SARATOGA COUNTY MENTAL HEALTH CENTER

Friendship House 433B Geyser Road Ballston Spa, NY 12020 518-885-4521

Saratoga County Alcohol and Substance Abuse Services (aka: SCASAS) 254 Church Street Saratoga Springs, NY 12866 518-587-8800

Saratoga County Mental Health Clinic Main Office 211 Church Street Saratoga Springs, NY 12866 518-584-9030 Mechanicville Satellite Mechanicville Community Center 6 South Main Street Mechanicville, NY 12118 518-584-9030 (Main Office)

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Saratoga County Mental Health Center

February 2013

INTRODUCTION The mission of Saratoga County Mental Health Center (SCMHC) is to provide outpatient mental health and alcohol/drug treatment services that are accessible and responsive to the needs of persons suffering from mental illness and alcohol/drug problems. Persons are treated when their mental illness or substance abuse significantly impairs their ability to function in the community, when they pose a serious risk to themselves or others, or when they experience significant distress. Center services assist them, whenever possible, in living within the community in ways that are acceptable to the community and that are personally satisfying and productive. Goals: 1. To provide treatment for individuals suffering from serious mental illness and alcohol/drug abuse and dependence with the goals of ameliorating symptoms, improving functioning, strengthening personal recovery supports in the community, and supporting the capacity of families to cope with and address the realities associated with mental illness and alcohol/drug problems; To protect both the public and individuals (a) from the manifestations of mental illness in suicidal and violent behavior, delusions and hallucinations, severely impaired judgment, mood instability, and similar symptoms and (b) from the impairments of alcohol/drug abuse or dependence such as driving under the influence, domestic violence and child abuse, unemployment, poor health, and crime; To be responsible stewards of public monies supporting the Center. Center services are provided to Saratoga County residents who have limited or no access to alcohol, drug, or mental health treatment due to minimal reimbursement for treatment Medicare recipients, Medicaid recipients, and the uninsured. The complexity of problems many of these individuals present with also limits access. Private practitioners are often unable to provide the continuum of services and level of support required to manage and treat these individuals. Finally, Center services are a last resort for some individuals who are no longer welcome in other programs a last resort. A sampling of patient diagnoses gives a flavor of the issues the Center deals with. 183 individuals receiving services fall into the category of severe bipolar illness, 111 of whom experience psychotic features, if untreated. 295 individuals receive services for severe depression, 88 of whom have experienced psychotic features. 415 individuals have a thought disorder that significantly impairs their daily functioning. 41 individuals have an explosive or impulse control disorder that creates a threat for those around them. The lives of these individuals, their families, and their neighbors are often disrupted, often significantly. A number

2.

3.

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Saratoga County Mental Health Center

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present a public safety risk, unless actively treated. It is, however, important to remember that persons with mental illness are more likely to be victims of violent and criminal behavior than perpetrators. Center staff, as staff of a public clinic, are attuned to their responsibilities to the community in terms of public safety and public accountability, as well as their responsibilities for patient care. Decisions regarding the course of treatment take into account the safety of the community. Only services that are required are provided. This fiscally, as well as clinically, sound approach saves both Medicaid and Medicare dollars. The focus on engagement with patients helps to minimize the use of emergency departments and inpatient and rehabilitation facilities.

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Saratoga County Mental Health Center

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STATUS: 2012 GOALS 1. Find (lease or build) appropriate space, minimally for Clinic operations, preferably for Center operations. Three proposals were presented to the Board of Supervisors. The Board passed three resolutions to approve and facilitate leasing of an appropriate space for consolidation of Center programs on South Broadway, Saratoga Springs. 2. Design and implement a Center Dashboard to monitor Center operations. The Dashboard will track Center fiscal performance, staff productivity, compliance with regulatory requirements, performance improvement, and identified outcomes. The Center Dashboard was implemented. In its first year, the focus was on revenue, productivity, and compliance. All Center managers and supervisors participate in the monthly Dashboard Meeting. It has achieved the goals of increasing accountability and focusing attention on outcomes and has begun to encourage continuous improvement initiatives. 3. Continue to pursue PROS conversion for Friendship House. PROS conversion is being sought to provide more recovery-oriented treatment and to improve reimbursement for Friendship House services. Discussions were on-going with NYS Office of Mental Health (OMH) at the Regional Office level. The process was held up in the Central Office as they determined whether monies were available for conversion. We are still negotiating with OMH to minimize consequences for Unlimited Potential. Required programmatic design documentation has been provisionally approved by the Regional Office. 4. Move to a hosted environment for the Center administrative and clinical management information system. The move to the hosted environment was successful. Our experience has been positive. The benefits of not maintaining a secure, functional server and MIS software on-site has outweighted the connectivity issues that have arisen related to Time Warner service interruptions and the hosted environment going down twice. 5. Meet new federal HIPAA 5010 requirements for electronic submission of Medicare and Medicaid claims.

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Saratoga County Mental Health Center

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The upgrade and programming of our MIS upgrade, while difficult and time-consuming, was successful. We are able to submit and receive 5010 electronic files. 6. Implement necessary changes clinical, SPOA (Single Point of Access), TCM (Targeted Case Management) to meet new Health Home requirements. Implementation has been delayed by NYS Department of Health (DOH) due to negotiations with CMS at the federal level. Three local health homes were selected by DOH at year end. Implementation will commence in 2013. 7. Continue performance improvement of Clinic services: steamline intake, improve risk management, and implement physician-only care post verbal therapy. This goal was largely met. We are still working on improving risk management, using continuous quality improvement processes. Intake has been streamlined our response to County citizens initially seeking services has been improved. Physician-only caseloads are increasing. This allows us to open more intakes with our clinical staff. This has been critical, given the hiring freeze.

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Saratoga County Mental Health Center

February 2013

2013 GOALS 1) Center programs. Relocate and consolidate the Mental Health

2) Continue to build the required IT infrastructure for Center operations. In 2013 this will necessitate establishing an electronic data interchange portal for our two County Medicaid Managed Care Providers and implementing required operational changes related to billing code changes promulgated by the American Medical Association (2013 CPT). 3) Continue to enhance the new Center Dashboard to include performance improvement activities and, based on last years experience, to provide more focused information for managers and supervisors. Continue to enhance services for County residents, either directly or through partnerships. Friendship House conversion to PROS will remain a top internal priority. The Center will provide continued support for the Veterans Peer-to-Peer Initiative funded through NYS OMH that will be implemented by Veterans Affairs. Both at the Community Services Board and Center levels, implementation of NYS DOH Health Homes will be supported through designated partnerships and necessary operational changes.
4)

5) Determine appropriate staffing levels medical, clinical, and support in light of relocation and daily operations. Between retirements and resignations, Center services and operations are increasingly impacted. Juggling current operational needs within the context of the benefits of the up-coming relocation has been and remains a difficult task. Center needs will be addressed with the Board, as indicated.

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Saratoga County Mental Health Center

February 2013

DEMOGRAPHICS & SERVICES Persons Served: 2,622 UNITS OF SERVICE

TREATMENT Friendship House Clinic Adult Clinic Youth SCASAS

5,726 12,841 3,437 7,463

Consults SCCF Assessments* DSS Other Statutory Actions* Family Court Competency (7.30) Pick-Up (9.45) AOT (Mandated Tx)
*Not Included inTreatment

1,221

342 4

Total Treatment Services 29,467*

61 36 135 12

*Total services are down except for Youth Services, which became fully staffed just prior to the hiring freeze. In spite of a significant number of resignations and a departure, the numbers, except for Friendship House, reflect a significant improvement in clinical staff productivity. DSS assessments are no longer included in the treatment services number.

BASIC DEMOGRAPHICS
Admitted for Treatment

FH Sex (%)* Female Male Race (%)* Minority White Unknown Age (%)* 0-18 19-55 >55 --86 14 8 85 7 48 52

MHC ADULT 55 45 7 89 4 --73 27

MHC YOUTH 46 54 7 82 11 97 3 ---

SCASAS 29 71 8 86 6 2 90 8

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Saratoga County Mental Health Center * Percentages rounded

February 2013

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ZIP CODE BY CENTER PROGRAM 12010 12019 12020 12027 12065 12074 12118 12134 12148 12151 12170 12188 12801 12803 12804 12822 12828 12831 12833 12835 12839 12846 12850 12859 12263 12866 12871 12884 Clinic 5 24 257 6 77 16 81 6 8 2 19 38 1 23 2 65 10 70 32 16 2 1 23 9 1 398 26 2 1220 FH 2 28 2 4 4 SCASAS 1 32 230 7 58 4 60 3 3 4 27 20 3 14 1 40 12 53 35 9 1 2 15 14 2 307 26 3 986 Total 6 58 515 15 139 20 145 9 11 8 46 60 4 37 3 108 22 129 69 25 3 3 39 25 3 765 54 5 2326

2 2

3 6 2

1 2 60 2

120

This list only includes persons who received services at the above locations at some point in 2012. It does not include home visits or consultations for SCCF or Maplewood. Zip codes with less than three are not included. Persons without a zip are not included 2,209 unique persons received services from the Clinic, Friendship House, and SCASAS. Persons are not recounted for readmissions to a program in 2012.

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Saratoga County Mental Health Center

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DESCRIPTION Mental Health Clinic: The Saratoga County Mental Health Clinic (MHC) provides outpatient treatment services in a clinic setting. Treatment includes emergency and crisis intervention, screening and referral, individual, family, and group counseling, medication education and management, and symptom management. Outreach services in the community are provided on an exception basis. In addition to the main clinic in Saratoga Springs, the Clinic maintains a satellite for adults in Mechanicville, thanks to the generosity of the Mechanicville Community Center. Youth Services provides treatment for emotionally and behaviorally disturbed children and adolescents up to the age of eighteen, who, together with their parents, often require intensive and community-based interventions. These children and youth are often highly disruptive of family life and typically perform poorly in school. Many are involved with Family Court and DSS. Adult Services provides treatment for mentally ill adults, particularly those who are seriously and persistently mentally ill. They are often isolated and live disorganized lives. Many have little to no contact with family. They typically are unable to become active in community life. Some are a threat to the community, unless actively treated. For the seriously and persistently mentally ill, a long-term disease management approach to medication management and supportive therapy is utilized. Person-centered and recovery-oriented services are being incorporated in a step-wise manner. Continuing Day Treatment Program: Friendship House (FH) provides treatment for mentally ill patients who require more structure and more intensive clinical interventions than can be provided in a clinic setting. Participants suffer from similar impairments as patients of the Clinic, but more severe. They are active from 2-5 days a week, depending on their stage in treatment and their treatment goals. This program is also frequently the first stepping stone for persons mandated to treatment under an AOT (Assisted Outpatient Treatment) order. Services are designed to support continued living in the community, to enhance and maintain functioning, and to develop increased capacities to cope with the requirements of daily living. Services include medication education and therapy, supportive therapy, symptom management, skills training, individual and group counseling, and case management. Alcohol and Drug Outpatient Services: Saratoga County Alcohol and Substance Abuse Services (SCASAS) is a medically supervised outpatient program providing treatment for individuals suffering from an alcohol and/or drug problem and for family members trying to cope with the presence of alcohol or drug problems within the family. Many (>35%) are mandated to treatment, because their drinking and drug use has led to legal involvement. Treatment is designed

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Saratoga County Mental Health Center

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to promote abstinence, to improve community integration, and to improve daily functioning. Services include screening, referral, assessment, individual and group counseling, and medication management. NYS STATUTES CIVIL AUTHORITY The Director of the CSB is responsible and required to initiate certain statutory actions to protect the mentally ill person who poses an immediate and major risk to self or to others. These actions include, among others, the 9.45 pick-up order and the 7.30 competency evaluation (requires two psychiatric assessments) to determine whether the individual is deemed able to participate in his/her defense in a criminal proceeding. In addition, when criteria are met, the CSB Director petitions the Saratoga County Court to mandate treatment (Assisted Outpatient Treatment AOT) for the mentally ill person who has a history of refusing to engage in treatment and who poses an on-going danger to others or self. If the Court mandates treatment, the CSB Director is responsible to ensure the mandated treatment is available and to monitor compliance and progress. The Center provides all mandated treatment services. SERVICES TO COUNTY DEPARTMENTS Sheriffs Office The Sheriff by statute is required to provide medical and mental health care for individuals incarcerated at the Saratoga County Correctional Facility (SCCF). The SCCF Medical Director is responsible for the provision of medical and mental health services. Saratoga County Mental Health Center provides required mental health services on a consultation basis. A Center Psychiatrist (0.5 FTE) and a Center clinician (0.5 FTE) are assigned to the SCCF. They provide suicide and violence risk assessments, medication review and consultation, crisis intervention, and referrals to mental health treatment after release. In addition, the Sheriff can access psychiatric consultation at the Center in case of emergent situations that do not require hospitalization, such as dangerous acting out behavior or rapid deterioration in mental status. The SCCF Medical Director and the Mental Health Consulting Staff maintain a solid working relationship to manage inmates and the risks associated with their incarceration. Another important service the Center staff provide is consultation to the Corrections Officers regarding management of inmates presenting with suicidal, violent, or difficult behaviors. Maplewood Manor Maplewood Manor is also required to provide for the mental health needs of its residents. SCMHC has assigned a Psychiatrist to provide consultation services to the Medical Staff. Medical Staff refer residents presenting with behaviors who are a risk to themselves or others or whose mental condition is deteriorating.

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The Psychiatrist provides consultation regarding diagnosis, recommended medications, and follow-up. Follow-up by the psychiatrist is primarily related to reviewing the residents response to medications. In addition, the Director of Maplewood Manor can access psychiatric consultation, typically within 24 hours, in case of emergent situations that do not require immediate transport to Saratoga Hospital. Family Court The Center psychologist performs psychological evaluations and alcohol/drug assessments for custody cases. SCASAS staff also provide alcohol/drug assessments related to PINS and custody cases. In addition, staff psychiatrists, usually a child psychiatrist, provide psychiatric assessments to establish diagnosis and make treatment and medication recommendations for difficult cases. In addition, a number of specialty assessments are provided, primarily related to neglect and abuse cases. Social Services Child Protective Services and Foster Care utilize services from all Center programs. Youth Services remains a primary resource for children and youth from families with limited financial resources or limited coverage. Youth Services staff closely collaborate with both Child Protective Services and Foster Care in protecting abused and neglected children who are emotionally disturbed and acting out and in trying to resolve highly dysfunctional family behaviors. In addition, Youth Services staff also assist in the orientation of individuals interested in becoming foster parents. Assigned Center clinicians work collaboratively with Adult Protective Services (APS) to address the mental health needs of adults, often senior citizens, who are unable to care for themselves, isolated, abused, or without family and other social supports. Clinic staff accompany APS workers on home visits, upon request, if an adults behavior or living circumstances indicate the presence of serious mental illness. Saratoga County Alcohol and Substance Abuse Services provides alcohol and drug assessments for individuals applying for public assistance and Medicaid, to meet the Federal mandate for screening and assessment of alcohol and/or drug problems. SCASAS is also a resource for those individuals mandated to outpatient alcohol/drug treatment by Public Assistance and Child Protective Services. Drug Treatment Courts The Mental Health Center, particularly SCASAS, remains a primary treatment provider utilized by the Saratoga County Drug Treatment Courts for alcohol, drug, and mental health services.

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Probation The Probation Department frequently refers to the Mental Health Center as a condition of probation. Solid working relationships exist between the two departments. This solid collaboration is necessary, because successful treatment of alcohol and/or drug abuse and the successful management of mental illness often prevent or significantly decrease recidivism. As an added benefit to the community, the sessions provided by Mental Health Center staff increase the level of monitoring received by these individuals. This collaboration with Probation requires careful juggling of the goal for successful engagement in treatment versus the goal of public safety. Individuals become increasingly guarded and less engaged in treatment, if they believe what they say will be communicated to Probation to be used against them by Probation in its role as enforcement. Public Health Public Health staff utilize the Center on a consultation basis, when needed, to assist in developing home health care plans for individuals who are mentally ill. Center Nurses meet with the Public Health Professional Advisory Board and the Utilization Review Committee. The Mental Health Center is included in the County Disaster Preparedness Plan as one component of the public health response. Center nursing and social work staff have received specialized disaster response training to prepare them for disasters that may arise. Personnel The Mental Health Center provides unofficial employee assistance services for County and Town employees, when requested by the Personnel Department. Personnel refers employees for screening when alcohol, drug, or mental health issues are implicated in the employee behavior. The most common referral is for drivers with a commercial drivers license who obtain a dirty urine. The purpose of the screening is to determine whether and what treatment might be indicated. The Personnel Department handles the case after the results of the screening are received. Finally, Personnel consults with the Center regarding possible interventions and referrals in difficult cases.

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