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Coping with complex behaviors

Alaska's service continuum has a difficult time meeting the needs of Medicaid clients with complex needs who are often aggressive, assaultive and difficult to support. The Complex Behavior Collaboration seeks to improve in-state services for these Alaskans.

The goal is to help clients live as independently as possible, and avoid Alaska Psychiatric Institute, jail, emergency rooms or out-of-state care. Benefits include:

  • Better quality of life for Alaskans with complex needs
  • Cost savings for state
  • Development of robust, competent workforce
  • Development of infrastructure for collaborative interventions, continuity of care
  • Prevention of ADA violations

The first step is to provide support agencies with technical assistance on serving challenging clients during a six-month consultation and training pilot project in early 2012. This pilot project has also been called “the Hub” during planning.

Consultation & training pilot

Target clients for the pilot project are adults who:

  • currently receive services from Senior & Disabilities Services or Behavioral Health
  • have housing where they can be assessed and get the pilot services
  • have behaviors that are so complex that they are
    • outside the range of expertise of local caregivers and providers, or
    • available treatment has been exhausted without success for the individual

A likely client has a cognitive impairment with complex behavior management needs and also has one or more complicating issues:

  • chronic mental illness
  • intellectual disability
  • dementia/Alzheimer's
  • brain injury
  • substance abuse

Target clients for the pilot may be in Pioneer Homes, Alaska Psychiatric Institute, or live in the community.

The contractor, overseen by the state, will choose which services an agency will receive with an emphasis on mentoring and training for staff and family.


The project started in 2009, when the State and the Alaska Mental Health Trust Authority contracted with WICHE (Western Interstate Commission for Higher Education) to examine how Alaska served Medicaid clients with complex needs and challenging behaviors.

WICHE in 2010 identified gaps in Alaska's continuum of care, and suggested a model consisting of three components (executive summary):

  1. specialized training support for service providers
  2. short-term stabilization of clients
  3. medium-term intensive intervention

The first step, the 2012 pilot project, was launched with one-time funding from the legislature.