Communities of Care

MHVC comprises seven counties of great diversity, each with inspiring examples of Communities of Care. We will be sharing partner stories here, and we hope you will contact us at montefiorehvc@montefiore.org with even more.

New and Old: With New Name and New Technology, CoveCare Center Focuses on Older New Yorkers

BH provider using $1 MM state grant to expand services

Using a combination of technology and high-touch outreach, one Putnam County behavioral health (BH) provider is overcoming the limitations of its rural setting to reach its senior clients.

“This population is very vulnerable,” explained Alison Carroll, LCSW-R, VP of Strategic Initiatives at CoveCare Center. “Age and isolation compound the problems with substance use and mental health conditions, jeopardizing how long they are able to live in our community. We needed to figure out how to get to them in their homes.” Putnam has one of the largest senior populations in the state, and is one of the fastest growing: one in four residents is over the age of 55. In addition, the county is rural, so the elderly tend to be isolated and can’t easily get to services.

In January 2017 CoveCare Center, which changed its name from Putnam Family & Community Services in July, was one of eight behavioral health providers that received $1 million grant, spread over five years, through the New York State Office of Mental Health (OMH). The goal of the grant was expansion of community-based programs for older adults facing mental health, substance use, and aging related issues.

CoveCare is the lead agency of a “Triple Partnership” with the Office for Senior Resources (OSR) and the Prevention Council of Putnam (formerly known as the National Council on Alcoholism and Other Drug Dependencies/Putnam). The three agencies are collaborating to identify, assess, and provide access to behavioral health and aging services to Putnam seniors aged 55 and older in need.

Leading the initiative is a licensed clinical social worker, care manager, and recovery coach, as well as nursing and psychiatric supports. The program identifies and offers services to individuals aged 55 and older whose independence and involvement in the community may be compromised by behavioral health issues. “This is an exciting new model of care that not only involves mobile services for this population, but also employs telehealth monitoring units for our more fragile individuals,” adds Carroll. The telehealth monitors will be used to communicate with seniors who are at risk and can benefit from daily monitoring of certain conditions.

According to OMH, the inclusion of telehealth monitors, which will be activated by the end of this year, was a big deciding factor in the awarding of the grant to CoveCare. The monitor boxes are attached to the phone system in the client’s home and are pre-programmed with functions tailored for each client. “The telehealth monitors were a critical component for us,” explained Carroll. “Many clients miss appointments or never engage in treatment because they can’t get to the clinic site. The monitor will allow us to see client data in real time, regularly, and lets the client ‘check in’ to the clinic virtually.”

“In addition to the Triple Partnership, we are working with police departments, emergency rooms, the Department of Social Services, and many others to identify at-risk individuals,” said Carroll. “The emphasis is on identifying resources needed before someone goes into crisis.” Carroll gave the example of repeat calls the police department receive on 911; instead of directing these callers to the emergency department (ED), they now refer these callers to the program for assessment.

Recovery coaches are another critical part of the program’s success. “Our recovery coach is working hard to connect to clients and to connect clients to the resources they need,” said Mariel Roth, LCSW, Director of Community-Based Services for CoveCare. “For example, they pick up clients and take them to Alcoholics Anonymous or Narcotics Anonymous meetings, or set up online meetings.” The team is constantly looking for ways to improve the quality of life and services for their client population, especially ones that acknowledge access difficulties. “These clients have been isolated for so long that they often lack social connections,” continued Roth. “Those connections are an Important part of getting healthy.”

“This is a team effort, between the Triple Partnership and all of our other collaborators in Putnam County,” said Carroll. “Our aim is to identify how to get clients the services they need, where they need them -- whether at home through the monitors and services from the care team, AA or NA meetings, other county services, or our clinics. The ED is no longer the first stop, and remaining in the community is the expected outcome.”

Puppet Troupe Takes on Tough Issues -- with Fun!

“Kids on the Block” educates in forgotten, unexpected places

If a picture is worth a thousand words, then a troupe with life-size puppets of kids in every shape and color would be worth a whole lot more.

Kids on the Block (KOB) is a community education program of Mental Health America of Dutchess County, Inc. (MHA Dutchess), that educates children using life-like, life-sized puppets on personal safety, bullying, gang prevention, learning disabilities, children’s mental health, alcohol/tobacco/drug abuse prevention, childhood obesity, and multiculturalism. “In the mid-1990s, United Way came to us and asked for an idea for a special project,” said Janet Caruso, Director of MHA Dutchess. “A staff person had seen KOB puppets and scripts, but they were expensive so we started small, with a few puppets and scripts. Over the years we obtained more scripts and puppets with small grants from local funders.”

Performances are free, and have been given to thousands of kids over the years. The troupe has performed in public schools, day camps, after-school programs, health fairs, day care centers, nursery schools, libraries, and reading programs in the summer. “We like to set up shows at unexpected, unusual, and forgotten places and populations, such as family shelters,” said Marlene Taylor, Coordinator of Community Education. “We also strive for diversity in our puppet troupe. For example, we have a group of special-needs young adults practicing to be puppeteers.”

Each puppet’s character, like real children, has likes and dislikes, hopes, fears, talents, and limitations; some have mental, physical, or emotional disabilities. Each performance includes a lively script that stimulates open communication between the audience and the puppets. The program currently has 14 puppets and 35 scripts, according to Taylor. “I have been doing this about ten years, and it is gratifying to see how creative our team and the kids are. The kids themselves are now generating scripts.”

The post-performance discussion is a critical part of the process. Educators are given enrichment materials for follow-up, and the audience is engaged with scripted questions. “Once we do a script, we ask both the adults and kids, ‘Why did we share this script with you?’ ‘What does this mean to you?’” said Taylor.

If you are interested in learning more about KOB, volunteering, or scheduling a performance, contact Marlene Taylor at mtaylor@mhadutchess.org or 845-473-2500, ext. 1309.

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