David Minot, Executive Director of Mental Health News Education, the non-profit organization that publishes Behavioral Health News, interviews Steve Miccio, CEO of People USA. Steve speaks about the Crisis Stabilization Center located in Dutchess County, NY and his collaboration with the NYS Office of Mental Health to develop a sustainable stabilization center model that can be replicated in counties across the state.
(David Minot) Hello, and welcome to the launch of the Behavioral Health News Spotlight on Excellence series, featuring exceptional leaders and innovative healthcare solutions that are raising the standard of care in the behavioral health community.
Today, we are speaking with Steve Miccio who is the Chief Executive Officer of People USA, located in Poughkeepsie, NY. Inspired and driven by his personal lived experience, Steve has spent over two decades creating, providing, and promoting innovative crisis response services and systems-level improvements both across the United States and internationally. These improvements raise the bar on customer service, person-centered communication, trauma-informed care, empathy, and positive expectations for people’s recovery and wellness outcomes. Steve’s unique models and approaches significantly reduce hospital utilization, incarceration rates, and overall healthcare spending.
(Steve Miccio) Thank you, happy to be here.
Let’s begin by talking a bit about the Crisis Stabilization Center in Dutchess County, New York. When did it open and who does it serve?
The Center opened February 13th of 2017 and it serves the community of Dutchess County, which has about 300,000 residents, and it also serves other counties because people hear about it and come from other counties – it really serves everyone.
What was your inspiration for developing this center? What is your goal, and how is it funded?
I had been doing a lot of work in building pure respites – we are a peer-run organization – and 21 years ago I started the first respite, which is a seven-day stay for people dealing with crisis issues. Back when they were closing the Hudson River Psychiatric Center here in Dutchess County, there was reinvestment money that was going to be given to the county and the County Executive put together a committee of behavioral health leaders in the county to figure out what to do with that money. So, we got together as a group and one of the first things we talked about was the need for a mobile team – some kind of mobile crisis team because there was a lot of that need out there and it wasn’t being addressed and that was something we all agreed on.
There were some other small dollars going to my having a peer in the emergency room here and in Dutchess County. There were some children service dollars that went out there, but I remember in the meetings that we were having with the County Executive, they kept talking about integration and collaborations. What always struck me is that we always, as providers, have come to provider meetings and said we will work together well and we do provide good collaboration, but I wasn’t seeing that. I was really kind of holding to my truth, which was: we need to develop a better system for people because we’re not providing it, and I think we can do better.
One of the things I brought up was a Wellness Center – I didn’t call it a crisis stabilization center – I called it a Wellness Center. I’ve been traveling around the country to different parts of the world looking at crisis services and what they were designing and doing, and a couple of them just struck me that they were very fast and efficiently greeting the guests and finding out what their needs are and moving them along in a continuum. That’s what I wanted to create it here in Dutchess County. So, I kept talking about it at the meetings and the County Executive finally said, well, let’s give it a shot and he went to the county legislation and asked for the money to not only open the program but also renovate the building that we were working in.
And so, we redesigned the building, we put together a workflow and a plan of how it was going to run, and we put it together and opened in about 1 1/2 years.
What services are provided at the Crisis Center? Are all services provided in-house or do partnerships with community provider organizations play a role?
Yeah, this is really about partnerships and community collaborations and follow-through. Anybody can come to the center be experiencing the crisis. It’s voluntary; there is no mandated treatment at the center. They can be experiencing mental health issues, emotional issues, addiction issues, substance use issues, and even health issues when they come to the center.
The center is designed to do an assessment to figure out what’s happened to you, what you need, and get you to that service in the community within 24 hours. We actually have 23 hours and 59 minutes, but within 24 hours. So, we can get someone into a medically supervised detox, a regular detox rehab, medical care or mental health care within those 24 hours. And that’s a lot of working with the community providers and partners to ensure that we’re going to be able to move someone in that continuum that fast. And that’s what we do.
What is your philosophy of how you operate?
The philosophy is really around wellness – around a strength-based focused on excellent customer care. I want it to be as good as a five-star hotel that somebody would walk into – when people walk in O want them to know that they’re welcome that they’re greeted with a smile, that they’re greeted, with kindness, and they’re not plugged into any kind of diagnosis; it’s more of what happened to you, what brought you here, and how can we help you?
The Crisis Center is very person-centered and very trauma-informed too. We ask our guests constantly, “Do you feel safe here?” and they’ll give us some comments and pointers and we’ll change the environment as much as we have to in order to ensure that people feel safe when they come to us. When people are in that state of mind, when you’re in crisis, you’re not thinking very clearly about everything. The more you can make a safe and welcoming environment, the better information you’re going to get from that individual and the better outcome you’re going to have as they go into the services.
Yeah, I imagine that the experience is really what makes it unique and positive for the guests.
It really is and we get testimonies constantly; we don’t even ask for them. People will say, “Nobody ever treated me this way before. Nobody ever asked me those questions before. I feel so good here. Thank you for everything you do.” We’ll get follow-up phone calls and letters from guests that came to say thank you. Thank you for saving my life. Thank you for helping me. Thank you for helping my son or daughter. It does make a difference, the way you treat people.
Can you speak to the peer-led aspect of the organization?
That’s where most of our pride comes from is that we are a peer-led peer-run organization operating a crisis stabilization center. It’s more of a non-clinical model. It’s a very supportive model that we’ve created, but we do have therapists there. We have licensed social workers and we have credentialed alcoholism and substance abuse counselors (CASAC) there, recovery specialists, and peers are there of course. Some of those employees under social work or other titles also disclose that they’ve also had mental health or substance use issues. It is primarily a peer-run stabilization center and that’s important to us because the mutuality is what helps build trust in the people you serve. When you can say to someone, “I know may not know exactly what you’re going through, but I can tell you my lived experience is similar and this is what happened to me,” and that really creates a better and stronger relationship with the person that you’re serving.
In an earlier conversation, you mentioned that the NYS Office of Mental Health has started work on developing a similar model based on your Crisis Stabilization Center so that it can be implemented across the state. What is your role in helping them get this developed?
This was this was a great thing. I had been working exclusively on building a funding tool under Medicaid to make the stabilization center more sustainable and to also say to the county, we can give your money back eventually because we built a sustainable tool that will allow us to pay for it through Medicaid dollars instead of county dollars. When I shared that with the Office of Mental Health, they said, “Well, actually we like the stabilization center idea and we’re going to license it and we’re going to find a payment system through the licensing.” At first I was a little upset and I said, “Did I do this work for nothing because now you’re going to give us this license and we go forward with that?” But no, they wanted the tool that I created, so I shared that with them and I also shared a lot of the philosophy and the operations of the stabilization center so they could put that into the licensing to keep the fidelity true to the values of trauma-informed, peer-centered, and also person-centered and focused on moving someone along the continuum more efficiently and effectively than a hospital emergency room could or other crisis services can.
Do you view this model being replicated across the country beyond just New York?
I do and we’re hearing more and more about stabilization centers. The only thing I think that’s different is the leadership or the philosophy behind them is run differently. I’ve been to some stabilization centers that were very similar to walking into a hospital emergency room, which is not the most welcoming environment. And then I’ve been to other stabilization centers that are more welcoming – their environments feel safer and look nicer. So, it’s a mix. What I would like to see is the fidelity of the model that we’ve created go forward because how can you say no to a comfortable and engaging and friendly environment rather than cold-hearted experience where you are asked “What’s wrong with you and why are you here again?” We don’t do that.
How has COVID impacted your operations?
When it first started we went into a slight panic mode to say, how are we going to do this? Then we went to telephonic and then to a combination of web and telephonics like a telehealth was happening. As time progressed and people were vaccinated, we started opening up to guests again. At the time we were only taking guests when they were brought in by the police.
What I didn’t mention is that we also have trained about 700 police in the county about the stabilization center but also trained them in crisis intervention team training, which is a 40-hour training on how to engage more safely with the community members that are struggling with addiction or substance use or mental health issues. We were taking those folks in during COVID because we had the space to separate and keep everyone safe.
And then as more people got vaccinated, we started opening up in different capacities – 25%, 50%, and then 75%, which is where we are now.
What is your vision for the future of the Dutchess County Crisis Stabilization Center and the treatment model in general?
Well, it’s evolving for us. When we first opened it, one of our partners was the hospital. We have several partners in the center. We have a case manager organization that helps out. We have a children and family organization that has staff that worked with us in the center, and we had nursing. We never really got to the level of need for the nursing when we had it, so we eliminated it about 2 1/2 years ago because we have medical partners in the community. Based on self-assessments, if somebody was challenged with any medical conditions, we could get them right to our partner, so we didn’t need that that nursing.
Now as we’ve evolved, I can see the need for a better health assessment and a nurse would be helpful to have, so that’s going to happen. But overall, I think we’re learning every day about what’s working, what’s not working, and we’re very attuned to the success and the strength of the people we serve. So, we’re making constant modifications to the environment, constant modifications to our workflow, including putting more peers in there and we put another social worker in there, so it is growing with capacity.
The vision I have is that these are in every county going forward, but also that the systems of care and the community responds to these. You can open a stabilization center and say, “We have a stabilization center,” but if you don’t have the partners and the workflow to get people to community services immediately, it’s not going to be successful – it’s going to become another kind of holding area for people in crisis instead of a wellness area for moving people along continuum. So, there’s a lot of asset-based community development work that needs to be done to ensure that every stabilization center is successful in what they do.
That’s a big job in each community that you move into.
It really is, yeah.
Well, I want to thank you so much for your time, it’s been such a pleasure to speak with you, and thank you for being part of the launch of our series!
Thank you for having me.
For more information about Steve and the Dutchess County Crisis Stabilization Center, please visit People USA at www.people-usa.org and stay tuned for the next installment of the Behavioral Health News. Spotlight on Wellness and excellent series.