Services for the UnderServed, Inc. (S:US) will continue our one year of experience operating a Certified Community Behavioral Health Clinic (CCBHC) at Wellness Works, formerly known as Comprehensive Treatment Institute (CTI), located at 177 E. 122nd Street in East Harlem with a satellite location at 1366 Inwood Avenue in the Highbridge area of the Bronx. These neighborhoods have some of the highest rates of serious mental illness, substance use disorder, and serious emotional disturbance in NYC. S:US has long served these individuals and will continue to serve them for this project. We will continue to use EBPs such as Motivational Interviewing, Intentional Peer Support, and Medication Assisted Treatment to provide services including individual and group counseling for SUD, targeted case management, psychiatric evaluations and counseling, medical assessments, medication monitoring, and peer-led recovery and support groups for individuals with SMI, SUD, COD, or SED. We will provide these services to 600 individuals per year (1,200 over the two-year program). Our partner, Union Community Health Center, will provide integrated medical care at S:US’ Wellness Works.
In our first year of operating Wellness Works as a CCBHC, 1 in 4 clients had an opioid use disorder (OUD). Based on community statistics and characteristics of the population Wellness Works currently serves, we predict an increase of individuals with OUD at Wellness Works. In the past year, we created an outreach team in Harlem consisting of Peer Specialists who help engage people with OUD and connect them to counseling and MAT services at Wellness Works. S:US will continue outreach and to engage individuals with OUD, expanding the team to the Bronx, a part of the city with high need for these services.
The majority (70%) of the people we serve are transitioning from hospitals, long-term residential treatment, and incarceration. Not only are they in need of clinical services to sustain and strengthen their recovery, comprehensive case management and peer support are essential for successful reintegration into their communities. Based on current referrals to Wellness Works, we estimate that that the majority (75%) will identify as male, 20% as female, and 5% as transgender. The majority (46%) will identify as African American or Black, Latino or Hispanic (29%), and White (16%). Nearly half (45%) will not have a high school education, and 80-85% will be unemployed when they first engage in services at S:US.
Program goals include: 1) Increasing access to and improve the quality of community behavioral health services in Manhattan and the Bronx: 2) Increase access to CCBHC services through comprehensive assessment for new consumers: 3) Increase staff capacity to provide culturally competent patient-centered services: 4) Integrate primary care and behavioral health care to improve health outcomes for individuals with SMI, SUD, COD, or SED: 5) Increase capacity for sustainable CCBHC services.