In order to lay the groundwork for systems change to better meet the needs of older adults in New York State, the Geriatric Mental Health Act was enacted on August 23, 2005. The law authorized the establishment of the Interagency Geriatric Mental Health and Chemical Dependence Planning Council, the geriatric service demonstration program, and an annual report to the Governor and the Legislature regarding the geriatric mental health needs of the residents of New York. Since the inception of the Geriatric Demonstration Grant Program in 2007, there have been four rounds and over 50 demonstration grants awarded. The grants are flexible and allow for each grantee to design a program model that best suits the needs of their particular communities by leveraging and coordinating local services for older adults. The grants focus on providing integrated physical and behavioral health and aging services to older adults in their communities and in their homes. These integrated, mobile models of care assist older adults in more easily accessing a wide-ranging array of services in the most convenient manner possible.
In order to create lasting change, the geriatric service demonstration program seeks to integrate sustainability planning into each round. Expert technical assistance is made available to each grantee in order to tailor sustainability planning to the unique structure of each agency. Utilizing this assistance, grantees have the opportunity to focus effort on the sustainability of their program, and many have found innovative ways to ensure they can continue to implement the successful practices established by the demonstration grants. Flushing Hospital Medical Center (FHMC) is an example of a grantee who has been able to successfully sustain the integration of behavioral health and physical health services for over a decade.
Flushing Hospital Medical Center (FHMC) is an accredited 299-bed voluntary, not-for-profit teaching hospital, founded in 1884. FMHC is located in the one of the most culturally diverse county in New York State. FHMC’s Department of Psychiatry and Addiction Services consists four divisions, including: a 30 bed medially managed detoxification unit, which is the only medically managed detoxification unit in Queens County and is the highest census medically managed detoxification unit in New York state; an 18 bed voluntary Psychiatry Inpatient Unit, which is one of the only voluntary psychiatry inpatient units in New York State; a Mental Health Clinic; and, a Chemical Dependence Clinic.
Daniel Chen, MD, is currently the Vice-Chairman of the Department of Psychiatry and Addiction Services. Ira Frankel, PhD, LCSW, is currently the department’s administrator. Drs. Chen and Frankel have been collaborating together around successful aging projects since 2001.
At FHMC, the concepts of integration of services within an aging population were gradually infused into the entire culture of the hospital. In 2003, FHMC’s Department of Psychiatry and Addiction Services sponsored an annual conference entitled, “The New Gerontology: Towards and Expanded Vision of Successful Aging.” The basic theme of the conference was that the probability of successful aging was achieved through diet, exercise, the pursuit of mental challenges two of which are diet and exercise, self-efficacy, which is the belief that if one engages in successful aging practices, then the likelihood is greater that one will be successful in aging successfully, and, finally, social support, that is, individuals helping each other to engage in the ingredients of successful aging.
Going forward from 2003, FHMC’s Department of Psychiatry and Addiction Services incorporated the ingredients of successful aging into its culture. The ideas were discussed in Grand Rounds, Case Conferences, Journal Club presentations, and generally, disseminated throughout the entire department as a way to think about helping individuals with mental illness and substance use disorders achieve recovery. In addition, the ideas about successful aging were disseminated throughout the department as ideas that held true, not only for patients, but also for staff, as well.
FHMC was initially funded in the first round of Geriatric Demonstration Grants to integrate behavioral health services into primary care, and they have successfully sustained the integration work for the past 12 years. FMHC accomplished this by creatively tapping into statewide initiatives that are funding integration. Specifically, they applied for and received a newly created Integrated Services License that was being piloted by the NYS DOH, OMH and OASAS. FHMC was awarded two Integrated Services licenses- one was to integrate physical health care in the Mental Health Clinic, and the second to integrate physical health care into a Chemical Dependence Clinic. The Integrated Services Licenses allowed them to continue the integrated care work that was initiated through the Geriatric Demonstration grant, by retaining the Adult Nurse Practitioner who was hired by grant funds, to become a permanent employee in both the Mental Health Clinic and the Chemical Dependence Clinic.
FHMC then turned to the Delivery System Reform Incentive Payment (DSRIP) program as another source of sustainability. Within DSRIP, safety net providers such as FHMS were required to collaborate to implement innovative projects focusing on system transformation, clinical improvement and population health improvement. One of the most important innovative projects supported by DSRIP was integrated care. FHMC was able to leverage the integration work that was funded by the geriatric demonstration program to participate in the DSRIP program. Because their senior administration saw the successes achieved in the integrated services grant project in the Ambulatory Care Center and because it already had integrated services in their Mental Health Clinic and Chemical Dependence Clinic, senior administration approved the hire of a clinician to continue integrating behavioral health services into the Ambulatory Care Center in order to meet DSRIP objectives.
Drs. Chen and Frankel also decided to use data to support their sustainability plans. They retrieved and analyzed data on ED visits, hospitalizations and cost of care for all of the patients seen and served by grant funded clinicians for at least one visit during the duration of the grant project from 2007-2012. One significant finding that came from this analysis was that emergency department visits were reduced during this time. Drs. Chen and Frankel then wrote about their findings in an article that is currently in press in the Journal of Integrated Care (The citation is: Daniel Chen, Alex M. Torstrick, Robert Crupi, Joseph E. Schwartz, Ira Frankel, Elizabeth Brondolo, (2019) “Reducing emergency department visits among older adults: A demonstration project evaluation of a low-intensity integrated care model”, Journal of Integrated Care, Vol. 27 Issue: 1, pp.37-49).
FHMC worked creatively to support sustainability by leveraging individual level client data, along with the Integrated Services Licenses and the DSRIP initiative, to maintain the viability of the work that began 12 years’ prior with the Geriatric Demonstration grant award. In this way, FHMC is a model of what may be accomplished when sustainability plans are prioritized and when service providers work creatively and strategically within the existing structures available to support sustainability.
Daniel Chen, MD, is Vice Chairman of the Department of Psychiatry and Addiction Services at Flushing Hospital Medical Center. Ira Frankel, PhD, LCSW, is Administrator, Department of Psychiatry and Addiction Services at Flushing Hospital Medical Center. Emily De Lorenzo PhD, MSW, is Program Manager of the Bureau of Program and Policy Development, at the NYS Office of Mental Health.