(s): Christine Axford, Med, LPC, Berks Counseling Center
Rosa Davis, POWER • Cassie Dundon, MS, LPC • Amy Herschell, PhD
Elissa Nulton • Kate Pompa, MSCP, LPC, NCC
Track(s): LD, HR
This workshop session will be organized as a panel discussion, moderated by Dr. Amy Herschell. Five community-based behavioral health leaders will serve as experts on the panel, including Christine Axford, Rosa Davis, Cassie Dundon, Elissa Nulton, and Kate Pompa. Collectively, this panel represents urban and rural providers serving clients across the lifespan with mental health and substance use disorders. Their expertise also includes peer services, diverse populations, and innovative clinical practices. Following introductions and a brief overview by Dr. Herschell of recent evaluation data on the impact of COVID-19 on the workforce, panelists will share success stories of how they were able to recruit and maintain staff during the “Great Resignation.” Audience members will be encouraged to ask questions and share expertise/experiences to ensure a lively conversation. Discussion will focus on practical, realistic suggestions that audience members can immediately implement in their organizations.
Preparing for Value-Based Healthcare in Human Services: Leveraging the Power of Business Intelligence to Help Manage Alternative Payment Models (APMs)
Presenter(s): Scott Bachik, MScA, Enkompas BI
Susan Bennett, MA, Lakeshore Community Services
Jenifer DeMers
Track(s): BO, CO, EL, FM, HRF, MH, VBP/R
This presentation is a case study review of how Lakeshore Community Services transformed their organization from manual data management to using advanced Data Analytics and Business Intelligence to manage Pay-For-Performance Quality Measures and payment models. The attendees will take away a framework of how to adjust operational processes and procedures to track key information and how to use Business Intelligence to analyze and report the data to support data-driven management and enhance performance.
Programs That Promote Change for Sexually Problematic Behaviors
Presenter(s): Jack Berkenstock Jr., MHS, The Bodhana Group
Track(s): IDD
Programs supporting persons with sexually problematic behaviors who also have intellectual disabilities are complex and need more than just a standard environment with some considerations. These programs are forensic, evidence-based practices that require oversight and consideration of liability and accountability. This presentation will discuss the core elements of as successful program to help guide agencies in implementing strategies and programs that offer effective treatmernt with safeguards for client rights and agency concerns for safety. The presenter will review components and their importance as well as concerns for safety and ethics, then present guidelines for designing and managing effective programs.
Identifying and Addressing Health Disparities Related to Tobacco Use Among Individuals with Mental Health and Substance Use Disorders
Presenter(s): William Stauffer, The Pennsylvania Recovery Organizations – Alliance
Tony Klein, MPA, NCACII, PA Statewide Tobacco Free Recovery Initiative
Track(s): DA
This presentation thoroughly explores tobacco use specific to individuals with mental illness and other substance use disorders. Data is reviewed to explain a high smoking prevalence and severity of tobacco use disorder, disproportionate health consequences, and common misconceptions that sustain smoking as a social norm in the recovery and treatment culture. Evidence-based tobacco interventions tailored to a behavioral health setting will be provided. Teaching methods comprise didactic presentation, brief video clips, participant Q&A, and a 30-minute interactive exercise that allows for participant discussion on knowledge gained and how the information will be applied to practice.
To be determ
Thursday, October 13
Session F • 9:00 am – 10:30 am
Northwest Pennsylvania Veteran Suicide Prevention Program (NWPAVSPP)
Presenter(s): Greg Griffith, BA, University of Pittsburgh Program Evaluation and Research Unit (Pitt PERU)
Mandy Fauble, PhD, LCSW, UPMC Western Behavioral Health at Safe Harbor
Stacey Buettner, LCSW, UPMC Western Behavioral Health at Safe Harbor
Track(s): MH
Using examples and lived experiences from an active suicide prevention initiative, the presenters will help the audience understand the importance of using holistic strategies and building multi-sectoral partnerships to reduce community suicide rates. Audience members will have an opportunity to brainstorm how the strategies presented can be implemented within their organizations. The following provides a high-level description and time blocks for the presentation. 0-5 minutes: Present speakers’ backgrounds, experiences, and motivations for suicide prevention work. 5-30 minutes: Provide an overview of suicide as a public health problem (i.e. discuss current national and state statistics, considerations for special populations, micro/mezzo/macro contributing factors, and resilience/recovery/protective factors). 30-60 minutes: Present strategies for a holistic approach to suicide prevention using examples from the NWPAVSPP. 60-75 minutes: Breakout discussions (e.g. suicide prevention and intervention training, building sustainable partnerships for suicide prevention, strategies for community and healthcare engagement). 75-90 minutes: Report out from breakout discussions and Q&A with all speakers.
PART I: Having Difficult Conversations With Employees
Presenter(s): John Amato, MEd, Familylinks
Track(s): EL, HR, LD
In this presentation, we will explore some of the reasons that having these conversations may be difficult. We will also discover methods for increasing our confidence and competence in having these difficult conversations in a way to promote a positive outcome. We will also understand the relationship these conversations have with an accountable team.
Evaluating the Use of a Digital Therapeutic to Improve Client Engagement and Access to Post-Discharge Outcomes
Presenter(s): Jennifer Irvin, PsyD, Pyramid Healthcare, Inc.
Winnie Nagle, LPC, PhD, Pyramid Healthcare, Inc.
Track(s): BO, DA
Historically, either psychotherapy, medication, or a combination of both were the recommended treatment protocols for behavioral health disorders. However, as our world continues to innovate, so has behavioral health treatment, and now a fourth option has been gaining clinical traction. Specifically, in both the physical and mental health arenas, practitioners are seeing the advent of digital health devices, health and outcomes-focused software, and applications collectively known as “Digital Therapeutics.” A tremendous focus on research and development, as well as the FDA publishing in 2017 the “Digital Health Innovation Action Plan,” has provided a pathway for these Digital Therapeutics to launch clinically-validated digital health devices. This session will cover how a Behavioral Health System, eager to explore this new landscape, commenced a structured process to evaluate, select, and design a pilot program to measure the effectiveness of the identified digital therapeutic. Specifically, the presenters will take participants through the full process of digital therapeutic education, a selection based on organizational needs, development of key performance indicators, review of the pilot program results, and how to best apply this information as session participants embark on their own digital therapeutic discovery journey.
Father Engagement Through the Eyes of the Child
Presenter(s): George Fleming, Allegheny Family Network
Misty Woody, Allegheny Family Network
Track(s): MH
Studies show that having a father involved in a child’s life is one of the most important protective factors in offsetting the impact of childhood stress caused by income challenges, unstable living conditions, and racially disparate policies and practices. But in many of the neighborhoods whose residents experience trauma on a regular basis, fathers are absent, discouraged from having a meaningful role in their children’s lives by systemic bias against men as parents. This causes a demoralizing role identity crisis. This presentation will explore the results of the absence of fathers’ meaningful involvement in their children’s lives and offer a model that is highly successful in engaging fathers in services. Through engagement, disenfranchised fathers find the path to be the fathers they want to be.
You Have All the Data — Now What? How to Leverage Data to Demonstrate Quality
Presenter(s): Rayni Brindley McMahon, MEd, BCBA, Consulting for Human Services (CFHS)
Track(s): BO, CO, VBP/R
Human services organizations oftentimes have more data than they know what to do with. Admiring data does not help an organization; it must be fully analyzed and acted upon to be worth collecting. However, most organizations do not have the capacity or resources to do this or do not know where to start in setting up the process. This presentation will give practical tips on defining meaningful, measurable metrics as well as on how to collect and extract data to show progress for monitoring, business development, and value-based purchasing purposes. Using the OKR model (objectives and key results), participants will leave with the ability to create goals that address their organizations’ needs, broken down into an easy-to-understand and implementable way. Teams will then be able to identify what data points are needed to measure goals, how they will be collected, and how they will be extracted for analysis and action. Examples of metrics, tools, products, and processes to further simplify the process will be presented.
Technology Solutions to Elevate the Level of Independence for Individuals With Disabilities
Presenter(s): Shaleea Shields, BS, LumiCare
Madison Obert, LumiCare
Track(s): CH, EL, IDD, PDA, TH
Technology offers many opportunites to elevate the level of independence for individuals with disabilities. This session will discuss various technology solutions and the value of sustained training and support services.
Possibilities of Play — Board Games for Skill Building
Presenter(s): Jack Berkenstock Jr., MHS, The Bodhana Group
Colleen Madrigale, LSW, Community Services Group
Track(s): CH, IDD, MH
This presentation shares stories of programs designed and facilitated by the Bodhana Group to aid in core skill development for children, teens and adults. We will be discussing games and showcasing how the modern tabletop hobby has an immense array of titles that can help teach and practice core skills. You need to demonstrate the skills to play and win the game, thus play, which is more engaging than standard approaches helps clients grow and change while having fun. We provide examples of modern board games and also break down familiar titles to showcase how task analysis helps us find the right games for the right reasons.
How Supportive Care Services Addressing Social Determinants of Health Impact Quality of Life
Presenter(s): Mia Haney, MBA, COO Personal Care, Modivcare/CareGivers America
Phil Wilkins, CDP, SDoH/Community Engagement, Modivcare
Track(s): BO, DEI
Leaders at Modivcare will describe their journey from being a transportation provider to providing a comprehensive Social Determinants of Health offering, addressing health inequities by providing holistic connections to care. The results are positive health outcomes by transforming connections to care via supportive care delivery and coordination and the potential long-term impact that could have on managed care.
Thursday, October 13
Session G • 11:00 am – 12:30 pm
Connecting Pieces for Success: Utilizing a Two-Generational Approach and Collaborative Multi-Organizational Work Model to Affect Lasting Change
Presenter(s): Sara Newman, LCSW, Project-Mosaic, Inc.
Track(s): CH, EL, MH
The goal of this presentation is to utilize a current service delivery model to teach the audience about the impact a two-generational and collaborative service model can have when serving families. Impact can be seen in two ways: increasing the number of individuals identified and served as well as increasing access and engagement by taking a collaborative approach. The audience will learn about how families’ psychosocial needs are identified and addressed, will be given research, will participate in discussion and critical thinking exercises, and will be walked through the development and implementation of the program and model being discussed.
PART II: Having Difficult Conversations With Employees
Presenter(s): John Amato, MEd, Familylinks
Track(s): EL, HR, LD
In this presentation, we will explore some of the reasons that having these conversations may be difficult. We will also discover methods for increasing our confidence and competence in having these difficult conversations in a way to promote a positive outcome. We will also understand the relationship these conversations have with an accountable team.
Specialized Telehealth for Individuals With IDD
Presenter(s): Maulik M. Trivedi, MD FACEP, StationMD
Track(s): EL, IDD, TH
A specialized telehealth solution geared towards individuals with IDD can serve as a backbone of care for this population. The individual can gain access to specially-trained clinicians that understand their needs and provide care in their home setting. This solution oftentimes avoids the need for ER or urgent care use, improves care coordination, supports both formal and informal caregives, and elevates the quality of care for this vulnerable population.
Improve Clinical Outcomes and Enter Into Value-Based Contracts Using Clinical Data
Presenter(s): Dominick DiSalvo, MA LPC, KidsPeace
Track(s): BO, CH, CO, EL, LD, MH, VBP/R
To be successful, a holistic approach that infuses the principles of family/youth lead, healthy community interactions, evidence-based/data-driven interventions, and life skills development is needed. Through the use of data, family inclusion/engagement, and youth voice, our team helps to effectively target interventions to meet the needs of our youth and families. The KidsPeace Clinical Way is our initiative to integrate all of our resources to improve safety, engagement, connection, clinical practice, and outcomes for all staff, youth, and families, which has led to improved outcomes and VBP awards.
Returning Citizens Housing Smart Model
Presenter(s): Claire Ryder, MS, Resources for Human Development
Curtis Gillard, Resources for Human Development
Clayton Moser, MSW, LSW, MA, PMHCC
Taeesha Smith, PMHCC – DBHIDS
Track(s): DA, MH
This presentation will include the history of the Housing Smart model, the preliminary results of recent pilots, and the current variations on the model. This will be highlighted through the Returning Citizens variation on the Housing Smart model, which is a housing program with social and behavioral health supports for people being released from incarceration. Presenters will include the program unit director who can speak to the strengths and challenges of the work, our city partner and payor, and business development staff who works on establishing these relationships to leverage for the success of the program.
Social Determinants of Health Innovations and Best Practices in LTSS
Presenter(s): Heather Clarke, Pennsylvania Health & Wellness
Brendan Harris, UPMC Health Plan
Frank Santoro, AmeriHealth Caritas
Sharon Alexander, AmeriHealth Caritas
Track(s): BI, BO, EL, HRF, PDA
The session will recap the activities each of the three CHCMCOs have in Pennsylvania and will focus on innovations to support and sustain participants in the community. Each of the plans will have a segment of the meeting where the leadership in SDOH will share activities and plans to leverage the resources available to truly support whole person care. Additionally, the plans will bring to you the new ideas they have implemented in Pennsylvania and other states as well as share their successes and opportunities for providers to participate. You will have an opportunity to interact with the plan leaders and ask your own questions. The facilitator will be Fady Sahhar, President/CEO of ProVantaCare.
CMS Home and Community-Based Services (HCBS) Quality Measures Set
Presenter(s): Juliet Marsala, MS, MBA, CRC, CPRP
Tracks: BO, CO, IDD, PDA
On July 21, 2022, CMS released the first ever HCBS quality measure set to promote consistent quality measurement within and across state Medicaid HCBS programs. The measure set is intended to enable states to measure and improve health outcomes for people relying on long-term services and supports (LTSS) in Medicaid. This is also a critical step to promoting health equity among the millions of older adults and people with disabilities who need LTSS because of disabling conditions and chronic illnesses, providing states with tools to better understand and compare health outcomes across groups receiving HCBS. This set also provides states with tools to better understand and compare health outcomes across groups receiving HCBS. This session will review the purpose of the measure set, the measure selection criteria, and considerations for implementation. Providers are encouraged to use this information to assess and improve quality and outcomes in their HCBS programs.
Thursday, October 13
Session H • 2:00 pm – 3:30 pm
Leading Through Crisis
Presenter(s): Stacey Nybeck, MBA, Serve, Inc.
Track(s): EL, HR, LD
Leading Through Crisis will summarize practical ways to maneuver through times of difficulty and adversity. We will discuss how to effectively battle setbacks during times of crisis and stress and adopt successful thinking habits to think your way through any crisis. The session is designed to help participants develop ways to see and turn adversity into advantages while helping others around them to do the same. Session participants will be provided with small, daily, practical steps that will enable them to find and leverage the advantages found in a time of adversity. The program outline includes: everything worthwhile is uphill; develop a positive life-stance; adversity makes you relatable to others; and always look for the big picture.
How Measurement-Based Care (MBC) Informs Health Reform and Value-Based Reimbursement Advocacy
Presenter(s): Shannon Hall, JD, Community Behavioral Health Association of Maryland
Simon Weisz, JD, Greenspace Health
Jason Frittaion
Track(s): BO, CH, CO, ET, EL, FM, HRF, LD, MH, VBP/R
The presentation will begin by providing an update on the success of the Maryland MBC implementation over the last two years, sharing the various types of organizations involved, the different populations served, and the strategies used to unite all organizations under one coordinated implmentation. This will include the approach across organizations to implement one set of coordinated assessments and strategy in order to best infliuence health reform and reimbursement advocacy, as well as how each individual organization has added onto/customized the approach based on their specific programs/populations served to ensure this implementation provided both advocacy and clinical value. We will also share learnings from the system-wide implementation and individual implementation at the clinic level, with recommendations based off these learnings. Lastly, the most significant focus will be providing a transparent review of the context of health reform and value-based reimbursement conversations within Maryland and how MBC has been able to help influence these discussions as well as tackle roadblocks presented. We will also provide an opportunity for questions throughout for audience members to inquire around how MBC could impact their unique settings or advocacy discussions at an organizational or system level.
Provider and Member Centric VBP Development in IBHS — A Success Story That Benefits All Parties
Presenter(s): Debra Luther, PhD, Beacon Health Options
Steven Herr, PhD, Advanced Metrics
Kim Bowser-Murtha, CAC, LPC, MSEd
Track(s): MH, VBP/R
The Pennsylvania Department of Human Services (DHS) states that value-based programs and payment models are critical for improving quality of care, efficiency of services, and reducing costs. According to DHS, “Value-based purchasing (VBP) requires providers to improve patient outcomes at a lower cost. VBP success is dependent on using community-based networks that individuals typically access and use to support improving their health.” As a result of this directive, a partnership between Fayette County community-based providers, Beacon Health Options, Fayette County Behavioral Health Administration (FCBHA), and Advanced Metrics was formed. This invested, community-based collaborative undertook the development and implementation of a value-based purchasing initiative in Fayette County. Our presentation will review the role and function of each partner in the successful development of a VBP initiative. The importance of provider engagement in the design of the implementation of a VBP initiative will be reviewed. Furthermore, we will discuss how VBP models can promote successful licensure of a provider program by using regulations to inform the design of the VBP model and the appropriate service targets. Outcomes data will inform and support the presentation. The collaborative spirit that drove the initial VBP pilot initiative in Fayette County brought value to the community through developing an increasing accountable clinical delivery system that improves quality of services and outcomes for children. We will demonstrate how a universal consensus to ground this VBP model in member experience, recovery, and data driven decision-making results in a universal win for all involved.
Building an IDD System of Care Through Mergers and Affiliations
Presenter(s): Tine Hansen-Turton, MGA, JD, Woods Services, Inc.
Roy Leitstein, Legacy Treatment Services, Inc.
Karen Colman
Lori Plunkett, Woods Community at Brian’s House
Track(s): EL
Woods Services has built a System of Care across Southeastern PA and throughout New Jersey, which is responsive to the needs to individuals with IDD, autism, and brain injury, many of whom experience complex co-occurring medical conditions. The System of Care is also responsive to evolving national trends and changes in the IDD and health care sectors, which are increasingly becoming more linked together, both on the payer and programmatic sides. Woods’ CEO will present the context in which the System of Care has been developed and lead a panel discussion of the leaders of the Woods System of Care affiliate organizations. The panel discussion will highlight How the System of Care has been developed through mergers, affiliations and partnerships; an overview of the various legal partnership models from joint ventures, limited liability organizations, affiliations, and mergers; a discussion of Woods’ model for shared services and overall collaboration across the System of Care organizations; and the experiences of individual organizations and their leaders along the evolving pathway of affiliation and forming the System of Care.
Supporting the Middle Manager
Presenter(s): Andrea Brown, MA, LPC, UPMC WBH
Katie Clauss, MS, CPRP, UPMC WBH
Juliette Ballough, MEd
Track(s): LD
So frequently employees are promoted into management because they are good at their current role, which is often because they have displayed exemplary clinical work. Unfortunately, these staff are often not provided with any additional skills or tools to develop them into a strong supervisor, manager, or director. At UPMC Western Behavioral Health, we recognized this discrepancy and examined how we can help support these middle managers. This presentation will go over what we have been doing for the past year to help support our supervisors and directors, by developing a core team of current managers, directors, and supervisors from different programs and service lines that would lead the other, newer, teammates through relevant problem areas, topics, and resources to support each other. Then we provided virtual monthly supervisor curriculum meetings. Next, we decided to implement an electronic site (TEAMS) where we listed relevant information that was easily available and accessible to help the managers in their current role as well as resources to help their own professional/leadership development. We have found that in the past year, even though the monthly meetings are not required to attend, they are consistently attended by a significant amount of our middle managers. We have also sent two surveys, one at six months and another at one year, to get the managers’ ideas of what topics they would like to learn, to help formulate information and topics that they want and need to help them be successful in their jobs.
How to Transform ID/A Service Delivery Through Technology — A Provider’s Journey
Presenter(s): Craig Douglass, MPPM, Mainstay Life Services
Kim Sonafelt, MS, LPC, CADC, Mainstay Life Services
Heather Lewis, ETIS
Christina Romel, BA, SafeinHome
Maddie O’Rourke, MBA, Wellbridge Health, Inc.
Track(s): IDD, MH, TH
Technology is transforming services for people who live with intellectual disabilities and autism. For decades, the only support tool that was perceived as effective was a DSP. However, technology has begun to decrease people’s reliance on paid supports and increase their independence in more meaningful ways. Mainstay Life Services started its journey as a technology-first organization in late 2019. One important lesson Mainstay has learned along the way has been that leveraging technology in support occurs one person and one partner at a time.
Innovations in Long-Term Services and Support Managed Care
Presenter(s): Blair Boroch, CEO, UnitedHealthcare
Tammy Palmgren, Vice President of Sales, Highmark Wholecare
Track(s): BO, DEI, HRF, PDA
Two leaders in the national and Pennsylvania market will share their Managed Care innovations to engage consumers, support providers, and participate in the community of providers. UnitedHealthcare and Highmark Wholecare have introduced innovative practices in the delivery of services, development of person-centered service plans, and addressing social determinants of health. You will meet leaders of these two plans and will have the opportunity to consider how these innovations can impact your services.ined
To be determined