INTEGRATION OF CARE COMMITTEE
Veronica Fortunato & Donald Powell, IOC Co-Chairs
Wednesday, February 16th, 2022, 10a-12p
Attendance: Donald Powell (co-chair), Veronica Fortunato (co-chair) John Schoepp, Janet Goldberg, Guadalupe Dominguez Plummer (Recipient), Deborah Greene, Emma Kaywin, Mitchell Caponi, Bill Gross, Billy Fields, Paul Carr, Graham Harriman (Gov’t Co-chair), Rose Chestnut, Joel Zive, Dorothy Farley, Emma Kaywin, Press Canady, Gregg Bruckno, Claire Simon, Francine Cournos, James Walkup, Karen McKinnon, Adam Thompson
Staff/PHS: Frances Silva, Tye Seabrook, Johnell Lawrence, Cullen Hunter, Bryan Meisel, Aria Shahi (PHS), Johanna Acosta, Jose Colon-Berdecia
Agenda Item #1: Welcome/Introductions w. Pronouns/Moment of Silence/Review of Minutes
Conducted. Minutes were accepted with submitted changes,
Agenda Item #2: Public Comment
Agenda Item #3: NJ Behavioral Health and HIV Integration Project Presentation
Adam Thompson presented on how NJ tried to achieve large scale collaborations among government service systems. Aim of collaborative was to bring develop a system of care in NJ that integrates behavioral health (BH) and HIV primary care to improve system and patient outcomes.
Key highlights of the talk follow. Link to the video of the meeting is here: https://health-nyc-gov.zoom.us/rec/share/xcq9pGaaMxLoy7XrZeRE-R3jcS6TgvVNKrHMUGaEG6OFfOeq6E8oaEfR_ZvSOPg.6eRl_VMLDtU-Z0tB?startTime=1645024074000
Institute for Collaborative Improvement Model was used-
Every 3 months gather for learning sessions, 8 learnings sessions over 3 years. Went from in-person to virtual due to pandemic.
Introduced conceptual frameworks on coordination, co-location to integration
Movement of the data was more important than physical co-locaiton
Regardless of a person’s substance use patterns – many options for treatment.
Very little tracking of what is happening in community – but community based services are the most widespread and impactful.
Macro, Meso, Micro – BHIP focused on Meso (middle) level. Engaged all Ryan White parts except Part D – focus on improving environment and staff support to better deliver services.
Referral process seemed to make clients wait, or never transpired.
Developed 3 categories of performance measures – a lot of over-screening and improper screening was happening – asked orgs to pick a tool that was evidence based.
How BHIP performed: statistically significant improvement in screenings
Most clients in need of mental health and substance use services are not captured easily unless symptomatic or active in treatment
Important to conduct an environmental screen of funding resources – is this funding being duplicated.
Need to look at how to align service systems
Critical to support CBOs that do not have health info. Technology
CBOs cannot document and prove that they are providing these services
Fund infrastructure for BH – outreach and home-based services
Important to think about how to create a welcoming physical space
Conduct a Big Idea microgrant – supported rapid adoption of interventions including utilization novel treatment modalities
PWH represent an untapped workforce capacble of providing effective community based informal and formal care for PWH with BH disorders
Substance use (s/u) tended to be the more significant barrier for PWH who were struggling with adherence
Important for agencies to have a data request system that allows them to access data on clients
Need for collaborative applications for funding – smaller agencies need that support
Can be achieve by convening meso and micro level partners
Important for agencies to develop population based registries to better understand and monitor engagement in care- constantly putting the identifier on those who behaviors deviate from the norm is rooted in stigma and misses opportunities to bring people into care and access helpful interventions
Establish standards for community based care and services – by tracking referrals utilization and retention to these services in real time. Need to build bridges to ensure people are actively engaged in informal sources of care, i.e. AA. Providers should be checking in by following up with clients.
Important to require competency in the delivery of BH services and interventions requiring specific skills – no checks to ensure that providers of these special skills have the competency.
The system has not set the standard and established the steps to reach the standard with monitoring to ensure fidelity.
i.e. SBIRT model turned out to just be a screening and not the intervention – indicates confusion about what the skills actually entail
Simultaneous trauma informed care (TIC) project was happening – TIC project was at agency level and engaging the institutional leadership – some agencies were engaged in both process – was helpful.
Project did catalogue challenges experienced by different agencies – which helped form the recommendations. Project focused more on the solutions than the barriers.
Request for a new slide set.
For the microgrant, only a one time opportunity.
Dr. Cournos noted using viral suppression as the outcome measure is problematic when looking at mental health and s/u disorders. Early mortality must be tracked to better understand who is harmed and who benefits from the current treatment. Must go back to tracking mortality.
Another project on treating opioid use was ongoing – but it was operating in a silo. NJ project did a lot of cross training.
Silos are a huge problem.
Agenda Item #4: Bureau of Mental Health Service Overview
Acting Assistant Commissioner Jamie Neckles presented on the Bureau of Mental Health (BMH) which focuses on adults and serious mental illness.
BH Crisis Services: Highlights public safety and health responses: EMS, Police, 311
No one agrees on definition of a BH crisis – police – a few minutes to a few hours for mobile crisis teams and. Back end transfers exist between NYC Well and 311 and 911.
Federal line 988 will likely replace NYC Well.
Services provided by BMH include: Homeless Outreach Reams (HOT), Mobile Crisis Teams (MCT), Crisis Respite Centers, Triage Desk, Co-Response Team (CRT), Health and Engagement Teams (HEAT), Outpatient Services, Comprehensive Psychiatric Emergency Programs (CPEP) and Psychiatric Emergency Departments, Support and Connection Centers
Single Point of Access (SPOA) specialty care for people with mental illness – anyone can refer into the system, which then leads to Intensive Mobile Treatment, Assertive Community Treatment, Shelter Partnered ACT, Forensic ACT, Care Coordination. Usually years of treatment
Care Coordination is for people without Medicaid – assist people with finding treatment, get to treatment, and in applying for benefits.
BMH Permanent Supportive Housing – congregate and scatter site
BMH Psych Rehab Services – supportive services around education and employment
Connector Services – Supportive Transition and Recovery Team – for people experience psychosis for the first time aged 16-30, approximately 300/year
Assisted Outpatient Treatment (AOT) mandated treatment for people who have been hospitalized or violence. Ideally when court order expires people continue voluntarily
NYC Well is the best place to go for someone experiencing a BH crisis. Have hundreds of crisis counselors to manage the calls.
A lot of change is happening with crisis response teams – BMH keeps NYC Well informed to ensure clients get connected to most appropriate referral.
Psychotic symptoms are not always the same thing as being in a crisis – though it can be.
BHEARD, am intervention that directs calls into 911 to BH specialists with EMS. It is a pilot that only serves a small part of the city right now.
On Track – specialty episode treatment programs, personalized care coordination. Is managed by OMH. BMH does handoffs to them.
988 will become operation on July 1. Will largely replace NYC Well, but won’t resolve limitations in capacity to accessing services and the long wait.
Intensive Mobile Treatment started about 5 years ago for people with escalating violence and transience. People were afraid to work with them. Homelessness is not a requirement, but more than 60% are homeless. Highly intensive, huge peer component. Everyone who has been referred is engaged in care – no one gets closed out. 42% of those identified as homeless move into housing.
Agenda Item #5: NYC Ryan White Behavioral Health Portfolio
Cullen Hunter and Bryan Meisel gave an overview of the services n Harm Reduction and Mental Health.
Ryan White Part A: Substance Abuse Treatment Services—Outpatient service
- Service delivery began in June of 2016
- 17 Contracted Agencies
- Program Goals as stated in RFP
- Provide easily accessible harm reduction and substance use services
- Promote access to and maintenance in HIV primary care
- Reduce negative effects of substance use
- Enhance ARV treatment adherence
- Individual, family, and group Alcohol and Other Drug (AOD) counseling
- Evidence-based health interventions and education
- Healthy Conversations
- Seeking Safety
- Overdose prevention training and distribution of naloxone
- Counseling on PrEP/PEP
- Buprenorphine Treatment
- Auricular acupuncture
- Program locations:
- Community-based organizations
- outpatient hospital settings
- medical health clinics
- syringe exchange programs
- Staffing consists of Certified Alcohol and Substance Abuse Counselors (CASAC), licensed clinical social workers and mental health counselors, NYS Certified Peers
Mental Health Services (MHV)
- Nine contracted agencies in four boroughs in NYC
- Required co-location with Article 28 or 31
- Staff can include NYS Licensed Mental Health Practitioner (e.g., LMSW, LMHC), Psychiatrist or Psych N.P., Substance Use Counselor (e.g., CASAC), NYS Certified Peers
- Services Include
- Mental Health Counseling (Individual, Group or Family)
- Psych Eval or Visit
- AOD Counseling (Individual, Group or Family)
- Tx Adherence Counseling (Individual, Group or Family)
- Wellness (Individual or Group)
- Biomedical Counseling-Partners
- Seeking Safety (Individual or Group)
- Care Coordination-PCP
- Client Engagement
- Outreach for Client Re-Engagement
- Client Assistance
- Staff Travel
Supportive Counseling (SCI/SCG) Service Category Goal
- Ryan White Part A Supportive Counseling
- SCI Indicates there is a co-located syringe exchange program (SEP)
- 15 programs in four boroughs in NYC (eight are SCI)
- Often located in medium to small agencies as award amounts are smaller than MHV or HRM
- Staff can include Case Managers and Community Health Workers
- Services Include:
- Accompaniment (can be with translation services)
- Coordination with Service Providers (can be with translation services)
- Outreach for Client Re-engagement
- Client Assistance
- Counseling (individual, group or family)
- Biomedical Counseling-Partners
- Seeking Safety (individual or group)
- Pastoral Counseling* (individual or family)
- Staff Travel
New behavioral health portfolio
- An Integrated MHV and HRM can be co-located with an Article 28, 31 or 32 clinic.
- Programs would project for services in line with their client’s needs.
- Insurance billed first, as Ryan White Part A is POLR.
- HRM Programs currently co-located with an SEP can include SCI programs that offer additional services.
- SCG programs continue to fill the need of smaller organizations to have:
- Counseling inclusive of case management
- Psychoeducation services.
- Programs are asked to estimate the number of services they will be providing in each service category. These projections have to do with contract spending
- Getting patients timely appointments in this time has been highly difficult
- Lots of issues around language and cultural competency
- In harm reduction people who don’t own their problems with drugs and alcohol cannot be accepted because they are not ready to talk about it yet
- BH is siloed in a way that people don’t feel comfortable discussing what is happening in other spaces
- Combining these with supportive counseling lowers the barrier to access