Wednesday, April 2, 2025
4/2/2025
FY 2024 Behavioral Health Service Expansion - Northern Counties Health Care (NCHC), established in 1976, provides integrated community health services to nearly one-third of the medically underserved tri-county region of Vermont (VT) known as the Northeast Kingdom (NEK). NCHC does this through seven primary care locations (including two walk-in clinics) and three dental centers. Despite our sizeable footprint and existing behavioral health (BH) services, high rates of depression and anxiety, substance misuse, opioid-related deaths and suicides plague the rural NEK. Essex County reports the highest rate of opioid deaths and highest percentage of adults reporting frequent mental distress in the state. Caledonia County has the highest suicide rate and third highest drug overdose mortality rate in VT. This situation has only worsened post-COVID and the historic flooding in July of 2023 that severely affected the NEK. We know through our needs assessment and research that limited access to local BH services is a significant contributor. The ratio of patients to mental health provider is higher in the NEK, especially in Essex County where it is a staggering 1499:1. Three of NCHC’s clinics (two in Essex County) lack Medications for Opioid Use Disorder (MOUD) capacity and Orleans County’s only primary care clinic is not a MOUD spoke. A recent survey of our primary care providers (PCPs) indicated that most are open to prescribing MOUD but identify lack of education and support as a barrier. We heard from NCHC patients and NEK community members that waitlists, lack of specialized BH services and stigma were primary barriers to mental wellbeing and recovery. Though our current integrated BH program offers short-term counseling, consultative psychiatric services, brief intervention and facilitated referrals out to the community for longer-term, specialized treatment; often these referrals fail due to lack of service availability in our community. Despite our best efforts, NCHC has struggled to recruit licensed BH providers to our rural, under-resourced area. This project will address barriers to a comprehensive and effective BH system in the NEK by expanding NCHC’s BH program service capacity within our Patient-Centered Medical Homes where patients report less stigma accessing care. In addition to better serving our existing patients, particular efforts will center on individuals struggling with opioid use disorders and mental health issues, and isolated and vulnerable populations at greater risk of poor behavioral health outcomes (BIPOC, LGBTQ+, disability, chronic pain and/or complex trauma). We will enhance counseling access and expand MOUD prescribing capabilities at all of our clinics, extending service hours to evenings and weekends to better accommodate patients. We will establish counseling services and Rapid Access to MOUD programming in our Orleans Express Care location. We will increase the availability of specialized care by providing BH staff with evidenced-based training in trauma and chronic pain treatment modalities and PCP education in MOUD. We expect this training to assist us in recruiting new BH clinicians and PCPs to NCHC who are seeking enhanced training opportunities and a place to utilize these skills and will enable us to meet our patients’ needs in-house, reducing unsuccessful transitions in care. We will expand group therapy offerings including a Peer Recovery Support Specialist program to diversify our menu of services and highlight the role of lived experience in reducing stigma. Finally, we will deepen collaboration with community partners, such as Emergency Departments, recovery centers, homeless shelters, and planned Certified Community Behavioral Health Clinic. By investing in workforce capacity, service expansion and coordination, NCHC’s project will provide a sustainable solution to address the root causes (provider shortages, skill deficits, stigma and geographic isolation) of BH service fragmentation and inaccessibility in the NEK.
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).