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24 page on Questions 20 See number increase substantially? substantially? increase number improve appreciably? appreciably? improve not just from the standpoint of administra- of standpoint the from just not
Will this this Will treatment. get disorders mental Will the quality of mental health services services health mental of quality the Will reduce fragmentation. Will they succeed, succeed, they Will fragmentation. reduce
about 40% people with with people 40% about only Currently 1. get even minimally adequate treatment. treatment. adequate minimally even get structures are specifically designed to to designed specifically are structures people in need where they are? are? they where need in people
1/3 1/3 most at treatment, get who those Of 5. service providers. New managed care care managed New providers. service e efforts to engage engage to efforts e activ by characterized
managed. managed.
health providers, and with other human human other with and providers, health offices and more more and offices in clients/consumers
the remaking of how care is financed and and financed is care how of remaking the dressed effectively? effectively? dressed ers, between behavioral and physical physical and behavioral between ers, ized by professionals waiting for patients/ for waiting professionals by ized
tions that need answers before we celebrate celebrate we before answers need that tions find it. Will these problems be ad- be problems these Will it. find mental health and substance abuse provid- abuse substance and health mental tal health services become less character- less become services health tal
American population? Here are 20 ques- 20 are Here population? American treatment could help them or where to to where or them help could treatment among mental health providers, between between providers, health mental among centers and houses of worship. Will men- Will worship. of houses and centers
mental health of the the of health mental the in and care health and/or because they do not know that that know not do they because and/or with inadequate coordination coordination inadequate with fragmented, or in local settings such as community community as such settings local in or
and fundamental improvements in mental mental in improvements fundamental and that surrounds mental illness illness mental surrounds that stigma The mental health service system is is system service health mental The 8. teams and will use services in their homes homes their in services use will and teams
on Mental Health? Will they result in real real in result they Will Health? Mental on widespread widespread still the by created shame of
efforts such as ACT ACT as such efforts outreach to sponsive
Freedom Commission Commission Freedom New President’s the mental health services because of a sense sense a of because services health mental grated treatment approaches? approaches? treatment grated come to mental health programs are re- are programs health mental to come
mation called for early in this century by by century this in early for called mation 4. Many people do not seek or reject reject or seek not do people Many 4. appreciable increase in the use of inte- of use the in increase appreciable 10. Many people who do not or cannot cannot or not do who people Many 10.
But will they result in the kind of transfor- of kind the in result they will But
-diagnosis” treatment. Will there be an an be there Will treatment. -diagnosis”
ness is done in the mental health system. system. health mental the in done is ness for people who have real lives? lives? real have who people for orders and even fewer get integrated “dual integrated get fewer even and orders sive to their needs and desires? desires? and needs their to sive
new structures will change the way busi- way the change will structures new be offered in places and at times that work work that times at and places in offered be ment very few get treatment for both dis- both for treatment get few very ment health system as manageable and respon- and manageable as system health
zations and health homes. No doubt these these doubt No homes. health and zations services become affordable? Will services services Will affordable? become services treatment, and of those who do get treat- get do who those of and treatment, significantly more experience the mental mental the experience more significantly
structures such as accountable care organi- care accountable as such structures hours and the like. Will mental health health mental Will like. the and hours do not get get not do disorders use substance and they find satisfying and meaningful? Will Will meaningful? and satisfying find they S S
velopment of elaborate financial financial elaborate of velopment by cost, distance, inconvenient office office inconvenient distance, cost, by co-occurring mental mental co-occurring with people Most 7. with serious mental illness have lives that that lives have illness mental serious with
the United States through the de- the through States United the Access to available care is often limited limited often is care available to Access 3.
mation. Will significantly more people people more significantly Will mation.
in New York State and throughout throughout and State York New in
ple with mental disorders? disorders? mental with ple Freedom Commission’s call for transfor- for call Commission’s Freedom
ystem transformation is underway underway is transformation ystem poverty areas? areas? poverty ffective care for peo- for care ffective e provide to capacity was the major goal of the New New the of goal major the was centered”
nificantly, especially in remote and high high and remote in especially nificantly, Will primary care practices develop the the develop practices care primary Will “recovery oriented” and “person- and oriented” “recovery
Will service capacity increase sig- increase capacity service Will quate. pared to identify or treat mental disorders. disorders. mental treat or identify to pared 9. Creating a mental health system that is is that system health mental a Creating 9.
University School of Social Work Work Social of School University people with mental illness is simply inade- simply is illness mental with people who are not pre- not are who physicians care primary
Adjunct Associate Professor, Columbia Columbia Professor, Associate Adjunct capacity to treat treat to capacity the NYS, in counties ment is that so much of it is provided by by provided is it of much so that is ment experience of people getting care? care? getting people of experience
By Michael B. Friedman, LMSW LMSW Friedman, B. Michael By 2. In most parts of the U.S. and in many many in and U.S. the of parts most In 2. 6. One of the reasons for inadequate treat- inadequate for reasons the of One 6. tive and financial relationships but in the the in but relationships financial and tive
Before We Celebrate: 20 Questions That Need Answers Answers Need That Questions 20 Celebrate: We Before
Will “System Transformation” Transform the System? System? the Transform Transformation” “System Will
24 page on Future The see neighborhood. Nearly all consumers will will consumers all Nearly neighborhood. services, criminal justice, child welfare, welfare, child justice, criminal services, als and community supports will be in- be will supports community and als
vices occurring in every milieu and and milieu every in occurring vices t, housing, human human housing, t, enforcemen law vices, dination. The interweaving of profession- of interweaving The dination.
comprehensive and multi-component ser- multi-component and comprehensive public health, education, older adult ser- adult older education, health, public tion will grow in sophistication and coor- and sophistication in grow will tion effects. Their own behavioral well-being, well-being, behavioral own Their effects.
health centers will increasingly direct direct increasingly will centers health cross-sector collaboration will engage engage will collaboration cross-sector t, and transporta- and t, unemploymen security, ing to observe and report on treatment treatment on report and observe to ing
Behavioral Behavioral supports: Deconstructed that facilitate community wellness. Such Such wellness. community facilitate that by addressing issues like housing, food food housing, like issues addressing by teams, including defined roles and coach- and roles defined including teams,
and guide intervention. intervention. guide and to align resources and make investments investments make and resources align to tend to the “social determinants of health” health” of determinants “social the to tend to serve as partners in care with treatment treatment with care in partners as serve to
agendas using agreed metrics to measure measure to metrics agreed using agendas will align with funders from other systems systems other from funders with align will the inclusion of new partners able to at- to able partners new of inclusion the encouraged to allow their family members members family their allow to encouraged
etc. in resource sharing to address mutual mutual address to sharing resource in etc. creasingly seamless. Healthcare payers payers Healthcare seamless. creasingly and physical healthcare is old news, but but news, old is healthcare physical and the focus of treatment but will be strongly strongly be will but treatment of focus the
Integrating behavioral behavioral Integrating communities: and family members. Consumers will remain remain will Consumers members. family
A bridged gap between professionals professionals between gap bridged A longer used to marginalize consumers’ consumers’ marginalize to used longer
lieve the future holds: holds: future the lieve HIPAA will be better understood and no no and understood better be will HIPAA
local communities. Here’s what we be- we what Here’s communities. local and family-engaged.” Privacy laws like like laws Privacy family-engaged.” and
pared to meet the ever-changing needs of of needs ever-changing the meet to pared all healthcare will be “person-centered “person-centered be will healthcare all
drive progress, and guided by leaders pre- leaders by guided and progress, drive In the future, future, the In families: for role real A
by investments intentionally calibrated to to calibrated intentionally investments by delivery design and facility improvements. improvements. facility and design delivery
creasingly informed by science, financed financed science, by informed creasingly and fluidly be elicited to inform service service inform to elicited be fluidly and
of convergence and consolidation, in- consolidation, and convergence of and their input and feedback will routinely routinely will feedback and input their and
health services will continue to be a story story a be to continue will services health ships. Service consumers will have options options have will consumers Service ships.
evolution of behavioral behavioral of evolution W within specific environments and relation- and environments specific within
it’s no surprise that the the that surprise no it’s functional capacities and quality of life life of quality and capacities functional
body are inseparable, so so inseparable, are body contextualized DSM symptoms but in in but symptoms DSM contextualized
e know that the mind and and mind the that know e comes will be measured not in de- in not measured be will comes
employment settings. All treatment out- treatment All settings. employment
interventions in the home, school and and school home, the in interventions
Health Management Associates Associates Management Health treatment plans will include adjunctive adjunctive include will plans treatment
Meggan Schilkie, MBA MBA Schilkie, Meggan with their licensed professionals. All All professionals. licensed their with
Heidi Arthur, MSW, and and MSW, Arthur, Heidi nity health workers working side by side side by side working workers health nity
By Barry J. Jacobs, PsyD, PsyD, Jacobs, J. Barry By have access to peer specialists or commu- or specialists peer to access have
System Transformation: What Does the Future Hold? Hold? Future the Does What Transformation: System
ON MENTAL HEALTH AND SUBSTANCE ABUSE TREATMENT AND AND TREATMENT ABUSE SUBSTANCE AND HEALTH MENTAL ON 2018 FALL VOL. 6 NO. 2 2 NO. 6 VOL. SERVICES
YOUR TRUSTED SOURCE OF OF SOURCE TRUSTED YOUR INFORMATION, EDUCATION, EDUCATION, INFORMATION, ADVOCACY AND RESOURCES RESOURCES AND ADVOCACY
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EALTH EALTH EHAVIORAL EWS
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Table of Contents Editorial Calendar
This Issue: System Transformation Behavioral Health News 2019 Theme and Deadline Calendar 1 System Transformation: What Does the Future Hold?
1 Will “System Transformation” Transform the System? Winter 2019 Issue:
4 SUD Measures and Preparing for Value-Based Purchasing “Changes in Our Children’s System of Care” Deadline: January 8, 2019 5 Responding to the Mental Health Needs of the Aging
6 ACES: Transforming Systems of Care from Within Spring 2019 Issue: 7 New Column: The Coalition News Desk “Caring for Older Adults: Challenges and Solutions”
8 Consumer Perspectives: A System in Transformation Deadline: April 1, 2019 10 The Promise and Peril of Performance Measurement 12 Ongoing Transformations at The MHA of Westchester Summer 2019 Issue: “The Behavioral Health Workforce: 14 The New ICL East New York Health Hub On the Front Line of Behavioral Health Care” 16 Turn and Face the Change: Children’s Medicaid Redesign Deadline: July 1, 2019 16 Sherry Tucker Appointed CEO of WellLife Network 18 Building an Integrated Delivery System Through Collaborations Fall 2019 Issue: 18 Two New York Behavioral Health IPAs Merge “Models of Integrated Care Across the Healthcare Sector” 19 The NYSPA Report: New York’s Parity Reporting Bill Deadline: October 1, 2019 20 TMS Now Approved for OCD 21 The Recipe to Recovery and Storytelling as Medicine 21 Transition at NYTC – Stay’n Out Programs To Submit an Article or Advertisement 22 Partnerships and Collaborations Help Children and Families Call: (570) 629-5960 Email: [email protected]
22 Building Partnerships to Transform Autism Services Visit Behavioral Health News: www.mhnews.org 23 Leaders Join Mental Health News Education Board To Subscribe, Advertise, View Our Media Kit, 25 A Performance-Driven Culture for Children’s Mental Health Submit an Article, and Read Back Issues.
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Substance Use Disorder Measures and Preparing for Value-Based Purchasing
By Arlene González-Sánchez studied the feasibility of continuity and dence for alcohol medication measure). Commissioner medication measures. The American Soci- This means that while we need to con- NYS Office of Alcoholism and ety of Addiction Medicine (ASAM) en- tinue to identify more direct measures of Substance Abuse Services dorsed 9 potential measures of quality in a outcome in treatment, improving these 2014 article*. However, none of these measures will very likely have a positive measures were endorsed or, at the time, impact on SUD outcomes. n a previous column, I wrote about moved toward endorsement. The next question from providers was the measures for value-based pur- OASAS and the Center on Addictions what to do about these measures. Some of chasing being developed together worked with a group of stakeholders to the measures can be tracked at a program with the New York State Department identify the measures that were most level like initiation and utilization of medi- ofI Health and the Center on Addictions, likely associated with outcomes in addi- cations and continuing engagement in treat- our partner on many projects. Our work to tion to those that were most feasible to ment. Programs should be aware of how develop clear measures has set the founda- develop quickly to identify a set that we well they compare to the statewide and re- tion for insurance plans, providers and could further develop and employ in New gional performance on these measures. Oth- OASAS to assess how well substance use York. The measures include: ers will require data from other sources for a is being identified, how treatment is being group of Medicaid members who are served initiated, and the effectiveness of how well • continuity of care from withdrawal man- by a network of providers and many Behav- people are engaged in treatment (see chart agement (detox) to next level of care ioral Health Collaborative Care (BHCC) below for 2016 data on current measures) within 14 days of discharge; groups are working to identify ways of fol- and cared for in New York through Medi- lowing more system level measures. caid and ultimately, all by all payers. As • continuity of care from inpatient reha- Finally, programs must be able to iden- we move toward value-based purchasing, bilitation to next level of care within 14 tify ways of improving the measures. In a the next step for OASAS will be to help Arlene González-Sánchez days of discharge; VBP environment, the responsibility for providers and payers understand the impli- how well members do is shared with pro- cation of these new measures. an important measure of how well health • initiation of medication for opioid use viders of health and mental health care. Many providers are working together care responds to diagnosed substance use disorder within 30 days of diagnosis; However, program level practices can to form networks capable of looking at disorder. This measure of quality is sig- how people with SUD and mental health nificant because, as we know, substance • utilization of medication for opioid use lead to movement on these measures. disorder are doing. They may aggregate use, even when recognized is not always disorder – any medication prescribed dur- During the past year, OASAS has focused and share the data they have and collec- addressed and many people are not con- ing 12 months; on access, quality and integration. As a tively identify practices and processes that nected to care that can help, and even leader in your program, I recommend that can move the needle toward better per- when they are, they may not be appropri- • initiation of medication for alcohol use you focus on practices that will help to formance on the measures. I am fre- ately engaged. We will look at these rates disorder within 30 days of diagnosis; reduce the time from the initial phone call quently asked why we chose these meas- for New York later in the article and I will to access to services in addition to those ures and how should programs be prepar- pose the question, how would we react if • utilization of medication for alcohol use that improve retention in care and better ing to use them. The remainder of the these rates applied to individuals diag- disorder – any prescription during 12 integrated care. OASAS is committed to article will focus on these two questions. nosed with heart disease or diabetes? months; and a continuing to work with providers, plans, As measures were developed during OASAS recognized the need to go state sister agencies and others to contrib- the past two to three decades for physical beyond these measures and was supported • continuation of engagement in treatment ute to the development of a robust set of health conditions to better track quality of by the Department of Health to work to- – 6 consecutive months with at least one measures that support quality, transpar- care for health conditions, substance use ward additional measures for VBP pilots visit with primary diagnosis of SUD. ency and promote consumer choice and disorder had only one Health Care Effec- and quality performance measures for excellence in addiction treatment. tiveness Data and Information Set (HEDIS) Medicaid Managed Care plans. During Each of these measures has significant endorsed measure to identify how well peo- the past several decades, there have been evidence from research that show a corre- * American Society of Addiction Medicine. The ASAM ple were initiated into substance use disor- many national conversations among sub- lation to better SUD outcomes for indi- Performance Measures for the Addiction Specialist Physi- der care (within 14 days of an initial diag- stance use disorder experts. The Washing- viduals. The evidence is very strong for cian Available at: https://www.asam.org/docs/default- nosis) and engaged (measured as a second ton Circle developed the Initiation and the continuity, engagement and opioid source/advocacy/performance-measuresfor-the- visit within 30 days of initiation). This is Engagement measure and proposed and medication measures (there is less evi- addiction-specialist-physician.pdf?sfvrsn=0 BEHAVIORAL HEALTH NEWS ~ FALL 2018 visit our website: www.mhnews.org PAGE 5
Responding to the Mental Health Needs of the Aging
By Ann Marie Sullivan, MD • Collaborating with managed care and comes in Geriatric Mental Health in Long Commissioner community-based service providers to Term Care for Skilled Nursing Facilities, NYS Office of Mental Health develop a value-based payment proposal called “Project ECHO GEMH” for short. that targets residents with complex or Project ECHO GEMH provides train- intense needs to help pay for needed ser- ing through a “virtual clinic” using video- ging is an inevitable part of vices or building adaptations that address conference technology. Best practices are life. As we get older, we often the social determinants of health. shared through a combination of short think of physical problems didactic presentations and case-based dis- A such an aching back or pain in • Connecting with informal caregivers and cussions with content experts. The clinic our knees. But the elderly also have con- families, noting that when these trusted peo- sessions connect frontline nursing home siderable mental health needs, as well. ple were available, they were key members staff with clinical experts at academic Here at the Office of Mental Health of the wrap-around support team needed for medical centers. Staff collaborate to iden- (OMH), we’ve been looking at innovative individuals living with mental illness to tify the residents to take part in the pro- interventions to address the mental health join, return, or remain in their communities. gram, address physical health needs of issues that New York State residents face residential clients, help prepare long-stay as they as they age. And we are working Skilled Nursing Facility Care patients for discharge, and explore alter- to ensure that older New Yorkers who native strategies to placement. require services have access to appropri- For some individuals, care in the com- Project ECHO GEMH and the alloca- ate treatment, whether they’re living inde- munity or in their homes is not an option, tion of 24 Community Mental Health pendently in their community, require and they require the care of a skilled nurs- Nurses are the major components of the services in their homes, or need the care ing facility. OMH has found that, while OMH Skilled Nursing Facility Enhanced provided by a skilled nursing facility. In skilled nursing facilities were quite able to Support Project. The goals of the Skilled order to provide a continuum of care to Dr. Ann Sullivan provide quality medical care to clients, Nursing Facility Enhanced Support Pro- patients as they age, OMH has been work- many were hesitant to address their be- ject are to: ing to develop effective programs through related concern. Triple partnerships are havioral health needs. These disorders the Interagency Geriatric Mental Health designed to pull together the resources of represent significant public health chal- • Increase timely discharge of individuals and Chemical Dependence Planning mental health, substance use disorder, and lenges – including impaired quality of in state-operated psychiatric centers who Council, and important demonstration aging services. The Partnership Innova- life, increased healthcare utilization, cost, meet criteria for skilled nursing facility projects such as Certified Community tion program is administered by OMH, morbidity, and mortality. However, spe- placement. Behavioral Health Clinics and the Mental the State Office for the Aging and other cialty care for late-life psychiatric and Health Aging in Place initiative. state agencies, and awards grants to pro- memory disorders is associated with bet- • Support the skilled nursing facilities to viders in the areas of community integra- ter outcomes and lower costs. meet the psychiatric needs of individuals Community-Based Care tion, improving quality of treatment, inte- OMH is working with the University accepted from OMH facilities during the grating services, workforce, family sup- of Rochester to address this issue now, transition period. OMH has been working to strengthen port, finance, specialized populations, with an innovative program called the the resources available to support commu- information, and staff training. Extension of Community Healthcare Out- see Aging on page 29 nity caregivers. During the past five state fiscal years, the plan has been re- Help at Home balancing the agency’s resources by de- veloping community-based mental health For seniors living with mental illness services – focusing on prevention, early who are homebound, OMH has been identification and intervention, and evi- working with OMH residential providers dence-based clinical services and recov- and with the home health care industry to ery supports: gain insight into the type of needs that home care providers were encountering Home and Community Based Services are with residents, barriers to accessing ser- designed to allow enrollees to participate vices, and strategies used to increase ac- in a vast array of habilitative services. cess to home care and make aging-in- Participants have been granted access to place possible. Ideas included: skill–building activities while having vari-
ous necessary rehabilitative needs met. • Cultivating relationships with home Services include: care coordination, skill health agencies – use existing residential, building, family and caregiver support behavioral health staff, and case managers services, crisis and planned respite, prevo- to partner with home health agencies and cational services, supported employment specific aides serving residents. services, community advocacy and sup- port, youth support and training, non- • Promoting “cluster care,” highlighting a medical transportation, habilitation, adap- home health/personal care agency’s abil- tive and assistive equipment, accessibility ity to serve multiple clients within the modifications, and palliative care. same building.
Managed Long Term Care is streamlining • Advocating for residents in need of the delivery of long-term services to peo- (additional) home health and personal ple who are chronically ill or disabled and care help – leverage professionals in regu- who wish to stay in their homes and com- lar contact with residents to consult with munities. These services, such as home physicians writing orders for home/ care or adult day care, are provided personal care. through managed long-term care plans that are approved by the Department of • Providing efficient access to psychiatric, Health. substance use treatment, and medical sup- port (onsite/co-located, nearby, telehealth/ Through its Partnership Innovation for tele-psych) enables people to age-in-place Older Adults program, OMH has been and avoid (re) hospitalizations and unnec- working with mental health providers essary ER visits. throughout the state to establish “triple partnerships” in their communities to help • Reviewing care coordination and insur- adults age 55 or older whose independ- ance plan options available to residents ence or survival is in jeopardy because of that may assist in more efficient access to a mental health, substance use, or aging- psychiatric and medical care. PAGE 6 visit our website: www.mhnews.org BEHAVIORAL HEALTH NEWS ~ FALL 2018 ACES Are High: Transforming Systems of Care from Within
By Lisa Furst, LMSW, MPH, Cristina Harris, MSW, and Elizabeth Speck, PhD
he concept of system transfor- mation in behavioral health is one that has garnered much at- tention in recent years. In New YorkT State, this often refers to the evolv- ing iterations of Medicaid managed care and value based payment. This transfor- mation is focused on the “triple aim” of better care, improved outcomes, and con- tained cost. At the same time, however, another transformation is taking place – the increased recognition of the impact of trauma on the lives of people with behav- ioral health needs, and its impact on those Lisa Furst, LMSW Cristina Harris, MSW Elizabeth Speck, PhD who serve them. If we are truly to achieve improved clinical and psychosocial out- matic childhood experiences are ex- social determinants associated with poor But we have to do more. The results of comes through system transformation, tremely common and that they are health and behavioral health outcomes. the largest study to date on adverse child- increasing the efficiencies of program strongly associated with negative health The implications of this research are hood events reveals significant disparities implementation and payment is not and behavioral health outcomes. As the staggering. The ubiquity of trauma and its in traumatic experience across popula- enough. Our goal as service providers, ACEs research demonstrates, trauma deleterious effects require us to design tions. People of color, disproportionately and as advocates who shape the system in takes many forms. Domestic violence, and deliver our programs in a manner bear the burden of personal, historical and which we work, should be to ensure that sexual assault and child abuse and neglect that, if not directly treating the symptoms environmental trauma. This is reinforced trauma-informed practices are central to are just a few kinds of experiences that of trauma, recognizes its impact and, at and exacerbated by government reim- program and policy development in New are all too common in our society. It is minimum, does not exacerbate traumatic bursement structures that engender deficit York State and beyond. also clear that environmental, as well as reactions or inadvertently re-traumatize -based, reactive operations in the non- Wherever you are in the behavioral interpersonal, factors can be traumatic and the people we serve. Fortunately, it is profit organizations providing essential health system, you likely know something that interpersonal traumas may be exacer- becoming a widely-embraced standard for human services. It is a vicious cycle. about the groundbreaking research on bated under particularly difficult environ- human service organizations and systems Therefore, understanding the structural adverse childhood events (ACEs) that mental circumstances. For example, pov- of care to embed a trauma-informed ap- and environmental contributors to trauma began in the 1990s and is ongoing. Be- erty, homelessness, and community vio- proach into their work in recognition of cause of this research, we know that trau- lence are all sources of trauma and are all trauma’s impact on outcomes. see ACES on page 29 BEHAVIORAL HEALTH NEWS ~ FALL 2018 visit our website: www.mhnews.org PAGE 7 The Coalition News Desk Serving New York’s Behavioral Health Community
The Behavioral Health Community Today: Change, Challenge and Opportunity
By Jason Lippman was intended to be an important step for- fully partner with MCOs, and having Interim President and CEO ward towards achieving the goal of inte- opportunities to reinvest shared savings The Coalition for Behavioral Health gration. Community-based providers have back into the collaborative. devoted a lot of time and resources into DSRIP, but for them the hope has not Care Outcomes ver the last several years, the been realized. The hospital-based PPSs community behavioral health have largely held on to DSRIP funding As the demand for mental health and landscape has changed. New and the program is scheduled to conclude substance use services increases, New O York State is driving reforms in 2020, with many PPSs transforming York State (through its mid-level payers toward achieving the Triple Aim for better into ACOs or IPAs. and community providers), is obliged to care and improved health at lower costs. In Health Homes are designed to be the provide optimal care to the most vulner- doing so, the community-based behavioral lynchpin of integration, providing care able and complex populations. Nonprofit health sector has been charged with under- coordination that links behavioral health mental health and substance use providers going several system transformations: with primary care, addresses social deter- are dedicated partners with the state in moving from fee-for-service to managed minants of health and avoidable use of holding up the safety-net up and keeping care, integrating behavioral health care hospitals. Yet Health Homes are not with- it intact. They go above and beyond their with physical health care, participating in out their own engagement challenges and initial missions to ensure that services in initiatives like the Delivery System Reform bureaucratic obstacles. For most enrol- the community are available to all who Incentive Payment (DSRIP) program and lees, Health Home payments and care need them, despite fragmentation and transitioning to Value Based Payment management functions are flowing persistent disparities and gaps in care (VBP) arrangements. through MCOs. As the program continues throughout the service delivery system. All the reform puzzle pieces offer Jason Lippman to evolve, Health Home leads and Care For the Triple Aim to succeed, commu- community-based providers opportunities Management Agencies (CMAs) are look- nity-based providers must have the re- for advancing whole health outcomes expensive. It can involve significant capi- ing to change their business models and sources that are necessary to deliver high- among individuals living with severe tal investments such as the acquisition of engage in strategic partnerships to enlarge quality, integrated, collaborative care. This mental illness and substance use disor- new sites, expanding or retrofitting exist- their network for referrals. includes investing in a high-quality, spe- ders. While maneuvering through the ing space and purchasing new equipment. Value-based payments adds another cialized workforce that is committed to labyrinth of system transformation, com- It can require obtaining new health infor- critical dimension that will shape the achieving these ambitious goals. Further- munity-based providers have changed mation technology (HIT) platforms, elec- system and the future. As a result, pro- more, system transformation requires a people’s lives for good through providing tronic health records (EHR) and telehealth viders are now forming specialized net- thoughtful change management strategy. stable housing, employment, education capabilities. In addition, there is the im- works to deliver care through ACOs, As it evolves, evaluation and assessment of and care management services. At the plementation and coordination of new IPAs and BHCCs. To help behavioral the strategy need to occur with necessary same time, providers struggle with align- billing processes, linking with the health health providers prepare for Value Based modifications along the way. ing policy with practice. information exchange (HIE), adding Payment arrangements, the NYS Behav- Positive consumer outcomes are at the workforce capacity, coordinating care ioral Health Value Based Payment center of the continuum of care provided Care Integration across multiple entities, training for staff Readiness Program was launched with by community-based behavioral health on oversight and data analytics, and gaug- $60 million over three-years to fund se- providers. This entails social supports and Integrating care is a desirable goal to ing ambiguous criteria for care transitions. lected BHCCs. The BHCCs are tasked preventative care through the entire life- ease the fragmentation of physical and with enhancing the collective quality of cycle to increase independence and better behavioral health services. There is no Care Collaboration care by facilitating a shared infrastruc- health outcomes for people living with one straight path to integration. In fact, ture that is clinically and financially inte- mental illness, who die on average of 25 there are several and they can be bumpy Surviving and thriving in the current gration with the use of community-based years younger than the general population. an uneven. Total integration with a full- environment requires being part of a col- recovery supports, and utilization of ser- In addition, ending the stigma surrounding service team that is holistic, interdiscipli- lective, effectively working together, util- vice data to improve behavioral and behavioral health so that people are com- nary and person-centered is exemplified izing shared resources and infrastructure physical health outcomes. Under the vi- fortable seeking help before a crisis arises. by the federally Certified Community to meet provider missions more effi- sion of value-based payments, plans will It is therefore necessary to ensure the Behavioral Health Clinic (CCBHC) pro- ciently. System transformation created delegate some risk, network development sustainability and viability of the sector to gram. CCBHC’s provide a comprehensive several networking opportunities to nur- and care management activities. But for guarantee that consumers have access to range of addiction and mental health ser- ture a more integrated system of care, VBP network contractors to be success- and receive the high quality, integrated vices, while meeting additional require- embracing Managed Care Organizations ful, access to real-time and actionable care that they deserve as articulated under ments related to staffing, governance, data (MCOs), Performing Provider Systems health plan and PPS data is fundamental, the goals of the Triple Aim: better care and quality reporting and more. In return, (PPSs), Accountable Care Organizations in addition to the capability to meaning- and improved health at lower costs. CCBHC’s receive a Medicaid reimburse- (ACOs), Independent Practice Associa- ment rate based on their anticipated costs tions (IPAs), Behavioral Health Care Col- of expanding services to meet the needs of laboratives (BHCCs), Health Homes, and these complex populations. other care delivery entities. Become a Member of The Coalition Today Other examples of integration include, The move to Medicaid managed care collocating with another group of licensed brought about Health and Recovery Plans specialists; sharing office space where (HARPs), which are specialty health plans providers share regulatory accountability for people living with severe mental illness Join with over 150 organizations and providers and inform consumers of who is provid- and substance use disorders. HARPs are ing their services; or referral with a “hot crucial for VBP contracting and quality as we address the vital policy concerns of New York’s handoff” to other behavioral health or management to happen, as well as access physical health services. Additionally, to Home and Community Based Services there is the practice of lean integration, (HCBS) to help individuals achieve life mental health and substance use community. which involves continuously improving goals and be more involved in the commu- data and systems flow, patient flow, pre- nity. While HCBS providers prepared for vention, removing access barriers, while and invested in high volume HCBS infra- For more details, visit us online at keeping back office functions as is; as structure, the quantity envisioned has not well as employing peer navigators and come to fruition, and HCBS remains mis- health outreach workers. However, meet- aligned with the realities on-the-ground. www.coalitionny.org ing regulatory obstacles is complex and Participation in DSRIP and the PPSs PAGE 8 visit our website: www.mhnews.org BEHAVIORAL HEALTH NEWS ~ FALL 2018
A System in Transformation
By Andre, Derreck, Diomayra, While we may not have all been famil- our discussion. Each of the quotes in this apy called DBT (Dialectical Behavior Eugene, Isaiah, Rhonda, Robert iar with the term ‘system transformation’ piece represents sentiments expressed Therapy), but I didn’t know how to find a or the exact names of each of the services directly by one of us. list of people who specialize in DBT. My we’ve been provided, our discussion Care Coordinator helped me find someone his article is part of a quarterly made it clear that we have seen a signifi- How System Transformation and stayed on me to make sure that I kept series giving voice to the per- cant change in the way we have received Has Impacted Us that appointment, because there was a six spectives of individuals with care over the years. month waiting list. My Care Coordinator lived experiences as they share Our talk revealed a range of experi- Accessing services that can change our has really helped me out. She had resources Ttheir opinions on a particular topic. The ences: from confusion and continued frus- lives: For a few of us, after finding stabil- at her disposal that I could utilize.” authors of this column facilitated a focus tration in working through the current ity in our health and housing, for some group of their peers to inform this writing. structure, to life-altering revelations and time we still found it difficult to take full Staying on track in scheduling, keep- The authors are served by Services for the realizations that have emerged from our advantage of the services available to us. ing, and traveling to appointments: A big UnderServed (S:US) a New York City- interaction with the structure of care. Our The assistance of Care Coordinators has part of having full access to care involves based nonprofit that is committed to giv- needs are very individual, so each of us been transformational in helping us to following through on logistical tasks. ing every New Yorker the tools they can feels differently about what quality sup- realize our deeper needs, find specialized These things may seem simple but can use to lead a life of purpose. port and services mean. Still, when asked primary care and mental health providers, prove tedious when the system is confus- There was something refreshing about whether the system today has led to better and get the most out of available care. ing, when we have to juggle schedules, talking through the way the delivery of care, more access, improved health, and when we don’t have a way to travel to an care has transformed over the last few better experiences for us, our collective “I was given housing at S:US because I appointment or meeting, or when we are years. Through our lives, we have had to answer was a definitive ‘yes.’ Although have veteran status. I had housing but I simply feeling discouraged. navigate not only systems of healthcare there are more aspects to system transfor- still wasn’t settled. That’s when I got intro- Care Coordination and the services and services, but also our own resilience mation, Care Coordination is a service duced to the Care Coordinators. I now that have become available over the last and strength. To some degree, everyone in that the majority of us were most familiar have a Wellness Coach and a Care Coor- few years have helped us immensely with our discussion group has experienced with, so we touch on that particular ser- dinator, because my mind doesn’t remem- following through on appointments. From homelessness, trauma, mental illness, and vice the most in this piece. ber the way that it used to. My psychiatrist other challenging circumstances. Below are some of the main themes of told me that I need a special type of ther- see System on page 26 BEHAVIORAL HEALTH NEWS ~ FALL 2018 visit our website: www.mhnews.org PAGE 9 PAGE 10 visit our website: www.mhnews.org BEHAVIORAL HEALTH NEWS ~ FALL 2018 The Promise and Peril of Performance Measurement
By Ashley Brody, MPA, CPRP ers and providers. For instance, the ACA remuneration. Perhaps not surprisingly, Chief Executive Officer established the Hospital Readmissions most PPSs are poised to achieve a 25% Search for Change, Inc. Reduction Program (HRRP), an initiative reduction in potentially preventable read- that authorized the Centers for Medicare missions (the overarching goal of the and Medicaid Services (CMS) to impose DSRIP program) by 2020. By December ew would dispute the assertion financial penalties on hospitals whose 30- of 2017, PPSs had already reduced such that our behavioral healthcare day readmission rates exceed accepted readmissions by 16.5% (New York State system and the many institutions standards (Muller, 2018). (A readmission Department of Health, 2017). One cannot on which it depends are in a state within 30-days of discharge is often con- help but wonder whether this trend, promis- Fof transformation, if not upheaval. This strued as a “failure” and indicative of in- ing as it seems, obscures a rise in other transformation is characterized by many effective treatment, inadequate discharge practices potentially deleterious to the overarching themes and trends, most of planning or other deficiencies that, if cor- welfare of many of our state’s most vul- which aim to enhance the quality of care rected, would preclude readmission.) The nerable recipients. delivered to recipients of healthcare ser- imposition of financial penalties produced Our mounting preoccupation with per- vices and at lower costs. The Institute for the desired result, or so it seemed. Read- formance measures also threatens to re- Healthcare Improvement envisioned noth- mission rates decreased. Subsequent duce inherently complex phenomena to ing less when it introduced the “Triple analyses revealed a potentially insidious unduly simple, albeit readily quantifiable, Aim” of healthcare reform in 2007, an trend, however. Between 2006 and 2013, elements. Proponents of performance ambitious plan that added improvement in the incidence of “observation stays” for measurement often attempt to correct for overall population health to its goals for Medicare patients nearly doubled (Muller, this tendency via “risk adjustment,” a the new millennium (American Hospital 2018). Patients placed on observation practice that calibrates measures to reflect Association, 2015). Subsequent develop- status are effectively admitted for rela- unique characteristics of the specific ob- ments, including the enactment of the tively brief periods and receive a variety jects of measurement. Nevertheless, this Patient Protection and Affordable Care of services customarily provided to occu- process often lacks the rigor or sophistica- Act (ACA) and establishment of the Ashley Brody, MPA, CPRP pants of inpatient units. Services rendered tion necessary to account for innumerable Medicaid Redesign Team (MRT) and to them are simply classified (and billed) factors that influence the measurement Delivery System Reform Incentive Pay- ments (Muller, 2018). This outsized in- differently. Most significantly, such ob- process, as revealed by another analysis of ment (DSRIP) program, readily adopted vestment has failed to produce a commen- servation stays are not considered read- hospital readmission rates among Medi- the Triple Aim and its corollary initia- surate benefit to the public, however. The missions for public reporting purposes nor care patients. An investigation of risk tives. Foremost among these is the re- World Health Organization (WHO) ranks do they incur penalties pursuant to HRRP adjusted readmission rates exposed grave placement of Fee-for-Service reimburse- the American healthcare system as 37th provisions. Our state DSRIP program deficiencies in the adjustment algorithm ment systems with Alternative Payment overall (World Health Organization, similarly aims to reduce potentially pre- applied to the population of interest inso- Models (APMs) that recognize and re- 2018). Such an imbalance between invest- ventable hospital admissions, and Per- far as it adjusted only for patients’ age, ward quality in service delivery. Behav- ment and results is especially pronounced forming Provider Systems (PPSs) that fail gender, discharge diagnosis and recent ioral healthcare providers (and the many in our backyard. New York spends more to achieve established metrics in this and Community Based Organizations (CBOs) per capita than any other state on health- related domains are subject to reduced see Promise and Peril on page 27 that provide ancillary support services to care (excepting New Mexico) for which it individuals with behavioral health needs) has achieved a mediocre ranking of 17th can no longer rely on payers to compen- “best” based on cost, accessibility and sate them simply for the volume of ser- outcomes (Robinson, 2018). The need for vices delivered. As envisioned in the New reform is indisputable, and it is hardly sur- York State Roadmap for Medicaid Pay- prising this industry has been subject to a ment Reform, providers must demonstrate proliferation of process and performance their “value” through measurable contri- measures in recent years that aim to en- butions to the attainment of the Triple hance the quality and efficiency (i.e., Aim (New York State Department of value) with which its services are deliv- Health, 2018). How does a provider, ered. These are logical and laudable goals, agency, or consortium of agencies demon- but they run a grave risk of producing un- strate value? It is all in the measurement intended consequences. process. And therein lies great opportu- In 1976 the social psychologist Donald nity and tremendous peril. Campbell suggested quantitative measures Performance measurement is certainly used to inform policy decisions are in- not new to the healthcare industry nor is it variably subject to corruption (Hess, unique to it. Frederick Winslow Taylor 2018). His formulation gave rise to an and his fellow progenitors of “scientific eponymous law that exerts considerable management” were among the first to influence in performance measurement apply the tools of the industrial efficiency programs. Perhaps the most common and movement to public school reform more recognizable manifestation of Campbell’s than a century ago (Muller, 2018). Such Law occurs within the realm of policing. “reforms” continue to abound, as manifest The requirement that officers issue a in the No Child Left Behind Act, the minimum number of citations within a Common Core curriculum and myriad specified time period (i.e., quotas) as an other initiatives of enduring influence and indicator of productivity is fraught with dubious merit. Other sectors including obvious pitfalls. Similarly, standardized law enforcement, the military, business tests in public education may distort and and finance have also been subject to vari- compromise the educational process, es- ous forms of performance measurement, pecially when used as bases for instruc- most of which were borne of the seem- tors’ performance evaluations. “Teaching ingly noble intention to promote quality, to the test,” a practice wherein instructors efficiency, transparency and accountabil- focus exclusively on material that might ity in the name of a greater public good. appear in such tests, is potentially detri- The healthcare industry is another emi- mental to students inasmuch as it neglects nently logical target for reform inasmuch other subject matter essential to their bal- as it commands an ever-increasing share anced and comprehensive education. Ex- of our collective resources and produces amples of such unintended consequences uneven results, at best. By 2025 it is ex- abound within the healthcare industry, pected to consume a fifth of our nation’s and they will likely continue unabated in GDP, nearly 50% of which will be shoul- view a recent propagation of “pay for dered by local, state and federal govern- performance” arrangements between pay- BEHAVIORAL HEALTH NEWS ~ FALL 2018 visit our website: www.mhnews.org PAGE 11 PAGE 12 visit our website: www.mhnews.org BEHAVIORAL HEALTH NEWS ~ FALL 2018 Ongoing Transformations at The MHA of Westchester
By Ruthanne Becker, MA, During the past year, MHA’s Care MHA clients who have been high utilizers implementing a protocol of enhanced staff Barbara Bernstein, PhD, Management program has not only grown of intensive and expensive services due to support, activated particularly following Cindy Peterson-Dana, LMHC, significantly, but recognition of our qual- histories of multiple psychiatric hospitali- a client death. Staff support includes a Stephen Smith, PhD, and ity outcomes has resulted in contracts to zations and/or periods of incarceration. The menu of HR, clinical, and peer support, Jenna Velez, LCSW, embed Care Managers in non-MHA sites, INSET program augments existing ser- drawing on our internal resources and The MHA of Westchester such as in primary care settings. Cur- vices with additional intensive supports, staff expertise to assist our providers in rently, we are looking at providing similar including mobile clinicians, care managers, managing the impact of client loss, tend- services in other types of settings such as and peer professionals. The INSET team ing to their emotional needs, reducing he Mental Health Association of homeless shelters. supports these clients in the community, secondary traumatization, and increas- Westchester (MHA) continues links them to needed social services, en- ing retention and staff satisfaction. Ac- to actively transform the deliv- Integrated Substance Use gages family supports, and coordinates tive endorsement by all levels of execu- ery of our expansive array of Disorder Services care across MHA services. tive staff are essential for the success of services,T increasingly moving from a con- this initiative. ceptual commitment to provide holistic Through new services and staff train- Change Management Since its creation in 1946, MHA of services to operationalizing a unified fab- ing, MHA is addressing the growing con- Westchester has continued to evolve with ric of existing and newly created services. cern of opioid use and co-occurring sub- Initiating, implementing and sustaining and also to lead change in order to most Simultaneously, we maintain our unwav- stance and mental health conditions ex- significant change requires planning, on- effectively meet the needs of those to ering focus on shared decision making perienced by our clients. Select staff are going monitoring and management. To whom we provide services. Our current and person-centered care. Our changes are being trained in Integrative Harm Reduc- that end, MHA employs proven change transformative initiatives continue that more than incremental as we work to offer tion and Dialectical Behavior Therapy for management techniques facilitated by long tradition. the “right care, at the right time, and in the Substance Use Disorders preparing them designated staff and overseen by a dedi- right place”* to the people that we serve to integrate substance use approaches with cated Project Management team. Key * Institute for Healthcare Improvement: whose health services are primarily cov- more familiar clinical interventions. Staff Performance Measures are regularly re- http://www.ihi.org/resources/Pages/ ered by Medicaid and Medicare. across all services – from clinics to resi- viewed to assess progress toward goals AudioandVideo/WIHI-Right-Care-Right- The goal is to address the full range of dential, peer professionals and support and drive changes in strategy. Our new inte- Setting-Right-Time-of-Hospital-Flow.aspx an individual’s health related challenges staff are trained in the use of NARCAN to grated Electronic Health Record, with an by offering an expanded array of services provide emergency substance use first aid expected go-live date of January 2019, is a About the authors. Ruthanne Becker, that work in concert with each other. His- services if necessary. Once our pending key vehicle through which we will manage MA, is Senior Vice-President of Rehabili- torically, challenges to this approach have application is approved, our psychiatric patient care. tation Services; Barbara Bernstein, PhD, derived from several factors, such as de- staff will begin to offer Medication As- is Chief Planning Officer; Cindy Peterson fined sets of services that did not address sisted Treatment (MAT). Along with estab- Staff Support -Dana, LMHC, is Vice-President of Peer the full range of needs, including the im- lishing policies for MAT, our medical staff and Recovery Services; Stephen Smith, pact of social determinants of health, is creating a protocol to reduce the use of As we work with a growing number of PhD, is Director of Training; and Jenna limitations on the role of peer support, benzodiazepines, and concomitantly in- individuals with increasingly complex Velez, LCSW, is Vice-President of Behav- regulatory obstacles related to billable creasing the use of alternative techniques health and behavioral health needs, the ioral Health Services at the Mental services, barriers to information sharing, such as mindfulness to manage anxiety. toll on staff can be significant. We are Health Association of Westchester. and a workforce that was inadequately prepared to deal with the impact of com- Expanding Clinic Services plex trauma, substance use, and the inter- relation of physical and behavioral health. Our Intensive Outpatient Program The following describes several initiatives (IOP) provides an array of intensive sup- now underway to achieve our goal of inte- ports and services, particularly during grated care. times of crisis and transitions from hospi- tal care. Clients in our IOP are supported Integrating Medical Care by clinicians and peer professionals, who provide multiple points of contact and Care management services play a vital wrap around supports during times of role in client care. Our work prioritizes increased need. Frequency and length of both physical and behavioral health to contacts are dictated by individuals’ fluc- improve quality of life and to avoid un- tuating levels of need. Furthermore, co- necessary emergency services. The work location at the Sterling Community Center of care managers may include coordina- provides easy access to Employment and tion of medical care, making connections Peer services. to specialists, and managing successful Within MHA’s OnTrackNY program, transitions out of hospital settings. which provides early intervention services Though essential, much of this work was to those experiencing a first episode, a previously done in silos, with most clini- new research initiative offers social net- cal and care management services operat- work meetings as an optional additional ing in parallel spaces. Embedding care service. Social network meetings bring managers into our main clinic settings together the individual receiving services was an essential first step towards inte- and members of his or her social circle, grating the two services. New workflows including family and/or other close rela- were established to insert care manage- tionships. Through the social network ment services at several points of contact meetings, all participants are given the within the clinics, including at referral, opportunity to express their thoughts and intake, and throughout the course of treat- feelings in order to facilitate dialogue and ment. Clinicians have been trained to pro- understanding. The hope is that these vide more thorough medical assessments meetings will enhance clinical and recov- and screenings. These new workflows ery outcomes while preserving and im- also enable us to push out real-time infor- proving relationships. mation to our clinicians when we receive alerts from Healthlink, an alert system Integrated Peer Support Services which notifies providers when a client, who has consented, utilizes the hospital/ MHA’s Integrated Peer Support Ser- ER for medical or behavioral health vices unify traditional and novel services to needs. This in turn, allows us to commu- address clients’ needs and life situations. nicate with and provide timely services to Our Intensive and Sustained Engagement clients at especially vulnerable times of and Treatment (INSET) program offers crisis and upon discharge from hospital. adjunctive and integrated supports for BEHAVIORAL HEALTH NEWS ~ FALL 2018 visit our website: www.mhnews.org PAGE 13 PAGE 14 visit our website: www.mhnews.org BEHAVIORAL HEALTH NEWS ~ FALL 2018
The East New York Health Hub: Realizing the Promise of Whole Health
By David Woodlock ter, “Creating a Culture of Whole Health; creating a sustainable network of commu- President and CEO Recommendations for Integrating Behav- nity resources to bring better health care Institute for Community Living ioral Health and Primary Care.” Research- to the people of East New York. ers attributed the “fragmentation in healthcare delivery” to “the artificial sepa- Joining Forces to Enhance Health ver the last few decades, there ration of ‘mental’ health from ‘physical’ has been an increasing focus health that “almost always comes back to ICL was very deliberate in our choice on health care reform and a need for intentional integration at all of Community Healthcare Network O bending the cost curve through levels to achieve a foundation for better (CHN) as our medical services partner in a combination of new approaches includ- health.” They argued that “primary care the Hub. An outstanding provider of pri- ing social determinants of health, trauma- cannot be practiced without addressing mary and preventive healthcare for adults informed treatment, health equity, patient mental health concerns, and all attempts and children, CHN is a Federally Quali- engagement and integrated care. While to do so result in inferior care.” The re- fied Health Center (FQHC) with 15 sites these elements have clearly found a place search showed that where integrated care throughout New York City and a highly in the literature, few attempts to compre- was introduced, “it appears to improve respected leader in comprehensive com- hensively address these issues have had health and healthcare and contain costs.” munity medical care for underserved New significant impact. One program in East York City residents. New York may soon change all of that A Continuing Commitment to Early on, we knew this would be a and in an unprecedented way. Integrated Care very successful partnership. In talking On Monday, September 24th, the ICL about the Hub, Bob Hayes, CHN CEO, East New York Health Hub opened its Through more than 30 years working says that “it is inspiring to work with the doors. This milestone was the culmination in distressed communities, ICL had come ICL team. We share a common vision to of years of planning to bring a wide range David Woodlock to understand that changing health out- bring the finest care to people in dis- of health and behavioral health services comes is not just about improving medical tressed communities long ignored by tra- under one roof in a way that would be into mental health treatment planning a services or “better doctoring” but a fully ditional service systems. Our integration much more than co-locating programs or specific, targeted consideration of health ecological approach. of physical and mental health care will offer opportunities for sound referrals. issues to help clients address their physi- So guided by the research and our own make a huge difference for the people of For ICL, this carefully designed, light- cal and mental health concerns. Thanks to client outcomes, ICL went to work to de- East New York. One day soon we will filled 45,000 square-foot space was the a generous, multi-year SAMHSA grant in velop a physical center – a place where wonder why there were ever separate sys- realization of a long-held dream. And we 2011, ICL instituted a Healthy Living community residents could come to have tems for health and behavioral healthcare.” chose an equally committed and enthusi- initiative with a survey of all clients taken the complexity of their needs better met. ICL and CHN met regularly prior to astic organization – Community Health- at six-month intervals to assess how indi- We knew it would not be an easy road but the move to explore how we could en- care Network -- as our primary healthcare viduals were doing – were they in fact were determined to overcome the bureau- hance communication and service deliv- partner. getting better with us. Each year since cratic and financial hurdles. We felt com- ery. An Altman Foundation grant is al- As the Hub officially opens, we are starting the survey the answer has been a pelled to do what we knew could signifi- lowing us to create a manual of standard confident its success will bear out our resounding yes. Over the past three years cantly impact the lives of the people of operating procedures culturally responsive long-held belief that you cannot separate some 98% have said they feel more in East New York, one of the most dis- to the health needs of Black/African health from mental health care nor from control of their lives and connected to tressed communities in New York City. American and Hispanic/Latino communi- the social determinants of health. The Hub community as a result of their involve- In addition to offering clinical and ties in East New York to be used by both instead offers a unified model of care to ment with ICL services. support services for adults living with organizations. A grant from the New York address health and behavioral health and In 2017, SAMHSA chose ICL from mental illness and substance abuse, help- Community Trust further supports a shared the larger social and economic factors that around the entire country as one of only ing families is a major focus. The Hub service framework for a whole-person care we know lead to significant health prob- three organizations to receive its Path- will be home to ICL’s Family Resource approach to health and wellness. lems and disparities. ways to Wellness award for impacting Center (FRC), giving people access to this Whatever “door” a person enters at the people with chronic health conditions. highly sought-after family support pro- Community at the Core Hub – a medical appointment for a The principles guiding the Hub reflect gram; at the same time, FRC’s 500 fami- chronic sore throat or a monthly appoint- SAMHSA’s contention that the integra- lies have the chance to get their medical To make inroads into the seemingly ment with their therapist for depression – tion of mental health, substance abuse, care there. And with our understanding of intractable health disparities of the social our goal is for that person to leave with and primary care services is the most ef- the benefits of intervening early and ef- determinants of health, research continu- what they need from a whole health per- fective approach for people with multiple fectively, we will offer wellness pro- ally underscores the importance of patient spective. The person in therapy might healthcare needs and that care coordina- grams, access to healthy food, counseling, engagement and patient activation. At reveal a lethargy from not eating nutri- tion across providers and disciplines in- and job and housing programs.. ICL we apply these individual constructs tious foods and leave with a bag of fresh creases efficiency and improves outcomes Our plans for the Hub better prepare us to engaging the community as a whole. vegetables from a local community gar- and satisfaction with care. to fulfill New York State’s five-year plan From the start, we recognized the im- den (and Hub partner) or the person see- Other national policy groups support for Value-Based Payment to improve out- portance of working closely with local ing their primary care doctor leaves with this shift to a whole health approach. A comes, reduce skyrocketing costs, and community organizations, service provid- an appointment at the ICL mental health 2016 report by the Robert Wood Johnson improve patient experience. The Hub ers, churches, businesses and schools to clinic to explore the still numbing grief Foundation contended that to promote a could become a model for moving from offer the most effective services and reach they feel after losing a child to violence culture of health requires “health provid- fee-for-service to a whole health approach communities of color. that may be making them sick. ers to fully understand the social determi- to comply with the state’s plan requiring We engaged two leading community The plan for the Hub is profoundly nants of health and take these determi- 80% of Medicaid spending be in a Value- development organizations – Local Initia- different than a simple co-location of ser- nants into account in its treatment of pa- Based arrangement by 2020. We believe tive Support Corporation NYC (LISC vices. ICL and CHN are firmly committed tients including collaborating with social the Hub offers one of the most promising NYC) and Hester Street Collaborative – to a shared sense of responsibility for eve- services and other systems to provide nec- ways to help turn around an out-of-control to conduct a comprehensive planning ryone who walks through its doors. The essary services outside the purview of the system unprepared to meet basic health study to identify unmet needs and make Hub offers a reimagining of what a health care system.” RWJF defined the care needs, particularly for the high-need, the Hub inclusive and inviting. Over a neighborhood health center can and social determinants of health as “factors high-cost populations we see every day in two-year period, virtually every group should be. such as where we live, how much money our programs. they met with expressed excitement; the Throughout its 31-year history, ICL we have, our education level, and the In recent years we have come to better Hub vision clearly resonated with local has been committed to serving New York problems we struggle with that have been understand the country’s unsustainable residents. City’s most vulnerable populations. At the clearly linked to our well-being, the qual- healthcare costs and the need to address Cruz Fuksman, a community outreach core of our 110 programs throughout New ity of our lives, our health, and how long causes. One reality is that 5% of the US worker who has lived in East New York York City – counseling, clinics and com- we live.” Research by the Kaiser Family population spends 40% of health care her entire life and is a member of our East munity and residential support – is a com- Foundation shows that social determi- monies, predominantly in disadvantaged New York Health Advisory Council, mitment to treating clients with respect nants of health account for at least 60% of communities like East New York. made a comment at a focus group that has for their experiences and engaging them a person’s health. The Hub is also in sync with state and stayed with me. “I’ve lived in this com- on their terms. The problems inherent in a siloed sys- city initiatives to combat poverty, vio- munity all my life and we’ve always I am proud that ICL was among the tem were underscored in a 2016 report by lence and poor health in severely under- first behavioral health agencies to build the Eugene S. Farley Health Policy Cen- served and disadvantaged communities by see Hub on page 28 BEHAVIORAL HEALTH NEWS ~ FALL 2018 visit our website: www.mhnews.org PAGE 15 PAGE 16 visit our website: www.mhnews.org BEHAVIORAL HEALTH NEWS ~ FALL 2018 Turn and Face the Change: Children’s Medicaid Redesign
By Ryan Logan, LMSW of care, providers must not lose sight of families around the world is seemingly Director, Children & Family Services the challenges the system will face. worth the effort needed to put new sys- WellLife Network Much like parents today developing new tems in place to mitigate the challenges ways to prevent their youth’s access to this connectivity brings to our world. inappropriate content on the internet or Similarly, if the Children’s Medicaid Re- hange is inevitable. Change protect their youth from cyberbullying, design efforts can increase youth and their has and will always be a part the Children’s Mental Health System on a families’ access and connectivity to the of life, but it seems that the last whole will need to develop new strategies, behavioral health services and supports C couple of decades have workflows, policies, and procedures to that help them meet their goals and thus brought about an unprecedented rate and ensure these challenges are overcome. their full potential, then it is well worth scale of change in our society. Technol- While the full extent of challenges (and the effort of the system of care to embrace ogy, of course, can be identified as a benefits for that matter) are yet to be seen, these changes. driving factor and has radically trans- some have already become apparent, such With this in mind, the WellLife Net- formed every aspect of our children’s as the significant need for education and work is committed to developing and ex- lives. The internet, social media, and training to all stakeholders within the sys- panding services within the Children’s mobile phones have brought a number of tem regarding the changes and their role Mental Health System to increase access benefits as well as challenges to the lives in the delivery of these new services, a to youth and families across Long Island of our youth and the families that strive greater reliance on the coordination of and New York City. The WellLife Net- to strike a balance with this double edged multiple providers providing multiple work has been designated to provide nu- sword. Parents in the digital age have services as we move away from unified merous services within the CFTS and had to educate themselves and develop programs, and the need for increased net- HCBS array of services and plans to ex- new strategies for parenting to leverage working and partnerships amongst provid- pand its Children’s Health Home pro- the positives over the negatives. ers in the system of care. gram. Join us as we embrace this change Like the rise of the digital age, the Ryan Logan, LMSW To take a lesson from the radical shift and work to transform the system to better Children’s Mental Health System is un- in life brought on by the digital age, de- serve our communities. dergoing a major transformation in the Prevention and Early Intervention spite the challenges we face as a society form of Children’s Medicaid Redesign Reflect the New Standards in Excellence as technology, the internet, mobile “Change can be frightening, and the temp- that will significantly redefine many as- phones, and social media dramatically tation is often to resist it. But change al- pects of the current system of care. As a These changes have begun and will reshape the ways in which we operate, the most always provides opportunities - to parallel process to the parents we serve, continue to redefine service delivery prevalence and continued integration of learn new things, to rethink tired proc- providers in today’s system will have to within the Children’s Mental Health Sys- technology into our lives seems to indi- esses, and to improve the way we work.” educate themselves around these changes tem marking a dramatic shift from com- cate that the benefits far outweigh the – Klaus Schwab as well as develop new strategies for ser- prehensive, unified programs to coordi- challenges. The increased ability through vice delivery to leverage the benefits over nated, individualized services. The inten- technology to access information and ser- For more information about WellLife the challenges. tion behind this shift is to focus on pre- vices that enhance our lives and allow us Network’s Child and Community Based vention, early intervention and flexibility, to stay connected with our friends and programs, call (631) 920-8302. Sweeping Changes giving providers the ability to identify the Focus on Quality of Care needs and challenges of youth and their families earlier, wrap services that match The sweeping change that the Chil- those needs around youth and families Sherry Tucker Appointed CEO of dren’s Mental Health System is currently timelier, in addition to giving providers experiencing consists of several major more opportunities to engage youth and initiatives: Health Homes, Children and families in settings that work best for WellLife Network Family Treatments and Supports (CFTS), them (i.e. their home communities). In an expanded array of Home and Commu- capturing the intention behind the trans- By Staff Writer nity Based Services (HCBS), the transi- formation, the phrase, “the right services, Behavioral Health News tion of behavioral health benefits into at the right time, in the right amount,” was managed care, and a shift in focus to qual- often referenced. The idea is simple – ity of care (value-based payments). provide a service which matches the herry Tucker has been named The Health Home model, which was needs of the youth and family, at the time Chief Executive Officer of Well- launched in the children’s system of care that need is identified, for the amount of Life Network. She succeeds Alan in December of 2016, aims to provide time that is necessary to address the need, S M. Weinstock, who retired on care coordination services. CFTS and and we can hopefully help youth and their June 30, 2018. Ms. Tucker was formerly HCBS will establish an array of individu- families be more successful at reaching serving as President of WellLife Network. alized services (as opposed to a program their goals and preventing reliance on “Sherry brings a wealth of experience with multiple components) that can be more intense, longer term services. and a deep commitment to our mission. wrapped around youth and their families By understanding the intentions be- We look forward to working with her and to help facilitate and support progress hind the changes, it is easy to begin to the vitality she brings to the organiza- towards meeting goals. Services in the pinpoint some of the benefits this new tion,” said Jeffrey Finkle, Chairperson of CFTS array include Other Licensed Pro- system of service delivery hopes to the Board. vider, Psychosocial Rehabilitation and achieve such as quick, early access to the Sherry Tucker a woman of conviction, Community Psychiatric Supports and least restrictive services necessary to vision and dedication began her career at Treatments which are expected to begin achieve the desired outcomes. Addition- WellLife Network, formerly PSCH, in a on January 1, 2019; Family Peer Support ally, these changes hope to usher in consulting position in 2010. Sherry Services are targeted for July 1, 2019; and benefits beyond those that are readily helped lead the effort to bring the organi- Sherry Tucker Youth Peer Support Services and Crisis apparent such as expanding services, zation to a place of financial stability. Intervention are due to launch on January expanding eligibility for these services, Accepting the CFO/SVP position in 2015, University of South Florida and becom- 1, 2020. The expanded HCBS array of increasing engagement by meeting youth Sherry set a strategy to continue to grow ing a CPA early in her career, Sherry has services will include services such as Res- and families where they are at (both in and strengthen the organization. She also held a number of senior management po- pite (planned and crisis), Prevocational regard to their physical location as well led the successful rebranding of the or- sitions in a variety of for-profit and non- Services, Supported Employment, Care- as their strengths and needs at a given ganization. Today, WellLife Network, profit organizations. In all of her posi- giver/Family Supports and Services, point) and focus on quality of care over one of the largest regional behavioral tions, what she found to be the greatest Community Advocacy Training and Sup- quantity. health nonprofits in New York City and asset to a successful outcome was a port and will begin on January 1, 2019. Long Island, provides life-changing ser- strong team surrounding her. Joined by The transition of behavioral health bene- Re-Education Challenges vices to some 25,000 vulnerable individ- Chief Operating Officer, Ann Marie Bar- fits to managed care occurred on July 1, Facing Parents and Network Providers ual and families in the New York metro- barotta and Chief Financial Officer, Lori 2018 while the focus on value- based pay- politan area. Alameda, Sherry is excited for the future ments is slated to be addressed after the While it is easy to focus on the bene- Earning a degree in Business from of WellLife and welcomes the new chal- majority of the transition has occurred. fits this change will bring to the system Indiana University, an MBA from the lenges and opportunities it will bring. BEHAVIORAL HEALTH NEWS ~ FALL 2018 visit our website: www.mhnews.org PAGE 17 PAGE 18 visit our website: www.mhnews.org BEHAVIORAL HEALTH NEWS ~ FALL 2018 Building an Integrated Delivery System Through Community Collaborations
By Jorge R. Petit, MD ioral health interventions that, coupled days for the cohort and a 57% reduction President and CEO with a specialized emphasis on social de- in inpatient admissions. The CBC/Project Coordinated Behavioral Care (CBC) terminants of health, promote a healthier Renewal Bronx Pathway Home Team, New York. These collaborative efforts had an even more extraordinary impact serve as the foundational underpinning of with an 85% reduction in inpatient and oordinated Behavioral Care a clinically integrated delivery system that emergency utilization. (CBC) was launched in 2011 by allow CBC and our partner agencies to Another successful collaborative effort a committed group of NYC not- participate in the healthcare system trans- is exemplified by the Staten Island PPS C for-profit behavioral health formation underway as we move toward (SI PPS) partnering with CBC and Project organizations to meaningfully participate Value Based Payment. Hospitality on an innovative intensive in NYS’s Medicaid Redesign and Value One such example of an effective col- care management program providing tar- Based Purchasing initiatives. CBC is laboration with amazing outcomes is the geted outreach, engagement and support dedicated to improving the quality of care CBC, Bronx Partnership for Healthy to individuals with a goal of reducing for New Yorkers with serious mental ill- Communities (BPHC) SBH Health Sys- their reliance on emergency settings by ness, chronic health conditions and/or tem’s Performing Provider System (PPS), connecting them to community-based substance use disorders. CBC has devel- and Project Renewal innovative care tran- services. The project, Helping, Engaging, oped a citywide Health Home, which is sition partnership. This PPS initiative, and Linking to Health interventions currently the largest of its type in NYC including three other provider groups, was (HEALTHi), modeled on the successful providing care coordination services to intended to provide a six-month Pathway Camden Coalition’s Healthcare Hot- tens of thousands of New Yorkers of all Home/Critical Time Intervention (CTI) Spotting Initiative, uses data analytics to ages, through 50+ community-based Care program to support individuals with seri- identify high utilizers and focuses on pro- Management agencies located in all five ous mental illness as they transitioned viding a safety net of resources to indi- boroughs. CBC has launched innovative Jorge R. Petit, MD from a hospital setting back to a homeless viduals with complex chronic conditions community-based programs that build on shelter or a precariously housed living who are also affected by the social deter- the expertise of its community-based grams to holistically address individuals’ situation. Based on first year data (2017) minants of health. agencies; organized as an Independent treatment and recovery needs, while as- this model resulted in a reduction in hos- The HEALTHi project is aligned with Practice Association (IPA) that includes a sessing community deficiencies and con- pital utilization, an increase in primary the other initiatives funded by SI PPS citywide network of primary care, mental necting individuals to needed supports. care and outpatient utilization, and in- under the Delivery System Reform Incen- health and substance use treatment pro- Over the years, CBC has worked creased access to housing and employ- tive Payment (DSRIP) Program, and over- viders, thousands of units of supportive closely with multiple stakeholder groups ment services. The initial goal was a 25% all goals of the Medicaid Redesign. The housing, recovery and support services, and developed strong relationships and reduction in hospital days measured by a HEALTHi project locates and actively and assistance with concrete needs such collaborations to fulfill its mission of lev- 6 month pre- and post-intervention re- engages individuals who have serious as food, employment and housing. The eraging community partnerships toward view. The impact was far greater than CBC IPA Network “knits together” pro- the goal of integrated medical and behav- expected with a 62% reduction in hospital see Collaborations on page 28
Two New York Behavioral Health IPAs Merge
By Aley Weidman, Intern hospital systems. In addition CBHS’s Health Management Associates BHCC has 47 affiliates, including the largest hospital, FQHC, and health home providers in the region. oordinated Behavioral Health CCN is a not-for-profit IPA comprised Services (CBHS) and Compre- of thirteen behavioral health providers hensive Care Network of the serving Medicaid beneficiaries in five C Hudson Valley (CCN), two In- counties in the Hudson River region. dependent Practice Associations (IPAs) While their focus is primarily substance serving individuals in the lower Hudson use services, CCN members also offer River valley, are merging. Both organiza- mental health services in Westchester and tions are recipients of state Value Based Rockland counties. CCN also partners Payment (VBP) Readiness Program grants, with twenty-six health, housing, and pre- which enabled them to form Behavioral vention affiliates in an effort to provide Health Care Collaboratives (BHCCs). social supports to its growing client base. During the process of developing their When interviewed, leaders of both BHCC work plans, both organizations CBHS and CCN agreed that partnerships recognized that gaps in their networks among behavioral health providers and be- could be well filled by the other IPA. tween the specialty behavioral health com- CBHS’s network lacked sufficient capac- munity and the greater healthcare system ity for substance use disorder services, The BHCC Steering Committee Member (photo details at end of this article) were critical in delivering cost-effective while CCN’s had insufficient mental quality care, and that adding value for pri- health services available. When leadership care, behavioral health providers have had their quality of care, and generate econo- mary care and hospital system providers of the two organizations recognized the very limited access to those funds. The mies of scale, they chose to merge their will be essential to serving their commu- extent to which their networks were com- $60m that state policymakers were able to IPAs. nity going forward. CBHS Co-Chair Liz patible, and the almost complete overlap secure for BHCCs enables some of the CBHS is made up of ten not-for-profit Kadatz, Director of Operations of RSS, in their service geographies, they decided work needed for integration, but in order provider organizations, and one IPA said about the merger: “We want to do that a merger between the two IPAs was to develop the necessary infrastructure, (which is comprised of seven agencies) the very best work we can for these the wisest way to proceed. and build a sustainable model, these two and covers seven counties. Shortly after populations. We are committed and seri- This merger is consonant with national IPAs chose to bring their networks, and the organization formed as a nonprofit in ous about building solutions. We expect trends in mergers among providers at all their BHCC funds, together. Both CCN 2012, it became an IPA. The IPA allowed we can do this through implementing levels, resulting from the move to VBP, and CBHS understood the overlap in their CBHS to provide integrated care solutions ideas that work and learning from those and the infrastructure demands that result. client bases, and sought to eliminate du- for individuals with complex healthcare that do not.” Likewise, CCN Co-Chair While some in the state have utilized the plication, increase outreach, and provide needs. Partnering allowed these organiza- Adrienne Marcus, CEO of the Lexington $8.4b Delivery System Reform Incentive more cost-effective, high quality care. In tions to improve quality outcomes while Center for Recovery said that they “have Payment (DSRIP) program in order to an effort to improve the health outcomes working with various other healthcare facilitate their transition to accountable of the individuals they serve, enhance entities including, MCOs, FQHCs, and see Merge on page 28 BEHAVIORAL HEALTH NEWS ~ FALL 2018 visit our website: www.mhnews.org PAGE 19
The NYSPA Report: New York’s Mental Health and Substance Use Disorder Parity Reporting Bill
By Richard Gallo and • Any other data or metric the Superinten- General’s office. NYSPA leadership en- organizations. Also essential were the Rachel Fernbach, Esq. dent deems necessary to measure compli- gaged Senator Rob Ortt (R-North individual grassroots efforts of providers New York State Psychiatric Association ance with MH/SUD parity including (i) Tonowanda) and Assemblymember who took the time to call and write their adequacy of the company's in-network Aileen Gunther (D-Forestburgh), the legislators, Senate and Assembly leader- MH/SUD provider panels and (ii) reim- Chairs of the Senate and Assembly Men- ship and the bill sponsors in support of the f signed into law by Governor bursement for in-network and out-of- tal Health Committees, respectively, to legislation. Cuomo, New York’s parity reporting network MH/SUD services compared to sponsor the legislation. NYSPA is very proud to have played bill (A.3694-C/S.1156-C) will be reimbursement for in-network and out-of- The original version of the reporting an integral part in legislation that will among the most comprehensive laws network medical and surgical services. bill was introduced at the end of the 2016 have a significant role in improving parity ofI its kind in the country. The bill was legislative session, laying the ground enforcement and compliance and will passed by both the New York State Senate The state will evaluate the data col- work for further advocacy in the follow- positively impact consumers, families and and New York State Assembly in the final lected to verify compliance with parity ing session. Upon further discussions and providers across the state. Barry B. week of the 2017/2018 Legislative Session, laws and publish its findings in a parity consultation, the legislation was amended Perlman, M.D., longstanding chair of which concluded this past June. The pas- report. If the bill is enacted into law, the in 2017 to add requirements for submis- NYSPA's Committee on Legislation, was sage of this legislation represents a major first such parity report would be published sion of additional data elements. In late quoted in a Psychiatric News article on step forward in advancing parity compli- in September 2019. May 2018, the bill was further refined to parity enforcement: “This is clearly one of ance by health insurers and health plans. include an evaluation of network ade- the most consequential pieces of legisla- The bill, called the “Mental Health and Background on Parity quacy and in-network and out-of-network tion undertaken by NYSPA, and one that Substance Use Disorder Parity Report reimbursement as well as any other metric will advance the goal of fully implement- Act” would amend Section 210 of the New York already has strong parity the Department of Financial Services ing the spirit and intent of the federal and Insurance Law, which requires the state to laws in place. Timothy’s Law, New deems necessary. The legislation was vig- New York’s parity law that we all fought annually publish a Consumer Guide to York’s mental health mandate enacted in orously opposed by health insurers, health so hard to enact twelve years ago.” Health Insurers. The Consumer Guide 2006, requires all group health plans to plans and behavioral health management At the time of publication, the bill had provides a ranking of insurance compa- provide coverage for a minimum of 20 companies who argued against increased not yet been sent to the Governor’s office nies from best to worst based upon claim outpatient visits and 30 inpatient treat- reporting requirements. for consideration. Once it is sent, the Gov- processing or medical payments made ment days per year for the treatment of However, as a result of advocacy on ernor will have ten days to either sign or during the preceding calendar year. The mental illness. Timothy’s Law also pro- the part of mental health provider and veto the legislation. It is essential that pro- new legislation would require insurers, vides for unlimited coverage for adults consumer groups, on June 18, 2018, the ponents of the bill reach out to the Gover- health plans and behavioral health man- with schizophrenia/psychotic disorders, NYS Assembly passed the legislation by a nor’s office by phone, email or direct mail agement companies to submit data to the major depression, bipolar disorder, obses- vote of 137-1. Two days later, on June to express their support and urge him to state and information on parity compli- sive-compulsive disorder, delusional dis- 20th, the NYS Senate passed the bill by a sign the parity reporting bill into law. ance, including: orders, panic disorder, bulimia and ano- vote of 60-0, in one of its final acts of the To contact the Governor’s office re- rexia. The federal Paul Wellstone and Legislative Session. Clearly, there was garding the legislation, please use the fol- • Rates of utilization review for mental Pete Domenici Mental Health Parity and significant bipartisan support for this sig- lowing link: https://www.governor.ny.gov/ health and substance use disorder (MH/ Addiction Equity Act of 2008, expanded nificant piece of legislation. content/governor-contact-form. SUD) claims and rates of approvals and New York’s 30/20 benefit into a full par- This success would not have been pos- denials, compared to medical and surgical ity benefit, requiring full coverage of all sible without the support of 22 different Richard Gallo is the Government Rela- claims medically necessary treatment for mental organizations, including organized psy- tions Advocate for the New York State health or substance use disorders. chology, organized social work, the Medi- Psychiatric Association. Rachel Fern- • Number of prior or concurrent authori- Despite strong parity laws on the fed- cal Society of the State of New York, bach, Esq. is Deputy Director and Assis- zation requests for MH/SUD services and eral and state level, full implementation other medical specialty societies and tant General Counsel of the New York number of denials compared to medical and enforcement of these laws has yet to many consumer and provider advocacy State Psychiatric Association. and surgical services be achieved. As evidenced by investiga- tions conducted by the New York State • Rates of appeal of adverse determina- Office of the Attorney General, health tions for MH/SUD claims including rate insurers and health plans continue to ex- New York State of appeals upheld or overturned, com- hibit non-compliance, impeding imple- pared to similar rates for medical and sur- mentation and inhibiting access to care. gical claims To date, the Attorney General’s office has Psychiatric Association entered into settlement agreements with • Percentage of claims paid for in- eight insurers in connection with policies network MH/SUD services, compared and procedures that violate the parity stat- with the percentage of claims paid for in- utes. As described in the settlement agree- Area II of the American Psychiatric Association network medical and surgical services ments, certain insurers continue to apply Representing 4500 Psychiatrists in New York more stringent and frequent utilization • Percentage of claims paid for out-of- review standards to MH/SUD benefits network MH/SUD services, compared than to medical/surgical benefits and to Advancing the Scientific and with the percentage of claims paid for out deny care and treatment for MH/SUD -of-network medical and surgical services benefits at a higher rate than medical/ Ethical Practice of Psychiatric Medicine surgical benefits. In addition, insurers • The number of behavioral health advo- continue to apply medically necessary cates or staff available to assist policy- criteria and models inconsistent with ap- Advocating for Full Parity holders with MH/SUD benefits plicable law and regulation, resulting in adverse coverage determinations and re- in the Treatment of Mental Illness • A comparison of cost sharing require- duced access to care. ments (co-pays and coinsurance) and benefit limitations (limitations on the Advocacy Efforts Advancing the Principle that all Persons scope and duration of coverage) The original concept of an annual with Mental Illness Deserve an Evaluation • Number of providers licensed to practice parity evaluation and report was ad- in New York State that provide MH/SUD vanced by NYSPA’s Committee on Leg- with a Psychiatric Physician to Determine treatment and diagnosis who are in- islation and further developed in con- Appropriate Care and Treatment network (by type) junction with representatives from organ- ized psychology and organized social • The percentage of providers of MH/ work with an intent to focus in large part SUD services who remained participating on the most common areas of non- www.nyspsych.org providers compliance identified by the Attorney PAGE 20 visit our website: www.mhnews.org BEHAVIORAL HEALTH NEWS ~ FALL 2018 Transcranial Magnetic Stimulation (TMS) - Now Approved for OCD
By Adam Shapiro, MD utes to administer and have been known previous Substance Abuse, and multiple Psychiatry Resident, Westchester in research circles for years as a faster and medical comorbidities were allowed to Medical Center equally effective method of administering participate as long as when asked by TMS. Currently, the only device to have screeners reported depression as being received this approval is Magven- their primary psychiatric problem as op- he last few months have seen ture’s MagVita TMS Therapy system, posed to any other psychiatric condition. major advancements of TMS in though as the Magventure system em- There was a mathematical difference of the treatment of psychiatric ill- ploys the traditional figure-8 coil, it will outcome in participants who had ness. In August TMS was ap- likely not be long before other manufac- MDD without PTSD, which would have provedT by the FDA for the treatment of tures receive this approval as well. reached significance if this study was able Obsessive Compulsive Disorder, a third Whether or not the faster TMS treatment to double the number of participants thus indication after depression in 2008 and will have an impact on insurance reim- increasing its power. What might be more migraine with aura in 2013 (this approval bursement remains to be seen - a treat- interesting though than how effective the was broadened in September 2017 to in- ment that used to take half an hour now treatment was for the active treatment clude prevention of migraine). The FDA’s takes three minutes, with some speculat- group – 41% of active treatment partici- announcement included the following ing insurers will mandate patients first fail pants achieved remission, is that the sham statement by Carlos Peña, PhD, MS, and treatment with TBS to then receive other treatment group also reported such a high director of the Division of Neurological TMS protocols. remission rate, 37%. Compare this to the and Physical Medicine Devices in the There are numerous studies continu- 5% sham remission rate in the OPT-TMS FDA’s Center for Devices and Radiologi- ously being published that add to the trial (the study that lead to FDA approval cal Health, “Transcranial magnetic stimu- growing body of literature supporting of TMS for depression) as well as the 7% lation has shown its potential to help pa- TMS as an effective treatment for psychi- sham remission rate in the Neuronetics tients suffering from depression and head- atric and neurological conditions, includ- manufacturer’s trial, and one must wonder aches; with today’s marketing authoriza- Adam Shapiro, MD ing just recently Tobacco Use Disorder, what is behind this discrepancy. tion, patients with OCD who have not Parkinson’s, Somatic Symptom Disorder, This is not the first time a randomized responded to traditional treatments now TMS devices utilizing the traditional fig- and stroke. But one study published this clinical trial involving military veterans have another option.” The specific device ure-8 coil receive approval for OCD. summer in JAMA Psychiatry has received with psychiatric disorders in the VA sys- approved is Brainsway’s H7 coil which August also saw the FDA’s approval a lot of attention for being one of the few tem has failed to show efficacy for a treat- targets the medial prefrontal and anterior of a newer, much quicker TMS treatment TMS studies that did not find a difference ment that had been effective in initial cingulate cortices. The treatment takes 30 for depression. Whereas traditional TMS between active and sham treatment studies. Earlier this year, a VA study minutes and is administered five times a depression treatments have relied on a 10- groups. The study, ‘Effect of Repetitive found no difference between Prazosin and week for 6 weeks. One month follow-up 20Hz protocol taking anywhere from 18- Transcranial Magnetic Stimulation on placebo in the treatment of PTSD- outcomes showed significant benefit in 40 minutes to administer, the new proto- Treatment-Resistant Major Depression in associated nightmares. There was a nega- active vs sham subjects. Because of col utilizes a different pattern of TMS US Veterans; A Randomized Clinical tive randomized trial of sertraline for Brainsway’s unique H-coil design, it may known as Theta Burst Stimulation (TBS). Trial,’ was an effectiveness trial and not be some time before other FDA-approved TBS protocols take as little as three min- an efficacy trial - participants with PTSD, see TMS on page 27
BEHAVIORAL HEALTH NEWS ~ FALL 2018 visit our website: www.mhnews.org PAGE 21 Treatment Works! The Recipe to Recovery and Storytelling as Medicine
By Tom Wright, MD After treatment with Rosecrance Kris- distinct pillars, health, home, community Senior Vice President of Medical tin now has more than a year of sobriety and purpose, which, very simply, serve as a Affairs and Chief Medical Officer and begins school next month to become a basic recipe for recovery. Rosecrance Health Network substance abuse counselor. Her inspira- tional story certainly deserves celebrating, Health- Investing in physical, mental and although it’s not altogether unique. Many emotional health and well-being is para- hen I was training to be a of us have known or loved someone ex- mount to recovery. In many cases, health child psychiatrist many periencing a mental health or substance begins with successful treatment and es- years ago, I had a mentor use disorder. In fact, one in five Ameri- tablishing healthier lifestyle habits. W who was one of the most cans is living with mental health condi- well-known and beloved child psychia- tions, according to National Alliance on Home- Even after successful treatment, trists in Illinois: Jay Hirsch, MD. Jay had Mental Illness (NAMI), and 21 million individuals still have to integrate back many sayings, quotes, and “clinical Americans experience substance use dis- into their everyday lives and routines. pearls” he taught all of us and I continue orders, according to Substance Abuse and This can be scary as recovery is often a to use today. One of my favorites was that Mental Health Services Administration complete lifestyle change. The ‘home’ he believed everyone had a story about (SAMHSA). ingredient includes establishing new rou- their lives and why they were coming for The good news is…treatment works! tines, new people, places, things and sup- help. He said that it was our job to find a Millions of Americans have transformed port, new coping skills and new ways of way for our patients to feel safe to tell that their lives through recovery. At Rose- thinking. story, and for us to hear it. He said that if crance, we experience that truth every we could do that, we’d be great psychia- day. We see individuals transform and Community- Staying involved in the re- trists. Recently, I was reflecting on these lead productive, rewarding lives; we wit- covery community is integral to overall words: Storytelling can change the world. ness families being restored and commu- success. It provides an individual with a There’s a lot of truth there. Storytelling nities working towards healing and support network where they can receive acts as a sort of medicine and a rudder Tom Wright, MD wholeness. helpful feedback and encouragement; stay when all else feels directionless: stories As we celebrate recovery this month, connected and be held responsible for we tell at the end of a long day; stories cation Assisted Treatment. After 20 years we call attention to individuals, like Kris- their actions and decisions. that bring people together over a meal and of abusing opioids, Kristin had lost nearly tin, who have achieved and maintained stories we turn to during our darkest of everything. However, she began actively their hard-earned recovery, but also in- Purpose- Purpose helps sustain and main- times. With that in mind and in the spirit working towards recovery and receiving form and educate others on the level of tain recovery. Individuals may experience a of recovery month, I begin with a story of monthly injections of Vivitrol to help con- commitment recovery really takes. new found life purpose through their recov- recovery from a Rosecrance client… trol her cravings. It changed her life. I like to think of recovery as a recipe ery, which motivates and drives them to At Rosecrance we see over 30,000 “I feel like everything I've tried to do that needs the right combination of ingre- continue moving forward. For many, this clients annually and we hear a lot of in- to stay clean is finally working,” says dients. What does that recipe look like? includes giving back and sharing their story. spiring stories along the way. Kristin I. Kristin. “I feel like I'm succeeding at This year’s recovery month theme “Join recently shared her experience with Medi- something for the first time in my life.” the Voices of Recovery” focuses on four see Recipe on page 28
Transition at NYTC – Stay’n Out Programs
By Staff Writer peutic Communities through the Ameri- Behavioral Health News can Correctional Association. These stan- dards have also been adopted by the Fed- eral Government. onald Williams, Founder and the Ronald Williams has received numer- President/CEO announced his ous awards including commendation by the retirement, effective July 2018 – NYS Bar Association for outstanding con- after which he will continue in a tributions to the Rule of Law and the Ad- Rpart time capacity, and subsequently a mem- ministration of Justice. He has also been ber of the NYTC Board of Directors. awarded the Saint Bonaventure College NYTC, Inc was founded in 1977, and has Award for excellence in Public Service and over forty years of experience providing the NYS Governors Lifetime Service substance abuse treatment to adults in the Award for extraordinary dedication and criminal justice system. They operate com- years of service in the field of addiction. munity-based programs utilizing a therapeu- Mr. Williams states, “As Founder and tic community (TC) model. The mission is Developer of this landmark program, I to help participants effect changes in be- take great pride in having served as its havior and attitude that will enable them to President/CEO for the 41 years of its make those choices appropriate to a existence. I am pleased to announce that healthy, positive lifestyle. Since its incep- a friend and colleague, who has served as tion in 1977, NYTC has successfully my Executive Vice President, for the treated thousands of men and women, Ronald Williams Seep Varma past 20 years, Mr. Seep Varma, will as- helping them to lead productive lives, free sume the position of President/CEO. of involvement with drugs and crime. tic Community that served male and female programs are currently served in both resi- This is more than well deserved. I wish Mr. Williams began his career in the inmates of the NYS Department of Correc- dential and outpatient modalities. to thank my Board of Directors for their substance abuse field over 50 years ago as tions for over 30 years. The Stay’n Out pro- Mr. Williams has assisted in the imple- untiring support, our exceptional funding one of the founders and first graduates of gram was the first such in-prison therapeutic mentation of in-prison treatment programs source, OASAS, our Sister Agencies, the Phoenix House organization, where he community (TC) program that was inde- in 32 states and several foreign countries, and the outstanding Staff of NYTC, Inc., held clinical and administrative positions. pendently researched from inception and including, Malaysia, Thailand, Columbia who have made this magnificent journey During his many years of involvement in whose impressive success rate attracted and Italy. Mr. Williams has served as possible. Above all, my thanks and admi- this field he has served as an expert in National and International attention and Vice President of Therapeutic Communi- ration to the clients that we have served demand reduction and as a technical assis- replication. Mr. Williams also implemented ties of America and is former Chair of the throughout the years and who by their tance advisor and trainer for the US De- the Serendipity Community-based TC pro- Criminal Justice Task Force of that asso- success, proved that NYTC, Inc. is an partment of State. gram or criminal justice clients returning ciation. In this position he led the success- exemplary program.” Mr. Williams is the Founder of the from incarceration and, also as an alterna- ful effort to develop and implement ac- NYTC, Inc., Stay’n Out in-prison Therapeu- tive to incarceration. Participants of NYTC creditation standards for in-prison Thera- see Transition on page 27 PAGE 22 visit our website: www.mhnews.org BEHAVIORAL HEALTH NEWS ~ FALL 2018
Partnerships and Collaborations: A Model for Enhancing Access and Enrollment of Children and Families into Health Home Care Management
By Amanda Semidey, LCSW, and monitor and more successfully transition Kathleen Rivera, LCSW children and families to appropriate CBC and JCCA needed services. Despite this, many medi- cal providers remain unfamiliar with the process of enrolling children and are re- ommunity-based case manage- luctant to make referrals to Health Home ment (CM) services, in general, Serving Children programs (Citizens and specifically those geared Budget, 2018). This fact remains true C toward children and families, even when providers recognize that com- have historically been fragmented. Prior prehensive care management is needed to the Patient Protection and Affordable and will result having in social determi- Care Act (ACA), New York State had a nants of health needs addressed, and be- wide array of disparate CM services, in- havioral health services offered to some cluding Targeted Case Management of the youngest and most vulnerable pa- (TCM) serving children with severe emo- tients they serve. The challenge for many tional disturbances, Voluntary Foster Care medical providers has been in understand- Agencies (VFCA) 29I providing case ing how they can refer their patients, management to children separated from while parents and caregivers may con- their caregivers, State Plan Services, and tinue to have difficulties accessing the 1915c Waiver Programs to name a few. In right services at the needed intervals due 2012, New York State opted to implement to “separate social-service realms and Health Home (HH) under Medicaid Re- divergent funding streams” (Center for design (MRT). Health Home was thus Amanda Semidey, LCSW Kathleen Rivera, LCSW New York City Affairs, 2018). defined as the mechanism/vehicle to ad- Coordinated Behavioral Care (CBC), a dress health care fragmentation and bal- agement and coordination, integration of was identified as the hub and gateway to member-led organization, established in looning population health concerns physical and mental/behavioral care, and Community-Based Care Management 2011 by many of New York City’s behav- (Thomas E. Smith, Matthew D. Erlich, & links to non-clinical supports—thus has services and the Health Home Serving ioral health and human services providers, Lloyd I. Sederer, 2013), intended to sup- the potential to improve the overall health Children (HHSC) model was expected to offers a vast array of medical, behavioral port a more integrated model of service and quality of life for some of the most provide “no wrong door” access to an health, rehabilitation and supportive hous- delivery shifting the practice standard vulnerable Medicaid beneficiaries” (U.S. array of critical Care Management ser- ing services across the 5 boroughs, was from siloed to collaborative practices Department of Health & Human Services vices for children beginning in December designated a Lead Health Home in 2012. (Mechanic, 2013). “The health home Assistant Secretary for Planning & 2016. By linking individuals to behavioral CBC’s Health Home provides city-wide model’s whole-person approach— Evaluation Office of Disability, 2017). health and medical providers, Community encompassing comprehensive care man- In New York State the Health Home -Based Care Management is expected to see Model on page 23
Building Partnerships to Transform Autism Services
By Ilene Lainer originated the idea for the school, and its experimental nature, HARPP is now a Co-Founder and President recruited private donors; the New York part of Hunter, its courses offered by the NEXT for AUTISM State Board of Regents, which issued the college’s Education Department. charter; and the New York City Depart- The Center for Autism and the Devel- ment of Education, which operates the oping Brain (CADB) was conceived at ince 2003, NEXT for AUTISM school. This public-private partnership time when families facing an autism diag- has launched an average of 1.5 resulted in high-quality, evidence-based nosis often had to coordinate disparate programs per year, a pace that public education options for families in services while simultaneously trying to S matched the urgent needs of indi- the five boroughs of New York. Among understand what a diagnosis of autism viduals and families living with autism the innovations were community-based truly meant for their child and their family. and our own desire to help grow the field instruction, work internships, and peer NEXT for AUTISM, whose founders and of autism services. As proud as we are of mentoring programs. The school has since board members are parents themselves, this pace, we could not have achieved it been replicated in the Bronx, fulfilling approached NewYork-Presbyterian Hospi- alone. We wanted to go fast, and we also NEXT for AUTISM’s wider transforma- tal and its partner medical schools, Colum- wanted to go far. tional goal – in this case, creating capacity bia Vagelos and Weill Cornell, as partners NEXT for AUTISM has understood that in a large, metropolitan school system to to address this immediate need for a more in order to accelerate change, we had to rethink education for children with autism rationalized approach. Our vision was to build partnerships. Rather than reinvent the and create two specialized autism schools create a family focused diagnostic and wheel, we chose to enhance quality services inside of already existing public schools treatment center offering comprehensive that already existed, particularly for people located in underserved communities. and coordinated treatment by clinicians with developmental disabilities other than Ilene Lainer The Hunter Autism Research Practice from multiple disciplines. We also sought autism, and adopt them to meet the specific & Policy Center (HARPP) at Hunter Col- to build capacity for autism research within needs of the autism population with evi- cation and professionalism of the found- lege has an ABA-certification program for a major metropolitan hospital system. dence-based strategies. We rely on data to ing staff at each newly launched entity; professionals within the City University Throughout several years of planning, assess the needs, then build on best-in-class and the continued support provided by of New York system and a Masters of the partners formulated details that ranged solutions to transform the landscape of au- each partner to the new entities at critical Science in Applied Behavioral Analysis from CADB’s clinical approach, to lead- tism services for people with autism. stages of growth. opening this year. At the time of ership recruitment, affordability of care, Our partnerships involve public and HARPP’s creation, ABA was gaining and the bricks and mortar renovation of a private entities, as well as collaborations Large-Scale Partnerships momentum as an effective intervention dedicated building on the Westchester among not-for-profit organizations. They for autism. Based on research that we had campus of NewYork-Presbyterian. The succeed in affecting systems transforma- The NYC Autism Charter School in gathered, with commitment from Hunter outcome was a state-of-the art center, led tion, in large part, due to: a high level of Harlem opened after several years of col- College at the dean’s level, and funding by one of the country’s foremost experts commitment at the leadership level of laboration among three key partners: from private donors, HARPP came to life in autism, Founding Director Dr. Cath- each partner organization; a shared insti- NEXT for AUTISM, which identified the and has since educated thousands of pro- erine Lord. Since 2013, CADB has tutional drive towards innovation and a need for evidence-based education for fessionals in ABA practices. Once a spe- comfort with program iteration; the dedi- children with autism in New York City, cial program of the Dean’s office due to see Autism Services on page 27 BEHAVIORAL HEALTH NEWS ~ FALL 2018 visit our website: www.mhnews.org PAGE 23
Leaders Join Mental Health News Education Board
By Staff Writer Behavioral Health News
ental Health News Education, Inc. (MHNE), the nonprofit organization which publishes Behavioral Health News and MAutism Spectrum News, is pleased to
announced three leaders who will be join- ing the organization’s Board of Directors this fall. Debbie Pantin, MSW, MS-HCM, MHNE Board Chair and President and CEO of Outreach, remarked, “We are delighted to welcome three new out- standing leaders to MHNE’s Board of Directors. They represent vital sectors of the nonprofit and corporate community that support the behavioral health and autism education mission of our organization.” Roy Kearse Matthew Loper Keri Primack Roy Kearse, LCSW, Vice President for Recovery and Community Partnerships Mr. Kearse stated, “I am honored to In 2014, while at OrbiMed, he was the BWD Group Ltd, and in the life insur- Samaritan Daytop Village join the MHNE Board of Directors and struck by the idea of using scalable digital ance department for Nathan & Lewis Se- will endeavor to help this vital organiza- interventions and behavioral economics to curities. She started her career at IDS, as Roy Kearse, LCSW and CASAC tion further its’ behavioral health and au- improve the behaviors and outcomes for an assistant to a financial advisor. emeritus has worked in the field of ad- tism education mission.” individuals with chronic conditions. He Ms. Primack is a Certified Financial diction and mental health for over 35 started Wellth to accomplish that goal and Planner (series 7 and 63 registered), and a years. Serving in various administrative Matthew Loper has raised $7.5 million of venture financing graduate of the State University of New and leadership roles with major nonprofit CEO and Founder from strategic investors including large York, Oneonta with a Bachelor of Science organizations, he has served on many Wellth insurance companies like AXA and NY degree in business economics. boards and government oversight enti- Life as well as large pharma companies A native New Yorker, Ms. Primack ties. They include: Board Chair of the Matthew Loper has long been inter- like Boehringer Ingelheim. lives on Long Island with her husband, Faith Mission Crisis Center; the OASAS ested in scalable approaches to improve Mr. Loper stated, “I am excited by the Adam, and their two children, Ian and Credentialing Board; Past President of the health and wellbeing of people. He mission of Mental Health News Educa- Blake. ASAP; past Member of the Governor’s studied biological engineering at MIT in tion, and its’ important focus on mental Ms. Primack stated, “I am very dedi- Advisory Council; past 2nd Vice Presi- the hopes of someday developing novel health issues that has been overlooked by cated to the autism treatment, advocacy, dent of the NYC Chapter of NASW; therapeutic treatments for those who suf- our health system, society, and govern- and education mission of MHNE’s pub- Board Member of NYS TCA; Board fer from previously untreatable condi- ment for too long.” lication, Autism Spectrum News, and Member of Exponents Harm Reduction; tions. But after experiencing the realities look forward to assisting in MHNE’s Board Chair of New York Certification of academic research, he strived to get Keri Primack, CFP, Managing Director, vital efforts to help families learn about Board, and current Vice President of exposure to the healthcare industry from Senior Vice President and Client Advisor and cope with children on the autism Recovery and Community Partnerships. more of a commercial and entrepreneu- Gerstein Fisher spectrum.” Mr. Kearse has devoted his career to rial point of view and headed to Wall MHNE Founder and Executive Direc- improving pathways to recovery and Street. After working in the Healthcare Keri Primack, CFP, joined Gerstein tor, Ira Minot, LMSW and Associated helping thousands on that journey. Investment Banking Division of Gold- Fisher, an investment management and Director, David Minot, stated, “We are In his personal life he is a proud fa- man Sachs, he headed to OrbiMed Advi- advisory firm, in March 1998 and is cur- both so honored and excited to have Roy, ther, husband, and community servant sors, a healthcare focused investment rently a Managing Director, Senior Vice Matthew and Keri join the MHNE Board. serving on his church Deacon Board and firm that manages $14 billion and has President, and Senior Client Advisor. Their backgrounds and expertise in the participating in the Long Island Prison funded some of the most impactful phar- Before joining Gerstein Fisher, Ms. behavioral health, corporate, and autism Ministry where he mentors incarcerated maceutical, biotech, and healthcare ser- Primack worked in the property casualty communities will help us greatly in chart- individuals about making the right choices. vices companies in its 20-year existence. division of the insurance department for ing the future course of our organization.”
Model from page 22 multiple projects with the goal of devel- staff and families understood clearly the enrolled child and his/her family into oping and identifying best practices and concept of Care Management and the CBC’s HHSC program. The closed loop Community-Based Care Management opportunities designed to enhance the value add of HHSC services toward im- referral process supported workflow ad- services, through 48 Care Management utilization of Community-Based Care proving access to care while addressing herence, strengthened rapport, and as- Agency (CMA) partners, operating one of Management. In Brooklyn, CBC part- behavioral health and health outcomes. sured individual stakeholder accountabil- the largest behavioral health HHs in NYS, nered with Maimonides Medical Center CBC, JCCA, and MMC had numerous ity so that medical providers would know serving 18,000 enrolled members with an (MMC) and one of our largest children’s collaborative meetings to level-set expec- the status and disposition of each referral. additional 2,500 potential members in serving CMAs: JCCA, a founding mem- tations, develop the design and tenets of MMC invested resources and allowed outreach and engagement services. Build- ber agency of CBC. JCCA has a nearly the model, and identify workflows for the JCCA to train their providers and admin- ing on the technology platform, training 200-year history of providing comprehen- seamless identification of referents with istrative support staff on HHSC services, and technical assistance, quality and ad- sive care to more than a million abused, the best practice goal of a closed loop the co-location model and vision, and the ministrative oversight established in the neglected, and traumatized children, referral process. full array of JCCA services well beyond adult HH, CBC was formerly designated young people and families who come The Co-Location Care Management Care Management. JCCA reinforced the as a HHSC Lead in December 2016. Our from New York’s diverse communities. Model pilot was launched in April 2018, same educational programming and train- HHSC program oversees 24 Children’s The early partnership included case with JCCA co-located at MMC’s Newkirk ing with its own workforce and hired a CMAs, serving nearly 2,400 young peo- conference reviews and strategic planning Family Health Center in Flatbush, Brook- dedicated Master’s Level intake/outreach ple and their families, with a core mis- in the identification of potentially eligible lyn several times per week. The work- coordinator specific to the co-location sion of delivering high quality Commu- and appropriate individuals for HH ser- flows were designed to optimize access to pilot. This staff person served as the liai- nity-Based Care Management that sup- vices. It was with this concept in mind, and needed services and facilitate HHSC eligi- son for MMC staff and the families served port cost effective, integrated health care leveraging this long-established relation- bility screenings with an on-site JCCA by the Newkirk Family Health Center. services across developmental stages and ship, that CBC, JCCA, and MMC, first intake/outreach coordinator. The collabo- The coordinator was equipped with mo- functional needs. developed the vision of a Co-Location ration involved all stakeholders working bile technologies affording her the Over the years, CBC has collaborated Care Management Model in the fall of closely with MMC’s clinicians to ensure and partnered with many stakeholders on 2017. The goal was to ensure that medical access was timely and meaningful to each see Model on page 26 PAGE 24 visit our website: www.mhnews.org BEHAVIORAL HEALTH NEWS ~ FALL 2018
The Future from page 1
strained by caregiver duress, will be rou- tinely assessed, monitored and supported. True rapprochement between the be- havioral health and substance abuse worlds: Neuroscientific findings proving the connections between mood and anxi- ety disorders and substance use will lead insurers to insist that behavioral health and substance abuse services co-locate and integrate. This momentum will ensure that therapeutic and medication assisted treatment are provided based on each per- son’s needs and wishes, unrestrained by provider biases, and informed by science. A healed rift between behavioral and physical health: In the future, all medical settings of every subspecialty will have behavioral health providers on their teams to provide services tailored to a con- sumer’s given condition (be it cancer or Crohn’s disease), psychological status Barry J. Jacobs, PsyD Heidi Arthur, MSW Meggan Schilkie, MBA (merely stressed or sunk in despair) and social stratum (resource-rich or low in- mission rates and related metrics to iden- including medical and social experts, who be better overall care for all, especially come). All independent behavioral health tify consumers who require more intensive will treat consumers holistically in their the most vulnerable and populations that agencies will have established ties and services across multiple settings. Outreach, homes, communities and, when critical, are currently devastated by health dis- easily accessed communication systems to engagement, and intervention will benefit within facilities. Telehealth and telemetrics parities. surrounding medical facilities to share from local liaisons and advisors whose will routinely and seamlessly reinforce care Daring leadership: Leaders who thrive patient data, medication lists, and treatment community health workforce will be best delivery at every stage of treatment and in the future will continue to be those who plans for far better care coordination. Con- able to engage high risk individuals and provide access in areas and settings facing are bold, compassionate, and ready to take sumers and family members will no longer populations. provider shortages. risks. They will direct organizations that feel that one “healthcare hand” doesn’t Expanded Ease of Access: Most outpa- A firm grasp on value: Costs for this attend to provider wellness and wellbeing know what the other hand is doing. tient services will include interprofes- “go-anywhere/do-everything”, team- with as much attention as to consumer A command of complexity: Behavioral sional, cross-trained and highly collabora- based care will be borne by shared sav- wellness and wellbeing. Data-informed health agencies are already ahead of their tive teams able to offer individualized ings, reductions in hospital utilization, management systems will target provider physical health counterparts in identifying care when and where needed and as in- and braided/blended funding from across support and training for providers based the highest-need consumers and creating formed by meaningful demonstration of the health and human service systems. on measures of their performance out- wrap-around services to keep them out of success with similar conditions. Consumer Increasingly consolidated, multiservice comes, productivity, and satisfaction. emergency rooms, hospitals, and jails. feedback and data analytics will guide will providers will be organized into inte- Leaders will be supported by involved They will continue to refine their ap- guide ongoing attention to ensuring that grated networks to share resources and board members who share a commitment proach to those at highest need by further teams are culturally and linguistically com- efficiencies. They will benefit from qual- to progress and innovation. extending into these and other sectors and petent, and providers will have support to ity indices and population health strate- Robust and transparent quality systems community settings and networks. In the identify and address even their uncon- gies that help them pivot proactively to will guide and inform efficient and pro- future, complex care management will be scious biases. Cross sector collaborations address emerging issues and target high- ductive team-based care in a culture that more advanced and effective, using pre- will support stratification and intervention need/high-cost consumers with new or dictive analytics, rather than hospital read- to deploy these interprofessional teams, more intensive services. The result will see The Future on page 30
20 Questions from page 1 prescription and over-use of opioid pain- jobs in the system of care. Will these very killers. Will treatment for substance abuse difficult issues be addressed? 11. People in crisis often do not get an become more readily available? Will adequate response. Emergency rooms, harm-reduction measures be put in place 20. Finally, inadequate funding for a broad especially in large urban areas, are often a to reduce deaths from overdoses? range of mental health services is one of the horrible experience. Mobile crisis teams, reasons that America’s mental health system few as there are, often are not available at 17. It does not appear that the incidence has improved only gradually over the past times when they are needed. People who and prevalence of mental and substance half century. New financial structures are seek help for themselves or their families use disorders have declined as the behav- explicitly designed to reduce future costs by do so when they feel they are in crisis, but ioral health system has grown and more reducing the need for intensive, high-cost they often experience long waits to get effective treatments have been developed. services such as emergency rooms and inpa- mental health services in overloaded clin- Will more broad-based preventive inter- tient treatment. Better care at lower cost is ics and cannot get intensive services when ventions be put in place? the promise. This is a promise that has been they need them. Will these problems be made many times before. Dorothea Dix adequately addressed? 18. The behavioral health system is unpre- promised that asylums would reduce the pared for the major demographic changes costs of poor houses. The Community Men- 12. People with serious mental illness die taking place in America—the elder boom tal Health Centers Act promised that the 10-25 years younger than the general and the shift from a white majority to a dollars would follow the patients. Neither population. Will the mortality gap be reduced? non-white majority. Will the needs of proved to be true. Will the new promise be older adults become a major concern of fulfilled? 13. Too many people with serious, long- the mental health system? Will the needs term mental disorders do not have stable of non-white populations, especially those I am personally both hopeful and skep- housing or are homeless. Will homeless- for whom English is not a primary lan- tical about the new financing structures. ness be reduced and stable, safe housing Michael B. Friedman, LMSW guage, be addressed? Their brilliance is undeniable; their effec- increased? tiveness is yet to be proved. And even if 19. At the heart of many of the inadequa- they work, it is not clear that they will 14. Too many people with serious mental 15. Suicide is on the rise—up 20% since cies of the mental health system are vast bring about broad transformation of the illness are in jails or prisons. Will the the turn of the century. Will more effective workforce shortages. We need more, and mental health system. We’ll see. number of people with serious mental suicide prevention interventions be devel- more competent, mental health profession- illness in jails because they cannot make oped and put in place? Will the mental als including psychiatrists—especially Michael B. Friedman is Adjunct Asso- bail be reduced? Will incarceration for health system face up to the fact that guns child and geriatric psychiatrists, psycholo- ciate Professor at Columbia University minor crimes be replaced by humane al- are the major instrument of suicide? gists, clinical social workers, nurses, etc. School of Social Work and the volunteer ternatives? Will the criminalization of We also need more and better trained para- Chair of the Geriatric Mental Health Alli- substance abuse be replaced by intelligent 16. Overdose deaths are increasing de- professionals doing some of the most im- ance of New York. He can be reached at “harm reduction” interventions? spite some effective efforts to reduce the portant but underappreciated and underpaid [email protected]. BEHAVIORAL HEALTH NEWS ~ FALL 2018 visit our website: www.mhnews.org PAGE 25 A Performance-Driven Culture in a Children’s Mental Health Agency
By Andrew Malekoff and contextual variables, performance- is being made toward the goals of treat- Executive Director, North Shore driven organizations must consistently ment. Standardized tests should be a part Child & Family Guidance Center collect and organize data in order to meas- of the mix in determining progress. ure the impact of their services The data may be guided by the following four • What is the cost of service? This has to eveloping a performance- questions: 1) What do we do well? 2) do with cost and how effectively you are driven culture in the children’s What impact are we having? 3) Why using your resources to support your mis- mental health system is a com- would anyone refer to us? and 4) What sion. This should include the time spent plex process that includes en- outcomes make us most proud? on collateral contact, which can be espe- gaging,D assessing, treatment planning, Although we can describe outcomes cially costly in the children’s mental gathering data, measuring outcomes, and anecdotally, measuring them by collecting health system. The payer mix is also im- evaluating and continually improving care. data is essential to making the most pow- portant to understand. Although evidence-based practice erful statement about the value of your (EBP) has become a norm, treatment- service and what you do well. A good Measurement Criteria and Continuous based evidence must also be considered place to start is by gathering the data you Quality Improvement given the multiple variables in play that already have. This includes: do not adhere to the laboratory conditions It is best to select data that is likely to within which EBPs were formulated. • Who is served? This refers to data which show change and success, using data that is For example, attention to crises and col- offers an understanding of the population measurable and actionable. For example, lateral contacts with family members and and demographics of those that seek your data that measures engagement and reten- child-serving systems is essential to any services with an eye toward any dispari- tion can lead to planning and action steps credible children’s mental health service. Andrew Malekoff ties around, for example, race, ethnicity, to improve practices that lead to children There are costs associated with collat- religion, socioeconomic status, language, and their families staying in treatment. eral work and crisis intervention that must nary and team-oriented nature of credible disability status, sexual orientation, gen- Using a continuous quality improve- be quantified in determining appropriate children’s mental health practice. der identity, etc. ment (CQI) model aiming at incremental rates of value-based payment. change can help. This might include con- At the same time that collateral and Gathering Data • How are they served? This utilization sidering the following three questions: (1) crisis work must be elevated in determin- data helps you see how your resources are how are we doing? (2) how do we know? ing value, the use of evidence-based pro- A key source of information for this being used, how productive you are in and (3) can we do better? tocols cannot be overestimated. section was a presentation by Brianna engaging those who need you and how A Plan – Do – Study – Act (PDSA) Too often, evidence-based practices O’Connor and Boris Vilgorin, NYU well you sustain contact. approach can then be used for implement- lack sufficient attention to (1) context McSilver Institute, “Tools to support the ing incremental change projects. (e.g. poverty, oppression, community vio- development of a performance-driven cul- • How well are they served? This refers to For example, at North Shore Child and lence, etc.); (2) the multiple intervening ture,” July 25, 2017, at New York Univer- outcome data that includes understanding Family Guidance Center we keep variables in a child’s life that are at play at sity School of Social Work. whether people are getting what they need any given time; and (3) the multidiscipli- In addition to paying attention to EBP in a timely manner and whether progress see Culture on page 27
Human Development
Services of Westchester
Human Development Services of Westchester is a social service organization providing quality psychiatric, Brown Bell Consulting is a full service Government rehabilitative, residential and neighborhood stabilization and Community Relations company. We provide services in Westchester County. organizations with customizable solutions to meet all of their local, state and federal government relations needs. HDSW is dedicated to empowering the individuals and To find out more about how we can help your organization, families we serve to achieve well-being. The mission is ac- please contact us for a personal consultation. complished through the provision of housing, vocational
We look forward to working with you. services, case management, community support, and mental health rehabilitation services. Constance Y. Brown-Bellamy, MPA President and CEO - Brown Bell Consulting, LLC HDSW - Main Office HOPE House - Clubhouse 930 Mamaroneck Avenue 100 Abendroth Avenue External Relations Specialist Mamaroneck, NY 10543 Port Chester, NY 10573 [email protected] (202) 486-0495 (914) 835-8906 (914) 939-2878 PAGE 26 visit our website: www.mhnews.org BEHAVIORAL HEALTH NEWS ~ FALL 2018
Model from page 23 The staff also had a strong foundation in In order to minimize the length of time MMC to strengthen the service delivery social determinants of health and their from referral to outreach/enrollment activi- system, while working toward the ulti- flexibility to enroll the families at a time overall impact on behavioral health and ties, MMC provided access and trained mate goal of integrating care for children and location that was most convenient for health outcomes. The investment of Mas- JCCA staff on their electronic health re- and their families. While these findings them, whether it was on site at MMC or at ter’s Level staff, oftentimes at a higher cord (EHR) systems. This enabled the in- demonstrate early successful collabora- a later time in the community. salary, was nonetheless made to safeguard take/outreach coordinator to quickly access tions, CBC, JCCA, and MMC continue to Convening frequent joint meetings had that the pilot was initiated with skilled referrals, connect with the families imme- focus on building a strong alliance, with the dual focus of macro as well as micro- staff with expertise in delivering personal- diately at the clinic or in the community, the identified undertaking of community system change implications. HHSC 101 ized engagement and care planning. This and begin the engagement and enrollment access to Care Management services trainings were offered to the medical staff, seasoned staff was the gateway to JCCA’s process promptly. This workflow enhance- aimed at prevention and improved out- including specialty staff, such as neurolo- broader services, but also educated and ment also mitigated concerns about secure comes. In July 2018, the Co-Location gists and psychiatrists, with an emphasis engaged families in a professional and methods of obtaining necessary supporting Care Management Model was expanded on Community-Based Care Management person-centered way related to Commu- documentation used to determine HHSC to include referrals from MMC’s Pediatric intended to improve the continuity of care nity-Based Care Management services eligibility and appropriateness criteria for Emergency Department and Pediatric and address issues of social determinants offered by CBC’s HHSC program. The Care Management services. Inpatient units. The numbers thus far are of health, particularly how these gaps staff needed to be nimble, and despite the modest, with only 20 referrals from the jeopardize or impede improved behavioral multiple stakeholders involved, an expec- Outcomes & Programmatic Enhance- hospital directly, nevertheless this rein- health and health outcomes (Braveman & tation was set that alliance would be in the ments: There was an understanding that forces the commitment to creating path- Gottlieb, 2014). Studies indicate increased best interest of the child and family roadblocks and obstacles would need to ways to healthcare and Community-Based parental satisfaction when Care Manage- served. The expectation was established be addressed along the way. The goal was Care Management services. ment services were co-located into pediat- that the intake/outreach coordinator would to start small and learn as we progressed. CBC, along with our partners JCCA ric settings. Parents reported an increased ensure a warm hand-off to CBC’s HHSC MMC provided space several days a week and MMC, aim to be at the forefront of capability and fluidity in discussing con- and JCCA’s Care Management program for JCCA staff to engage families pri- changes in the overall health care delivery cerns with nursing and medical staff, a and communication of the disposition of vately. Space, always being a scarcity, system in order to ensure all individuals greater ability connecting to community the referral was shared with the referent. proved to be both invaluable as it commu- receive needed services in their commu- resources, and an enhanced aptitude re- nicated a formal extension of the services nity in the most expeditious and appropri- lated to both the “goals for care” and ad- Communication & Relationship Building: rendered at the Newkirk Family Health ate manner. Our mission has allowed the herence in filling prescriptions (Antonelli Community providers have historically Center and, on occasion, a challenge as stakeholders to focus on both short and & McAllister, 2009). competed for contracts and staff, MRT space at most sites is limited. Leadership long-term goals, while recognizing that This pilot involved the co-mingling of has afforded stakeholders an opportunity at both MMC and JCCA capitalized on system transformation must include all teams, departments and programs and to view each other as collaborators, yet it these interactions as a creative time to stakeholders to ultimately be successful. required a significant culture shift. There remains important to address “buy-in.” reinforce the collaboration toward further The longer-term impact of these transfor- was an early acceptance and understand- The longstanding “what’s in it for me?” stakeholder engagement. Jointly, the enti- mations remains to be seen. The Co- ing that both MMC and JCCA would need question must be first acknowledged and ties began to approach space limitations Location Care Management Model has to modify their traditional referral proc- then addressed. A focus on the inherent as opportunities to engage newer provid- yielded early modest successes and CBC, esses. Both entities rallied their work- synergy among the stakeholders and the ers into the co-location model and in- JCCA, and MMC continue to coalesce our forces, guided by the goal of creating ac- children and families that could be en- crease child and family referrals. programs around the goals to provide the cess, engagement and enrollment to gaged via this model remained at the fore- quadruple aim: better care, improved HHSC services, with a shared understand- front of our work. Designated “point- Over the co-location pilot’s first 5 health outcomes, lower healthcare costs, ing that this focus would improve the persons” were identified to troubleshoot months, MMC has referred 83 children to and improved experiences by individuals health and behavioral health outcomes of issues, provide guidance and/or address CBC’s HHSC program. JCCA has suc- meaningfully engaged in their health out- all enrolled children. Promoting an effi- barriers. Workforce development and cessfully enrolled 49 children (59%) and comes. We remain committed to design- cient enrollment process was paramount to cross-training of front-line staff as well as 24 children (29%) are receiving outreach ing collaborations such as this one toward the success of the pilot. A few tenets have supervisors and administrators was neces- services, thus far representing an impres- the ongoing improvement of children and guided this collaborative endeavor, includ- sary and determined to be an ongoing sive combined engagement and conver- young adults’ system of care, while simul- ing a unique focus on the intersection be- requirement. Stakeholders developed sion rate (88%). It’s well documented that taneously adapting to the larger healthcare tween the provider (MMC), the Lead workflows jointly, cross-trained key staff enrollment in HHSC has remained a chal- system transformation. Health Home (CBC) and the Care Manage- in tandem, and collaboratively envisioned lenge; for example, since December 2016, ment Agency (JCCA), while at the same the inherent value in creating a clinical CBC’s HHSC year-to-date has received a About the authors: Amanda Semidey, time not losing sight of the child and fam- pathway of access to Community-Based total of 327 referrals for all potential NYS LCSW, is Vice President of Care Coordi- ily served. Here are some best practices Care Management toward improved out- referents combined. The Co-Location nation Services at Coordinated Behav- and lessons learned from our pilot: comes. These collaborative activities each Care Management Model at MMC’s ioral Care (CBC). Kathleen Rivera, addressed “buy-in” as well as provided a Newkirk Family Health Center therefore LCSW, is Senior Vice President of Care Staffing Skill & Level: The Care Manage- streamlined and efficient referral proce- represents over a fifth (22%) of all exter- Management Services at the Jewish Child ment staff involved in the pilot were se- dure, and what ultimately emerged was an nal stakeholder referrals into our Commu- Care Association (JCCA). For more infor- lected to ensure skills and competency in infused passion for community-based nity-Based Care Management services mation regarding CBC’s HHSC Co-Location interacting with MMC providers, as well partnership. since the inception of our HHSC program. Models, contact Amanda Semidey at as being able to engage and interact with The Co-Location Care Management [email protected] or visit our website at children and families swiftly and fluidly. Data Collection & Workflow Development: Model has allowed CBC, JCCA, and http://www.cbcare.org.
System from page 8 society speaks about mental health. Initia- therapist I’ve had. When they would our disposal, and some conflation about tives like New York City First Lady Chir- leave, I would maintain my balance by the different roles of staff and providers. reminder phone calls, to car services to lane McCray’s ThriveNYC, acknowledg- taking my medication and doing my ther- Turnover among staff and providers can help us get across town, these simple ser- ing mental health, educating the public apy…And I haven’t utilized or needed a also be difficult. It is hard when you find vices help us follow through with care and that mental illness is nothing to be Care Coordinator. I practice something rhythm and establish a good relationship stay motivated. ashamed of, and promoting available ser- called mindfulness, which, to be honest with someone, only for them to leave and vices are not only helpful in breaking with you, has been one of the major fac- not be immediately replaced. As one of us “Back in the day when I first came here, stigma, but also help us feel empowered tors in allowing me to stay on the true expressed, “In the last three-and-a-half I wasn’t going to any appointments or and more informed. right path: sober, no drugs, no crime… years, I’ve had four psychiatrists and one groups. I didn’t care. I just got my apart- For those of us who have less of a need But if I ever reach the point where I be- psychologist, and every time I turn ment and I was happy that I wasn’t on the for services like Care Coordination and lieve I need a Care Coordinator, I know around, they are gone. Then you have to streets. But everything changed and it’s Home and Community Based Services, who to call. I know about these services start the whole process over again.” gotten much better…I don’t want to miss we spoke about the ways that we draw on and am aware that they are available. If I Still, we see immense value in the anything because I want to progress.” our own personal resilience -- our own ever need it, I’ll take advantage of them.” goals of system transformation: better tools and resources to deal with our health care, improved health, lower costs, and The reassurance of knowing that ser- challenges. While our experiences have been improved patient experiences. We look vices are available: Thinking back to the mostly positive, we still see challenges in forward to seeing how care will continue way services have changed, we also real- “I’ve had six therapists in the seven the current system of care. Some of us to be transformed to move us closer to full ized that, in some ways, transformations years since I was released from prison. expressed confusion about all the services attainment of these goals and happy, in care have paralleled changes in how I’ve developed a connection with every available to us, not knowing everything at healthy futures. BEHAVIORAL HEALTH NEWS ~ FALL 2018 visit our website: www.mhnews.org PAGE 27
TMS from page 20 familiar with the shortcomings of studies Autism Services from page 22 Brain at NewYork-Presbyterian Hospital performed in their facilities, and practitio- in further partnership with the Southern PTSD, despite the FDA’s approval of the ners in this community continue to pre- served thousands of families, and thanks Westchester Board of Education Ser- drug for this condition. Other examples scribe Prazosin for PTSD-associated night- to leadership commitment among the vices. From lessons learned and suc- include a negative trial of trauma-focused mares, depot risperidone for Schizophrenia, partners, it was able to leverage the hospi- cesses in this earlier internship program, psychotherapy for PTSD, a negative trial and naltrexone for alcoholism. Recommen- tal’s bargaining power with insurance the partners went on to develop the cur- of FDA-approved naltrexone for alcohol- dations in VA practice guidelines state that companies to cover the individualized rent Project SEARCH - Autism En- ism, and a negative trial of depot risperi- sertraline be used as first-line pharmaco- services which previously may have been hancement package, which provides the done (vs. oral) for schizophrenia - all in therapy for PTSD, with trauma-focused challenged. NewYork-Presbyterian’s af- framework for job and life skills training solely VA populations. Why is the vet- psychotherapy promoted as first-line evi- filiated medical schools at Weill Cornell to adults. To date the package has been eran population so often at odds with the dence-based psychotherapy. Finally, with and Columbia University also became implemented nationally at sites including general population? One proposed reason the data from this recent TMS study in front partners in research, leading to collabora- Drexel University, the University of lies in who these people are and the train- of them, the VA purchased 40 TMS devices tions with researchers from these institu- California at Irvine, the University of ing they received. All of these study par- for use in its facilities around the country. tions and others around the world. Washington, Seattle, and again by ticipants go through at a minimum basic Indeed, these are exciting times in the NEXT for AUTISM at NewYork- training i.e. boot camp where the purvey- field of TMS. This summer I had the Employment Training for Presbyterian Hospital in partnership with ing ethos is no man left behind; these are pleasure of working with neuroscientists Adults with Autism The Arc Westchester. people willing to take a bullet for one in the brain stimulation labs at the Medi- ADVICE emerged from the growing another. Devotion to the cause, ‘esprit de cal University of South Carolina, where Project SEARCH – Autism Enhance- demand among companies to diversify corps,’ is impressed heavily among veter- TMS took root more than two decades ment, a training package offered to institu- their workforces and NEXT for AU- ans and lasts a lifetime. Though a veteran ago, and the most cutting-edge TMS and tions wishing to prepare adults with autism TISM’s recognition that there were not themselves may not be experiencing bene- brain stimulation experiments are cur- for successful employment, evolved from enough specialists to help develop the fit of a particular treatment or therapy, they rently under way. TMS as an instrument NEXT for AUTISM’S collaboration with capacity of corporations to integrate peo- may be inclined to see that one of their to measure consciousness, EEG-guided Project SEARCH at the Cincinnati Chil- ple with autism. NEXT for AUTISM has combat brethren has the opportunity for TMS, TMS for pain, cocaine addiction, dren’s Hospital Medical Center, an inter- always been a firm believer that a broad wellness, and over-report improvement to and acute suicidality, are not far-off theo- nationally recognized employment training range of people with autism can be excel- make a particular therapy or medication retical concepts, rather their future appli- service for people with significant disabili- lent employees provided they have the available to all, not appreciating the impact cations are being tested right now, and ties. We first approached Project SEARCH appropriate supports. Together with Au- this has on statistical analysis. show great promise for the treatment of to adopt its model program for youth tran- tism Speaks and led by a nationally re- There are numerous proposed reasons many neuropsychiatric conditions. sitioning from high school to adulthood. nowned expert , James Emmett, we cre- studies of the VA population often do not To tailor the already excellent program to ated ADVICE to train a cadre of consult- coincide with studies of other popula- Dr. Shapiro is currently a fourth-year students with autism, we worked with Dr. ants who will fan out to companies and tions, medication compliance, selection psychiatry resident at Westchester Medi- Catherine Lord to develop a comprehen- provide management training on such bias, and secondary-gain issues among cal Center in Valhalla New York. adam- sive program enhancement, with clear areas as supporting people with autism at them. The VA however, thankfully, is [email protected]. sequences and goals that target the work, creating workplace structures to strengths and challenges of learners with ensure successful outcomes, and em- autism. We then invited the TEACCH ployee sourcing. Corporations such as Transition from page 21 the Past Chairperson of the Criminal Jus- Autism Program at the University of North Cintas, Staples, and Quest Diagnostics tice Committee of the Alcohol and Sub- Carolina to work with us on the current have joined this partnership, resulting in Seep Varma is a NYS Licensed Clini- stance Abuse Provide (ASAP) Association autism enhancement package. hundreds of managers trained and an cal Social Worker, and CASAC, and has of New York State. This three-way partnership resulted equal number of autism hired. been with NYTC for 20 years. He holds a He joined New York Therapeutic first in a high-school to adulthood transi- MS degree from Columbia University Communities, Inc. (NYTC) in 1998 as the tion program that operated out of the Please visit www.nextforautism.org for School of Social Work, and a certificate Regional Director, primarily responsible Center for Autism and the Developing more information. in non-profit management from the Har- for oversight of the Stay’n Out in prison vard Business School. He currently serves TC programs and was named Vice Presi- as the Chair of the Coalition for Community dent of Clinical Services in 2005 and Ex- Culture from page 25 by administration; and defining roles. Services, is the Secretary of the Board for ecutive Vice President in 2008. During Time-limited cycles of up to four the Association of Alcoholism and Sub- this time, he has been instrumental in the track of broken, cancelled and kept ap- weeks in duration are best, so as not to stance Abuse Providers (ASAP), and serves agencies growth into outpatient treatment, pointments. To improve our practice we schedule meetings that have no end in on the Executive Committee of Treatment expansion of community based residential incorporated follow-up calls and then sight. The key to success is understanding Communities of America (TCA). services, oversight of the NYTC educa- follow-up texts and discovered that texts that this is not a static process, but rather Mr. Varma began his career tion and training programs and most re- have the greatest impact in improving a dynamic one. The idea is not to seek at Hospitality House in Albany, New cently in establishing an enhanced out- rates of attendance. perfection but to aim for continuous qual- York. He has also worked as a Psychiatric reach and engagement program for opioid ity improvement. Social Worker at Bellevue-New York users in Brooklyn. Teamwork and Culture Change University Medical Center and as Senior In accepting the position, Mr., Varma Hearts and Minds Case Manager for Treatment Alternatives stated “I look forward to continuing the Small teams of staff members devel- to Street Crime (TASC). He has assisted NYTC philosophy of delivering high oping time-limited changes projects work A performance-driven culture is about in the development of an in-prison thera- quality, effective, client-centered care and best. Having some institutional knowl- what you do well, how you will measure peutic community training curriculum for building on the over 40 years of success edge of group work planning and devel- its value and success, and how you con- the University of Missouri, served as con- of providing services to underserved opment is essential to developing suc- tract for value-based rates. sultant for the National Development and populations, I thank Mr. Williams, and cessful teams that are problem-focused For many organizations this may rep- Research Institutes (NDRI), and served as the NYTC Board for the opportunity.” and do not collapse prematurely or end- resent a culture shift. Agency leadership lessly flounder. is required to keep the momentum mov- There are fundamentals to building a ing forward, continuing to educate staff Promise and Peril from page 10 will surely influence the outcomes of their successful team that cannot be taken for members and bringing them on board interventions. granted. Most critical is proper planning, with their full hearts and minds. diagnoses. The authors stratified this popu- Performance measurement is now which includes clearly defining the needs lation according to an additional 29 char- deeply embedded in our health and be- to be addressed; formulating a clear pur- Mr. Malekoff may be reached at North acteristics and found 22 of them were sig- havioral healthcare system, its limitations pose; affirming logistics that are accept- Shore Child & Family Guidance Center, at nificantly predictive of readmission be- notwithstanding. It is incumbent on pro- able to all team members and sanctioned [email protected]. yond the standard adjustments originally viders and the emerging networks of applied (Barnett, Hsu & McWilliams, which they are a part to carefully evaluate 2015). Behavioral healthcare providers the opportunities it provides to advance that aspire to establish value-based pay- the Triple Aim and the hazards associated ment arrangements for complex popula- with its application. Our system’s long- tions, such as those enrolled in Health and term sustainability and the health and Recovery Plans (HARPs), would do well welfare of the individuals entrusted to its to heed these findings lest they be unjustly care hang in the balance. penalized by risk adjustment algorithms that fail to account for the many medical, Mr. Brody may be reached at Search for socioeconomic and other demographic Change at (914) 428-5600 (x9228), and by factors unique to these populations that email at [email protected]. PAGE 28 visit our website: www.mhnews.org BEHAVIORAL HEALTH NEWS ~ FALL 2018
Hub from page 14 Looking Ahead
talked about needing a place like the Since the start, the Hub project has Hub. The only thing we were missing been defined by dedication and collabora- was ICL.” I took what she said as tion. It’s a true team effort -- from the both a great honor and a profound funders and tax credit issuers who came responsibility. The Advisory Council, up with the complex financing arrange- which Cruz is an active member of, ments to the architects and designers who continues to help us understand the took up the challenge of creating the cen- structural and cultural barriers to ter that fulfilled our vision. And our com- health and well-being as well as ser- mitted and talented staff did the heavy Providing award-winning programs vice gaps and program needs. lifting to get us to the finish line and con- The Council is helping ICL estab- tinue to do the work of healing and sup- staffed by highly skilled professionals, since 1895 lish formal linkages with community- porting all those who come to us for help. based organizations to allow the Hub We are optimistic that the Hub will to make available additional support bring the people of East New York the related to conditions that can cause or improved access to care they deserve exacerbate health concerns, like legal and better serve a community that has services, domestic violence support, been highly underserved for generations. or advising on entitlements and hous- And it may well be a model that could ing. be replicated around the city, the state Central to our community engage- and even the country. ment plan is collaborating with Whatever “door” people enter at the clergy. We’re working with faith- Hub, we believe they will find the finest based communities and local minis- care and in the process experience a sense Merge from page 18 chester), Amy Anderson-Winchell ters and religious leaders to address of improved possibilities for their future (Access Support for Living), Kathy how we can help support church and the future of the community. a lot to learn from CBHS, and hopefully Pandekakes (Human Development Ser- members and how clergy can help us Come visit the East New York Health they will learn from us…We want to vices of Westchester), Nadia Allen be more responsive to the important Hub and see for yourself how health and better serve these populations and can do (Mental Health Association in Orange role religion plays in the life of the behavioral health care can live together – so through this merger.” County, Inc.), Pat Lemp (Westchester community. and help people flourish – under one roof. Jewish Community Services), Stephanie Photo Details: Back Row (L): Mark Madison (Mental Health Association of Sasvary (Hudson Valley Mental Health), Rockland), Lydia Edelhaus (Mental Recipe from page 21 of recovery so that, together, we can cele- Seth Diamond (Westchester Jewish Health Association of Dutchess); Sitting brate and incite change. Community Services), Elizabeth Kadatz (L): Diane Russo (CoverCare Center), Of course, in order for this recipe to So, whether you work in the addiction (Rehabilitation Support Services, Inc.), Susan Miller (Rehabilitation Support Ser- flourish, we must recognize hurt and heal- or mental health field, you are in recovery Amy Gelles (The Guidance Center), vices, Inc.), Eric D'Entrone (Arms Acres/ ing comes in many forms and each indi- yourself, know someone in recovery or Ashley Brody (Search for Change), Liberty Management), Adrienne Marcus vidual has a unique set of circumstances you are just a person who happens to be Katariina Hoaas (Access Support for (Lexington Center for Recovery), Alison to consider. We must also keep combat- reading this, I urge you to get involved. Living), Andrew O'Grady (Mental Carroll (CoverCare Center), Charles ing stigma, removing barriers to treat- Get educated. Share your stories and, Health Association of Dutchess), Jeff Quinn (RECAP: Regional Economic ment, improving access to care, develop- most importantly, be a voice for recovery Spitz (Restorative Management); Mid- Community Action Program); Missing: ing new treatment modalities and allow- this month, and always. dle Row (L): Saqib Altaf (Hudson Val- Sonia Wagner (Mental Health Associa- ing individuals the appropriate amount of Dr. Thomas Wright is the Senior Vice ley Community Services), Susan Sayers tion of Rockland), Stacey Rob- time to get well. President of Medical Affairs and Chief (Coordinated Behavioral Health Ser- erts (Mental Health Association of West- Still, I’m happy to say Rosecrance has Medical Officer at Rosecrance, a non- vices), Andrea Straus (Hudson Valley chester), Kelly Darrow (Human Devel- helped thousands of clients get this recov- profit organization and national leader in Community Services), Charlotte Ostman opment Services of Westchester), Polly ery recipe right! And, we will always substance use and mental health treat- (Mental Health Association of West- Kerrigan, Aron Reiner (Bikur Cholim) bring more people into the conversation ment services.
Collaborations from page 18 pite beds and weekend clinic services. tient behavioral health treatment, facilitat- with a focus on increasing community Since April 2018 the HEALTHi team has ing appointments for primary care to man- tenure and avoiding readmission to the behavioral and medical conditions and enrolled 48 individuals, with 92% engage- age chronic health conditions, and tack- inpatient setting. CBC partners with Ser- uses wrap-around enhancement funds to ment and connection to primary care; ling many of the social determinates of vices for the Underserved (SUS), Catholic address immediate, easily resolved social 90% of those discharged from a hospital health, like housing stability and food Charities Neighborhood Services (CCNS) needs, such as food and clothing, to se- had an outpatient visit within 30 days, and security. During this 6-month interven- and Institute for Community Living (ICL) cure trust and engagement in care. The 100% of people with schizophrenia pre- tion, the mission of CORE is to provide in the care delivery and the teams use the HEALTHi multidisciplinary teams’ out- scribed an antipsychotic medication were intensive support in order to stabilize and extensive services of the wider CBC pro- reach efforts are in person at the individ- adherent with their prescribed medication transition individuals to ongoing commu- vider network to ensure successful com- ual’s address, known hangouts, and/or regimes. Though outcome data for the nity-based services. munity outcomes. Currently serving over through known social networks. If an in- DSRIP year is preliminary, the team has In 2014, CBC embarked on the imple- 500 people annually, Pathway Home out- dividual is hospitalized at the time of re- closed over half of the identified “Gaps in mentation of an innovative care transi- comes include over 90% aftercare follow- ferral, the HEALTHi team engages with Care,” which promote better health and tions program called Pathway Home, up to behavioral health appointments, them, as well as the inpatient staff, at the community tenure. which has, through a multidisciplinary 94% with no hospital readmissions and a hospital and plays an active role in the Additionally, CBC is working closely team approach and the use of Critical 77% enrollment in Health Home care discharge and aftercare planning process with the Mount Sinai PPS on another hot- Time Intervention (CTI) techniques, management services. as both their advocate and a community spotting intervention program, Commu- significantly improved community out- CBC’s network of community-based services expert. This is a time-limited 6- nity Outreach for Recovery and Engage- comes after long-term psychiatric inpa- providers understand their communities month intervention that begins with asser- ment (CORE). This partnership with The tient hospital stays. Initially, a one year and have been historically addressing tive outreach and engagement, continues Bridge was launched in mid-July to pro- grant funded program, the astonishing gaps in care and will continue to realize with intense care management, and ends vide outreach and engagement for high- outcomes and improvement in health out- better health outcomes for individuals with transition to community-based ser- utilizers of Emergency Department (ED) comes led to a partnership with the New most in need. In an era of significant and vices to maintain recovery. The teams and inpatient services identified by the York State Office of Mental Health serious healthcare system transformation have small caseloads to enable the level of MS PSS partner agencies. CORE consists (OMH) and the expansion of the program occurring at the Federal, State and local intensity needed to connect and manage of a multi-disciplinary team with a pri- to serve additional populations. Pathway level, community-based partnerships like the care needs of this population. mary goal to outreach, enroll and provide Home is a high-touch, intensive, care co- these will continue to be the future of The HEALTHi team provides 24/7 on care coordination to 50 high utilizers over ordination program that promotes pre- healthcare reform. By understanding com- call coverage, ensuring individuals have the year. In the first 2 months of the pro- discharge engagement, immediate needs munities, addressing gaps, and working access to community services and care at gram, the staff has outreached 33 indi- assessments, peer role modeling and con- together, CBC network providers will all times. The team also utilizes CBC’s viduals with over 50% successful enroll- nection and engagement with community continue to improve on population health network of community-based services to ment in CORE. The team continues to providers. During this 9-month interven- outcomes, reduce healthcare costs and expedite access to crisis care such as res- work on engaging individuals in outpa- tion, individuals are supported by a team, increase consumer satisfaction. BEHAVIORAL HEALTH NEWS ~ FALL 2018 visit our website: www.mhnews.org PAGE 29 ACES from page 6 regularly-scheduled reflective supervision; Based on attendance numbers and feed- text of relationships. So, too, we should explicit skills training focused implicit back from direct service and management realize that our individual organizations does not end with understanding our cli- bias, internalized oppression, vicarious staff, the demand for such forums is great. cannot reshape the system alone. We must ents’ experiences. While “trauma-informed trauma, and institutionalized racism; au- To help nonprofit organizations weave the collectively create the trauma-informed practice” is an increasingly well-known thentic feedback expected and modeled at trauma-informed concepts from the train- transformation that we want to see. We service approach, we must also focus on all levels of the organization; and transpar- ing series into the daily fabric of organiza- are all in this together. the inevitable impacts of vicarious trauma ent leadership that intentionally addresses tion life, Vibrant Emotional Health created on our sector. Yet mere recognition of our staff’s mental and emotional well-being. a corresponding toolkit called Staying in About the authors. Lisa Furst, LMSW, MPH, is Assistant Vice President, Center own trauma experiences is not enough - Balance: Healthy Solutions for Managing we also need to reflect on how our experi- On an organizational level, the recog- Workplace Stress. This toolkit can be a for Policy, Advocacy and Education, Vi- ences influence our interactions with cli- nition and response to trauma must be helpful place for organizations to start to brant Emotional Health; Cristina Harris, MSW, is Program and Training Manager, ents. How do we ensure that direct ser- woven into the fabric of the culture in identify and address issues related to stress, vice, administrative staff, and others order to support staff reflection, healthy self-care, and organizational practices; it is Center for Policy, Advocacy and Educa- working within our sector are managing responses, and resilience. This approach easily accessed on the NPCC website: tion, Vibrant Emotional Health; and Elizabeth Speck, PhD, Principal, Min- their own trauma reminders and are using must exist throughout the organization, as www.npccny.org. strategies that minimize the re- transformation on this level requires a Organizations are leaning into dismantling dOpen Learning Strategies, LLC
traumatization of others during interac- willingness to challenge the existing para- the roots of structural racism, violence, and References tions? How do we ensure that individual digms and shift practices to ensure that stigma, but it can almost feel like a game of employees, their families, and their com- the principles of trauma-informed care whack-a-mole: new payment structures vs. 1. https://www.samhsa.gov/capt/practicing- munities have access to the same basic exist throughout the organization’s infra- trauma-informed evidence based practices vs. effective-prevention/prevention-behavioral rights and healing opportunities that they structure. These guiding principles in- diversity equity and inclusion initiatives. -health/adverse-childhood-experiences work to provide for those designated as clude: 1) safety, 2) trustworthiness and Without adherence to a guiding principle of (Accessed 9-20-18) transparency, 3) peer support and mutual behavioral health consumers? equitable access to behavioral health for all— 2. https://www.npr.org/sections/health- The answers to these questions are not self-help, 4) collaboration and mutuality, inclusive of living wage and job satisfaction shots/2018/09/17/648710859/childhood-trauma- simple, and not found in the mastery of a 5) empowerment, voice and choice, and for the workforce—organizational life will and-its-lifelong-health-effects-more-prevalent- 6) cultural, historical and gender consid- single technique or practice. And the re- continue to mirror the lack of control and among-minorities (Accessed 9-20-18) sponsibility for answering these questions erations. These guiding principles must be safety that come with trauma exposure. 3. https://www1.nyc.gov/site/doh/health/ cannot solely rest in the hands of individual integrated into hiring practices, supervi- As champions of behavioral health, we sion structures, design of physical space, neighborhood-health/center-for-health- practitioners. The ability to transform our need to ask ourselves, can we in good equity.page (Accessed 9-20-18) system of care starts with shaping the cul- and leadership practices, making them the conscience continue along a status quo ture of our organizations to support practi- lifeblood of the organization. path? As service providers, we are com- 4. https://www.nonprofitleadershipalliance.org/ tioners. True transformation requires Recently, we were involved in an ini- mitted to shifting the paradigm of care resource/awake-to-woke-to-work-building-a- race-equity-culture/ (Accessed 9-20-18) awareness of the systems of oppression tiative that sought to exemplify programs and transforming from within. As a sys- underlying intergenerational and environ- and practices that can help advance or- tem, we value reflective practice in our 5. http://humanservicescouncil.org/wp-content/ mental trauma, reflection on the power ganizations’ ability to meaningfully ad- clinical work and take this value and ap- uploads/Initiatives/RestoreOpportunityNow/ dynamics between staff and clients that dress trauma. During the fall and winter ply it to our organizational culture. We RONreport.pdf; http://racetolead.org/race-to- of 2017 and 2018, The Nonprofit Coordi- may be unconsciously perpetuated as a recognize what needs to be done and are lead/ (Accessed 9-20-18) result of trauma, and organizational struc- nating Committee of New York (NPCC), increasingly taking steps, albeit some- 6. https://www.samhsa.gov/samhsaNewsLetter/ tures that transparently address these dy- in partnership with Vibrant Emotional times slowly, to integrate trauma- Volume_22_Number_2/trauma_tip/ namics by providing the training, skills, Health, and with generous support from informed practices throughout everything guiding_principles.html (Accessed 9-20-18) and safe space for staff to reflect. Exam- The New York Community Trust, pro- we do. This work is daunting. It is chal- ples of concrete practices at an organiza- vided a series of workshops called Ad- lenging. It isn’t easy – but nothing truly 7. https://www.npccny.org/2/wp-content/uploads/ tional level that evidence the attention to dressing Trauma: Self-Care Strategies for transformational ever is. We know that sites/2/2018/06/NPCC_Vibrant_Toolkit_FINAL- these areas may include: an emphasis on You and the Communities You Serve. people heal from trauma within the con- 6-26-18.pdf (Accessed 9-20-18)
Aging from page 5 Community mental health nurses in their role as psychiatric nurse engagement
• Use ECHO GEMH’s model to help specialists continue to support the skilled skilled nursing facilities build and sustain nursing facility staff with the provision of capacity to meet the needs of people with enhanced supports for two years’ post
serious mental illness. discharge of the client to the skilled nurs- ing facility. Data on the program is col- The Skilled Nursing Facility Project is lected monthly from each facility. Re- Samaritan Daytop Village Invites You to Our managed by the OMH Office of Coordi- gionally, facilities are currently working nated Nursing Services. Coordinators have to address issues such as a limited num- been assigned for upstate and downstate ber of skilled nursing facilities that will 3rd Annual - Where Good Lives Gala regions. There are project teams at 14 adult accept OMH clients and a lack of psychi- civil facilities. The program is currently atric consultation at some facilities. Oth- Honoring staffed by 24 community mental health ers, in the meanwhile, have been effective nurses, working in close collaboration with in developing relationships with local Tino Hernandez, Past President and CEO social workers, discharge planning teams, area skilled nursing facilities.
and Mobile Integration Teams. OMH Transformation Plan Samaritan Daytop Village The ECHO GEMH project can be es-
pecially helpful patients of state psychiat- As I’d indicated before, these pro- Mark Otto, Executive Director ric centers who no longer require the in- grams are a part of OMH’s Transforma- tensive care provided by the psychiatric tion Plan, an initiative to re-balance the United War Veterans Council center but would benefit from skilled agency’s institutional resources by nursing care. Because of ECHO GEMH, strengthening community-based mental Sher Sparano, Senior Vice President individuals who had difficulty being ac- health services throughout the state and cepted into such a facility as a result of providing support for community provid- One Group behavioral issues are welcomed because ers to meet the psychiatric needs of cli- of the support ECHO GEMH provides. ents who are making a transition from Wednesday, October 10, 2018 - 6 to 9 p.m. Once approved for placement – state-operated psychiatric centers to com- through a number of processes including munity-based services. OMH has used the Enhanced Preadmission Screening reinvestment funding to develop new Tribeca Rooftop and Resident Review (PASRR), commu- mobile crisis teams, expand clinic ser- nity mental health nurses, discharge plan- vices, provide additional peer support ning staff in close collaboration with cli- services, and fund additional supported 2 Desbrosses Street, New York, NY 10013 ents, and family work to find placement housing units. Through the Transforma- in the community. Upon discharge, psy- tion Plan, OMH is helping to move long- chiatrist at each facility is available to stay individuals with complex medical For More Details and Registration provide psychiatric consultations as needed and behavioral health needs to more inte- Visit: samaritanvillage.org during the transition period. grated and less-restrictive settings. PAGE 30 visit our website: www.mhnews.org BEHAVIORAL HEALTH NEWS ~ FALL 2018
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