The behavioral health sector has been in the throes of a generational change over the past decade, one that has challenged the very way we offer treatment, organize operations and receive funding for our services. Our agencies have worked hard to adapt to these changes while maintaining the strongest commitment to the people we serve and the quality of their care.
Among the most significant challenges has been in preparing our workforce for the shift to integrated care. Fortunately, ICL had long understood the importance of treating both the physical and mental health needs of an individual as well as the impact of their total life experience – the social determinants of health. As far back as 2011, our agency was awarded a SAMHSA grant to support a ”whole health” perspective that addressed the critical importance of person-centered care.
One of the most significant challenges of the shift to integrated care has been how to help staff incorporate this approach into their work to best serve clients.
ICL recognized that this whole health perspective required a completely new way of looking at practice. In 2013, when David Woodlock became ICL CEO, he brought with him a longstanding commitment to integrated care that was central to his plans for the agency. While integrated, person-centered care had already begun to be practiced at ICL, under his leadership, the agency moved toward more formalized training by identifying four pillars of care – otherwise known as TRIP – care that was trauma-informed, person-centered, integrated and recovery-oriented. This became the centerpiece of training and ongoing education at ICL and would come to be shared with staff at all levels – from social workers to fee clerks, from case managers to office managers.
Understanding Social Determinants of Health
This new paradigm in care has meant reshaping ICL services through an integrated care lens and giving staff a deeper understanding of who they are serving – people in poverty, in distressed, underserved and highly diverse communities and the multiplicity of factors affecting their lives – the Social Determinant of Health. What sets apart ICL is that in our widely varying programs, all staff are now trained to address medical issues with clients. Workers helping people with serious mental illness now ask about their diet, how their blood pressure is, if they are taking insulin for diabetes. We encourage and track our clients getting flu shots and having ‘heir A1c tested. Among the many tools we offer staff is a Healthy Living Workbook with tools and tips for assessing and improving health status of all clients.
For the past decade, we have been writing and discussing individuals with “co-morbidities”—who have both a psychiatric illness and a medical diagnosis such as diabetes, asthma or high blood pressure. In the process of building a more whole health approach to care, we’ve sought to break the cycle of emergency room usage and hospitalizations for both physical and mental health reasons. Driving our work is the staggering statistic that individuals with serious mental illness die 25 years earlier than the general population. Part of SAMHSA’s mission has been to urge providers to think about integrated care by incorporating Wellness Self-Management throughout all areas of programming and over the past ten years there has clearly been a positive shift in this direction.
At ICL, our outcomes are measured through twice yearly surveys – and the results have been consistently impressive. In 2018, for example, 98% of client say they feel more in control of their lives and more connected to family and community. Once again, SAMHSA recognized our work in 2017 when they selected ICL as only one of three agencies from around the country with their Wellness Award for improving health outcomes for clients with serious health challenges.
At the core of our shift to a more integrated care model is our commitment to and respect for our dedicated staff, who are always poised to learning and advancing new ideas. As a result of the intensive training we offer throughout the year, staff at all levels are developing and refining new treatment tools. Whether an in-patient setting or outpatient clinic, whether delivering services in the home, in a shelter or providing street outreach, ICL staff have become increasingly skilled at addressing both the emotional and physical needs of the people they work with.
All of this represents a major shift for staff, particularly people trained in behavioral health, where assessments were historically focused on past psychiatric hospitalizations, substance use history and other psychosocial stressors. While this remains critically important information in care planning, we understood it was simply not enough. We came to understand the need to “know all the facts” of a person’ life, including their physical health status.
Bringing the Whole Health Model to the Next Level
ICL’s embracing of an integrated care model took on even greater significance with the opening last Fall of our East New York Health Hub. After years of planning with community partners and funders and builders, ICL opened a spectacular 43,000 square foot center designed with the health of the community top of mind. A number of critical ICL programs including Family Resource Center, PROS, ACT teams and our Highland Park Clinic, moved into the space. But the Hub is far more than about co-location. It is about giving access for the people of East New York to the finest health and behavioral health services.
Our innovative health care partner in the Hub is Community Healthcare Network (CHN), a highly regarded organization that operates 13 FQHCs (federally Qualified Health Centers) around the city and shares our vision for maximizing care that addresses all aspects of a person’s life. While our two organizations operate under very distinct and sometimes contradictory regulations and have different cultures, from the beginning we have had an open dialogue and were open to learning from each other as we fine-tune the workings of the Hub. One of the principles we’ve both adopted is the understanding that people coming to the Hub are not a client of CHN or ICL—they are being served at the Hub; together we ensure people get the best and most integrated care possible.
Accomplishing true service integration at the Hub is not easy but the Altman Foundation and New York Community Trust are generously supporting our development of shared policies, procedures and workflows to standardize provision of care. Timely and effective service and information coordination between our organizations is critical for us to reach the best possible outcomes for the people we serve.
ICL and CHN staff meet regularly to address concerns and challenges; they also socialize and celebrate holidays, reflecting the importance of relationship-building that is at the heart of good practice.
Because in the end, good practice is still what drives us, especially in the face of major changes in the health care system. We continue to be guided by the roots of social work education and clinical practice and their emphasis on relationship-building, engagement and establishment of trust as rudimentary tenets in building rapport with individuals seeking services. In addition to adapting new tools and approaches, those working in direct care must still learn the fundamental skills of empathy, compassion, employ unconditional regard, demonstrate respect for cultural differences, and pay close attention to social justice, oppression and marginalized communities.
Ultimately the success of the paradigm shift around integrated care rests on our respect for our clients and the experiences that have affected them throughout their lives. This is the necessary first step to real recovery.
So while we’ve been at work rethinking how we provide services and want to help staff incorporate new approaches into their work, we have not lost sight of our core values and our mission that people get better with us. Our health care system is in constant evolution – we are confident that the work we are doing at ICL will continue to move the needle on health care that improves lives. Our staff are fully dedicated to be part of this incredibly important moment in history and to providing meaningful and impactful care to people in the 21st century—care that changes lives.