N ORTHERN V ERMONT D EVELOPMENT A SSOCIATION M ARCH 21, 2019 www.nkhs.org
About Northeast Kingdom Human Services • 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) 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
• Implementing broadband across more • The economic impact our staff has on • NKHS staff reside in 78 towns across • Our staff live, work, and recreate remotely and more efficiently of our region would allow staff to work businesses is significant tenths of our communities and Vermont, new Hampshire and Quebec. and Canada. across much of Vermont New England Our Staff as Community Members 10 20 30 40 50 60 70 80 0 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 # of Staff by Town 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 www.nkhs.org Peacham, VT Plainfield, VT Sheffield, VT St. Johnsbury Center,… Troy, VT West Charleston, VT West Danville, VT Westfield, VT
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 www.nkhs.org nature)
IDDS Payment Mechanisms • Daily waiver rate Service Planning and Coordination • Monthly case rate Flexible Family • Grant funding Community, Funding, PASAR Employment and Services • Contract invoicing Home Supports • Fee-For-Service Assessment and Evaluation, Crisis and Respite Medical Supports; Services and Coordination Public Clinical Safety/Offender Interventions 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 2 nd 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 as Chronic Disease • 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 www.nkhs.org
Adult Outpatient Services Payment Mechanism • Private insurance/private pay Clinic-Based and PCP Embedded • Multiple grant funding Treatment • Contract invoicing • Medicaid Fee-For-Service (DMH, DAIL, Co-occurring and Case Trauma Informed DVHA, ADAP) Management Services • Federal funding • Charitable donations Elder Care Offender Re- Services Entry Programs www.nkhs.org
Community Rehabilitation Therapy Payment Mechanism • Monthly case rate (6 month look Assessment, back -3% variance) Treatment and Case Management • Grant funding Community • Specialized payments for high Supports, Medical Employment and Management need individuals Housing • Private insurance Crisis Support, Peer Support Hospital Diversion and Step Down Clinical Interventions www.nkhs.org
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