Current Projects

NC Behavioral Health Evaluation and Learning Lab (NC-BELL)

Project co-PIs: Paul Lanier, Helen Newton

Research Associates: Amanda Dale, Emily Forrest Hutchens, Monica Landers, Sasha Zabelski

Data Scientists: Heather Copley (Primary), Jake Hyman, Melissa Sandahl, Joacy Gerard Mathias

Methodology and Translation Lead: Neil Kamdar

Lead Project Manager: Dawn Bergmire

Data Project Manager: Sabrina Malagon

Crisis Evaluation Summary

In the fall of 2023, the North Carolina General Assembly approved a historic investment of $835M dedicated to strengthening and reforming the state’s behavioral health system. A significant component of this investment ($135M, or a little over 15%) explicitly focused on reforming the state’s behavioral health crisis system. Building on plans first developed in 2022 to support implementation of 988 – the new federally mandated behavioral health crisis line implemented July 2022– these new investments planned for state fiscal year (SFY) 2024-2025 are expected to significantly expand North Carolina’s behavioral health crisis service delivery system through enhancing and expanding existing crisis services along the crisis continuum and developing and deploying new technology to support crisis systems and service delivery. This evaluation seeks to understand how recent investments in the crisis system impact crisis service delivery, quality (or effectiveness), and spending. Specifically, the goals and objectives of this holistic evaluation are:

  1. Better delivery through equitable access to crisis services (Objective 1.1); promotion of patient and community engagement in crisis system (Objective 1.2), and use of guideline concordant care among crisis providers (Objective 1.3).
  2. More effective care through improved community stabilization (Objective 2.1), increased timeliness of crisis response (Objective 2.2), reduced reliance on higher levels of care (Objective 2.3), prevention of future crises (Objective 2.4), promotion of recovery (Objective 2.5), and reduced suicide (Objective 2.6).
  3. Smarter spending on crisis services through increasing the parity of crisis service spending (Objective 3.1), reducing Medicaid spending for acute mental health and substance use disorder services (Objective 3.2), and ensuring access to high-value providers and crisis services for all North Carolinians (Objective 3.3).

Child Behavioral Health Evaluation Summary

Another major component of the state’s larger investment strategy in behavioral health includes an $80 million targeted investment to improve the child behavioral health (CBH) system. The stated objective of the CBH systems investment is “to ensure that children with behavioral health needs receive suitable, essential, child-centered, trauma-informed, and high-quality services, enabling as many children as possible to either remain in or return to a home setting.” The goal of the CBH systems evaluation is to better understand how state investments work together to improve identified outcomes. Specifically, NCDHHS has identified six key intended outcomes of these investments among children with a behavioral health need that the evaluation team will be examining over the next three years:

  1. Fewer emergency department visits for behavioral health
  2. Fewer children sleeping in Division of Social Services offices or hotels
  3. Fewer children boarding in emergency departments
  4. Fewer readmissions to residential or facility-based treatment
  5. Shorter length of stay in residential or facility-based treatment
  6. More children in foster care living in a home or community setting

Medicaid Outcomes Distributed Research Network (MODRN)

NC Site Principal Investigator: Paul Lanier

Co-Investigators: Helen Newton and Orrin Ware

Data Science Team: Melissa Sandahl, Jake Hyman

As the largest payer for treatment and recovery services, the Medicaid program has multiple roles in improving access and quality for individuals with mental health and substance use disorders. Since 2020, a state-university partnership between researchers from Sheps and the NC Department of Health and Human Services have participated in an innovative initiative called the Medicaid Outcomes Distributed Research Network (MODRN). Each state in the MODRN network implements a common data model and conducts analyses locally using standardized code. The state-level results are then aggregated at the data coordinating center to allow for cross-state comparisons to explore the impact of state policies on health outcomes.

With funding from the National Institute on Drug Abuse (NIDA; R01DA048029, PI: Donohue; RM1DA059365, M-PIs: Donohue & Barnes), 13 states in MODRN have worked together to produce a comprehensive assessment of opioid use disorder (OUD) treatment quality and outcomes. Further, the research team has produced numerous publications advancing the science of measuring OUD treatment quality in Medicaid claims and understanding factors that drive variation within and between states.

Sample Publications: