Solutions That Work: Adult Peer Innovations in the Value Equation

Tammy Bender & Eric D’Entrone, Arms AcresDouglas Hovey, Independent Living Inc. Facilitated discussion by Yves Ades, PhDSeptember 26, 2018

Introduction and HousekeepingHousekeeping:

• Slides are posted at MCTAC.org

• Questions not addressed today will be: • Reviewed and incorporated into future trainings and presentations

• Added to Q&A resources when possible

Reminder: Information and timelines are current as of the date of the presentation

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Next in the Solutions that Work Series…‣ Access and Engagement in the Value Equation• 10/23/18‣ Integrating Behavioral and Primary Health• 11/29/18

• Register at www.ctacny.org

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About Our Presenters‣ Tammy Bender: Tammy has been working in the field of

addiction for more than 15 years and with Arms Acres and Conifer Park Regional Team for over 4 years. Tammy is also the Alumni Coordinator for Arms Acres and manages several of the support services that are offered to the Alumni, such as the “Connections” Recovery App and the Recovery Coach Services for the Hudson Valley. Tammy is a Certified Addiction Recovery Coach and a Certified Recovery Peer Advocate. She is currently supervising the two Recovery Coaches that were hired via the Innovation Fund Pilot Project with Montefiore Hudson Valley Collaborative.

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About Our Presenters

‣ Eric D’Entrone: Eric is a professional in the field of addiction treatment for 20 years, and with Arms Acres and Conifer Park for 12 years. As part of the Regional Services team for Arms Acres and Conifer Park, Eric has created partnerships with many organizations in the community. Eric is also the point person for all DSRIP projects for Arms Acres, managing several initiatives including the Innovation Fund Pilot Project with Montefiore Hudson Valley Collaborative.

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About Our Presenters‣ Doug Hovey: As Founding Executive Director of Independent Living Inc., a

consumer-run advocacy and service organization based in the Mid-Hudson Region, Doug has long championed the cause of equal rights, access, and opportunity for all persons with disabilities, and recognizes that as people with disabilities our challenges are very much the same as we experience discrimination, separation, marginalization, underemployment, poor access to healthcare and limited affordable and accessible housing, to name a few. Doug holds graduate degrees in Health Care Administration and Rehabilitation Administration from the New School for Social Research in NY and The University at San Francisco, respectively, and is professionally and personally familiar with the challenges faced by people with disabilities. Under Doug’s leadership, Independent Living Inc. has grown from a staff of 3 to over 100 employees and a home care division that employs 750 homecare workers. He has led the development of several progressive peer based services that support the rights, rehabilitation and recovery of individuals with physical, psychiatric, substance use, developmental disabilities. With over 30 years of leadership experience in the field of disability and rehabilitation services, Doug has also served in various governance capacities.

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Arms Acres: Who Are We?‣ Arms Acres and Conifer Park: a combined 388 beds

licensed by NYS OASAS‣ Arms Acres: In Carmel, NY: 183 beds, including 31

detox, 131 adult rehab, and 21 adolescent beds (for boys and girls ages 12-18)

‣ Two levels of care under one roof: Medically Supervised Withdrawal and Stabilization (Detox) and Inpatient Rehabilitation

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Arms Acres

Multi-disciplinary Treatment

Team

• Physicians, Psychiatry, Nurse Practitioners, 24-hour nursing care, Physician’s Assistants, Licensed Social Workers, and Mental Health Counselors, CASAC counselors, etc.

Detox

• Stabilize withdrawal symptoms as well as co-occurring medical and psychiatric symptoms. Introduce structure and counseling: Motivational Interviewing

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Arms Acres

Inpatient Rehab.Evidence Based

Treatment Practices

Cognitive Behavioral Therapies

Trauma-Informed Clinical

Approach

Dual Focus Groups

Therapeutic Recreation

TherapyEquine Therapy

Program Family Program

Medication Assisted

TreatmentCase

ManagementRecovery App

offeredAlumni

Association

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Arms Acres: Who Do We Work With?‣ People who would otherwise be unable to have their

SUD symptoms managed in a lower level of care (i.e., residential or outpatient). Need stabilization first.

• People experiencing moderate to severe withdrawal needing medical supervision (with medical oversight, vital sign monitoring, and medication).

• People with co-occurring psychiatric symptoms.• People with chronic medical symptoms.

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Arms Acres: Innovation Fund Project-Recovery Coaches‣ Baseline: For all Arms Acres patients in 2017, rate at which people

kept aftercare appointments was 46.77%‣ Fall 2017: Received funding from Montefiore Hudson Valley

Collaborative as part of Innovation Fund to hire 2 recovery coaches.

• Goal was to improve the care transition from inpatient to outpatient.‣ Coaches are integrated into the Arms Acres workflow but not

clinical. Voluntary‣ People must meet the following criteria to be eligible: reside in the

7 counties of the Mid-Hudson Region, have Medicaid, and be identified by clinical staff as having a high risk of relapse.

‣ Coaches meet with individuals on the unit, develop rapport and trust, complete a person-centered Recovery Plan, and make plan to meet with them in the community post discharge.

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Arms Acres‣ Coaches provide a variety of functions with their

recoverees:• Accompany them to their 1st outpatient appointments

(“warm handoff”)• Connect recoverees to self-help meetings and other

recovery supports in the community• Accompany recoverees to court appearances, help them

navigate the DSS system to get or maintain benefits, get emergency housing, navigate transportation, etc.

• If individuals miss appointments, help them get new appointments scheduled

• Essentially: Support the person in their early recovery.

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Arms Acres: The OutcomesFrom January 1, 2018 through July 31, 2018‣ Total Recovery Coach Recoverees:85‣ Total kept 1st Outpatient visit: 84, for a rate of 98.2%‣ Total kept 1st Outpatient visit within 7 days of

discharge: 68, for a rate of 80%‣ Total kept 2nd Outpatient visit: 80, for a rate of 84.11%

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Arms Acres: Improving Engagement‣ 30 day outreach calls‣ From January through July, 2018, there were 73 follow

up calls made to track engagement in treatment 30 days post-discharge from Arms Acres.

‣ Of those 73 follow up calls made, 57 people were still engaged with their aftercare treatment provider after 30 days, a rate of 78.08%

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Arms Acres: Where Do We Go From Here?‣ Beginning to look at cost avoidance.‣ How many recoverees needed to be readmitted to

inpatient SUD?‣ How many recoverees went to an ED in the last 30

days?‣ How many recoverees required hospitalization in the

last 30 days?‣ This data, compared with regional and state data, will

give us a better understanding of return on investment.

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‣ Providing Proactive Peer Engagement Services

‣ Since 1987

‣ Guided by Core Values of Integrity, Respect & Customer Focus

Independent Living, Inc. is a consumer-directed, cross-disability, advocacy and

service organization dedicated to enhancing the quality of life for individuals with

disabilities.Our vision is a barrier-free society with

opportunities for all persons to achieve their maximum potential.

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‣ Guided by Core Values of Integrity, Respect & Customer Focus

Topics for discussion

• Relationships• Our History of Proactive Peer Engagement Services?• Peer Training and Credentials• Value and Outcomes/Results of ILI Peer Services• ILI Customer Experience• Medicaid billable capabilities and Sustainability

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The effectiveness of peer support is defined by the depth and quality of our

relationships

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Relationships:‣Empathy (lived experience)‣Respect‣Trust ‣Integrity and Reliability‣Agreements (big and small)‣White Flag Feedback‣Trauma informed‣Language

“The best thing we can do is approach people every day with the same freshness and hope as the first time we met them”(Author Unknown)

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‣Our History of Peer Bridger Services◦Middletown Psychiatric Center (closed)◦Cornwall Hospital (closed)◦Bon Secours Community Hospital◦Catskill Regional Medical Center◦Orange Regional Medical Center

Our History of Proactive Peer Engagement

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Training and CertificationsAll of our Peer Specialists receive the following trainings:

Motivational Interviewing NYS Certified Peer Specialists (OMH)

Certified Recovery Peer Advocates (OASAS)Trauma Informed Care (NYAPRS)

WRAP – (Copeland)Intentional Peer Support (Mead)

SafeTALK – suicide prevention (Living Works)DLA – 20 (W. Presmanes)

Preventing and Managing Crisis Situations (ORMC, Bon Secours, CRMC)

Mental Health First-Aid

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Value & Results of ILI Peer Services2016

‣Peer Transition/Diversion Service CRMC (Sullivan Co.)

• 1,021 individuals served – referrals from the Behavioral Health Unit, CRMC and Sullivan County Jail

• 1,019 out of 1,021 individuals did not return to the hospital within 30 days = 99% success rate

• 3,882 linkages to services in the community: physical, mental health, substance use, social services, natural supports: cost savings: 1,019 x $2,400* = $2,445,600 multiplied by an avg. inpatient stay of 3 days if admitted = $7,336,800

• 3 FTE’s in Sullivan County*1999 - 2014 AHA Annual Survey, Copyright 2015 by Health Forum, LLC, an affiliate of the American Hospital Association(Avg. daily inpatient cost for NY)

“If you teach a person to fish, s/he can eat for a lifetime.”ADULT MCTAC+

Value & Results of ILI Peer ServicesJanuary – June 2017

‣ Peer Transition/Diversion Service CRMC (Sullivan Co.)• 577 individuals served – referrals from the Behavioral

Health Unit, CRMC and Sullivan County Jail• 577 out of 577 individuals did not return to the hospital

within 30 days = 100% success rate• 2,244 linkages to services in the community: physical,

mental health, substance use, social services, natural supports: cost savings: 577 x $2,400* = $1,384,800 multiplied by an avg. inpatient stay of 3 days if admitted = $4,154,4700

• 3 FTE’s in Sullivan County*1999 - 2014 AHA Annual Survey, Copyright 2015 by Health Forum, LLC, an affiliate of the American Hospital Association(Avg. daily inpatient cost for NY)

“If you teach a person to fish, s/he can eat for a lifetime.”ADULT MCTAC+

Value & Results of ILI Peer Services2016

‣ Peer Bridger Services in Orange County– 984 individuals served – referrals from 9.39 Behavioral

Health Units at both area hospitals• 1,074 linkages to services in the community, including:

physical, mental health, substance use and social services that led to a 98.5% satisfaction rating from 984individuals served

• 3 FTE’s between ORMC and Bon Secours

“If you teach a person to fish, s/he can eat for a lifetime.”

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Value & Results of ILI Peer ServicesJanuary – June 2017

‣ Peer Bridger Services in Orange County– 670 individuals served – referrals from 9.39 Behavioral

Health Units at both area hospitals• 1,902 linkages to services in the community, including:

physical, mental health, substance use and social services that led to a 93.3% satisfaction rating from 670individuals served

• 4 FTE’s between ORMC and Bon Secours

“If you teach a person to fish, s/he can eat for a lifetime.”

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Value & Results of ILI Peer Services2016

‣ Peer Hospital Diversion Crisis Intervention Service• 189 individuals served – referrals from Hospital Emergency Departments

(ORMC & Bon Secours), Mobile Crisis and CIT Newburgh Police Department

• 567 services (engagements) provided (avg. 3 engagements/ individual over 30 days)

• 177 out of 189 individuals served did not return to the hospital within 30 days during Peer Hospital Diversion Crisis Intervention services = 94% success rate which led to:Cost savings: 177 x $2,400* (Avg. daily inpatient cost for NY) = $424,800 multiplied by an avg. inpatient stay of 3 days if admitted = $1,274,400

• 2.5 FTE’s in Orange County, NY

*1999 - 2014 AHA Annual Survey, Copyright 2015 by Health Forum, LLC, an affiliate of the American Hospital Association

“If you teach a person to fish, s/he can eat for a lifetime.”

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Value & Results of ILI Peer ServicesJanuary – June 2017

‣ Peer Hospital Diversion Crisis Intervention Service• 193 individuals served – referrals from Hospital Emergency Departments

(ORMC & Bon Secours), Mobile Crisis and CIT Newburgh Police Department

• 533 services (engagements) provided (avg. 3 engagements/ individual over 30 days)

• 191 out of 193 individuals served did not return to the hospital within 30 days during Peer Hospital Diversion Crisis Intervention services = 98.9% success rate which led to:Cost savings: 191 x $2,400* (Avg. daily inpatient cost for NY) = $458,400 multiplied by an avg. inpatient stay of 3 days if admitted = $1,375,200

• 2.5 FTE’s in Orange County, NY

*1999 - 2014 AHA Annual Survey, Copyright 2015 by Health Forum, LLC, an affiliate of the American Hospital Association

“If you teach a person to fish, s/he can eat for a lifetime.”

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Home and Community Based Services (HCBS)

Medicaid Billable Services‣ Approved vendor for OMH and OASAS Medicaid

Billing‣ Peer Supports – Empowerment Services: Peer Bridger,

Peer Diversion, Peer Advocacy, Peer Counseling‣ Family Support & Training‣ Psychosocial Rehabilitation (PSR)‣ Habilitation/Residential Support Services‣ Pre-vocational Services‣ Intensive Supported Employment (ISE)‣ Ongoing Supported Education/Employment‣ Education Support Services

Promoting Choice, Self-Determination & Total Participation

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Customer Experience2017

‣ “I was treated with respect.” = 92%‣ “Staff had pleasant, professional manner.” = 95%‣ “Staff were knowledgeable about community resources.” = 97%‣ “Services allowed me to be in charge of making my own

decisions.” – 89%‣ “Staff had positive attitude while working with me.” = 91%‣ “My concerns were listened to with empathy.” = 89%‣ “Services enabled me to work on my own goals.” = 90%‣ “Services helped me obtain or maintain my independence.” = 96%‣ “I felt empowered by the staff and services received.” = 87%‣ “I received information that improved my awareness, added to my

knowledge of resources or helped me feel competent in some area.” = 95%

Dedicated to enhancing quality of life; reducing stigma, and empowering individuals to achieve their maximum potential.

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Affiliations and Memberships

‣ Partnership for Wellness and Recovery IPA (PWR-IPA) – a seven agency Independent Practice Association

‣ Coordinated Behavioral Health Services IPA (CBHS) –a 12 member Independent Practice Association

‣ Behavioral Health Care Collaborative (BHCC) – an active member of the Hudson Valley BHCC

‣ Reach One – a Regional Strategic Partnership for Peer Services in Ulster, Dutchess, Orange, Sullivan and Rockland Counties

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Contact Us

‣Alison Heidemann, Regional Director of Peer Services

(845) 725-1244 Ext. 313 or (845) 219-9723aheidemann@myindependentliving.org

‣Douglas Hovey, Executive Director(845) 565-1162 Ext. 210 or (845) 220-8968

dhovey@myindependentliving.org

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Panel Discussion

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October Adult MCTAC+ Webinar

2nd in the Solutions that Work Series

Access and Engagement in the Value EquationOctober 25, 2018

Noon-1pmRegister at www.ctacny.org

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Questions and Discussion

Please email additional questions tomctacplusinfo@nyu.edu and register for future

events athttp://www,ctacny.org under “Upcoming Events”