Saturday, December 21, 2024
12/21/2024
Project Summary: The Jewish Board (JB) proposes to transition its Midwood Service Hub into a CCBHC that offers all required services--health screening/prevention, behavioral health (BH) treatment, 24/7 crisis care, rehabilitation/recovery services and more--to primarily low-income culturally-diverse Brooklyn, New York residents of all ages. During the 2-year grant period, JB will serve 7,000 people, the majority with a serious BH condition. People served annually/project period: In the 2-year grant period, JB will serve 7,000 individuals of all ages at the CCBHC and related off-site programs with 3,728 individuals served annually. Population served: JB will serve primarily low-income culturally-diverse residents of all ages living in 5 densely populated, underserved Brooklyn communities in New York City (NYC). Today, 2 of 3 Hub clients have a serious mental illness (SMI) and 10% have a substance use disorder (SUD). Two thirds (62%) are ages 18-64, 22% are children ages 0-17 and 16% are 65+; 72.7% are low-income on Medicaid. Many have unaddressed trauma and co-morbid medical conditions. In the service area, 10-17% of residents are smokers; 41% of an adult cohort with SMI reported smoking. In NYC, Brooklyn residents had the second largest number of overdose deaths from a range of substances. In the population, 23% are high utilizers of inpatient/ER services (JB 25%); 50% have no outpatient follow-up after a psychiatric inpatient admission (JB 43%). Strategies/Interventions: The Hub currently has a large Mental Health Clinic, rehabilitation / recovery services, ACT, care transition and care coordination. CCBHC funds will facilitate the addition of SUD services, in-home BH and crisis care, health screenings/preventive care, outreach/engagement to high-need populations (veterans, public housing, homeless) and comprehensive screening/care planning/navigation for individuals to determine their needs. Goals/Objectives: (1) Decrease tobacco use by screening & providing appropriate follow-up. (Staff will screen for tobacco use & develop/implement a tobacco reduction/cessation plan with nicotine replacement therapy as needed increasing from 35% to 70%.) (2) Reduce adult BMI through routine weight screening/follow-up. (Staff will screen ages 18+ for BMI & as needed develop/implement a follow-up plan for weight reduction, increasing from 10% to CMS benchmark 66.4%). (3) Improve diabetes detection in adults with schizophrenia/bipolar disorder using anti-psychotic medications. (Staff will screen A1C levels of ages 18+ using medications, increasing from 18% to 60%). (4) Increase depression diagnoses for ages 12+ using the PHQ & implementing follow-up plan as needed. (Clinicians will administer the PHQ-9 per evidence-based guidelines, increasing from 46% to CMS Benchmark 60%). (5) Improve follow-up after psychiatric hospitalization of ages 6-21 by providing care transition & home-based MH services. (Staff will provide in-hospital intake and post-discharge in-home MH treatment/care navigation, increasing follow-up after hospitalization within 7 days of discharge from 43.1% to 65%).
HHS’ Tracking Accountability in Government Grants System (TAGGS) website provides access to detailed descriptions of grants, loans, aggregated direct payments and other types of financial assistance awarded by the HHS Operating Divisions (OPDIVs) and the Office of the Secretary Staff Divisions (STAFFDIVs).