About Northeast Kingdom Human Services NKHS mission is to enrich - - PowerPoint PPT Presentation

NORTHERN VERMONT DEVELOPMENT ASSOCIATION

MARCH 21, 2019

www.nkhs.org

• NKHS’ mission is to enrich communities and enhance the ability of individuals and

families to improve their lives

• We are in the business of saving lives by providing patient care that includes evaluation,

assessment, diagnosis, treatment, and ongoing care to our citizens

• Established in 1960
• Two main offices located in Derby and St. Johnsbury
• Five licensed group homes located in Newport, Danville, Barnet, and Waterford
• Five non-licensed group homes
• Not a state agency
• 501(c)3, private, community owned organization
• Governed by a ten-member board of directors
• Serves Caledonia, Essex, and Orleans counties
• Covers an area of 2,027 sq miles (21% of Vermont)

About Northeast Kingdom Human Services

www.nkhs.org

About Northeast Kingdom Human Services

• Third largest employer in the Northeast Kingdom
• Employs almost 600 staff
• Mental Health, Substance Use Disorder, and Intellectual Developmental Disability

services across the life span

• 3,993 clients served in 2018 (6.3% of total NEK population)
• Medicaid is the largest payer (92%) with multiple State funding sources in our budget
• Major funding partners include Department of Disabilities, Aging, and Independent

Living (DDAIL), Department of Mental Health (DMH), and Vermont Department of Health (VDH), Alcohol & Drug Abuse Program (ADAP), OneCare Vermont

• Member of Vermont Care Partners
• Member of two Accountable Care Communities

www.nkhs.org

What is Mental Illness?

Mental illnesses are a common health condition involving changes in emotion, thinking or behavior (or a combination of these) and are associated with distress and/or problems functioning in social, work or family activities. Mental illness is nothing to be ashamed of. It is a medical problem, just like heart disease or diabetes.

• Nearly one in five (19 percent) U.S. adults experience some form of mental illness
• One in 24 (4.1 percent) has a serious mental illness*
• One in 12 (8.5 percent) has a diagnosable substance use disorder

*Serious mental illness is a mental, behavioral or emotional disorder (excluding developmental and substance use disorders) resulting in serious functional impairment, which substantially interferes with or limits one or more major life activities. Examples of serious mental illness include major depressive disorder, schizophrenia and bipolar disorder. Source: American Psychiatric Association

www.nkhs.org

What Do We Do?

As a Designated Agency, we have a statutory responsibility to meet all of the developmental and mental health service needs of our designated region within limits of available resource; and We believe and respect the fact that our clients are the experts of their own lives; and “As providers, we recognize that people are not identified by their diagnoses. No individual is schizophrenic or an alcoholic, they are individuals with symptoms of schizophrenia or challenged with substance use, or symptoms of psychosis or mania, and those symptoms are interfering with that person’s ability to navigate their lives and their

• recovery. Once symptoms are more stable, the individual can re-engage in life as defined

by them.” Marcia Stricker, Chief Clinical Officer, NKHS

www.nkhs.org

Our Staff as Community Members

10 20 30 40 50 60 70 80 Albany, VT Barton, VT Berlin, NH Bow, NH Canaan, VT Charleston, VT Coventry, VT Dalton, NH Derby, VT Dublin, OH East Burke, VT East Haven, VT East St. Johnsbury, VT Gilman, VT Greensboro Bend, VT Hanover, NH Hatley, QC Hyde Park, VT Island Pond, VT Jeffersonville, VT Lancaster, NH Littleton, NH Lunenburg, VT Lyndon Center, VT Monroe, NH Morgan, VT North Concord, VT North Troy, VT Newport, VT North Stratford, NH Orleans, VT Peacham, VT Plainfield, VT Sheffield, VT

• St. Johnsbury Center,…

Troy, VT West Charleston, VT West Danville, VT Westfield, VT

# of Staff by Town

• Our staff live, work, and recreate

across much of Vermont New England and Canada.

• NKHS staff reside in 78 towns across

Vermont, new Hampshire and Quebec.

• The economic impact our staff has on

tenths of our communities and businesses is significant

• Implementing broadband across more
• f our region would allow staff to work

remotely and more efficiently

www.nkhs.org

About Intellectual & Developmental Disabilities Services

• Intellectual and Developmental Disabilities (IDDS)
• The Bridge Program (families can access medical, educational, social, services for

their children)

• Home & Community Based Services (home, community, employment supports,

service coordination, clinical and crisis services, respite, transportation and crisis supports to those individuals with the most intense needs in our state)

• Flexible Family Funding (monetary supports up to $1,000 for caring for an IDDS

family member at home)

• Family Managed Respite (ongoing supports ongoing care for a child with MH or IDDS

disability)

• Global Campus Program (lifelong learning and teaching experiences to IDDS adults)
• Preadmission Screening & Resident Review (PASR are services for individuals residing

in a Skilled Nursing Facility that are beyond the scope of the SNF)

• Post-Secondary Education Initiative (provides typical college experiences that lead to

careers and competitive employment)

• Targeted Case Management (accessing services which are non-Medicaid Waiver in

nature)

www.nkhs.org

IDDS Payment Mechanisms

• Daily waiver rate
• Monthly case rate
• Grant funding
• Contract invoicing
• Fee-For-Service

Service Planning and Coordination Community, Employment and Home Supports Assessment and Evaluation, Medical Supports; and Coordination Clinical Interventions Public Safety/Offender Services Crisis and Respite Services Flexible Family Funding, PASAR Services

www.nkhs.org

The IDDS Difference

• The Brandon Training School closed in 1993. Prior to the closure, the cost of care for an

individual client was almost $329K

• Today, this cost is $56,672 and has been held constant over the last 17 years
• In Wisconsin, an average cost of institutionalizing a single individual with IDD ranges from

$299K to $501K, per year.

• Vermont ranks 2nd in the U.S. for employment of individuals with IDD, with nearly 50%

employed

• 28% of individuals with serious and persistent mental health illness are employed, as

compared to 21%, nationally

www.nkhs.org

About Mental Health Services

• Mental Health Services (MHS)
• Child, Adolescent, and Family Mental Health (promote prevention of known and serious

social, emotional, and mental health needs)

• Early Periodic Screening, Diagnosis & Treatment (embedding MH clinicians in the primary

care pediatric offices)

• Early Childhood Mental Health (preventive services to reduce risk factors, increase resiliency

and protective factors)

• Jump on Board for Success (improve employment and social functioning outcomes of youth

in transition)

• Mental Health Adult Outpatient Program (services for adults with severe emotional or

behavioral distress disrupting their lives, which do not meet the eligibility criteria for CRT)

• Community Rehabilitation and Treatment/CRT (multi-disciplinary support to individuals with

severe mental illness)

• Emergency Mental Health (365/24/7 counseling and face-to-face intervention including

screening and involuntary hospital admissions and referrals)

• Adult Crisis Stabilization Beds (24-hour sub-acute short-term intensive residential supports)

www.nkhs.org

• Mental health issues are on the

rise in Vermont and nationally

• Vermont has higher rates (22%) of

individuals diagnosed with depressive disorders or other mental health issues than the national average (17%).

• Mental health issues should be

treated as a disease like any other ailment

Mental Health as Chronic Disease

www.nkhs.org

Adult Outpatient Services Payment Mechanism

• Private insurance/private pay
• Multiple grant funding
• Contract invoicing
• Medicaid Fee-For-Service (DMH, DAIL,

DVHA, ADAP)

• Federal funding
• Charitable donations

Clinic-Based and PCP Embedded Treatment Case Management Offender Re- Entry Programs Elder Care Services Co-occurring and Trauma Informed Services

www.nkhs.org

Community Rehabilitation Therapy Payment Mechanism

• Monthly case rate (6 month look

back -3% variance)

• Grant funding
• Specialized payments for high

need individuals

• Private insurance

Assessment, Treatment and Case Management Community Supports, Employment and Housing Crisis Support, Hospital Diversion and Step Down Clinical Interventions Peer Support Medical Management

www.nkhs.org

About Substance Use Disorder & Addictions Services

• Substance Use Disorder (SUD) and Addictions
• Rocking Horse Circle of Support (ten-week, psychoeducational group intervention for

pregnant and parenting mothers that addresses substance use for women’s health, relationships, effects on family, life troubles and management)

• Substance Use Disorder Treatment (screening for co-occurring substance abuse

issues, assessment, appropriate treatment services, and on-going support through recovery centers)

• Over 53% of people in Vermont screened for public inebriation were admitted to

a bed and avoided incarceration

• DUI Recovery Group
• Group and individual therapy
• Criminal Conduct and Substance abuse treatment (CCSAT)
• Intensive Outpatient Program (IOP)
• Average 80 requests for service per month
• Gambling Addictions Treatment (NKHS has the only licensed gambling addiction

therapist in Vermont, who is also nationally certified)

www.nkhs.org

Substance Use Disorder Services- Payment Mechanisms

• Private insurance/private pay
• Grant funding
• Medicaid Fee-For-Service

Opioid Addiction Treatment Intensive Outpatient Treatment (IOP) Outpatient Treatment CRASH Public Inebriate Beds / Detox Prevention Services

www.nkhs.org

According to Vermont Department of Health 2/2019 Opioid Overdose Report, the opioid-related deaths in

• ur three counties have leveled off at

6 in 2018 compared to other counties that are still on the rise.

The Opioid Epidemic

In 2016, there were 101 opioid-related overdose deaths in Vermont—a rate of 18.4 deaths per 100,000 persons and more than the national rate of 13.3 deaths per 100,000 persons. From 2013 to 2016 the number of heroin overdose deaths increased from 20 to 45 deaths. Like heroin, the trend of synthetic opioid-related deaths rose from 17 to 53 deaths during the same period.

Opioid Overdose Death Rate (Age-Adjusted) Per 100,000 People

(Source: DataUSA)

www.nkhs.org

The Opioid Crisis by the Numbers

• Of the individuals diagnosed with

a SUD, 45% received treatment

• 17% stayed in treatment
• Heroin and other opioid use

treatment continues to climb

• Marijuana and alcohol related

treatment are on the decline or have leveled off

www.nkhs.org

Zero Suicide/QPR

• Vermont is ranked 18th highest rate of suicide in the nation
• On average one person dies by suicide every three days in Vermont
• Suicide is the eighth leading cause of death across all ages in Vermont
• Suicide is the second leading cause of death among people ages 15-35
• For every suicide death there are, on average, 32 suicide attempts
• NKHS has three trained Zero Suicide staff who provided 20 trainings in Vermont

communities, thus far in 2019

• QPR vs. CPR

www.nkhs.org

Crises Services Payment Mechanisms

• Private insurance
• Grant funding
• Fee-For-Service
• Case rate (CRT)

24/7 Crisis Response and Telephone Support Assessment and Referral Outreach Mobile Crisis Hospital Screening and Admission Coordination and Collaboration First Responder Training www.nkhs.org

Emergency Services

• Providing emergency services keeps individuals
• ut of the emergency rooms, saving our

communities hundreds of thousands of dollars annually

• An average visit to the ER costs $2,000. With over

80 calls per month to our crises team, we are saving tax dollars and lives

• Mental health emergency department visits have

increased 14.6% between 2011 and 2016

www.nkhs.org

About Children, Youth, and Family Services

• Child, Youth, and Family Stabilization Support
• Children Integrated Services (coordinated child development through maternal

health nursing and family supports, early child family mental health, and early intervention)

• Early Childhood Program (pediatric collaborative, consultation, referral)
• Home and Community Supports (individual and family counseling, group counseling,

psychiatry, risk assessment, and consultation)

• School-Based Services
• Behavior Interventionist Program
• Evidence-Based
• Trauma-Informed

www.nkhs.org

Children, Youth and Family Services- Payment Mechanisms

• Private insurance – private pay
• Daily waiver rate
• PNMI
• Monthly case rate (JOBS 90 day look back)
• Monthly case rate
• Bundled rate system (IFS)
• Grant funding
• Contract invoicing
• Medicaid Fee-For-Service

Assessment, Treatment, Case Management, Crisis and Respite Services Home, School and Community Supports Medical Management Hospitalization Diversion and Residential Services Prevention, Screening and Referral Consultation and Collaboration Therapeutic Services, Education and Employment www.nkhs.org

Towns Served by Children’s Division

• NKHS serves children in every

town within our 55 town service area, and a small number of children out of

• ur service area, based on

need

• NKHS works with the school

system and hospitals to provide a full system of support

www.nkhs.org

Funding Sources

www.nkhs.org

• Federal Dollars
• DMH: Grant-in-Aid
• DMH: Block Grant
• DMH: Case Rate
• DMH: Waiver Payment
• DMH: FFS Medicaid
• Vocational Rehab grants
• DAIL/DCF: Waiver
• DAIL: FFS Medicaid
• DAIL: SS Bulk Grant Fund
• DCF: Global Commitment
• Town Donations
• Charitable Donations

Funding Sources Cont’d

www.nkhs.org

• DVHA/3rd Party Insurance FFS
• DCF/DMH: PNMI
• ADAP: Grant
• ADAP: FFS Medicaid
• DOC Grants/Contracts
• DOE Grants/Contracts
• Court Admin Grants/Contracts
• DMH/DOC/DCF/DVR/DOH
• Private Pay FFS/Client Rents
• DCF CUPS Admin Med
• Medicare FFS
• School contracts
• United Way

Our Community Partners

• State agencies/AHS
• Hospitals/FQHC’s
• Department of Corrections
• Department of Children and Families
• State Police/ Police departments
• NEKCA
• NEKLS
• Rural Community Transport (RCT)
• BAART/Blue Print for Health
• Lund Family Center/ DCF
• Local Interagency Teams
• Community Justice Centers

Community partnerships are integral to our success and the success of our

• clients. As an organization, we are

good stewards of the tax payer

• dollars. Working together supports
• ur clients in efficiently accessing the

necessary care without the need of duplication of services.

www.nkhs.org

0.00 200,000.00 400,000.00 600,000.00 800,000.00 Adult Speciality Team SBS NECKA PCC So. SA Nwpt DWI SA St J Adolescence SA ST J CRASH DS Choices For Care SA Nwpt IOP DS Bridges Program CRT Crisis DS Community Supports DS Clinical OP Emergency Enhanced Services

69 of 90 Services Operate Profitably

Why Do We Do What We Do?

• Over 20 individual programs remain underfunded.
• NKHS spends $38 million on services. Towns

contribute about $70,000 to our annual budget.

• Increasing funding for our programs can help address

recruitment, retention, quality of programs and economic development, as a whole.

(300,000.00) (250,000.00) (200,000.00) (150,000.00) (100,000.00) (50,000.00) 0.00 Adult Outpatient SBS BI ISBs - S SBS NFI-Turning Points CRT VSH Outplacement EEF AM Child Respite - S Child Respite - N SA Nwpt CRASH Post Permanency Newport Pediatrics

21 out of 90 Services Operate at a Loss

Supporting the most vulnerable members of

• ur communities strengthens our

communities as a whole.

www.nkhs.org

How NKHS’ Services Impact Client Lives?

• 93% responded that they receive the services they need
• 96% responded that staff treated them with respect
• 93% responded that the services they received were right for them

www.nkhs.org

To continue to make a difference we must continue to explore creative opportunities for funding and resources, while collaborating with other community organizations like NVDA to envelop the needs of the entire Northeast Kingdom.

NKHS in the Community

• NKHS partners locally to support economic development

in the NEK

• NKHS workforce of almost 600 supports local businesses
• NKHS received a $30,000 grant to form a Specialty Team.

This team is a group of 18 members who respond to requests from community agencies, businesses, law enforcement and schools when crises, such as death, threats, or terrorism occur

• NKHS serves the population that struggles with meeting

basic human needs. NKHS is actively seeking funding and land to invest in projects, such as, Tiny Houses for

• ur clients who cannot find long term, stable housing.

www.nkhs.org

Challenges and Opportunities

• Recruitment and retention
• Improve salaries and wages
• IDDS and MH payment reform
• Economic development
• Internet broadband
• Northeast Kingdom’s demographics
• Cultural diversity
• Diversification of payor portfolios
• Grants/philanthropy
• Community communication and education
• Towns’ financial support
• Collaborations with organizations like NVDA,

NCIC

www.nkhs.org

What’s Next?

• NKHS shares the vision of NVDA that strong economies are built by strong local
• businesses. It is our goal to continue to grow NKHS in ways that support both our staff

and clients’ abilities to live and thrive in their communities and towns in the Northeast Kingdom.

• NKHS is at the beginning of reconstructing our strategic plan. We welcome the expertise
• f NVDA in enhancing our strategic objectives.
• Board talent recruitment. We need dedicated and creative professionals to work toward
• ur mission of supporting, enhancing and enriching individuals and communities.

NKHS NVDA Supporting community Developing economic systems Increasing community stability with good business practices

Economic development is the result of sustained actions of policymakers and communities that promote the standard of living and economic health.

www.nkhs.org