The Mental Health Association of Westchester (MHA) continues to actively transform the delivery of our expansive array of services, increasingly moving from a conceptual commitment to provide holistic services to operationalizing a unified fabric of existing and newly created services. Simultaneously, we maintain our unwavering focus on shared decision making and person-centered care. Our changes are more than incremental as we work to offer the “right care, at the right time, and in the right place”* to the people that we serve whose health services are primarily covered by Medicaid and Medicare.
The goal is to address the full range of an individual’s health related challenges by offering an expanded array of services that work in concert with each other. Historically, challenges to this approach have derived from several factors, such as defined sets of services that did not address the full range of needs, including the impact of social determinants of health, limitations on the role of peer support, regulatory obstacles related to billable services, barriers to information sharing, and a workforce that was inadequately prepared to deal with the impact of complex trauma, substance use, and the inter-relation of physical and behavioral health. The following describes several initiatives now underway to achieve our goal of integrated care.
Integrating Medical Care
Care management services play a vital role in client care. Our work prioritizes both physical and behavioral health to improve quality of life and to avoid unnecessary emergency services. The work of care managers may include coordination of medical care, making connections to specialists, and managing successful transitions out of hospital settings. Though essential, much of this work was previously done in silos, with most clinical and care management services operating in parallel spaces. Embedding care managers into our main clinic settings was an essential first step towards integrating the two services. New workflows were established to insert care management services at several points of contact within the clinics, including at referral, intake, and throughout the course of treatment. Clinicians have been trained to provide more thorough medical assessments and screenings. These new workflows also enable us to push out real-time information to our clinicians when we receive alerts from Healthlink, an alert system which notifies providers when a client, who has consented, utilizes the hospital/ER for medical or behavioral health needs. This in turn, allows us to communicate with and provide timely services to clients at especially vulnerable times of crisis and upon discharge from hospital.
During the past year, MHA’s Care Management program has not only grown significantly, but recognition of our quality outcomes has resulted in contracts to embed Care Managers in non-MHA sites, such as in primary care settings. Currently, we are looking at providing similar services in other types of settings such as homeless shelters.
Integrated Substance Use Disorder Services
Through new services and staff training, MHA is addressing the growing concern of opioid use and co-occurring substance and mental health conditions experienced by our clients. Select staff are being trained in Integrative Harm Reduction and Dialectical Behavior Therapy for Substance Use Disorders preparing them to integrate substance use approaches with more familiar clinical interventions. Staff across all services – from clinics to residential, peer professionals and support staff are trained in the use of NARCAN to provide emergency substance use first aid services if necessary. Once our pending application is approved, our psychiatric staff will begin to offer Medication Assisted Treatment (MAT). Along with establishing policies for MAT, our medical staff is creating a protocol to reduce the use of benzodiazepines, and concomitantly increasing the use of alternative techniques such as mindfulness to manage anxiety.
Expanding Clinic Services
Our Intensive Outpatient Program (IOP) provides an array of intensive supports and services, particularly during times of crisis and transitions from hospital care. Clients in our IOP are supported by clinicians and peer professionals, who provide multiple points of contact and wrap around supports during times of increased need. Frequency and length of contacts are dictated by individuals’ fluctuating levels of need. Furthermore, co-location at the Sterling Community Center provides easy access to Employment and Peer services.
Within MHA’s OnTrackNY program, which provides early intervention services to those experiencing a first episode, a new research initiative offers social network meetings as an optional additional service. Social network meetings bring together the individual receiving services and members of his or her social circle, including family and/or other close relationships. Through the social network meetings, all participants are given the opportunity to express their thoughts and feelings in order to facilitate dialogue and understanding. The hope is that these meetings will enhance clinical and recovery outcomes while preserving and improving relationships.
Integrated Peer Support Services
MHA’s Integrated Peer Support Services unify traditional and novel services to address clients’ needs and life situations. Our Intensive and Sustained Engagement and Treatment (INSET) program offers adjunctive and integrated supports for MHA clients who have been high utilizers of intensive and expensive services due to histories of multiple psychiatric hospitalizations and/or periods of incarceration. The INSET program augments existing services with additional intensive supports, including mobile clinicians, care managers, and peer professionals. The INSET team supports these clients in the community, links them to needed social services, engages family supports, and coordinates care across MHA services.
Initiating, implementing and sustaining significant change requires planning, ongoing monitoring and management. To that end, MHA employs proven change management techniques facilitated by designated staff and overseen by a dedicated Project Management team. Key Performance Measures are regularly reviewed to assess progress toward goals and drive changes in strategy. Our new integrated Electronic Health Record, with an expected go-live date of January 2019, is a key vehicle through which we will manage patient care.
As we work with a growing number of individuals with increasingly complex health and behavioral health needs, the toll on staff can be significant. We are implementing a protocol of enhanced staff support, activated particularly following a client death. Staff support includes a menu of HR, clinical, and peer support, drawing on our internal resources and staff expertise to assist our providers in managing the impact of client loss, tending to their emotional needs, reducing secondary traumatization, and increasing retention and staff satisfaction. Active endorsement by all levels of executive staff are essential for the success of this initiative.
Since its creation in 1946, MHA of Westchester has continued to evolve with and also to lead change in order to most effectively meet the needs of those to whom we provide services. Our current transformative initiatives continue that long tradition.
- Institute for Healthcare Improvement: http://www.ihi.org/resources/Pages/AudioandVideo/WIHI-Right-Care-Right-Setting-Right-Time-of-Hospital-Flow.aspx
About the authors. Ruthanne Becker, MA, is Senior Vice-President of Rehabilitation Services; Barbara Bernstein, PhD, is Chief Planning Officer; Cindy Peterson-Dana, LMHC, is Vice-President of Peer and Recovery Services; Stephen Smith, PhD, is Director of Training; and Jenna Velez, LCSW, is Vice-President of Behavioral Health Services at the Mental Health Association of Westchester.