Funding Area: Integrating Mental Health and Substance Use Services

More than 1.4 million New Yorkers are affected by co-occurring substance use and mental health disorders. Considering the scope of the problem, the New York Health Foundation and National Development and Research Institutes (NDRI) partnered to establish the first statewide Center for Excellence in Integrated Care (CEIC).

CEIC’s chief purpose was to serve as a resource to the 1,223 licensed-mental health and certified substance use service sites in New York State. CEIC provided the tools and assistance to transform their practices and increase their capacity to deliver services for both conditions at the same time and the same place. Further, CEIC ensured that the increased capacity of addiction and mental health outpatient clinics will provide integrated care that is standard, recovery-oriented, person-centered, and culturally responsive. CEIC was be guided by three goals: (1) implementing a standardized approach to screening; (2) adopting a uniform approach to assessment; (3) spreading the use of eight treatment practices that have been proven to work for integrated care.

In December 2009, NYHealth awarded NDRI an additional $442,570 for the project “Expanding Technical Assistance Support and Reach of NYHealth Center for Excellence in Integrated Care (CEIC).”

It is estimated that one in four adults suffer from a diagnosable mental disorder in a given year, which translates to more than 2 million New York City residents.

The New York State Office of Mental Health-licensed behavioral health clinics (Article 31 clinics) are frequently the first intervention in the lives of New Yorkers with mental illness; however, the viability of Article 31 clinics is in jeopardy.

Historically, Article 31 clinics have received inadequate reimbursements from Medicaid, Medicare, and private insurers. Until recently, agencies that operate Article 31 clinics have subsidized their services with foundation grants and private donations, underwriting 10–20% of their operating budget, depending on their payer mix. These clinics are facing a radically different reimbursement methodology; the freezing and cutting of government contracts with concurrent mandates that require programmatic restructuring; declining private philanthropy; and more complex administrative functions, such as billing, IT systems, record keeping, and reporting. Service provision and access is being restricted for financial reasons at a time when the demand for mental health services is increasing.

The Coalition’s project reengineered the business model for the many small, community-based organizations that operate mental health clinics. During the initial grant year, the Coalition identified 15 agencies to participate in a strategic reengineering process, which resulted in the identification and implementation of outsourcing and collaboration options for administrative services. At the end of the first year, at least 10 of the participants initiated changes to their business models. The project examined and reengineered functions, such as claims and billing, appointment scheduling, documentation of services, and information technology. In addition, materials were developed to enable other similar cohorts of providers to reengineer their business models.

NYHealth established the Center for Excellence in Integrated Care (CEIC) in 2008 with a four-year grant to NDRI. CEIC has employed various methods to provide technical assistance to addiction and mental health programs across New York State to help them achieve integrated care for both conditions.

The primary component of the initiative involves conducting on-site assessments of a program’s capability to provide integrated care with a tool called the Dual Diagnosis Capability in Addiction [Mental Health] Treatment (DDCA[MH]T) index. To measure whether changes had occurred since the first site visits, CEIC conducted a second round of the DDCA[MH]T assessments with a representative sample of 150 programs across New York State.

This project established whether there have been improvements in the overall effectiveness of addiction and mental health outpatient programs to deliver integrated services for clients with co-occurring mental health and substance use disorders. Data from the DDCA[MH]T assessments was used to measure specific outpatient program improvements in the areas of screening, assessment, and evidence-based treatment, as well as factors related to areas of improvement, such as staff composition, public-versus-private funded programs, or geographical settings.