Maintaining behavioral health is a key factor in an individual’s well-being. An individual’s social health is molded by conditions like academic and occupational achievement, economic stability, public safety, and social welfare expenditures (M. Alegria, Social Determinants of Mental Health, 2019). Historical data have shown that good social determinants of behavioral health improve outcomes. However, poor social determinants negatively impact the health outcomes of individuals and communities. Behavioral health expands mental health to include conditions such as substance use and external behavioral and societal factors that contribute to mental or emotional well-being. Behavioral health issues include substance misuse, severe psychological distress, suicide, and mental and substance use disorders (M. Czeisler, Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic, 2020). Therefore, maintaining good behavioral health is a vital component of one’s overall health and well-being.
Behavioral health also reflects the degree to which one’s emotions and thoughts allow them to fully participate in living a full life. Given what we know about an individual’s behavioral health status and its relationship to physical health and well-being, it is key that agencies help individuals to address their behavioral health issues by creating programs and services that address the unique behavioral health concerns of the community. With this in mind, the federal government established the Certified Community Behavioral Health Clinic (CCBHC) model (as part of the 2014 Protecting Access to Medicare Act law) to frame the foundation for agencies to improve health outcomes through increased access to quality behavioral health care while integrating mental health, substance use, and physical health services (SAMSHA, Certified Community Health Clinics Demonstration Program, 2017). This article focuses on BestSelf Behavioral Health, Inc.’s (BBH) innovative approach to provide services designed to address the social determinants of behavioral health through a community clubhouse system.
Certified Community Behavioral Health Clinic (CCBHC)
In 2014, the Protecting Access to Medicare Act was enacted, laying the framework for the implementation of CCBHC. In late 2015, New York State (NYS) (one of 23 states selected) was awarded a 1-year planning grant from the Substance Abuse and Mental Health Services Administration (SAMSHA) and Center for Medicare and Medicaid Services (CMS) to build the groundwork for the CCBHC program model. In partnership, the NYS Department of Health (DOH), NYS Office of Alcoholism and Substance Abuse Services (OASAS), and NYS Office of Mental Health (OMH) drafted a set of criteria that was used by NYS providers selected to participate in the CCBHC model (NYSDOH, Certified Community Behavioral Health Clinic Scope of Services Provider Manual, 2017). BBH was one of 13 providers selected to participate in the CCBHC model. Ultimately, NYS was one of 8 states selected to implement the model in a 2-year pilot (that continues as of this writing).
BestSelf Behavioral Health, Inc. (BBH) Community Clubhouse Model
As a designated CCBHC by New York State, BBH is the largest community-based behavioral health organization serving children and adults of all ages in Western New York (WNY). BBH’s CCBHC model began operating in July 2017, and programs established as part of the CCBHC model provides services to individuals with serious mental illness (SMI) or a substance abuse disorder (SUD), including opioid disorders; children and adolescents with serious emotional disturbance (SED); and individuals with co-occurring disorders (COD). In Erie County, the opioid epidemic is on the rise; the death rates attributed to opioid overdose have increased, 127 deaths in 2014 to 301 deaths in 2016 (NYSDOH, NYS Opioid Annual Report). Alarmingly, Erie County residents continue to face mental health provider shortage (228 providers per 100,000 residents) (Erie County DOH, 2020 Local Services Plan, 2020) and a significant barrier to psychiatric access – where BBH clients often had to wait about 30-45 days for appointments prior to CCBHC implementation
The state CCBHC designation allowed BBH to implement CCBHC and charge for services through a daily cost-based rate. SAMSHA then expanded the CCBHC model by providing two-year CCBHC Expansion (CCBHC-E) grants. BBH was the recipient of the initial round of this funding, in October 2018. The CCBHC-E funds provided BBH the ability to establish a tri-fold approach to address these access issues by creating a 24/7 immediate access clinic, a community clubhouse, and expanding Assertive Community Treatment (ACT) services. The BBH community clubhouses are established to function as supportive after-hours care facilities. The clubhouses provide community support in a safe, non-judgmental setting for any client of BestSelf aged 18 and above. Club goers can choose to participate in multiple activities or simply relax in a quiet space. Offerings include group fitness, music therapy, arts and crafts, guided meditation, movies, games and food. ClubWest is open 7 days a week and all holidays. The BBH clubhouses also provide resources related to employment, education, and housing. No appointments are needed for consumers to receive services from the clubhouses. Clinicians and staff also offer supportive care for non-life-threatening behavioral situations. Consumers are provided the safe space to talk when upset, or when in need of short-term medication refills for emergency conditions.
The frameworks of the BBH clubhouses are based on evidence-based models that include the wellness model, Whole Health Action Management (WHAM), and smoking cessation curricula such as the Tobacco Cessation – Healthy Living and You. The educational and vocational services provided by the clubhouses are based on the evidence-based Individualized Placement and Support (IPS) model, as well as linkages to supportive housing and other community-based support. The 24/7 clinic has a full time medical licensed professional available to provide prescriptions to patients in acute crises or as a bridge to linking with a permanent provider. Counseling and treatment are provided virtually utilizing telehealth technology (using telephone, video, and other technologies to increase access to care). The clubhouses provide integrated services readily available to people with co-occurring mental illnesses and substance use disorders, including medication-assisted treatment (MAT) for opioid use disorders and other substance use disorders. The clubhouses are staffed by certified peer advocates, registered nurses, rehabilitation specialists and licensed counselors, with psychiatric and MAT prescribers on call
Services by the Numbers
Since the opening of our first BBH clubhouse (ClubWest), the staff members of the facility have done an incredible job working with consumers who need services and resources outside of regular business hours. Since October 2019, 975 unique consumers have visited ClubWest. Roughly, 61% of the consumers were white, 77% were unemployed, 8% homeless, and 11% had 12th-grade completion. The 975 unique consumers accounted for over 10,000 total visits – with 5 of those consumers accounting for 12.9% of the total visits. An important component of the CCBHC model involves consumers being able to receive multiple services during a visit. The majority of the services provided to consumers have included peer support counseling (7,396 peer sessions), clinician counseling (1,653 sessions), individual therapy (1,618 therapy sessions), group therapy (1,196 therapy sessions), nursing (836 visits), health monitoring (1,085 sessions) and medication assistance (383 sessions).
Like most health care agencies in this current climate, the coronavirus pandemic has significantly impacted operations. Nevertheless, BBH has continued providing services to consumers using telehealth tools (video or telephone). From March to October 2020, ClubWest reported a 60% reduction of in-person unit services, but services provided via telehealth significantly increased during the same period. ClubWest reported a 22% increase in services provided through established telehealth platforms. During the same period, about 40% of all services provided to consumers through ClubWest were delivered through telemedicine. The increased rates and quick transition to providing services via telehealth was an incredible testament to the technological readiness and advances implemented by BBH.
BBH is wholly committed to providing care and services to consumers, even at times considered to be outside of business hours. The establishment of ClubWest has provided our consumers the flexibility to access care at all hours. It is well documented that access to care, especially for individuals experiencing behavioral health disorders services, is often a challenge. This challenge is also well documented in assessments completed by consumers that visit ClubWest. Roughly, an alarming 46% of our consumers reported staying home or doing nothing if ClubWest were not open – even during a crisis. An additional 15% reported going to the emergency room or hospital if ClubWest were not open. Delivering quality and accessible services is crucial to the success of the BBH CCBHC model. The BBH ClubWest has become the go-to facility for BBH consumers seeking support and connection with staff they trust, during the hours when their clinic is closed.
Clement Nsiah, PhD, MS, is Director of Population Health and Evaluation, James Butcher, RN, BSN, is Director of Health Integration and Nursing, and Jillian King, EdM, is Grants Manager, BestSelf Behavioral Health, Inc. For more information, please contact our Marketing and Development department at (716) 842-0440, Ext. 1691 or email firstname.lastname@example.org.