Seneca Health Services Inc

CONNECT - CONNECTING OUR NEIGHBORS BY INTERNET, PROVIDING EVERYONE COMPREHENSIVE TX - THE CONNECT INITIATIVE FOCUSES ON SUPPORTING & RESTORING THE DELIVERY OF CLINICAL SERVICES THAT WERE IMPACTED BY COVID-19 AND TO EFFECTIVELY ADDRESS THE NEEDS OF THOSE WITH SED/SMI/COD LOCATED IN GREENBRIER, NICHOLAS, POCAHONTAS & WEBSTER COUNTIES IN RURAL SOUTHERN WEST VIRGINIA ALL OF WHICH SUFFER FROM COVID-MAGNIFIED RATES OF OPIOID OVERDOSE, POVERTY, UNMET MENTAL HEALTH NEEDS, LACK OF TRANSPORTATION/BROADBAND & STIGMA. THE INITIATIVE WILL SERVE 1,175 CLIENTS (550-Y1, 625-Y2). PROJECT GOALS (INTERVENTIONS/STRATEGIES) ARE TO: SUPPORT/RESTORE THE DELIVERY OF CLINICAL SERVICES IMPACTED BY THE COVID-19 PANDEMIC & EFFECTIVELY ADDRESS THE NEEDS OF THOSE WITH SED/SMI/COD BY (1) STARTING THE CONNECT MOBILE CRISIS UNIT VIA (A) EXECUTING MOUS W/ LOCAL 1ST RESPONDERS (Y1); (B) PURCHASING 4 TELEHEALTH EQUIPPED MOBILE CRISIS RESPONSE SUVS (Y1); (C) HIRING/TRAINING A MOBILE CRISIS SUPERVISOR (Y1); (D) HIRING/TRAINING 4 MOBILE CRISIS RESPONDERS & 8 MOBILE CRISIS PEERS TO PROVIDE CRISIS SERVICES. (Y1); (E) TRAINING 911 OPERATORS, EMS & LAW ENFORCEMENT ON RECOGNIZING BEHAVIORAL HEALTH CONDITIONS, DE-ESCALATION, CIT & WARM HAND OFF OF BEHAVIORAL HEALTH CRISIS (Y1-2); (F) STARTING THE MOBILE CRISIS UNIT (Y1M4). (2) ADDRESSING STAFF MENTAL HEALTH NEEDS VIA (A) INITIATING A PROGRAM FOR STAFF GYM MEMBERSHIPS (Y1); (B) INITIATING AN EMPLOYEE ASSISTANCE PROGRAM (Y1). (3) STARTING RURAL CONNECTION HUBS VIA (A) SELECTING 5 RURAL AREAS IN WHICH TO ESTABLISH HUBS (2-Y1, 3-Y2); (B) HIRING/TRAINING 9 CARE NAVIGATORS IN Y1 (+2 IN Y2) TO SUPPORT HUBS; (C) WORKING WITH COMMUNITIES TO SELECT HUB LOCATIONS (Y1-2), (D) COMPLETING OUTREACH ACTIVITIES IN EACH SELECTED RURAL AREA (Y1-Y2); (E) INITIATING TELEHEALTH CAPABILITY IN CONNECTION HUB LOCATIONS (Y1-Y2); (F) IMPLEMENTING THE CONNECT CONNECTION HUBS (Y1M4). (4) INITIATING LAW ENFORCEMENT LIAISONS VIA (A) WORKING WITH COUNTY SHERIFFS TO PLACE 2 LAW ENFORCEMENT MENTAL HEALTH LIAISONS IN TARGET COUNTY DEPARTMENTS (Y1) (+1 IN Y2). (5) EXPANDING SHS CAPACITY TO MEET INCREASED COMMUNITY NEED VIA (A) HIRING/TRAINING 2 THERAPISTS TO PROVIDE WEEKEND/EXTENDED SERVICE HOURS (Y1); (B) HIRING/TRAINING 4 CASE MANAGERS IN Y1 & 2 IN Y2 TO ENSURE CARE CONTINUITY/SUPPORT ZERO SUICIDE; (C) HIRING/TRAINING 2 HEALTH EDUCATORS IN Y1 (+1 Y2) TO ASSESS/EDUCATE MEDICAL CLIENTS; (D) HIRING/TRAINING AN IT TECH TO ASSIST WITH INCREASED TELEHEALTH USAGE (Y1); (E) PURCHASING RELIAS TRAINING PLATFORM TO IMPROVE STAFF TRAINING (Y1); (F) INITIATING THE LOCUS MODEL OF CLIENT TREATMENT PLACEMENT (Y1); (G) FUNDING STAFF CONFERENCE ATTENDANCE (Y12). (6) IMPROVING CLIENT OUTCOMES VIA (A) SERVING 550 CLIENTS-Y1/625-Y2; (B) SIGNIFICANTLY IMPROVING MENTAL HEALTH FUNCTIONING; (C) REDUCING SUBSTANCE USE; (D) REDUCING # OF PSYCHIATRIC HOSPITAL ADMISSIONS; (E) REDUCING # INCARCERATION DAYS; (F) RETAINING 80% OF CLIENTS AT 6-MONTHS, (G) ENSURING THAT DISPARITY GROUPS HAVE EQUAL SERVICE ACCESS/USE/OUTCOMES Y1-2. (7) SUSTAINING CONNECT SERVICES VIA (A) HIRING A PROJECT DIRECTOR TO ENSURE SERVICE SUSTAINABILITY (Y1); (B) HIRING AN EVALUATION SPECIALIST TO SUPPORT DATA-DRIVEN SUSTAINABILITY (Y1); (C) INITIATING THE ADVISORY BOARD.

SENECA CCBHC-IA INITIATIVE - THE SENECA CCBHC-IA INITIATIVE WILL PROVIDE COMPREHENSIVE, COORDINATED BEHAVIORAL HEALTH CARE FOR ALL PEOPLE IN NEED OF BEHAVIORAL HEALTH SERVICES AT SENECA’S NICHOLAS COUNTY CLINIC WHICH SERVES NICHOLAS, POCAHONTAS & WEBSTER COUNTIES IN RURAL WV. THE FOCUS POPULATION SUFFERS FROM SUD, POOR MENTAL HEALTH, LOW MENTAL HEALTH WORKFORCE CAPACITY, POOR SDOH & POOR DISPARITY GROUP OUTCOMES. THE INITIATIVE WILL SERVE 2,800 CLIENTS (700/YEAR). PROJECT GOALS (INTERVENTIONS/STRATEGIES) INCLUDE: (1) INCREASE ACCESS TO & AVAILABILITY OF COMMUNITY-BASED MENTAL HEALTH/SUD TX AND SUPPORT FOR THE FOCUS POPULATION BY ENHANCING SHS’S CCBHC PROGRAM BY (A) HIRING THE CCBHC PROJECT DIRECTOR TO LEAD THE PROGRAM & ADVISORY BOARD; (B) ENSURING AGENCY COMPLIANCE WITH THE CCBHC CERTIFICATION CRITERIA; (C) COLLABORATING WITH THE STATE TO OBTAIN CCBHC CERTIFICATION; (D) MAINTAINING EXISTING & ADDING NEW SERVICE PROVIDER & COMMUNITY STAKEHOLDER PARTNERSHIPS; (E) CONDUCTING THE NEEDS ASSESSMENT; (F) INITIATING, ANALYZING & ADDRESSING CONCERNS IDENTIFIED VIA CLIENT SATISFACTION SURVEYS; (G) ADVANCING AND MONITORING AGENCY TRAINING IN RESPONSE TO THE NEEDS ASSESSMENT; AND (H) ENHANCING TRAINING VIA A FOCUS ON CULTURAL COMPETENCY & IMPLICIT BIAS TRAINING. (2) INCREASE ACCESS TO AND AVAILABILITY OF COMMUNITY-BASED MENTAL HEALTH AND SUBSTANCE USE DISORDER TREATMENT AND SUPPORT FOR THE FOCUS POPULATION BY ENHANCING SHS’S CCBHC SERVICES BY (A) CONTINUING TO PROVIDE THE 9 CORE CCBHC SERVICES; (B) ENHANCING CRISIS SERVICES BY HIRING 2 YOUTH CRISIS SPECIALISTS; (C) ADVANCING PHYSICAL HEALTH SCREENING, ASSESSMENT & DIAGNOSIS SERVICES; (D) IMPROVING TREATMENT PLAN QUALITY VIA TRAINING AND EHR IMPROVEMENTS; (E) EXPANDING MENTAL HEALTH SERVICES VIA HIRING A THERAPIST TO INITIATE INTENSIVE OUTPATIENT PROGRAMS; (F) EXPANDING PRIMARY CARE SERVICES TO THE NICHOLAS COUNTY CLINIC; (G) HIRING TWO CASE MANAGERS; (H) EXPANDING PEER & FAMILY SUPPORT SERVICES TO INCLUDE TWO MENTAL HEALTH PEERS; (I) INITIATING A VETERAN’S SUPPORT GROUP; AND (J) DEVELOPING AND IMPLEMENTING A TOBACCO CESSATION PROGRAM. (3) INCREASE ACCESS TO AND AVAILABILITY OF COMMUNITY-BASED MENTAL HEALTH AND SUD TREATMENT AND SUPPORT FOR THE FOCUS POPULATION BY IMPROVING SHS’S CCBHC INFRASTRUCTURE BY (A) FACILITATING CARE COORDINATION BY INITIATING MEDICAL EHR UPGRADES; (B) IMPLEMENTING HEALTH INFORMATION EXCHANGE SOFTWARE TO FACILITATE HEALTH INFORMATION EXCHANGE; (C) INITIATING AND MAINTAINING CARE COORDINATION AGREEMENTS WITH IDENTIFIED PARTNERS; (D) SUPPORTING PROCESSES AND PROCEDURES FOR COLLECTING, REPORTING & TRACKING ENCOUNTER, OUTCOME, AND QUALITY DATA; (E) UPDATING AND IMPLEMENTING A CCBHC-WIDE DATA-DRIVEN CQI PLAN FOR CLINICAL SERVICES & MANAGEMENT; AND (F) LEVERAGING THE PATIENT PORTAL TO CONDUCT MEASUREMENT-BASED CARE. (4) SUPPORT RECOVERY FROM MENTAL ILLNESS AND OR SUBSTANCE USE DISORDERS BY PROVIDING ACCESS TO HIGH-QUALITY MENTAL HEALTH AND SUBSTANCE USE SERVICES TO THE TARGET POPULATION BY (A) ENSURING THAT MARKETING PRODUCTS ARE CULTURALLY COMPETENT; (B) CONDUCTING COMMUNITY OUTREACH & SDOH SCREENING; (C) SERVING A TOTAL OF 700 CLIENTS ANNUALLY; (D) CLIENTS HAVING A STATISTICALLY SIGNIFICANT DECREASE IN ILLICIT SUBSTANCE USE AT 6-MONTH NOMS FOLLOW-UP; (E) CLIENTS HAVING A STATISTICALLY SIGNIFICANT DECREASE IN TOBACCO USE AT 6-MONTH NOMS FOLLOW-UP; (F) HAVING CLIENTS EXPERIENCE STATISTICALLY SIGNIFICANT IMPROVEMENT IN NOMS MENTAL HEALTH OUTCOMES AT 6-MONTH; (G) CLIENTS HAVING STATISTICALLY SIGNIFICANT IMPROVEMENT IN SOCIAL CONNECTEDNESS AT 6-MONTH FOLLOW-UP; (H) HAVING 80% OF CLIENTS REMAIN IN TREATMENT FOR AT LEAST 6-MONTHS THROUGHOUT THE LIFE OF THE GRANT; AND (I) MONITORING DISPARITY GROUP DATA TO ENSURE EQUAL ACCESS/USE/OUTCOMES/RETENTION. (5) SUSTAIN CCBHC SERVICES BEYOND GRANT FUNDING TO SERVE THE FOCUS POPULATION BY (A) HAVING THE PROJECT DIRECTOR LEAD THE CCBHC BOARD WHICH IS MADE UP OF 51% PEOPLE WITH LIVED EXPERIENCE; (B) CREATING A SUSTAINABILITY PLAN & (C) IMPROVING PRIMARY CARE BILLING

CERTIFIED COMMUNITY BEHAVIORAL HEALTH CLINIC EXPANSION: SENECA CCBHC EXPANSION INITIATIVE - SENECA CCBHC EXPANSION INITIATIVE FOCUSES ON STRENGTHENING COMPREHENSIVE BEHAVIORAL HEALTH SERVICES TO THOSE W/SERIOUS MENTAL ILLNESS, SUBSTANCE USE DISORDER (INCLUDING OPIOID DISORDER); CHILDREN W/SERIOUS EMOTIONAL DISTURBANCE, AND THOSE WITH CO-OCCURRING MENTAL & SUD LOCATED IN GREENBRIER CO. WEST VIRGINIA WHILE INCREASING SERVICES TO RURAL NICHOLAS/WEBSTER/POCAHONTAS COUNTIES, ALL OF WHICH SUFFER FROM HIGH OVERDOSE RATES/POVERTY/POOR MENTAL HEALTH/LACK SERVICES. THE INITIATIVE WILL SERVE 2,500 INDIVIDUALS (1,150-Y1, 1,350-Y2). PROJECT GOALS (INTERVENTIONS/ STRATEGIES) ARE TO (1) INCREASE ACCESS TO COMMUNITY MENTAL & SUD TREATMENT SERVICES FOR THE FOCUS POPULATION VIA (A) FINALIZING A STAFFING PLAN BASED ON A NEEDS ASSESSMENT; (B) HIRING 2 HEALTH EDUCATORS TO EDUCATE ALL PSYCH CLIENTS RE HEALTH; (C) BUILDING AN ACT TEAM TO SERVE GREENBRIER & NICHOLAS; (D) HIRING 2 SUD CASE MANAGERS TO ENSURE THAT 60% OF MAT CLIENTS STAY ENGAGED WITH MAT FOR AT LEAST 6-MO; (E) HIRING 2 CASE MANAGERS TO PROVIDE INTENSIVE CASE MGMT. TO CHILDREN; (F) HIRING 3 THERAPISTS TO EXPAND SERVICES TO ADDITIONAL CLIENTS; (G) PROVIDING CLIENTS WITH EVENING & WEEKEND SERVICE HOURS; (H) PROVIDING CLIENTS W/ EXPANDED TELEHEALTH SERVICES; (I) INITIATING AN APPT. REMINDER & TELEHEALTH PLATFORM ACCESSIBLE BY TEXT; (2) IMPROVE THE QUALITY OF COMMUNITY MENTAL & SUD TREATMENT SERVICES FOR THE FOCUS POPULATION VIA (A) IMPLEMENTING A NEEDS ASSESSMENT DRIVEN STAFF TRAINING PLAN; (B) HIRING 2 PROGRAM COORDINATORS TO PROVIDE SUPERVISION TO LICENSING TRACK THERAPISTS & PROMOTE SERVICE DELIVERY GROWTH; (C) INITIATING A CCBHC ADVISORY BOARD; (D) MEASURING EBP USE VIA SATISFACTION SURVEY & OUTCOME MEASURES; (E) CONDUCTING QTLY REVIEWS TO ID OPPORTUNITIES; (3) IMPROVE CLIENT BEHAVIORAL HEALTH OUTCOMES VIA (A) ADMINISTERING STANDARDIZED ASSESSMENTS TO 95% OF CLIENTS TO GUIDE PERSON DRIVEN SERVICE PLANS; (B) CLIENTS SHOW ANNUAL IMPROVEMENT IN MENTAL HEALTH FUNCTIONING; (C) CLIENTS SHOW REDUCED SUBSTANCE USE; (D) INCREASING LENGTH OF STAY IN TX FOR SUD/COD CLIENTS; (4) IMPROVE CLIENT PHYSICAL HEALTH OUTCOMES VIA (A) IMPROVING HEALTH INDICATORS VIA HEALTH EDUCATION; (B) REDUCING TOBACCO USE BY 25% VIA TOBACCO CESSATION SERVICES; (5) ENSURE THAT DISPARITY GROUP CLIENTS HAVE EQUAL SERVICE ACCESS, USE & OUTCOMES VIA (A) DEVELOPING TARGET POP. FOCUS GROUPS FOR TARGET POPS.; (B) MONITORING DISPARITY GRP ACCESS/USE/ OUTCOMES; (C) ESTABLISHING SERVICE TRAINING PROGRAM FOR TARGET POPS.; (D) INCREASING # OF MILITARY CLIENTS SERVED; (6) IMPROVING CRISIS RESPONSE/SERVICES TO ENSURE INDIVIDUALS IN CRISIS RECEIVE THE APPROPRIATE LEVEL OF CARE VIA (A) HIRING 2 CHILD CRISIS STAFF IN Y1; (B) HIRING 4 COMMUNITY CRISIS STAFF IN Y1; (C) REDUCING # HOSPITAL ADMISSIONS FOR PSYCHIATRIC REASONS; (D) REDUCING # JAIL DAYS BY 50% OR MAINTAIN 0 JAIL DAYS; (7) SUSTAIN THE SHS CCBHC INITIATIVE VIA (A) HIRING AN EVALUATOR TO INITIATE MOVING FROM FEE FOR SERVICE TO VALUE-BASED REIMBURSEMENT; (B) MAXIMIZING THE AGENCY EHR; (C) COMPLETING A SUSTAINABILITY PLAN; (D) JOINING WV STATE CCBHC EXPANSION GRANTEES IN WORKING WITH WV TO ACHIEVE FORMAL CCBHC STATUS; (E) SUSTAINING INCR. STAFFING/ RETENTION INCENTIVES VIA BILLABLE SERVICES & (F) INITIATING SUSTAINABLE TUITION REIMBURSEMENT PROGRAM.

SENECA TIEH INITIATIVE - THE SENECA TIEH INITIATIVE PROVIDES COMPREHENSIVE, COORDINATED, EVIDENCED-BASED SERVICES FOR INDIVIDUALS/CHILDREN/YOUTH/FAMILIES WITH A SERIOUS MENTAL ILLNESS/SERIOUS EMOTIONAL DISTURBANCE, OR CO-OCCURRING DISORDER WHO ARE OR ARE AT IMMINENT RISK OF EXPERIENCING HOMELESSNESS. THE FOCUS POPULATION IS RURAL & SUFFERS POOR MENTAL HEALTH, SOCIAL HEALTH DETERMINANTS, SUBSTANCE USE & HOMELESSNESS. THE PROJECT WILL SERVE 544 PEOPLE (75-Y1, 94-Y2, 108-Y3, 124-Y4, 143-Y5). PROJECT GOALS (INTERVENTIONS/STRATEGIES) ARE TO (1) ENGAGE AND CONNECT THE FOCUS POPULATION TO BEHAVIORAL HEALTH TREATMENT, CASE MANAGEMENT, AND RECOVERY SUPPORT SERVICES VIA (A) HIRING A PROJECT DIRECTOR, EVALUATOR, YOUTH/ADULT CRISIS SPECIALISTS, CASE MANAGERS, PEER RECOVERY SUPPORT SPECIALISTS (PRSS), THERAPIST & TRAINING COORDINATOR TO EXPAND FOCUS POPULATION SERVICES; (B) CONDUCTING COMMUNITY OUTREACH IN AREAS WHERE UNHOUSED INDIVIDUALS CONGREGATE TO OFFER SERVICES; (C) PROVIDING ANNUAL TRAINING TO COMMUNITY PARTNERS TO INCREASE PARTNER ABILITY TO IDENTIFY AND SERVE CLIENTS WITH SMI/SED/COD; (D) WORKING WITH REFERRAL PARTNERS TO OBTAIN PROGRAM REFERRALS; (E) PARTNERING WITH AREA SCHOOLS TO IDENTIFY AND OBTAIN PROGRAM REFERRALS FOR FAMILIES AT RISK OF OR EXPERIENCING HOMELESSNESS; (F) WORKING WITH THE STATE CRISIS LINE TO OBTAIN PROGRAM REFERRALS; (G) IDENTIFYING CULTURALLY COMPETENT REFERRAL PATHWAYS FOR DISPARITY GROUP MEMBERS & (H) REFERRING AND FOLLOWING-UP ON REFERRALS FOR INDIVIDUALS WHO ARE DEEMED INELIGIBLE FOR TIEH SERVICES. (2) ASSIST WITH IDENTIFYING SUSTAINABLE PERMANENT HOUSING FOR THE FOCUS POPULATION BY (A) WORKING WITH AREA HOUSING PROVIDERS TO IDENTIFY SAFE PERMANENT HOUSING FOR CLIENTS; (B) LINKING 100% OF CLIENTS TO HOUSING RESOURCES & (C) CONDUCTING A LANDSCAPE ANALYSIS TO DETERMINE ALL AVAILABLE RESOURCES FOR THE UNHOUSED. (3) PROVIDE CASE MANAGEMENT THAT INCLUDES CARE COORDINATION & SERVICE DELIVERY PLANNING THAT SUPPORTS STABILITY ACROSS SERVICES AND HOUSING TRANSITIONS FOR THE FOCUS POPULATION VIA (A) PURCHASING AN INITIATIVE VEHICLE TO BE USED TO PROVIDE OUTREACH, SERVICES & TELEHEALTH FOR CLIENTS; (B) CREATING A PERSON-CENTERED SERVICE DELIVERY PLAN WITH EACH CLIENT; (C) PROVIDING CASE MANAGEMENT SERVICES TO CLIENTS; (D) PROVIDING PRSS SERVICES TO CLIENTS & (E) ENSURING CLIENTS RECEIVE INFECTIOUS DISEASE SCREENING & EDUCATION. (4) IMPROVE FOCUS POPULATION MENTAL HEALTH, SOCIAL & SUBSTANCE USE OUTCOMES VIA (A) SERVING 544 CLIENTS; (B) EMPOWERING CLIENTS TO HAVE STATISTICALLY SIGNIFICANT IMPROVEMENT IN STABLE HOUSING OUTCOMES AT 6-MONTH FOLLOW-UP; (C) EMPOWERING CLIENTS TO HAVE STATISTICALLY SIGNIFICANT IMPROVEMENT IN NOMS MENTAL HEALTH OUTCOMES AT 6-MONTH FOLLOW-UP; (D) EMPOWERING CLIENTS TO EXHIBIT A STATISTICALLY SIGNIFICANT DECREASE IN SUBSTANCE MISUSE AT 6-MONTH FOLLOW-UP; (E) EMPOWERING CLIENTS TO EXHIBIT A STATISTICALLY SIGNIFICANT IMPROVEMENT IN NOMS SOCIAL OUTCOMES AT 6-MONTH FOLLOW-UP; (F) EMPOWERING CLIENTS TO REMAIN IN TREATMENT FOR AT LEAST 6-MONTHS THROUGHOUT THE LIFE OF THE GRANT; (G) MONITORING DISPARITY GROUP OUTCOMES TO ENSURE EQUAL ACCESS/SERVICE/OUTCOMES/RETENTION; (H) COMPLETING A SOCIAL DETERMINANT OF HEALTH SURVEY TO IDENTIFY NEEDS BASED ON DISPARITY GROUP STATUS & (I) IMPLEMENTING THE NATIONAL CLAS STANDARDS. (5) SUSTAIN TIEH SERVICES FOR THE FOCUS POPULATION POST-GRANT FUNDING VIA (A) INITIATING A STEERING COMMITTEE WHICH WILL OVERSEE THE PROGRAM & (B) CREATING A PROGRAM SUSTAINABILITY PLAN TO BE UPDATED ANNUALLY.