Project Name: Enhancing Mental Health and Substance Use Services for the Diverse Population of Youth, Families and Residents of the South Bronx.
Summary: This project aims to address the pressing and unmet mental health and substance use needs faced by the diverse population residing in the South Bronx. The target population includes residents of Mott Haven, Morrisania, Hunts Point, Highbridge, East Tremont, and Melrose. These neighborhoods exhibit socioeconomic disparities, with a high percentage of Hispanic residents and limited access to quality healthcare. The project's goals include improving access to comprehensive mental health and substance use disorder services, reducing behavioral crises, and enhancing overall health outcomes. Throughout the project's four-year duration, it is anticipated to serve 1,484 individuals, with an equal distribution between children (ages 5-18) and adults (ages 19 and older). The projected number of unduplicated individuals to be served annually is as follows: Year 1: 275, Year 2: 342, Year 3: 415, Year 4: 452.
Strategies and Interventions: The project will implement a range of core services, such as crisis mental health services, early intervention/prevention, crisis response services, stabilization services, screening, assessment, diagnosis, patient-centered treatment planning, outpatient mental health services, targeted case management, service referral and linkage, psychiatric rehabilitation services, intensive community-based mental health care for armed forces and veterans, and substance use services. The service delivery will be tailored to meet the specific needs of the population, taking into account cultural and linguistic considerations and access to care.
Project Goals and Measurable Objectives:
Become fully compliant with CCBHC requirements by the end of Year 1. Objectives: (1) Implement at least 5 of 9 core services by March 2024 and complete all core services by September 2024. (2) Establish a robust data infrastructure integrated with Electronic Medical Records (EMR) for efficient data collection, analysis, and utilization. (3) Maintain adherence to certification criteria for enhanced Medicaid reimbursement.
Increase equitable access to comprehensive mental health and substance use disorder services for youth, families, and adults in the Bronx. Objectives: (1) Provide Social Determinants of Health (SDOH) assessments to 100% of CCBHC patients. (2) Offer targeted case management services to 100% of CCBHC patients. (3) Facilitate warm hand-offs and care coordination with local health, social, and human service agencies. (4) Engage 100% of CCBHC patients in peer support services. (5) Enhance cultural responsiveness through staff trainings. (6) Collaborate with local Department of Veterans Affairs facilities to better serve veterans and their families. (7) Enroll eligible patients with lapsed Health Home eligibility in the VNS Health Behavioral Health CCBHC.
Decrease the risk and occurrence of behavioral crisis events among the population served. Objectives: (1) Conduct substance use disorder screening for 100% of CCBHC patients. (2) Ensure enrollment of CCBHC patients with substance use disorder in treatment. (3) Provide suicide risk assessments to 100% of CCBHC patients. (4) Reduce the risk of suicide by 75% using the Zero Suicide model. (5) Deliver Medication Assisted Treatment to 100% of CCBHC patients in need. (6) Establish robust care coordination with external agencies for seamless transition and integration of care.
Improve overall health outcomes for youth, families, and adults in the Bronx. Objectives (1) Conduct primary care screenings and health monitoring for 100% of CCBHC patients. (2) Screen patients for tobacco/electronic cigarette use and enroll 80% of CCBHC patients in cessation intervention.