Overview: The Jewish Board (JB) proposes to improve its Brooklyn Connected Care (BKCC) CCBHC by expanding substance use (SU) treatment and adding home-based child/family mental health care to meet pandemic-related needs, while continuing to support crisis care, health screening, outreach and other required services until they are financially sustainable. BKCC offers CCBHC services mainly to low-income culturally-diverse Brooklyn, New York residents.
During the 4-year grant period, JB will serve 4,500 unduplicated New Yorkers, the majority with a serious behavioral health (BH) condition (2,532 unduplicated clients in year 1; 2,652 in year 2; 2,773 in year 3; and 2893 in year 4. At BKCC, JB serves primarily low-income culturally-diverse residents 5 years and older living in the densely populated, underserved neighborhoods of Borough Park, Flatlands, Flatbush, Midwood, Southern Brooklyn and Central Brooklyn in Kings County (Brooklyn) in New York City. Disparities to be addressed are access to care barriers, higher risks to children/youth negatively impacted by the pandemic, increased substance abuse and historic racial/economic disparities in prevalence of chronic health conditions.
Population Served: In 2021, the CCBHC served 2,411 unduplicated individuals (62% female) with 84% having a mental health (MH) condition, two-thirds a serious mental illness (SMI) and 14% a co-occurring substance use disorder (SUD). Two thirds (62%) are adults ages 18-64, 21% are children ages 5-17, and 17% are 65+, which is representative of the age distribution in Brooklyn. In 2021, 70% of local residents using JB services are low-income on Medicaid or Medicare/Medicaid (compared with 17.8% in Brooklyn), with 66% White, 15% Black, 4% Asian and 15% other/unknown; 17% identify as Hispanic. Over half of BKCC consumers are Jewish and the rest are Catholic, Protestant, Muslim, other or no religion.
CCBHC Services: At the CCBHC, JB operates a NYS-licensed MH Clinic that serves children 5+ and all age adults; a PROS Program with treatment/rehabilitation; and 2 ACT Teams (with peers). These programs offer psychotropic medication, including long-acting injectable antipsychotic medication and psychotherapeutic interventions including individual, group and family therapy (only Clinic) with clinicians who utilize evidence-based practices such as Motivational Interviewing, Trauma Focused-Cognitive Behavioral Therapies, Dialectical Behavioral Therapy and more. The MH Clinic and ACT Teams offer SU interventions including medication-assisted treatment (MAT) for OUD and alcohol abuse, plus individual SU counseling and therapeutic groups. The Clinic, PROS and ACT offer nicotine replacement medications. JB will be adding Medicaid-funded Children and Family Treatment and Support Services (CFTSS) to provide in-home therapy, rehabilitation, crisis intervention and family peer support. The CCBHC offers 3 case management opportunities--Medicaid-funded Health Home, NYC-funded case management for adults not eligible for HH and ACT Team case management.
Goals/Objectives: (1) Improve Diabetes Detection in Those Using Antipsychotic Medications in those ages 18+. Goal: Increase from 70% to 85% Screening Rate (2) Improve Follow-Up After Psychiatric Hospitalization in those 6 yrs + Goal: 75% Follow-Up Rate for all ages (3) Improve BMI Screening & Follow-Up ages 18+ Goal: 70% Screening & Follow-Up (4) Improve Depression Identification & Follow-Up for ages 12+ Goal: Increase to 90% Screening & Follow-Up. (5) Improve SUD Diagnosis Follow-Up for ages 12+ Goal: 70% Follow-Up Rate (6) Improve Suicide Risk Assessment Follow-Up for ages 10+ Goal: 75% Follow-Up Rate.