Community Consortium Meeting – September 19, 2012

In attendance: Leah Bradley, Community Healthlink, Steve Como, Soldier On, Bob Guerino, Mass Health, David Modzelewski, Network to End Homelessness, Leon Sawh, UMass, Pamela Schwartz, Network, Julianne Siegfriend, UMass, Heather Zaykowski, UMass Boston

Steering Committee Meeting Update (Julianne):

Meeting on 9/4.  Heather provided some initial data on 6 month follow-up assessments.  Discussed outcomes including seeing a slight increase of substance use in alcohol and drugs; decrease in alcohol to point of intoxication.  Data for these analyses included 20 cases (6 month follow-up and initial base-line) – difficult to make definitive judgment about that being the direction of the entire sample.  Noting stressful time, establishing trusting relationships (more honest at 6 months than baseline).  Considering possibility of doing qualitative interviews between staff and clients.  Increase of social connectedness with family or friends (70% at baseline), up to 90% at 6 month mark.

Moving forward with manual rewrite.  Opening up process to case managers and peers – will make Mission Vet manual inclusive of non-veterans as well.

Evaluation update (Heather):  Exceeded our enrollment for Year  1.  Meeting follow-up goals.  Increased proportion that is housed, although housing remains a challenge.

Project Updates:

Community HealthLink (Leah Bradley):  a couple of clients moved due to fires.  One moved due to eviction notice for “too much traffic.”  A few clients have complained about feeling overwhelmed with multiple service providers.   CHL staff is more consistent – multiple providers on one site allowing for consolidation and ease; finding that seeing a consistent provider makes a difference to this population.

One person had to transition to rest home.  Staff there did not have same knowledge of serving this population.  Relapsed with abuse of hand sanitizer.  An example of the challenges in transition of care.

Planning to do some groups with 3 or 4 clients (transportation is a big barrier – clinician providing it).

Now identifying people for next fiscal year.  Waiting to hear from HUD on new housing.

People coming up on the 1 year mark, looking at sustainability issues.  Clinician will remain when they transition (via other funding).  Will filter into traditional case management (e.g., CSPECH), will continue to look for other resources.

Bob Guerino:  reminder that he is available to go into institutions (e.g., correctional facilities) and offer presentation on MassHealth and how to maintain benefits.

Behavioral Health Network (Jennifer Wuest):  one client faced with a 30 day notice.  Now sober and attending day treatment, connected with Mass. Rehab.   His treatment will likely avert eviction.

Challenges:  when assessing and enrolling people, not known to them, it can be difficult to diagnose psychotic illnesses (sometimes can have psychotic symptoms associated with specific trauma).  As treatment gets underway, psychotic disorders reveal themselves and can be beyond the scope of the Mission protocol.  Difficult to determine in advance.

Julianne:  can we screen for these symptoms?

Jennifer:  yes and no.  Yes in that more people could be ruled out, but that would end up ruling out people who are appropriate for services (people with symptoms more transient and connected to trauma).  Could screen more aggressively.  A balance but difficult to determine.

Dave M.:  regionally, notion of “housing first” has been embraced.  Clinicians hoping that housing could be part of change in client’s behavior.  Again, difficult to ascertain what will make the difference in advance.

Leah:  hard to predict who is going to connect to health care and who isn’t.  Would be a disservice to disqualify everyone with a psychotic symptom since it’s possible that housing could make a real difference.  Hard to make that prediction.

Jennifer:  Meeting people at a stressful time.  A big variation in the caseload.

Leah:  it can take until people are housed to have psychotic symptoms revealed.  Raises question on 1 year model for this population (not veteran).  First six months stabilizing, learning the real issues.  Does it make sense to allow 18-24 months for this population to stabilize?

Julianne will bring this back to David S. to discuss..

Other challenge:  Clients who are referred without prior engagement with providers can be especially challenge to engage in treatment.  With the prospect of housing, they appear engaged but once housed, they are not interested in services.

Soldier On (Steve Como):  Just got contract for 2 case managers to hire for HUD VASH.  Looking for licensed social workers.  Still working with VA, have 7 or 8 VASH units from last allotment.  Starting to do first 25 of the 50 new VASH.  Taking out 4 or 5 to look for housing.

Severe chronically mentally ill placed 2 weeks ago.  Isolated, started inviting people up for parties.  Got him involved with a few programs at the VA.  Making a positive difference.  Biggest challenge is finding housing stock and finding landlords interested in doing it.

Network (Dave Modzelewski):  strong REACH meeting yesterday with new participants.  Better prospect for connecting folks to services following year of MissionWest.  New PACT team who will pick up people who are DMH eligible; CSPECH growing;  Health Care for the Homeless  has new program to serve high-end users.  Housing piece continues to be the challenge.

Jerry Ray, Mental Health Associates, reported on its Shelter Plus Care units (13 units) –  still maneuvering its way through City contracts, almost final but not quite.  HUD going slowly because of new HEARTH regulations and questions around implementation.

Noted change in new regulations that precludes requiring behavioral health type services as a pre-condition to going into shelter plus care or any kind of rental assistance.  If something happens that jeopardizes tenancy, you can require intervention, but you can’t do it as a pre-condition.

All discussed PACT (Program of Assertive Community Treatment) – new contract with BHN via DMH to provide services to seriously mentally ill population with forensic involvement.  Small residential component.  5 beds in  a transitional house.  Will serve 50 clients.

Grant management re: new fiscal year:  For sub-contractors, will hear from Julianne regarding end of year wrap-up requirements.  Stay tuned.

Next meeting:  Wed., 10/17, 10- 11 am, BHN (Child Guidance Clinic).  Agreed not to do Monday morning call on 10/15 ( in anticipation of 10/17 meeting that week).

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