When New York State was just beginning to outline the potential impact of the new statewide Delivery System Reform Incentive Payment Program (DSRIP), Keith Leahey was paying close attention. “I was aware of DSRIP and how the Mental Health Association of the Southern Tier (MHAST) might fit into the plan. Until now, the funding just wasn’t available.” As Executive Director of MHAST, Leahey has been a proponent for expanded mobile crisis services for years. “Care Compass Network is providing us the opportunity to do work that will better serve the needs of the community.” Leahey continued.
The crisis stabilization project is one of 11 initiatives outlined in the Care Compass Network list of initial projects. Leahey recognized the DSRIP goal of diverting unnecessary emergency room visits and expressed interest in entering into a contract with Care Compass Network. Collaboration with United Health Services (UHS) and the Binghamton Police department began and together they proposed an idea that challenged a protocol that is decades old.
Typically, when a call came in to 9-1-1 indicating someone might be a potential harm to themselves, for example, local law enforcement was dispatched to the scene. In almost all cases, the individual in distress was taken directly to the Comprehensive Psychiatric Emergency Program (CPEP) at UHS in Binghamton. With the new program that’s now in place, law enforcement officials receive special training on Crisis Intervention and a Mobile Crisis Services Supervisor is now available to deescalate the situation. With the new protocol, the individual in crisis has the opportunity to talk with a licensed clinical social worker about their needs and receive potential outpatient follow-up. This is significant since hospital diversion is a key piece of the puzzle in Healthcare Delivery System reform.
Under the DSRIP program UHS, in collaboration with MHAST, has redefined the scope of mobile behavioral health services offered in Broome and surrounding counties. For areas where mobile, telephonic, or CPEP interventions may not be feasible or appropriate, CCN and UHS are also developing a new telepsychiatry program to better address access to behavioral health. The design of the telepsychiatry program allows patients in crisis to consult with a social worker, crisis evaluator, and psychiatrist without having to physically come to Binghamton. The impact of this program also reaches to the surrounding communities of Chenango and Delaware Counties. This program was developed with rural communities in mind, as Care Compass Network has helped to elevate the transportation barriers many patients in the area face. Additionally, the program will have an indirect impact on wait time in the Emergency Department as new care models are developed. While mobile visits and telepsychiatry are a focus point for both MHAST and UHS respectively, CPEP remains an option for high acuity situations.
MHAST employs a full-time Crisis Intervention Team (CIT) Supervisor position which is funded by the Broome County Mental Health department. Care Compass Network provided the funding for a full time Mobile Crisis Services Supervisor. “Since day one we could envision that pairing the County-funded Crisis Intervention Team project with the CNN funded Mobile Crisis Project would get great results, and it has.” Shared Arthur Johnson, the Broome County Department of Health Commissioner. The collaboration made it possible for both individuals to co-lead a 3-hour in-service training for police officers.
“Training makes a big difference,” explains Michael Hatch, a 23-year career police officer and recently retired Lieutenant of the Johnson City Police Department. Hatch made the decision to take the CIT Supervisor position last September. “In the Police Academy, we’re trained to control behavior. During the CIT training, we explain to them that in certain circumstances, we need to think more about how we can influence behavior.” He continued.
Sarah Harding, formerly with Family and Children’s Services is a licensed clinical social worker who began her work as the Mobile Crisis Services Supervisor in October. Hatch and Harding work together to help give the law enforcement officials the tools they need to reach the best possible and most appropriate outcome for the individual.
“I was pleased and surprised at how welcoming the law enforcement team was toward me,” Harding shared, “They gave me my own office space at the Police Station.” She exclaimed. Harding is currently covering call with the Binghamton Police Department during peak hours with the hope of adding additional team members in the near future. The goal is to have a Mobile Crisis Services professional working with all law enforcement entities in Broome County 24 hours a day, 7 days a week.
The current pilot program with the Binghamton Police Department gives the officers the ability to look to Harding’s expertise when they encounter an individual who warrants a mental health assessment. Harding responds to the call along with the police officers and proceeds to talk with the individual upon arrival on the scene. If the situation does not warrant immediate transport somewhere, and the individual is determined not to be at risk of harming themselves or others, Harding takes steps to determines the best way to help. In many cases, she arranges follow-up outpatient appointments for mental health support or coordinates a housing alternative. She always leaves her card to assure people that they can look to her as a resource.
Hatch will go on calls with Harding from time to time to observe first-hand how the process is working. He also takes part in the follow-up with those individuals who request it. “It gives you a great feeling to know you are really helping to make a difference for the individual as well as the law enforcement officers who are involved.” shared Hatch.
Presently, the police department still responds to every call but the future vision includes collaboration with the Broome County Emergency Management team to develop a decision tree and workflow that will ultimately divert some of the mental health crisis calls directly to the Mobile Crisis Service responders. The hope is that this will free up the police offers for other duties or calls for service.
Mark Ropiecki, Executive Director of Care Compass Network, sites the Mobile Crisis program as an excellent example of the spirit of collaboration CCN is encouraging. “UHS, MHAST, and the local government agencies have deep rooted commitments to the community and were engaged with DSRIP from the very beginning“ commented Ropiecki, “They helped pull the right people together and were ready to make the program a reality. We’re excited to duplicate this approach and energy across each of the counties we serve.”
Healthcare Delivery System Reform is focused on making changes that will improve access and quality of care while simultaneously reducing patient Emergency Department visits, re-admissions, and preventable admissions, thereby reducing costs. Harding recognizes that change is not always easy. “It’s a change in mindset and the transition takes time but it’s worth it. It’s a win for everyone involved from the consumer to law enforcement to the community as a whole”.