GRANT PROPOSAL: COMMUNITY ACCESS

OTTO BREMER FOUNDATION

  1. Community. Describe your community's needs and opportunities as they relate to your proposal.

Every year, 7.6M people check into inpatient psychiatric units. They range from chronic patients to those who have only recently fallen ill. Many of them end up in an emergency room by default; few resources are available to clients in crisis. Unless such clients have the money for alternative treatment or the help of loved ones who can provide them with the support they need, they have no recourse.

Once in an emergency room, a client's trauma only increases. Emergency rooms are chaotic and alienating; everything from the harsh lighting to the constant rush of staff adds indignity to the position of a person who has already lost so much. Over 80% of the people who arrive at emergency rooms for a psychiatric crisis report being traumatized by the experience.

Inpatient wards must focus on the immediate stabilization of the individual; their mandates force them to focus on the short-term, not on the extensive care and collaboration that a psychiatric crisis calls for. An inpatient psychiatric stay costs $2,000 per day; a two-week stay costs $28,000. At those prices, hospitals have little incentive to address the long-term needs of patients, especially in this managed-care climate.

All too often, clients pay the price. Hospitalization, especially for the seriously mentally ill, is often the first stage of a long slide into “professional patienthood.” A history of revolving-door stays, combined with increasing decompensation, leads to a client’s belief that they are incapable of being “normal.” Their needs – to have their autonomy respected, to receive guidance and learn coping skills, to have a network of support – are ignored.

  1. Proposed work. Describe the specific work and activities you propose and how they will move your community forward in ways that complement the Foundation's vision of healthy, vibrant communities as places where basic needs are met, mutual regard is prized and opportunities for economic, civic and social participation are within everyone's reach.

The Crisis Respite Center (CRC) will address the long-term needs of psychiatric clients in New York City. Designed as part of a Department of Health and Mental Hygiene initiative, Parachute NYC, it provides a “soft-landing,” community-based alternative to emergency hospitalization. A former OMH-licensed community residence that has been renovated from 14 to 7 beds, the CRC will offer a safe and supportive home-like environment to those in crisis.

The CRC will accomplish these goals by adopting two models, the Need Adapted Treatment Model (NATM) and Intentional Peer Support (IPS). The NATM aims to create an environment of stability to establish a sense of hope in each client. Principles such as:

  • responsiveness to the client’s preferences
  • the engagement of providers and loved ones in treatment plans
  • extensive follow-up after “discharge”

ensure that each client benefits from a network of resources.

IPS aims to maximize the bonds between peers, using principles like self-reflection and reframing. Almost 90% of the positions at the CRC will be staffed by trained peer counselors and educators. They will offer:

  • 24-hour peer support
  • self-advocacy education
  • self-help training to clients

Peer support is essential to the mission of the CRC, with both staff and clients enjoying an environment of mutual regard. Staff will share their experience, strength and hope, leading the way to better health.

Each client will create a treatment plan that addresses their unique needs, including follow-up care and social support. Peer support has been proven to enhance long-term recovery trajectories by teaching coping skills and self-efficacy. As clients begin their recovery journeys, rehabilitation becomes a reality as clients achieve their economic, social, and civic goals.

  1. Your organization and resources. Describe your organization in terms of its mission, goals, staffing and stakeholders. What experience, learning, connections or other non-financial resources does your organization bring to the work you propose? What non-financial resources do you need to access or develop for your proposed work to be successful?

Community Access was founded in 1974 on the Lower East Side of Manhattan. Since then, it has expanded into the rest of New York City. From our inception, we have offered respite to clients overcoming mental illness and homelessness. Specifically, our staff provide housing and support services, including job training and counseling. We believe that when people are given the opportunity to tap into their innate abilities, transformation happens.

Since 2005, we have worked with over 60 agencies and nonprofits around the world to develop housing and workforce projects. Our work includes the creation of the award-winning Howie The Harp Peer Advocacy Center (HTH), a peer-run agency that offers employment support. Its flagship program, the Peer Training Program, trains students in Intentional Peer Support and has served over 800 students since its inception.

Our staff is comprised of many people who have long histories of service. Our CEO, Steve Coe, has led Community Access since 1982 and is a member of several boards, including:

  • Supportive Housing Network of New York
  • Association for Community Living
  • NAMI NYC-Metro
  • New York State Campaign for Mental Health Housing
  • New York Association of Psychiatric Rehabilitation Services

Our board is diverse and includes real estate professionals, health industry professionals and a community advocate, all of different ethnic and intellectual backgrounds.

  1. Partners and networks. Describe the others you propose to work with to accomplish your goals. What is your organization's history with these partners, and how will they contribute to your work?

CRC is a program of Parachute NYC, an initiative funded by a three-year, $17.6 million Healthcare Innovation grant from the Center for Medicare and Medicaid Services. It is run by the Department of Health and Mental Hygiene, with the support of:

  • New York State Office of Mental Health
  • Visiting Nurse Service of New York
  • Mental Health Association of New York
  • Services for the Underserved
  • Transitional Services of New York
  • Community Healthcare Network

We have worked with some of these partners in the past, on projects such as improving services for MICA clients and designing better administrative procedures. We plan to capitalize on the talents of these larger organizations to improve our services.

  1. Looking ahead. How do you anticipate your community will change in the coming years? How will your work and organization evolve to fit those changes?

Parachute NYC will reduce gross Medicaid expenditures by $50 million over the next three years, while improving standards of care. Initiatives including:

  • four new crisis respite centers
  • new and enhanced mobile crisis services
  • a peer-staffed “warm line”
  • integrated primary health care

will maintain a continuity of care. As an agency, Community Access is committed to developing the peer workforce and aims to be at least 50% peer-run.