With seven counties, three PPSs, and demographic and geographic challenges that further complicate health care delivery, the Hudson Valley region does not have a “one size fits all” answer to improving health outcomes. MHVC realized from the beginning of DSRIP that the keys to reaching these diverse communities are the community organizations that understand local populations and problems; that have long-term relationships with other public, private, and religious organizations that serve their community; and that know the local health care system -- including its gaps -- well.
Creating New Community- and County-Wide Networks
Crisis Stabilization Mapping
The goal of the Crisis Stabilization Project (3.a.ii) is to provide readily accessible behavioral health crisis services that will allow access to appropriate levels of service and providers, supporting a rapid de-escalation of the patient’s crisis. MHVC is part of a dynamic collaboration of three PPSs — MHVC, Westchester Medical Center (WMC), and Refuah Community Health Collaboration — that was formed to take on this challenge in a unified, collective way.
Over 40 partners participated in developing the foundation of the project and in producing an exhaustive report on the honest opportunities and challenges of the project. The project highlights the power of three PPSs to talk to state government about what needs to change, and to be a template for other regions in the state and other parts of the country.
To date, crisis mapping sessions have been held in Westchester and Orange counties and will be planned for the remaining counties of the PPS. The interactive sessions give participants new understanding of roles and relationships between, among others, hospitals, government, first responders, providers at all levels, and community organizations, as they rationalize services and interactions in five key areas: mobile, respite beds, intensive services, and follow-up services. New awareness of who does what, when, and how it impacts others, will lead to better patient outcomes.
The state’s Medicaid Accelerated Exchange (MAX) Series Program provides a high-intensity, fast-track mechanism to effect immediate and long-lasting results in a community. We are fortunate that two teams of MHVC partners participated in the first MAX Series: St. Luke’s Cornwall Hospital and St. Joseph’s Medical Center. While both teams successfully engaged high utilizers in their hospital systems, St. Luke’s focused on high utilizers in the emergency department (ED), and St. Joseph’s on inpatient (IP) admissions. MHVC partner, HealthQuest, has been selected to participate in the current MAX Series round.
The MAX Series is a quality improvement initiative and an intensive eight-month learning collaborative aligned with DSRIP projects and measures. Participating organizations create multidisciplinary “Action Teams” comprised of subject matter experts both from within their organizations and external partnering organizations. The collaborative is phase-based and includes an assessment and preparation phase, followed by three full-day workshops and intermediary improvement cycles, concluding with a reporting period.
Public Health Campaigns
Anti-Tobacco Marketing Campaign
The Hudson Region DSRIP Public Health Council, a partnership between the Montefiore Hudson Valley Collaborative, Westchester Medical Center and Refuah Community Health Collaborative, has developed an anti-tobacco marketing campaign targeted to teens and their caregivers. The campaign is focused on the harmful effects of electronic smoking devices like vaporizers, e-cigarettes and electronic hookahs.
The ads, available for download here, have been distributed to Hudson Valley middle and high schools throughout the region. Local schools have used the ads to enhance student involvement in national initiatives like the Great American Smokeout, Lung Cancer Awareness Month, and Kick Butts Day.
In order understand the status of tobacco cessation efforts in its partner network and to identify areas for intervention and support, MHVC conducted an assessment of readiness and capacity to establish and enhance a continuum of tobacco cessation services. The “Tobacco Cessation and Tobacco-Free Policy Survey” of MHVC partner organizations covered three general areas: patients, employees, and smoke-free policies. The major finding was that there is a high rate of tobacco use among both employees and patients at behavioral health (BH) sites, while integrated sites (clinical and behavioral) reported higher levels of uncertainty regarding patient smoking rates. Integrated sites also offer the greatest mix of cessation services. In terms of smoke-free policies, clinical sites and integrated sites have the strictest smoke-free policies, and a greater proportion of BH sites allow outdoor smoking in designated places. Enforcement is the most frequent barrier identified by all types of sites. The survey results will help MHVC tailor its consultation and technical assistance for network partners.
The leading cause of premature death, and the second leading cause of overall death, in the Hudson Valley is cancer. Our Community Needs Assessment (CNA) showed there are “hot spots” for certain cancers in certain regions; not surprisingly, screening rates for these cancers are lower in the Hudson Valley than State average. Given this gap, MHVC intends to target cancer prevention (particularly among minority populations) for preventive care initiatives. Central to our project plan is incorporating the New York State Prevention Agenda goals to improve preventive care, particularly among minority populations.
How to Do It: PDSA and Tobacco Cessation
HDSW gets results from a program involving both clients and staff
Recognizing the high prevalence of tobacco use and tobacco-related diseases in the Hudson Valley, MHVC/Einstein created and disseminated a survey that examined readiness and capacity for tobacco cessation services amongst partner organizations in August, 2016. Although results showed a high prevalence of tobacco use, particularly amongst behavioral health organization staff and clients, most do not receive funding for tobacco cessation activities nor do they have a tobacco cessation program for employees.
One of MHVC’s community partners, Human Development Services of Westchester (HDSW), decided to act. HDSW discussed strategies for how they implemented tobacco cessation initiatives with both their clients and staff. Utilizing Plan-Do-Study-Act (PDSA), a rapid-cycle evaluation process, they designed an initiative that has already produced results.
Before starting the intervention, HDSW sent their staff nurse to an American Lung Association “train-the-trainer” session. As a result of the training, HDSW implemented an agency-wide screening for tobacco use at intake/admissions, and also referred clients to the NYS Smokers’ Quitline and a doctor, as needed.
Additionally, at HDSW's Hope House, a day-respite program, staff asked guests/clients if they wanted to have their own tobacco cessation program, and they said “yes.” Staff members were able to participate alongside guests/clients, and participated in a weekly discussion on tobacco use, with 8-15 participants. Guests/clients were allowed to select both a start and an end date for the tobacco cessation program. Successes included one long-term smoker quitting, and a number of both staff and guests/clients reducing the number of cigarettes they smoked per day. Other positive impacts included an increase in the number of conversations about tobacco use and cessation at Hope House and a stronger rapport with staff and guests/clients as they worked towards quitting smoking together. Hope House is gearing up to start another tobacco cessation initiative in January 2018.