Category: support

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.

 

 

 

Celebrating with your sober sweetheart

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Two of the most common relapse triggers are relationships and holidays, making Valentine’s Day an especially tough day for people in recovery. There are many reasons why this day can be a trigger, including:
  • You feel pressure to make the day extra special to make up for past disappointments;
  • You’re single and unhappy about it; or
  • You don’t know how to celebrate sober.

Here are some tips to stay clean and sober this Valentine’s Day: 
  • Relax. Talk to your partner about your concerns and work together to find ways to make the day special. Lifehacker has some great tips for a stress-free holiday, whether you’re in a relationship or single.
  • Find new ways to celebrate. Stay in and make a dinner for two instead of going out. Have a mocktail party with your single friends in recovery. Or go to a comedy club and forget about Valentine’s Day altogether. Want more ideas? Here are 10 more.
  • Get some perspective. Instead of focusing on yourself and your relationship (or lack of one), volunteer with a nonprofit, reach out to your peers in recovery, or do something nice for your community. 

Remember, Valentine’s Day means loving yourself too. Have any tips of your own? Leave them in the comments!

Peer Help for Parolees

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Bronx Free Press Reporter Gregg McQueen visited our outpatient clinic in the Bronx to speak with Mary Callahan, senior manager, director of Outpatient Services, and Michael Everett, a certified recovery coach, about this innovative program and how it will help reduce recidivism in participants.

An innovative new program based in part in the Bronx looks to help parolees return to the community after incarceration and lower their risk of relapsing into criminal behavior.

Powered by a $300,000 grant from the U.S. Department of Justice, local nonprofit Odyssey House will implement a pre- and post-release mentoring and recovery program for parolees from the Edgecombe Correctional Facility.

Dubbed the Edgecombe Peer Monitoring Program (EPMP), the initiative provides services for the formerly incarcerated to help them transition from prison to community living.

It will also help parolees maintain sobriety, as an estimated 80 percent of state prison inmates have histories of drug or alcohol abuse.

“This type of program we’re doing is very rare,” said Mary Callahan, Director of Outpatient Services for Odyssey House. “But I would say it’s the face of treatment and recovery for the future.”

Mary Callahan

Following release from Edgecombe, parolees will be paired with a “coach” at Odyssey House’s outpatient facility on Southern Boulevard in the Bronx, who they’ll meet with twice weekly to review recovery goals, receive substance abuse counseling and get connected with vital services.

Coaches will ensure that parolees follow through on appointments, and assist them with finding housing, job training, medical and mental health services and going back to school, as well as efforts to maintain sobriety.

The first few years after incarceration are a critical period when many inmates are at risk of relapse, said Callahan.

Approximately two-thirds of offenders in re-entry are arrested again within three years of release, with 52 percent returning to prison for a technical violation or a new crime.

Callahan said that individuals frequently receive treatment for substance abuse while in prison, but are often on their own once released to the community.

“This grant will pick up that part of things by linking people with coaches, who act like mentors, so when they leave prison they’ll still be getting the support they need,” she commented.

Participants in EPMP will be issued texting-enabled cell phones, so they can check in with each other routinely.

“We’ve found texting to be very successful with our other programs,” said Callahan. “Parolees will have 24/7 access to their mentor.”

The EPMP will launch in February and is expected to serve 200 parole clients over the next two years.

“And once they’re plugged into the strong recovery network we have here, parolees will still have the support they need once our grant ends,” said Callahan.

The certified recovery coaches employed by Odyssey House for EPMP are all in recovery from substance abuse and were previously incarcerated themselves, Callahan added.

“They can definitely speak more directly to the parolee and relate to them better,” she commented.

The EPMP builds off a program that Odyssey House currently sponsors at Edgecombe, which houses previously incarcerated males who have violated parole and also have a documented substance abuse issue.

Men are assigned to the facility for 45 days — during their entire stay, Odyssey House provides them with an intensive treatment program to help them overcome addiction.

Since Odyssey House began working with Edgecombe in 2008, more than 3,600 inmates have participated in the treatment program designed to reduce recidivism and substance abuse.

Callahan said that addressing the parolees’ sobriety issue is essential before they can accomplish anything else in the community.

“That’s really the foundation of everything,” she remarked. “When you’re dependent on drugs or alcohol, you’re less likely to find employment, continue schooling or stay out of jail.”

Michael Everett would agree.

Everett, now a Certified Recovery Coach with Odyssey House, fought his own past battles with addiction and served several prison stints.

“I only wanted to get high,” he recalled. “When I’d get out of jail, I’d go right back to smoking and selling drugs and robbing people.”

Michael Everett

Everett recently celebrated five years of sobriety and has been out of the prison system for 14 years.

Now, he has devoted himself to aiding others who are living through the same experiences.

“I didn’t have a program like this to help me when I got out of jail — I felt lost,” said Everett.

At Odyssey House, Everett has been helping to mentor young recovering addicts, some with a history of incarceration.

“Some people don’t even know how to apply to a school or who to turn to,” remarked Everett. “It’s about them making that transition back to accomplishing something positive.”

Callahan said that connecting parolees with housing is a major issue facing Odyssey House, as many individuals on parole have family members who reside in public housing.

“People on parole, they’re not permitted by law to live in public housing,” explained Callahan. “So, if that’s where their family lives, they can’t even go home to their family when they’re out of prison.”

Parolees will often end up in shelters, where they might reside with individuals who are not helpful to their recovery goals.

“A lot of times the shelters set them up to fail,” said Callahan. “There are a lot of barriers that these individuals face.”

Everett knows first-hand about these struggles. Now his role is to make his clients believe they can overcome them.

“I keep hope alive for these individuals,” remarked Everett.  “Once they get to a place where they feel they can accomplish one positive thing, it’s a big deal.”

Recovery coach Everett recently completed a 350-hour training course to become a substance abuse counselor. Once he completes his internship hours, he’ll be able to get a job in that field.

“The sky is the limit for me now,” said Everett.  “I’m not looking back, I’m only looking forward.”

Celebrating women of strength

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Friendships between women are special. In their friendships, women tend to share feelings and problems more than men do with friends; and in times of stress or anxiety, women are more likely to turn to their friends and confidantes for emotional relief.

Many people struggling with substance use disorders, mental illness, or homeless find themselves isolated, and studies show that losing connections with others is a particularly devastating aspect of addiction for women.


That’s why every March, in honor of Women’s HistoryMonth, we host a special Women’s Day event. It’s often the first time the women across our housing programs have a chance to interact. “It’s about introducing the residents to each other, to encourage them to socialize and form a support network,” said Victor Genao, program director of Park Avenue.
This year’s theme was “Strong Women Rise,” reflected on a mural painted by several of the women. The celebration was organized by Harriet Turner, who said, ‘I believe ‘strong women do rise’ above all adversities and being a part of the women’s month event at Odyssey House gives me an opportunity to bring together the women we serve and provide a forum of hope and inspiration while sharing stories of encouragement through their own achievements and the stories of others.”

The program included a performance by gospel singer Arlethia, poetry readings, and a ceremony honoring a woman from each program. Many of the speakers took the opportunity to share words of inspiration with their fellow tenants and colleagues:

“Everyone sitting at this table, know that you are an inspiration to someone – you are someone’s mother, sister, aunt, niece, daughter. More importantly, you are somebody.”

“You have a purpose in life – be a positive role model, not just at Odyssey House but in the world.”

They even learned how to pamper themselves a little bit. Kelly Ahearn, wellness coordinator, showed the women how to make a simple facial mask at home. 

Building a peer support system for people in early recovery

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Odyssey House has been awarded a three-year, $1.2 million grant by the federal Substance Abuse and Mental Health Services Administration (SAMHSA) to fund enhanced services for individuals and families in recovery from alcohol and substance use disorders. The new program, called the Odyssey House Recovery Oriented Care System (OHROCS), will deliver recovery support services using the evidence-based Therapeutic Community peer mentoring model that includes coaching, personal recovery plans, peer-to-peer support groups and incentives.

Dr. Peter Provet, president of Odyssey House, said, “A peer support system that builds on techniques individuals learn in treatment offers an exciting opportunity to extend the reach of recovery services to where people live and work.”

To learn more about OHROCS, read the press release here.