APEX 3.0 Frequently Asked Questions

School-based mental health service delivery has become a successful strategy in increasing access to needed services for students in Georgia.  The Georgia Apex Program (Apex), funded and managed by the Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD), is a partnership between community-based mental health providers and local schools and school districts that helps address the mental health needs of Georgia students.  The Center of Excellence for Children’s Behavioral Health, housed in the Georgia Health Policy Center at Georgia State University, provides ongoing evaluation of the program.

The programmatic goals of Apex are to:

1. Increase access to mental health services for children and youth,
2. Provide early detection of child and adolescent mental health needs, and
3. Strengthen coordination between community-based mental health providers and local schools.

Apex is anchored to enrolled DBHDD comprehensive community providers, also known as community service boards (Tier 1 providers), and Tier 2 providers of behavioral health core-services that are approved to bill the state (fee-for-service) for providing core services to children and youth with mental illness and/or co-occurring substance use disorders.  As a part of the Apex procurement process, DBHDD-enrolled providers, working alongside school districts, submit funding proposals for consideration.  DBHDD requires that all proposals include a letter of support, or memorandum of understanding, demonstrating that a school superintendent (or designee) has approved the proposal submitted for consideration.  School superintendents or designees (e.g., director of student services) collaborate with providers to prioritize schools based on need.  After reviewing proposals, DBHDD awards funding by contract to providers with winning bids.

Tier 1, or comprehensive community providers, function as the safety net, serving the most vulnerable and respond to critical access needs. https://gadbhdd.policystat.com/policy/6580902/latest/

Community Medicaid Providers (CMPs) provides behavioral health services and supports identified in the Medicaid State Plan for children and young adults covered by Medicaid.  Apex Tier 2 providers are limited to those currently approved to bill the state (fee-for-service) for providing core services to children and youth with mental illness and/or co-occurring substance use disorders. https://gadbhdd.policystat.com/policy/6588198/latest/

Apex is a single, statewide program.  However, the program is supported by coordinating three separate funding sources.  Apex started during the 2016-2017 school year with funds provided by the base budget for DBHDD’s Office of Children, Young Adults, and Families (Apex 1.0).  Based on recommendations from the Commission on Children’s Mental Health, Apex received a $4.2 million appropriation from the Georgia General Assembly to expand during the 2018-2019 school year (Apex 2.0).  In Governor Brian Kemp’s FY 2019 amended budget, Apex received a one-time $8.4 million appropriation from the Georgia General Assembly to expand during the 2019-2020 school year (Apex 3.0).  For additional information, see the Amended Fiscal Year 2019 Appropriation Bill, Page 20, Section 15.8 Child and Adolescent Mental Health Services, Line 522.

The Georgia Department of Education (GaDOE), received a $69.4 million appropriation from the Georgia General Assembly for the purpose of providing grants to local school systems for school security enhancements.  For additional information, see the Amended Fiscal Year 2019 Appropriation Bill, Page 41, Section 24.22 School Security Grants, Line 1251.

GaDOE received a $1 million appropriation from the Georgia General Assembly for the purpose of hiring additional high school counselors and enriching counseling programs for Title I schools.  The funds were transferred from the Governor’s Office of Student Achievement.  For additional information, see the Fiscal Year 2020 Appropriation Bill, Page 106, School Improvement, Line 157.7.

The Apex Expansion 3.0 procurement involved a two-step process.  Due to significant growth of the program during a short period of time, step one involved releasing a request for a quote, and selecting a fiscal intermediary to assist DBHDD with administrative oversight.  Step two involved releasing a request for proposals (RFP) on January 17, 2020, to invite bids for eligible providers.  The RFP will close in February 2020, at a date to be determined as published on the Georgia Procurement Registry.  Final evaluation and contract terms are anticipated for March 2020.  For additional information, please see: https://ssl.doas.state.ga.us/PRSapp/PublicBidNotice?bid_op=204410044100-DBH0000575

The Apex model is a multi-tiered service delivery model.  Providers embed into schools and implement services across all three tiers:

• Tier I interventions promote universal prevention benefiting the entire school (e.g., tables at PTO/family meetings, information sessions for teachers/students, etc.).
• Tier II refers to targeted early interventions for at-risk students with emerging mental health needs, which can be provided by counselors, social workers, and other mental health professionals (e.g., psychoeducation groups).
• Tier III refers to intensive intervention for students identified as living with mental health disorders.  Apex prioritizes addressing the intensive intervention needs for identified students (e.g., crisis intervention, individual sessions, family sessions, etc.).

Apex therapists/clinicians and behavioral health support staff are embedded within public schools and public charter schools, pre-kindergarten to 12th grade.  They also help with life skills development and other non-therapeutic activities.  Apex services cannot be provided in private charter schools, GNETS standalone facilities, private schools, or homeschooled/cyber public schools.  Click here for a list of approved public charter schools.

Apex services include assessment (behavioral health, diagnostic); crisis intervention; service plan development; counseling (individual, group, family); community support; clinical consultation; medication management; psychological testing; and psychiatric treatment.  Additionally, Apex funds can be used to cover non-billable expenses that providers incur as they establish and grow their school-based mental health (SBMH) programs.  These expenses can include but are not limited to, uninsured students, school office items, technology for clinicians, prevention programs/activities, etc.  Apex funds CANNOT be used for private insurance copays.

Apex includes services that are reimbursable by insurance and non-reimbursable services that require support from another funding source (e.g., DBHDD, grant, schools, Title IV, etc.).  As a best practice, approximately sixty percent (60%) of time is dedicated to billable, direct services.  At 60% productivity, the clinician’s/therapist’s position, becomes self-sustainable.  Medicaid accounts for more than 85% of billable services.  The remaining 40% of the time is dedicated to non-billable services and supports, such as mental health awareness education, classroom observation, teacher consultation, staff meetings, and in-service training.

If the Apex therapist/clinician at the student’s school is on the private insurance’s panel (i.e., in its network), and the private insurance company permits and reimburses for school-based mental health services, Apex providers can provide treatment.  Apex therapists/clinicians will provide crisis intervention regardless of whether a student is paneled with the private insurance company.  Once the crisis is stabilized, the student will be linked back with his or her regular behavioral health provider or a community provider enrolled with the private insurance company.

Crisis intervention services are directed toward the support of a child who is experiencing an abrupt and substantial change in behavior which is usually associated with a precipitating situation and which is in the direction of severe impairment of functioning or a marked increase in personal distress.  Crisis intervention is designed to prevent out-of-home placement or hospitalization.  Often, a crisis exists at such time as a child and/or his or her family/responsible caregiver(s) decide to seek help and/or the individual, family/responsible caregiver(s), or practitioner identifies the situation as a crisis.  Crisis services are time-limited and present-focused in order to address the immediate crisis and develop appropriate links to alternate services.  Services may involve the youth and his/her family/responsible caregiver(s) and/or significant other, as well as other service providers.  See the DBHDD Provider Manual for Behavioral Health Providers for additional information.

Individual and group therapy services should ONLY be provided by a licensed clinician (LCSW, LPC, LMFT); associate/provisionally licensed clinician (APC, LMSW, LAMFT), and/or a master’s degree level clinician seeking licensure, in accordance with the rules governing their practice.  Paraprofessionals can provide community support services such as life/social skills, assist with prevention programs/activities, and assisting students/families with non-clinical concerns.