Category: Opinion Pieces

Investing in a Professional, Caring, and Mission-driven Workforce

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BEHAVIORAL HEALTH NEWS

 By Staff Writer Odyssey House

The behavioral health care workforce is one of the fastest growing in the country. Projections for 2020, based on U.S. Bureau of Labor statistics, forecast a significant rise in employment for substance abuse and mental health counselors with a 36% increase from 2010-2020 – greater than the 11% projected for all occupations.

This increase, according to the Substance Abuse and Mental Health Services Administration (SAMHSA) Workforce Issues Report of 2013, is based on an expected increase in insurance coverage for mental health and substance abuse services brought about by passage of health reform and parity legislation; the rising rate of military veterans seeking behavioral health services; and the growing opioid epidemic.

SAMHSA’s prediction both confirms the value of our talented workforce and presents challenges for under-resourced social services to meet the increased demand.

As behavioral health care providers, we are confronted with a range of expectations: ensuring our services meet the needs of diverse populations with a complex set of problems; satisfying increased demands for demonstrated outcomes; and doing more with shrinking resources.

Helping us rise to these challenges at Odyssey House is our professional and dedicated workforce. This broad staff of 350 employees include licensed counselors, social workers, doctors, nurses, and dentists, wellness and recreational coordinators, facility and housing managers, educators, administrative, communications and financial managers, maintenance, nutrition, security and transportation coordinators. All of these staff perform essential roles that keep our clients moving forward in their journey towards health and recovery.

While the roles our staff fulfill each day are quite different, the expectations are the same across the organization: that clients come first; policies and procedures are strictly adhered to; and our resources are tightly managed to be cost-effective and outcome driven. Accomplishing these tasks in a challenging human services environment where clients require intensive care for a myriad of emotional, mental, and physical health deficits, demands practice and training.

Investing in Training

Training is an integral part of ongoing performance management at Odyssey House. We encourage our clinical and administrative staff to take advantage of inhouse training opportunities and offer tuition reimbursement towards the cost of professional accreditations and courses. In 2015, our employees earned 35 professional awards ranging from Credentialed Alcohol and Substance Abuse Counselor (CASAC) and Certified Addiction Recovery Coach, to Bachelor’s and Master’s degrees in social work and accounting.

The Odyssey House training department offers a range of professional development options that support direct service and management staff in both progressing their careers and delivering the highest quality care to our clients. Workplace trainings are adaptive to our service environment, track trends and study client profiles, monitor client management systems, and review incidents, chart audits, and quality assurance activities. Training is delivered by experienced licensed staff including medical doctors, clinical social workers, mental health counselors, and certified rehabilitation recreation counselors.

In 2015, clinical staff participated in one or more training sessions that included both group workshops and online individual courses that focused on motivational interviewing, opioid overdose prevention, level of care placement, diagnosis using DSM-5 criteria, ethics and boundaries, safety and crisis management for mental health workers, and cultural diversity and competency.

And we also offered administrative trainings including clinical recordkeeping, documenting medical necessity, fire safety, workplace safety, electronic health record keeping, incident reporting, HIPAA and other confidentiality rules, and basic writing skills.

Focused and Flexible Online Training

We recently enhanced our capabilities with the addition of flexible web-based training. This online system, offered by Relias Learning Management Systems (RMS), further allows staff to refresh their skills and stay up-to-date with regulatory changes ushered in by the 2010 Affordable Care Act and the Mental Health Parity and Addictions Equity Act of 2008. Topics covered include general administrative management requirements like corporate compliance and ethics, fire safety, HIPAA overview, sexual harassment/discrimination prevention, hazardous chemicals, infection control, quality improvement, blood-borne pathogens, and first aid refresher.

We are also utilizing RMS to deliver a range of clinical management trainings including: Screening, Brief Intervention, and Referral to Treatment (SBIRT) for individuals with substance use issues, domestic and intimate partner violence, overview of clinical supervision, best practices in substance use treatment engagement, structured group therapy approaches, co-occurring disorders, and HIV/AIDS.

Odyssey House is committed to developing and maintaining a professional behavioral health care workforce. The clinically focused in-service trainings we offer can be used towards CASAC continuing education credits and many are also approved for New York State Social Work continuing education hours.

By making training a priority, our staff can work in confidence, assured they have the resources and skills they need to succeed in a demanding and rewarding workplace. 

Merging Missions: Building a Staff Wellness Program

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BEHAVIORAL HEALTH NEWS

By Colleen Beagen

Bringing wellness into the workplace is a natural development for Odyssey House where the mission of the organization is to promote a healthy recovery for individuals and families facing a range of life challenges from substance use disorders, mental illness, homelessness and chronic medical conditions. In 2011, we introduced a free, voluntary program called R U Fit?! to offer employees the resources they need to improve their own health via education and a supportive work environment.

This staff wellness initiative is a continuation of our commitment to support and promote good health among program participants. It takes a similar positive reinforcement approach to the proven model Odyssey House developed with clients and provides staff with group support, free on-site fitness facilities, and access to an employee-only online health coaching service.

Our objective in implementing a wellness initiative is to help workers make changes in their lives that undermine their health, thereby boosting morale and productivity, improving employee recruitment and retention, and reducing health care costs.

The development of the program was spurred by Odyssey House president, Dr. Peter Provet, who has made wellness a top priority, based on his firm belief that “ultimately, it is the clients we serve who will be the beneficiaries of healthier, happier staff members.

“Given the steep rise in health care costs coupled with increased awareness of the importance of a healthy diet and regular exercise,” he added, “we looked at what we could do to both help staff improve their overall health and impact our bottom line. We found that a program that offered personalized and confidential coaching was a sound investment in our most valuable resource, the 350 counseling, educational, medical, and administrative staff who dedicate themselves to the mission of Odyssey House.”

A survey of American workers backs this up. The survey found that 51 percent of workers agree that having a wellness program encourages them to work harder and perform better at work; 59 percent said they have more energy to be productive; and 43 percent said that they have missed fewer days of work.

Conducted by The Principal Financial Well-Being Index in 2013, the survey further found that the incentive-driven and ease-of-access approach Odyssey House offers – an enhanced program that includes fitness center discounts, on-site prevention screenings, access to health experts, and onsite fitness facilities – is on target with wellness benefits most desired by employees.

Incorporating Wellness Into Company Culture

Fitness has long been a priority at Odyssey House. All staff are encouraged to practice healthy habits at work and have access to exercise equipment at Odyssey House treatment centers. The emphasis on diet and exercise is foremost in a number of events we host, including our annual 5K fundraiser, Run for Your Life, intramural sports leagues, and rigorous training with the Odyssey House Marathon Team (since 2002 more than 400 clients and former clients, staff, board members and other supporters have completed the New York City Marathon).

The purpose of R U FIT?! is to complement these activities with free, online, confidential health coaching and personalized programs to promote weight and nutrition management, encourage regular exercise and stress reduction, and support smoking cessation. All employees who enroll have access to health coaches, agencywide competitions, online workshops and more.

To allay any concerns staff may have about confidentiality and to encourage trust in disclosing personal information, Odyssey House provides these services via an outside company called Health Advocate. Data collected by the service is anonymous and in the aggregate, and only collated to monitor overall participation and refine services.

Each year we offer all staff on-site biometric screenings and confidential consultations with health educators. The screenings measure cholesterol levels, glucose readings, blood pressure and BMI (Body Mass Index). Using their results, employees complete an online Personal Health Profile (PHP), which provides a customized report containing overall wellness scores, identifying high risk areas, and describing steps that can be taken to reduce future health risks. In its first five years, R U Fit?! has contributed to a shift in culture toward a healthier overall lifestyle, and we have seen improvements in the health of our employees. Between 2013 and 2014, we found the following year-over-year improvements for all participating staff:

  • 50% improvement in average blood pressure
  • 55% improvement in average cholesterol ratio
  • 100% improvement in average glucose levels

For employees with at least one risk factor (e.g., BMI over 25, elevated blood pressure, high cholesterol) over the same period:

  • 55% improvement in average BMI
  • 45% improved average waist circumference
  • 70% improvement in average blood pressure
  • 75% improvement in average cholesterol

Our goals now are to continue to improve biometrics numbers for high-risk employees; maintain nonrisk employees in the healthy range; increase both participation and engagement in the R U Fit?! program; and expand the stress reduction program.

Sound Bodies, Sound Minds

To aid in managing R U Fit?!, we hired a nutritionist and wellness coordinator to act as a liaison between employees and Health Advocate. A registered dietician and certified Pilates instructor, the coordinator has been instrumental in promoting the program and encouraging staff participation.

She has made it her mission to build a wellness program that expands beyond the standard biometric screenings, gym discounts, health competitions, and cooking workshops. Her first order of business was to build trust with the community of employees that span across 13 locations from downtown Manhattan to the Bronx. By establishing rapport with the employees, the doors of communication were opened and she was able to carry on her mission within the agency.

Our coordinator used her expertise to develop nutrition and exerciserelated initiatives, such as agency-wide competitions like 10,000 steps, Pilates and yoga classes, and lunch and learn seminars. However, due to the fact that depression now costs employers more money than smoking does, she made it a goal to reach employees at a deeper level. Her latest initiatives focus on meditation, mindfulness, yoga and Pilates. She is also planning programs targeting compassion, gratitude, and self-esteem.

Employees often share their stories about how one or more aspects of R U Fit?! helped them in their lives, both professionally and personally. Whether it was the impact a nutrition seminar had on them, the weekly meditation classes, or the free gyms we have at six of our facilities, staff have been able to make changes to their lifestyle and create healthier habits that ultimately lead to a higher quality of life.

The Best and Worst of 2015, and Hopes and Fears for 2016

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Leaders in the field of drug treatment share their predictions for 2016 and the challenges ahead. See Dr. Provet’s below. Click here for the full report.

The escalating opioid epidemic among middle-class Americans drew unusual attention last year to our field across a wide public sphere of elected officials, leaders of medical and scientific communities, members of criminal justice and law enforcement agencies, and the mainstream media.

While this attention is welcome, we need to make sure the urgent need for treatment is reflected in the stabilization and expansion of services for vulnerable populations. As states (including New York, with high-need, disadvantaged populations) look to contain costs under Medicaid managed care, we must work hard to ensure that the federal block grant is maintained, the IMD [Institutions for Mental Diseases] exclusion is eliminated and parity under the ACA [Affordable Care Act] is fully enforced. Without these essential provisions built in to federal and state budgets and policies, nonprofit organizations that provide the bulk of safety net services will find it harder and harder to meet the increased demands for care.

At Odyssey House, we have been preparing for the impact of managed care for quite some time and have established new systems to both contain costs and streamline care. These include: electronic health record keeping and linkages with hospital and other community-based providers; evidence-based practices and medication-assisted treatment; and extended outpatient and housing support services.

My hope as we look to 2016 is that we will not only continue to provide quality care for disadvantaged substance abusers (who often require intensive residential services in order to have a chance at achieving and maintaining a functional life), but that their needs will be reflected in the ongoing national debate on how best to treat addiction and its accompanying social ills.

Peter Provet, Ph.D.

President & Chief Executive Officer

ElderCare Services Address “Hidden Epidemic” Of Drug and Alcohol Abuse Among Older Americans

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BEHAVIORAL HEALTH NEWS

 

As baby boomers, many of whom experimented with drugs in the 1960s and 1970s, head towards their senior years, the number of older Americans with substance use disorders is growing dramatically and with it the need for specialized treatment. Odyssey House’s ElderCare program has focused on the special needs of this population for more than 15 years, both by establishing dedicated residential and outpatient services and, more recently, developing a peer-run, community-based mentoring program.

Growing Demand for Services

Older adults represent one of the fastest growing segments of the US population in need of treatment for substance use disorders (SUD). The National Survey on Drug Use and Health found that among adults aged 50 to 64, the rate of current illicit drug use increased from 2.7 percent in 2002 to 6.0 percent in 2013. Additionally, Emergency Department (ED) admissions for illicit drugs and alcohol have been steadily increasing: from 2004 to 2010, the number of ED visits for drug use and misuse has grown 187 percent for adults ages 55-64 and 104 percent for those ages 65 and older.

The Substance Abuse and Mental Health Services Administration (SAMHSA) expects the number of adults aged 50 and older needing SUD treatment to double by 2020, from 2.8 million (2002 to 2006 annual average) to 5.7 million. The increase in substance abuse among older adults has led to a dramatic rise in the number admitted into treatment: substance abuse treatment admissions of individuals aged 50 or older increased by nearly 50 percent between 2004 and 2009 (Center for Behavioral Health Statistics and Quality, 2012).

The above data, coupled with national surveys that show older adults experience increased depression, isolation, and chronic medical conditions, point to the need for services that are age specific and address the unique physical, psychological, and social changes that may occur during this life stage.

Track Record in Treating Senior Substance Abusers

Odyssey House has an extensive track record in meeting the needs of this overlooked and underserved population. In 1997, we created the first-ever residential treatment program dedicated to treating older substance abusers, known as ElderCare. Since its inception, Odyssey House has increased capacity from 15 to 68 beds, reflecting the evergrowing demand for treatment among older adults.

While enrolled in the ElderCare program, residents receive specialized services and supports in addition to SUD treatment designed to help them to function independently within the community, such as life skills training, entitlements assistance, internal medicine, dentistry and psychiatry. Health care services are provided on-site at the Manor Family Center in East Harlem, where we also employ a geriatric social worker to work with our seniors to identify behavioral health care needs and develop a plan to address them.

In 2004, Odyssey House expanded services to include an outpatient SUD treatment track specifically for older adults. Because many elderly people are at risk of being cut off from their communities as they age, the treatment priorities of the ElderCare Outpatient Program, located on Southern Boulevard in the Bronx, are to encourage older people to develop a social support network among their peers in recovery; provide them with individual and group therapy; and visit them in their homes as necessary. Counselors trained in geriatric care develop individualized treatment plans incorporating age-related individual and group therapies targeting symptoms of depression and anxiety, bereavement counseling and life planning, and access to primary medical care.

To date, Odyssey House has served well over 2,000 older adults in residential and outpatient settings, and serves an average of 130 ElderCare clients annually. ElderCare consistently operates at full capacity and has a waiting list, reflecting the program’s appeal to a growing group of consumers as well as the tremendous need in the community.

Our residents are often the highest users of Medicaid services due to multiple risk factors: active SUD, cooccurring mental health disorder, (several) chronic illnesses, and homelessness. Forty-three percent have a primary medical diagnosis of hypertension, 20 percent are HIV+, 15 percent have asthma, and 10 percent have heart problems. Alcohol is the most common primary substance of abuse, 38 percent, although heroin and crack/ cocaine follow closely behind, 30 percent and 26 percent, respectively. Almost 68 percent list two or more substances of abuse at admission.

Building On Treatment: Peer Mentoring Network for Elders in Early Recovery

In Summer 2014, Odyssey House received a $445,000 grant from the New York State Department of Health to implement a peer mentoring track for older adults (Serving Older Adults Recovery System, or SOARS), based out of the Bronx-based Outpatient Services program. SOARS will allow Odyssey House to provide case management services and improve access to community-based recovery resources for up to 90 ElderCare clients over 14-16 months.

SOARS will deliver a continuum of support services for older adults utilizing both intensive case management and peer-based recovery coaching. Odyssey House case managers will work one-on-one with clients as they transition out of residential treatment, connecting them to community -based services to help them remain out of institutional care. In addition, clients will be paired with a volunteer Recovery Coach, who will serve as a peer mentor to assist in identifying and engaging in community-based recovery supports.

The goal of SOARS is to facilitate and expand older adults’ access to community-based Long Term Services and Supports (LTSS) and ongoing support through the utilization of intensive case management and peer recovery coaching. The expected outcomes from this project are to: keep older adults residing in their homes in the community; increase engagement in the recovery process; improve retention; reduce depression and drug use during and after treatment; and improve social connectedness, quality of life, and self-image.

Reference: Center for Behavioral Health Statistics and Quality (2012, January 12). Older Adult Substance Abuse Treatment Admissions Have Increased; Number of Special Treatment Programs for This Population Has Decreased. Data Spotlight. http://www.samhsa.gov/ data/spotlight/WEB_SPOT_043/ WEB_SPOT_043.pdf

Opportunities for Improved Services with Integrated Care

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BEHAVIORAL HEALTH NEWS

By Peter Provet, PhD

The key component of integrated care – coordination of primary and behavioral health services in a way that is accessible from one place – is not a new concept for many substance abuse treatment organizations, such as Odyssey House in New York City, that operate Article 28 licensed medical and dental services as part of comprehensive residential and outpatient treatment. Odyssey House opened its first NYS Department of Health-licensed primary medical clinic in 1992. Staffed by primary care physicians, psychiatrists, and registered nurses, this clinic, co-located in a residential treatment center, was an early model of integrated care. For close to 25 years, our residents have benefited from accessible, on-site services that provide coordinated medical, dental, and behavioral health care across a multi-site system of treatment and housing services.

Early on, substance abuse treatment professionals realized bringing primary care into the treatment community offers clients significant benefits including: integration of medical, psychiatric, pharmacy, prevention, and social work services, and less missed time from treatment. On-site medical clinics were found to reduce use of emergency rooms for non-urgent care, improve management of preventable conditions such as asthma, diabetes, and hypertension and treatment outcomes by encouraging clients to stay in long-term programs.

A 2013 report by the Center for Integrated Health Solutions, published jointly by the Substance Abuse and Mental Services Administration (SAMHSA) and Human Resources Administration (HRA), looked at integrated primary care services and substance abuse treatment and convincingly found that the integration of physical health and addictions care not only helps reduce barriers to primary care, it also enhances recovery from substance abuse.

“In fact,” the report states, “two or more primary care visits in a 6-month period have shown to improve abstinence by 50 percent in individuals with substance abuse disorders, and those with medical conditions related to substance abuse are three times more likely to achieve remission over 5 years. Regular health and addictions care for people with substance abuse disorders also decreased hospitalizations by up to 30 percent. Lastly, substance use screening and services improve the general health of individuals with co-occurring substance abuse and physical health conditions and reduce the overall costs to the healthcare system.”

Today’s model of integrated care, ushered in by passage of the Affordable Care Act (ACA) in 2010 and the earlier Mental Health Parity and Addictions Equality Act (MHPAEA) in 2008, provides opportunities for behavioral health care organizations to further develop integrated care services. According to SAMHSA, ACA expands benefits to approximately 60 million Americans. This legislation mandates coverage of certain preventive services and, together with MHPAEA, ensures health insurers provide the same level of benefits for behavioral health.

This, as we know, is all good news for people in need of substance abuse and mental health treatment who also have physical health needs. Studies have shown that individuals with substance use and mental health disorders who also receive treatment for medical conditions demonstrate improved outcomes in both behavioral and physical health. The demand for medical services is further supported by advances in addiction treatment medication which require appropriately trained staff to administer and monitor these medications for opioid and alcohol addictions.

With the expansion of services comes significant changes to the way Odyssey House, and other behavioral health organizations, must deliver care. Chief among them in New York is a restructuring of Medicaid under the DSRIP (Delivery System Reform Incentive Payment) as part of the Medicaid Redesign Team’s mandate. This effort is charged with reducing avoidable hospital visits by 25 percent over five years by transforming systems and clinical management, and improving population health. Achieving these goals requires the integration of several systems of care from community-based clinics and hospitals, to supportive housing and rehabilitation services.

Positioning for the New Health Care Marketplace

As we prepare for, and participate in, the restructuring of health care services, Odyssey House is gearing up to expand community-based primary, behavioral health, and dental services located at our Family Center in East Harlem and outpatient center in the South Bronx. We are currently included in three Preferred Provider Systems (PPS) that include Mount Sinai, Bronx Lebanon, and Health and Hospital Corporation of New York, and have executed numerous contracts with managed care companies for primary and behavioral health care.

Our services are aligned with the core Health and Recovery Plan (HARP) principles that require Medicaid beneficiaries with mental illness and/or substance use disorders be provided with services in their own communities. These include an array of mandated Home and CommunityBased Services (HCBS) that are:

  • Person-centered
  • Recovery-oriented
  • Integrated
  • Data-driven
  •  Evidence-based
  • Trauma-informed
  • Peer-supported
  • Culturally competent
  • Flexible and mobile
  • Inclusive of social network
  • Coordinated and collaborated.

As an HCBS provider Odyssey House is designated to provide the following behavioral health services:

  • Community psychiatric support and treatment
  •  Psychosocial rehabilitation
  • Habilitation/rehabilitation support services
  •  Family support and training
  •  Pre-vocational services
  • Ongoing supported employment
  •  Educational support services
  •  Empowerment services – peer supports.

Another way we are preparing for changes in the integrated behavioral health care environment is by exploring an FQHC Look-alike designation at our Family Center in East Harlem. While FQHCs qualify for enhanced reimbursement from Medicare and Medicaid, as well as other benefits, they must serve an underserved area or population, offer a sliding fee scale, provide comprehensive services, have ongoing quality assurance programs, and have an independent governing board of directors.

The criteria demanded to provide integrated primary and behavioral health care are aligned with the 48 year-old mission of Odyssey House to provide high-quality, holistic, treatment impacting all major life spheres: psychological, physical, social, family, educational and spiritual.

While the new regulatory environment brings challenges to how we manage our limited resources, who we partner with, and how we monitor the health needs of the individuals we serve, the benefits of an integrated system promise improved care for underserved Americans, not least among them the millions of individuals with substance use and/or mental health disorders.

 

 

 

Odyssey House Family-Focused Programs Offer a Trauma-Informed Approach to Treating Substance Abuse and Mental Health Disorders

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Behavioral Health News

By Justin Mitchell, LMHC, Vice President, Adult Residential Services, and Peter Provet, PhD, President & CEO

Women who have been physically, sexually, and/or emotionally abused are at a significantly higher risk of abusing alcohol and other drugs. As many as 90 percent of women with mental health and substance abuse disorders have histories of physical, emotional, or sexual abuse. It is impossible to effectively treat women without also incorporating clinical services which target trauma and its connection to substance abuse and mental health disorders.

In the past two decades, significant progress has been made in the integration of substance use and mental health disorder treatment. This progress is the result of years of research that supports the efficacy of treating co-occurring disorders in an inclusive manner. Providers have been slower, however, to recognize and treat co-morbid traumatic stress as it relates to substance use and mental health disorders. While treatment providers have made efforts at integrating trauma-informed and trauma-specific services, more providers need to undertake the programmatic changes that are necessary to effectively treat traumatic stress in relation to substance abuse and mental health disorders.

Odyssey House has undertaken this treatment imperative, and over the last four years we have implemented organizational changes that allow us to evolve our family program into one which is both trauma-informed in its delivery and which provides access to specific clinical services that address trauma, substance abuse, and mental health disorders.

Understanding Treatment Needs Of Women And Children

Women and children have long been at an increased risk of exposure to trauma. This risk only increases when we look at women and children who are struggling with mental health and substance abuse disorders. Research has demonstrated that between 48 to 90 percent of women with mental health and substance abuse disorders also have histories of interpersonal abuse (Lipschitz et al, 1996) and, according to Jahn Moses et al (2003), “Fifty-five to 99 percent of woman substance abusers report being victimized at some point in their lives.” Women with substance use problems are also significantly more likely than men to exhibit recent physical, emotional or sexual abuse (Gentilello et al, 2000); and children of substance abusers are almost three times more likely to be physically or sexually assaulted, and more than four times as likely to be neglected than children whose parents are not substance abusers (CASA, 1999).

Traumatic events experienced by these at-risk women and children include: physical, psychological and sexual abuse; domestic violence; witnessing violence against others; and preventable accidents in the home. In “Women and addiction: A gender-responsive approach,” researcher Stephanie Covington states that “a history of being abused drastically increases the likelihood that a woman will abuse alcohol and other drugs,” and suggests that by “integrating trauma treatment with addiction treatment, we reduce the risk of trauma-based relapse.”

Choosing Best Practice Models For Holistic Family Treatment

In 2009, we began the implementation of a new holistic family treatment model. We called it Healthy Mothers Healthy Families (HMHF) because the program addresses the unique life circumstances and needs of pregnant and postpartum women and their children. Funded by a grant from the Substance Abuse and Mental Health Services Administration (SAMHSA), this intensive service combines evidence-based trauma and parenting therapies with substance use disorder treatment in a model of care that incorporates the whole family unit, not just the individual in treatment.

To address clients’ histories of trauma and prevent trauma-related relapse, we implemented four evidence-based trauma-specific services that support clients in treatment for substance abuse and mental health disorders.

The first, Seeking Safety, is a present-focused coping skills approach designed to simultaneously treat substance use disorders and disorders related to histories of trauma. This practice is based on five key concepts: safety as the treatment priority; integrated treatment; a focus on ideals; attention to clinical processes; and the inclusion of cognitive, behavioral, interpersonal, and case management content areas.

The second practice, Trauma, Recovery and Empowerment Model (TREM), is a group-based intervention designed to facilitate trauma recovery among women with histories of exposure to sexual and physical abuse. Drawing on cognitive restructuring, psycho- educational, and skills-training techniques, the genderspecific group emphasizes the development of coping skills and social support. It addresses both short-term and long-term consequences of violent victimization, including mental health symptoms, posttraumatic stress disorder (PTSD), depression, and substance abuse.

The majority of women in treatment at the Odyssey House Family Center are parents. At any one time, 60 parents and 60 children under six years of age live in our residential center in East Harlem or community residence in the Bronx. For these women, and other participants who are seeking custody of their children, we utilize an evidence based practice specifically designed for families with a history of substance abuse. Nurturing Parent Program for Families in Substance Abuse Treatment and Recovery (NPP) is built on the principles of relational development: that parents and children are highly affected by their relationships with each other; that parents and children develop a sense of self through their relationships with each other; and that the parent-child relationship requires a sense of connectedness in order to experience healthy growth and mutual satisfaction. All activities in this practice are designed to help participants learn how to nurture themselves as individuals and in turn lay the foundation for a nurturing family unit.

Approximately 15 percent of women in our family programs are pregnant when they enter treatment. For these vulnerable women, extending their treatment stay through delivery and the postpartum period is a critical goal. The fourth evidence-based practice, Motivational Enhancement Therapy (MET), is designed to improve retention of women who were pregnant entering treatment. The results of applying this practice are particularly heartening. Almost twice as many women who participated in MET remained in treatment for 30 days compared to pregnant women who enrolled in treatment in the three years prior to the implementation of this therapeutic model.

Data-Driven Results Support Efficacy Of Intensive Residential Model

Over the course of the four-year HMHF grant, we served 150 women, 61 of whom were pregnant at the time of admission. Using intake and six-month follow-up screenings the data showed significant positive rates of change in all major areas measured. The largest increases at follow-up were observed in employment/education with one in three women in school or employed compared to one in 10 at intake (177 percent increase), and a 150 percent increase in abstinence. Criminal justice involvement was reduced, with 98 percent of women reporting no involvement at follow-up compared to 88 percent at intake, and almost 100 percent of participants reported improved social connectedness and no consequences of substance use.

The HMHF model has been effective at working with women to see a psychiatrist, if indicated at screening. This resulted in an 83 percent increase in the number of women prescribed medication for psychological or emotional problems, and a significant improvement in participants’ mental health, including a 40 percent reduction in depression, 18 percent reduction in anxiety, and 32 percent reduction in trouble understanding, concentrating or remembering. In addition, 60 percent of the women reported reduced trauma symptoms at follow-up and a 27 percent reduction in difficulty controlling violent behavior.

Future Development Of Best-Practice Substance Abuse And Mental Health Treatment

Odyssey House clinical experience points to the essential benefits of trauma-informed services when treating women with substance abuse and mental health disorders. The most effective model is a comprehensive service that screens and treats trauma-related symptoms using the following criteria:

All clients, especially women, should be screened and assessed for PTSD;
Clients identified with histories of traumatic experience should receive treatment that explores the relationship between substance use/mental health disorders and the traumatic experience;

Evidence-based trauma-specific services should be incorporated into the program structure.

For further information on Odyssey House treatment services for women and children, please call: 212-987-5100, or write to: info@odysseyhousenyc.org.

One Runner at a Time, We are Slowly Eroding the Stigma of Addiction

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BEHAVIORAL HEALTH NEWS

Recovery from substance use disorders often resembles training for a marathon. It’s a long process that requires discipline, focus, and ongoing effort. As addiction experts and mental health professionals gain greater insight into the behavioral-physical health connection, fitness programs are proving to be important components of long-term recovery.

This is particularly true at Odyssey House, where recovery includes engaging in regular physical activity and taking responsibility for your health. Research shows that exercise not only improves cardiovascular function and has other physical benefits but can also elevate mood, alleviate stress, and even improve brain function.

Exercise makes us feel better, both mentally and physically, and that is why physical fitness is such a big part of the Odyssey House experience. In my 25 years of clinical experience, I have personally seen the positive impact physical well-being has on the recovery process. Recreational activities, like running, help residents stay fit, develop self-confidence by achieving personal goals, and feel like they are a part of something larger.

A Perfect Antidote to Addiction

At Odyssey House, we encourage people in recovery to participate in physical fitness programs as varied as long-distance running, weight training, basketball, softball, Pilates, and yoga. Facilities are outfitted with exercise equipment and weights. In 2001, I founded “Run for Your Life,” a program that brings residents of all ages together several times a week in New York’s Central Park to walk or run. We have since had more than 300 clients and staff members complete the NYC Marathon.

The most widely understood benefits of regular exercise include weight loss, improved strength and enhanced cardiovascular health. And while physical health is an important reason for following a personal fitness plan, the effects of exercise aren’t limited to speed, strength and endurance. It also addresses the negative breakdown of the human spirit and provides those in recovery with a constructive, healthy way to spend their time. Addiction is time-consuming– a constant cycle of using and searching for the next fix. Training for a marathon, or embarking on a fitness program, fills that time. It requires long-term planning and commitment, necessary qualities for sustaining a lasting recovery and making exercise, in many ways, a perfect antidote to addiction.

Many of our clients enter treatment with decimated self-esteem and exercise gives them something to feel good about. The sense of accomplishment from completing a marathon or reaching a fitness milestone is powerful it can help carry clients through the difficult stages of early recovery and gives them a reason to stay in treatment when they get discouraged.

Exercise Can Boost Treatment Goals

Although exercise regimens are not yet part of traditional recovery programs, new research is lending evidence-based support to the potential for exercise to boost traditional treatment. A study at Butler Hospital, an affiliate of Brown University, found that individuals in early recovery who participated in regular exercise were more than twice as likely to be abstinent from alcohol as the control group (Sejourne, 2014)

Exercise can also improve the brain’s ability to resist the temptations of addictive drugs. Two independent studies funded by the National Institute on Drug Abuse indicate that exercise does more than simply provide an alternative activity that reduces the time available for drug seeking; both exercise and addictive drugs raise levels of dopamine in the brain’s reward system, and as a result, exercise may compete with cocaine as a source of pleasurable sensations (Whitten, 2012).

Power of Team Building

Social interaction is also crucial to recovering addicts, who must learn to build relationships without the help of drugs or alcohol. In addition to the direct physical and mental impacts of addiction, many recovering addicts and alcoholics have found organized exercise to be a source of camaraderie and support. Our marathon runners, for example, depend on each other to get them through the long training runs and past mental road blocks, both on the road and in treatment. And it’s not just our clients who are united in recovery. When our staff and clients train together, it establishes a mutual respect that evolves into improved therapeutic relationships.

Running also helps our clients reintegrate back into their community. People struggling with substance use disorders are often seen as a lost population. But our marathon team is changing the stereotype. Over the years, as Run for Your Life has become known in Central Park, I have seen the difference in how people respond to our clients. Once a source of concern, our clients are now a source of inspiration. One runner at a time, we are slowly eroding the stigma of addiction.

As our clients reintegrate, they become active members of their community and give back. Our marathon team is involved with Achilles Track Club, an organization that provides support, training, and technical expertise to people with disabilities. The Run for Your Life team volunteers at Achilles races and acts as guides for their runners. By giving back to the community, our clients reinforce their commitment to recovery.

Join us on September 20, 2014 for the 9th Annual Run for Your Life 5K Run & Recovery Walk. This event brings together individuals in treatment, their families and friends, and supporters of recovery services to promote the societal benefits of prevention, treatment, and recovery for mental health and substance use disorders. Visit odysseyhousenyc.org for more information and to register.

References

Sejourne, C. Exercise may help treat alcohol dependence, study shows. (2014, April 14). The Brown Daily Herald. Whitten, L. (2012, April 19). Physical Activity Reduces Return to Cocaine Seeking in Animal Tests. National Institute on Drug Abuse.

Treatment and Housing: A Seamless Service Model for High Need Populations

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BEHAVIORAL HEALTH NEWS

By Janice Slaughter, MSW, CASAC, Director of Mental Health and Housing Services, and Peter Provet, PhD, President and CEO, Odyssey House

A  report published by Columbia University Mailman School of Public Health in 2013 found that: “Supportive housing has been demonstrated to end homelessness for persons with complex needs and to reduce overall public systems’ involvement and costs.” These “complex needs” include an array of problems familiar to us and other providers of substance use disorder treatment and mental health services. At Odyssey House, we manage the urgent care of individuals who frequently cycle in and out of jails and homeless shelters, hospital emergency rooms and inpatient psychiatric hospitals, residential substance abuse and mental health treatment facilities.

This ‘cycling’ comes at enormous cost to the individuals who suffer from untreated mental health and substance use disorders, the families who struggle to find their loved ones appropriate care, and the taxpayer who largely foots the bill for expensive crisis intervention services.

For close to 50 years Odyssey House has been a strong provider and advocate for communitybased services that work to stabilize and treat people with chronic substance abuse and mental health disorders. We are known for providing intensive and extensive, cost-effective, evidence-based care for a diverse range of populations that includes: mothers with young children; adolescents; senior citizens; incarcerated adults; the homeless; people living with HIV/AIDS; and those with chronic mental illness. These populations require specialized services tailored to specific behavioral needs that, if left untreated, not only limit a person’s chances of living a healthy, independent life, they end up costing more in emergency shelter, criminal justice involvement, and healthcare services.

Extending Our Treatment Mission

Helping people faced with the challenges of mental illness and/ or substance use disorders is our mission. Our mission also extends to providing services for these individuals and families in their own homes. Odyssey House housing specialists and case managers offer tenants access to vocational, peer recovery, substance abuse, medical and mental health treatment in a range of permanent and transitional living situations.

In 1994, we opened our first congregate care, intensive residential treatment program for people who are living with mental illness and/or in recovery from substance abuse. This 60- bed program in East Harlem, the Odyssey House Harbor, currently provides essential transitional services for severely mentally ill homeless adults referred from city and state psychiatric hospitals who, with support, can live independent lives in the community. Since then, our housing portfolio has grown to include a wide range of housing options for more than 456 single adults and family members who have either completed residential substance abuse treatment, are homeless and living with HIV/AIDS and other chronic medical conditions, or are homeless and working to manage their mental illness and/or substance abuse disorders.

With the support of our government partners at New York State Department of Health (DOH), New York State Office of Alcoholism and Substance Abuse Services (OASAS), New York State Office of Mental Health (OMH), New York City HIV/AIDS Services Administration (HASA), and New York City Department of Housing Preservation and Development (HPD), our portfolio has grown to include scattered site apartments, community residences, and apartment buildings in Upper Manhattan, the Bronx, and Brooklyn.

Investment in Special Needs Housing

In the last few months we completed construction of two new apartment buildings in the Bronx. In partnership with OMH and private tax credit investors we custom designed, developed, and managed the construction of a 56-apartment green building (applying for LEED certification) on Soundview Avenue and a 65-apartment building on Tinton Avenue. Both of these new buildings (designed by Urban Architectural Initiatives) provide supportive housing for homeless men and women living with mental illness.

The capital and ongoing revenue funding for these new programs falls under New York State legislation to provide mental health services, including housing, within the community. With the opening this Spring of these two new buildings (and the 50-apartment building we opened in 2010 on 123rd Street and Park Avenue), Odyssey House currently manages the housing and supportive services needs of 171 formerly homeless New Yorkers who, despite serious mental health challenges, are now living independently in their own homes.

Working to Support Recovery In New York State

The demand for safe housing is also acute within the population of people in recovery from substance abuse disorders. Almost a third of the participants in our intensive residential substance abuse treatment programs are either homeless or marginally housed when they enter treatment. As part of their recovery process from chronic substance abuse, we work with them on relapse prevention techniques, work skills, job placement, and finding and maintaining secure housing. In New York City, where housing is premium priced and affordable housing is in short supply, we dedicate an increasing amount of our resources to helping clients secure housing and work closely with our partners in government to address urgent housing needs.

In the last several years, OASAS has partnered with us in providing a variety of housing options in either a transitional community residence or scattered site permanent apartments for 150 individuals and families who complete treatment. We count ourselves fortunate to be supported by our partners in OASAS whose mission statement calling for “safe, affordable housing and stable living-wage employment are fundamental to successful long-term recovery,” is congruent with the needs of our treatment population.

We are equally grateful to our partners in OMH for committing to “a future when every New Yorker experiences hope and recovery and when people across New York have access to and choice among the supports and services that fosters self-determination for living, working, learning and participating fully in their communities.”

As treatment services evolve to support individuals within their communities, we are developing housing and outpatient services that complement and extend the efficacy of residential treatment. Our evidence-based services provide a continuum of care proven to offer the best return on investment as measured by reduced recidivism, emergency medical visits, and shelter stays.

In its mission statement OASAS endorses “nonprofitoperated affordable housing, supported by on-site services … (as) the means by which New York State is able to give hope to individuals, families and communities in recovery.” We couldn’t have said it better ourselves.

For further information on Odyssey House treatment and housing services, please speak to an Admissions Specialist by calling: 212-987-5100, or send us an email at: info@odysseyhousenyc.org

Preparing for Managed Care: Staff Credentialing, Evidence-Based Practices, and Fiscal Systems

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BEHAVIORAL HEALTH NEWS

By Gary Harmon, PhD Vice President, Director of Research & Grants, and Peter Provet, PhD President & CEO, Odyssey House

For decades, behavioral health (BH) professionals have fought for the right to have mental health (MH) and substance use disorders (SUD) regulated in a similar manner as medical/surgical conditions. First the Mental Health Parity and Addiction Equity Act of 2008 and more recently the 2012 Affordable Care Act (ACA) have begun to make parity a reality. However, with parity has come an entire new set of challenges that BH providers must traverse to ensure that the specialized treatment offered by MH and SUD providers does not become diluted in a managed care model.

Here in New York, Medicaid Redesign Team (MRT) initiatives have piggy-backed on parity laws to begin to reform the BH landscape. No longer will BH agencies exist in a world of “carve-outs” and specialty populations funded through large state contracts. Rather, they will have to navigate new relationships with Managed Care Organizations (MCOs), Behavioral Health Organizations (BHOs), and private insurers for reimbursement while being held to a higher standard of care.

Although all in the BH field will agree that improved outcomes for our clients is the ultimate goal, the process of getting there in a new system will be complex and require the following changes for both organizations and the clinicians they employ.

Credentialing/Licensure 

While the MH treatment community has embraced licensed professionals for treatment of mental health conditions, the SUD community is often seen as employing “para-professionals” and clinicians that have little training and education beyond life experiences of SUD treatment and recovery. Whether or not this perception had any merit in the past, the SUD community has embraced education and training to ensure that clients (many of whom have co-occurring mental health conditions) are receiving optimal care. MCO/BHO contracting will be the final step in ending the old stigma of semiprofessionals providing care, as they will require that anyone billing for BH services is properly credentialed and/or licensed. While most SUD providers will have no issues with this and have been hiring only credentialed and licensed staff for many years, some agencies will need to figure out how they can direct current staff to continue education and training. However, one major challenge will be the increased salary requirements that credentialed and licensed staff will demand, and how these costs can be absorbed or shared by MCOs/BHOs, without increasing costs for the already vulnerable clients we serve.

Evidence-Based Practices 

The term “Evidence-Based Practice” (EBP) has been the buzz-word in the BH community for quite some time, and is often used anytime someone questions what type of treatment is being provided to BH clients. In the new managed care environment, simply saying that the treatment provided is “Evidence-Based” will not be sufficient. Providers will need to evaluate staff training and monitor fidelity to guarantee that interventions are being delivered in a manner where outcomes are optimized. The days of saying an organization practices “Motivational Interviewing – Type Services” for example, will be over, and the exact EBP will need to be manualized, delivered with consistency, with prescribed outcomes that can be directly attributed to the intervention. This will be a challenge for many organizations, as BH agencies often struggle with staff turn-over and issues related to the competency of staff to deliver complex EBPs.

Fiscal Preparedness

Most not-for-profit BH agencies were begun as charities, often founded and operated by individuals who were champions of client rights and wanting to make a difference for individuals afflicted with SUD and/or MH conditions. Through the years, many of these agencies have evolved into corporate-like structures in an attempt to adapt to regulatory changes requiring agency and facility licensure and managing of state, federal, and city contracts. The managed care environment will require additional transformation, where fiscal preparedness and operations will be as key to agency survival as clinical services have been. For example, smaller agencies with little or no experience billing Medicaid or private insurers will undoubtedly struggle initially with the complex billing and justification requirements set forth through MCO/BHO contracts.

Additionally, many smaller agencies may not have the administrative/fiscal staff available to re-bill rejected claims, analyze and implement regulations, and adequately justify the reauthorization of treatment. Recent requirements by New York State related to the maximum percentage of costs that can be expended on administrative staff will further limit the number of staff that agencies can hire to navigate reimbursement, which will undoubtedly lead to mergers for a necessary “economy-of-scale.”

These three challenges are only a few among the countless that will be encountered over the coming years. BH agencies will need to begin to work together through this process to maximize the success that can be achieved. As many large and established BH organizations are poised for success in this new landscape, they must work together will smaller agencies to help them survive and thrive. Recent data from SAMHSA showing that 18.9 million adults in the US had a past year SUD, and 41.4 million adults had mental illness in the past year underscores the need for more treatment options for clients (SAMHSA NSDUH 2011). The survival of all quality BH agencies, both big and small, is key to a strong BH system where help is available to those who need it.

Odyssey House is a not-for-profit, comprehensive, social services organization. Based in New York City, Odyssey House offers residential, outpatient, and family-based substance use disorder and mental health treatment, supported housing, medical, dental, vocational and educational services. For treatment referrals, admissions, and program services, please call: 212-987-5100, email: info@odysseyhousenyc.org, or visit us online at: www.odysseyhousenyc.org 

Total Wellness: The Key to Behavioral Health

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BEHAVIORAL HEALTH NEWS

By Peter Provet, PhD President & CEO Odyssey House

The term “behavioral health” is often used to describe the connection between behavior and the health and well-being of the body, mind, and spirit. Substance use disorders, mental illness, homelessness – these are all behavioral health problems that need a multi-faceted treatment approach. The path to recovery requires us to see the connection between substance abuse and related problems and to take the necessary steps to address these issues in a comprehensive and effective way. That is why Odyssey House provides high quality, holistic treatment impacting all major life spheres: psychological, physical, social, family, educational, and spiritual.

Established in 1967, Odyssey House is a nonprofit behavioral health care organization with a mission to provide comprehensive and innovative services to New Yorkers struggling with substance use disorders, mental illness, and homelessness. With 10 substance abuse, mental health and supportive housing facilities located in East Harlem and the South Bronx, Odyssey House provides a range of direct and supportive services, including residential and outpatient substance abuse treatment, trauma-informed services, case management, primary health care, dental care, mental health care, supportive housing, recovery coaching, housing assistance, vocational and educational support, and more.

Treating the Whole Person

At any one time, Odyssey House is home to more than 1,000 men, women, and children. Some of these residents are young mothers who enter treatment with their children, seeking a drug-free life for themselves and a brighter future for their families. Older men and women come into treatment to break a lifetime habit of addiction, while teens are attempting to get back on track and succeed in school and at careers. For all of these clients, Odyssey House provides a chance to recover from addiction and mental illness and, along with that, to experience the psychological and physical well-being that comes with recovery.

Throughout all programs, Odyssey House provides holistic care with wraparound services. Recognizing that there is no “one size fits all” treatment model, Odyssey House does not simply place clients in housing or treat them for their substance use disorders or mental illness. We provide ongoing, personalized support to teach daily life skills, reunite families through NYC Administration for Children’s Services mediation and family therapy, attend to educational needs through GED preparation and classes, and care for the body through our health clinics and on-site gym facilities.

This complete continuum of care stabilizes clients and puts them on the path to lasting independence. Through Odyssey House’s licensed medical clinic and dental clinic, clients of all programs are able to access a range of health care services, giving our clients a crucial opportunity to manage their health before their conditions degenerate into an emergency situation.

Managing Mental Illness

Men and women suffering from mental illness are especially prone to substance abuse. The effects of addiction combined with the challenges of chronic mental conditions can be devastating, isolating these men and women from family, making it almost impossible for them to lead productive lives in the community, and often rendering them homeless.

At Odyssey House, case managers and counselors enhance treatment in our supportive housing communities with intensive mental health services and coaching in life skills ranging from personal hygiene to financial management. Up to 250 residents, most referred from city and state psychiatric facilities, partake in supported community living plus group therapy, medication management, vocational counseling and job training—all part of preparing themselves to take control of their lives and re-enter the community.

When the time comes, Odyssey House helps these men and women make the difficult transition into permanent housing. Residents in treatment attend workshops that teach such real-life skills as budgeting, making rent payments on time, and grocery shopping. Once participants have successfully completed the workshops, a placement specialist helps them find affordable housing, accompanies them on interviews with landlords, and helps negotiate rental contracts. In this way, Odyssey House helps break the cycle of relapse and homelessness.

Beyond Treatment

At Odyssey House, recovery is more than just sobriety. Recovery includes engaging in regular physical activity, taking responsibility for your health, and expressing yourself creatively.

Research shows that exercise not only improves cardiovascular function and has other physical benefits but can also elevate mood, alleviate stress, and even improve brain function. Exercise makes us feel better, both mentally and physically, and that is why physical fitness is such a big part of the Odyssey House experience.

Facilities are equipped with exercise equipment and weights, and residents are encouraged to enjoy yoga, Pilates, basketball and other team sports. Especially popular is Run for Your Life, a program that brings residents of all ages together several times a week in New York’s Central Park to walk or run. Many clients also choose to participate in marathons and other races.

Creating art provides a way to access and express feelings, and helps relieve a sense of isolation. Residents at all Odyssey House facilities are encouraged to express themselves through art and writing, and also enjoy readings, film screenings, and museum visits. The Odyssey House Art Project engages residents in painting, sculpture, and other forms of expression. Every year, works by these residents are showcased in the Haven Art Gallery, occupying a handsome, lightfilled space in an Odyssey House facility on East 121st Street in Manhattan.

These activities provide residents with a chance to develop relationships with one another, improve their self esteem, gain control over their bodies, and get a change of pace from the strenuous, day-to-day routine of recovery. Most important of all, they introduce residents to yet another component of a richer, fuller, more satisfying substance-free life.