Ensuring Consumer Participation

The CCBHC certification criteria include a requirement for ensuring consumer participation through a representative board. This requirement can be satisfied in one of three ways:

• Option 1: Fifty-one percent of the board is comprised of families, consumers, or people in recovery from behavioral health conditions
• Option 2: A substantial portion of the governing board members meet the criteria, and there are other specifically described methods for consumers, people in recovery, and family members to provide meaningful input to the board about CCBHC policies, processes, and services
• Option 3: Other means are established to enhance the governing body’s ability to ensure that the CCBHC is responsive to the needs of its consumers, families, and communities, focusing on the full range of consumers, services provided, geographic areas covered, types of disorders, and levels of care provided

If option 1 or 2 is chosen, the CCBHC must describe how it meets this requirement or provide a transition plan with a timeline that indicates how it will do so.

If option 3 is chosen, the state must determine if this approach is acceptable, and, if not, require additional mechanisms that are acceptable. The CCBHC must make available the results of its efforts in terms of outcomes and resulting changes.

Special Exceptions

If the CCBHC is a governmental or tribal entity, or a subsidiary or part of a larger corporate organization that cannot meet the requirements for board membership under any of the three options, then the following requirements apply:

• The state must specify the reasons why the usual requirements cannot be met
• The CCBHC must have or develop an advisory structure and other specifically described method for consumers, people in recovery, and family members to provide meaningful input to the board about the CCBHC's policies, processes, and services

Other Representation Requirements

Members of governing or advisory boards must be representative of the communities in which the CCBHC's service area is located and will be selected for their expertise in health services, community affairs, local government, finance and banking, legal affairs, trade unions, faith communities, commercial and industrial concerns, or social service agencies within the communities served. No more than one half (50%) of the governing board members may derive more than 10% of their annual income from the healthcare industry.

The criteria require that the CCBHC have a governing board that:

• Is representative of those being served in terms of factors such as geography, race, ethnicity, sex, gender identity, disability, age, sexual orientation, and types of disorders
• Incorporates meaningful participation by adult consumers with mental illness, adults recovering from substance use disorders, and family members of CCBHC consumers

The CCBHC can use an advisory board to satisfy the governing board requirements of representation and meaningful participation and to provide input to the governing board if the CCBHC is a governmental or tribal entity, or a subsidiary or part of a larger corporate organization, that cannot meet the requirements for board membership under any of the three options. It is possible that an advisory board also might be used to help satisfy one of the two options that do not include 51% representation.

State Involvement in Processes

The state must develop processes to be used in certification for determining whether the criteria are being met and, in the case of option 3, whether the mechanism selected is adequate. The state also must be able to explain, if the CCBHC is a tribal or governmental entity or part of a corporate entity that cannot meet any of the three options for certification, why that is true.

Tips for Recruiting Consumer and Family Board Members

• Post a notice in the CCBHC waiting area to let consumers and families know about openings on the board
• Advertise for consumer board members on the CCBHC website
• Notify new consumers at intake that the board includes consumers and family members
• For clinicians at the CCBHC, consider alerting consumers and their families when there are board openings
• Consider that some portion of those who serve on the board may be people in recovery who are not consumers at the CCBHC. This widens the options available to others in the community who are served elsewhere.
• Reach out to community organizations, particularly those that work with populations that are under-represented on the CCBHC board, such as organizations working with members of specific ethnic communities or lesbian, gay, bisexual, and transgender (LGBT) individuals

Tips for Supporting Board Members

• Make sure potential board members understand in advance the role and responsibilities of the board and its members. This can alleviate misunderstandings before a person joins the board. Consider having a prospective board member sit in on a meeting before they decide whether to join.
• Provide an orientation for new board members to introduce them to other board members and their responsibilities
• Partner new board members with existing board members to help guide new members for the first three months

Take steps to ensure that board members who are CCBHC consumers or family members of consumers are not placed in a position that represents a conflict of interest with that role. This includes requiring recusal of the consumer/family member in any decision that involves clinicians providing services directly to them or their family member.