Pesach Tikvah CCBHC will advance primary-behavioral health and substance abuse integration and use evidence-based practices to serve an unduplicated 4,500 individuals (Y1: 2,822; Y2: 3,245) Target population are Orthodox Jewish individuals in Brooklyn, NY neighborhoods of Borough Park and Williamsburg with mental health conditions including serious mental illness, substance use disorders, co-occurring disorders and/or youth with serious emotional disturbance. Hispanic individuals and veterans will also be served. The target population experiences health disparities, high rates of poverty, stigma, cultural and language barriers and lacks access to outpatient substance abuse and behavioral health care. Recent hate crimes targeting the community have contributed to an increased need for trauma services.
Pesach Tikvah CCBHC goals include: 1) Expanding access to services by increasing capacity of behavioral health services and integrating substance abuse and primary care screening to be accomplished by obtaining licensure for substance use services, adding staff and developing collaborative relationships. 2) Improving quality of care and clinical outcomes by implementing risk stratification process and targeted case management program, implementing weekly team meetings and implementing evidence based practices including Screening, Brief Intervention and Referral to Treatment, Cognitive Behavioral Therapy, Cognitive Processing Therapy, Motivational Interviewing, MAT and Integrated Treatment for Co-occurring Disorders. Taken together, this will help decrease mental health symptoms by 45%, decrease substance use by 45% and achieve 50% compliance with medication. 3) Reduce total cost of care by increasing access to integrated care and using data to drive clinical decision making and quality improvement. This will contribute to sustainability by enabling the use of data to develop value based payment arrangements.
PT currently provides most of the required services (including outpatient mental health, 24/7 access to crisis, care coordination, screening/assessment, treatment planning, psychiatric rehab and peer supports, timeliness of access, etc.) In order to meet all certification requirements by 4 months post-award Strategies and Interventions include: 1) Develop Advisory Workgroup 2) Refine its existing Needs Assessment 3) Develop policies and procedures and workflows. 4) Develop formal relationships with care settings including a DCO relationship with Woodhull/HHC for ACT services 5) Train staff and implement EBPs 6) Complete a regulatory process for NYS licensure to provide SUD services, including MAT, and build a team of Integrated Specialists7) Hire a Nursing Director and a PNP with addiction specialty to provide primary care screening and prescribing. 9) Expand Care Coordination program 10) Implement weekly team meetings 12) Refine existing HIT and use Business Intelligence/Data Dashboard to assist with clinical decision making, 13) Apply a continuous quality improvement approach 13)Expand awareness of available services by conducting marketing and outreach campaign.