[NYAPRS Enews] ICL: NYC Provider Coalition Awarded Grant to Lead Diabetes/Integrated Wellness Initiative

[Harvey Rosenthal]

NYAPRS Note: Well deserved congratulations are due to the Institute for Community Living and its CEO Peter Campanelli for spearheading this very timely initiative. Stay tuned for more details!

 

NYC Not-for-Profit Six-Agency Coalition Receives $572,419 Grant to Address Urgent, Overlooked Health Crisis

People with Diabetes and Serious Mental Illness Die 25 Years Earlier Than Those without Mental Illness 

 

NEW YORK, NY, December 14, 2007 -The not-for-profit Institute for Community Living (ICL) announced today that New York State Health Foundation (NYSHealth) is providing a $572,419 24-month grant that will enable a coalition of NYC behavioral health agencies to impact the way the mental health care system works with people with serious mental illness and co-existing (or at risk of acquiring) Type 2 Diabetes. This project does not rely on new medication or new treatment, but rather, a new way of approaching and making lifestyle changes to address diabetes.

 

ICL has spearheaded the Integrated Wellness Initiative: Diabetes and brought together The Bridge, Federated Employment and Guidance Service (FEGS), The Jewish Board of Family and Children's Services (JBFCS), Services for the Underserved (SUS) and The William F. Ryan Health Center (Ryan Center) to form a ground-breaking coalition. The Urban Institute for Behavioral Health, a consortium of 21 behavioral health agencies which specializes in multi-agency implementations of best practices, is working with ICL to coordinate this initiative. The goal of the Initiative is to make sure people with mental illness can look forward to a better quantity of life, as they work to achieve a better quality of life. 

 

THE CRISIS

"All my friends are dying out there," says Marvin, a client of ICL's mental health services. Marvin refers to a crisis within an overlooked population; people with mental illness die 25 years younger than the general population, and they die from the same diseases - diabetes, heart disease and cancer.

 

By middle age, adults with serious mental illness often suffer a significant physical decline secondary to chronic medical conditions. With an average reduction in life expectancy of 25 years, the average consumer lifespan hovers between 50-60 years, near that found in undeveloped countries such as Sudan and Haiti. Estimates are that 60% of excess mortality has been due to medical conditions that were largely preventable or treatable and that despite advances in the treatment of these life threatening disorders, people who are seriously mentally ill rarely receive the full range of recommended interventions.

 

The dilemma is further compounded by the fact that some pharmacological treatments for serious mental illness increase risk factors for and exacerbate chronic medical conditions. Rarely are behavioral and medical medications coordinated on an individual level to achieve optimal outcomes and avoid iatrogenic effects. Likewise, preventive and early intervention screening, assessment and intervention for medical conditions are rare in the era of community-based care. Their predominant access to health professionals is within the mental health community where there is a lack of attention and focus on medical issues because the psychosocial issues being confronted tended to overshadow other concerns.

 

THE CHALLENGES

Many people living with mental illness, especially those with histories of poverty and homelessness, have a high tolerance for discomfort. This tolerance can create difficulty in motivating an individual to make changes to improve health and well-being. Additionally, many ICL clients have worked hard to kick an addiction or develop new habits to manage their mental illness, and thanks to the Smoking Cessation Program, many have quit smoking. When issues of lifestyle changes to improve physical health come up, many clients equate that to eliminating yet another source of enjoyment - food. 

 

How does one motivate them to change yet another part of their lives for the better without their feeling there is nothing left for them to enjoy? The needs of the client, in this sense, have to be kept in delicate balance, and a case manager has to understand the relationship of physical, mental and emotional health concerns in the client - and keep all of them in mind when determining recommendations for treatment and lifestyle changes. For example, one client, who was having difficulty finding an effective anti-depressant, remarked to his case manager, "I'm so depressed. I don't see the point of staying sober." 

 

THE INTEGRATED WELLNESS INITIATIVE:  DIABETES

Integrated Wellness Initiative: Diabetes is an ambitious plan that proposes nothing short of rapid systems transformation and evaluation. In light of the gravity of the current situation and the number of lives that are at risk, nothing short of an all-out effort is justified.

 

The Initiative's goal is self-management. The clinical intervention "toolkit" is predicated on a biopsychosocial model so as to address the complex and multidimensional reality of providing care to a seriously mentally ill person who has or may be at risk for developing life-threatening diabetes and may have secondary substance abuse disorder. The objective of the toolkit is to provide a risk-adjusted and disease-specific series of opportunities for interacting with consumers that will promote integration of care, wellness self-management and hope - a critical element.

 

On a biological level these would include:

*       Designing clinical pathways that utilize evidence-based and best practices for consumer assessment, treatment and outcome tracking

*       Designing cross system communication and disease-specific tracking protocols in order to establish disease status baselines

*       Design lifestyle modification protocols to facilitate wellness self-management in the area of nutrition, exercise and elimination of unhealthy behaviors

 

On a psychological level these interventions would include:

*       Develop assessment strategies that capture the consumer's existing coping strategies and existing strengths

*       The implementation of motivational strategies including motivational interviewing in order to engage consumers in improving their physical health

*       Provide psycho-education about the prevalence of medical co-morbidity, implications for people with serious mental illness, and specific steps that can be taken to promote wellness and recovery

*       Develop a consumer curriculum that promotes hope for recovery

*       Explore the use of cognitive remediation, cognitive behavioral therapy, and behavioral tailoring strategies to improve adherence to physical and mental health interventions.

*       The development of disease-specific wellness self-management manuals designed to be used by the consumer and the consumer's health care provider to track treatment adherence and outcome, as well as to structure circumstances when consumers need to alert case managers and health care providers

*       Structure disease management support groups designed to promote peer self-help and continuous adherence utilizing relapse prevention technology

 

On a social support level the toolkit would:

*       Promote the establishment of a peer or partner health care buddy system

*       Develop a network of consumers and buddies (wherein all get together on some basis) so that ideally, small groups of support are formed - these groups can be relied on and used to support one another when a chronic condition gets worse, or when things just get a little more stressful than usual

*       Engage both consumers and buddies in groups to discuss roles and experiences and to troubleshoot same. (May overlap with psychological intervention)

*       Transform case management to include the role of health care advocate and define the duties and responsibilities as well as the tasks attendant to that role

*       Establish a nurse care management system for consumers whose medical stability is tenuous and requires more intensive professional medical oversight

*       Provide access to a web-based support network- minimally, list medical, mental-health, and social support resources on a toolkit webpage

*       Develop screening methodology that includes assessment of social support along with physical and mental health

*       Provide outreach and linkage for family members and identified supports to ensure that their support and service needs are met

 

BACKGROUND:

The Institute for Community Living (ICL) serves over 8,000 disabled adults, children and families each year. This 21-year-old New York-based nonprofit offers an array of services including residential options for adults and children providing housing stability including a unique family reunification program as an alternative to foster care; mental health and healthcare clinics offering evidence-based treatment and best practice approaches; and assertive community outreach and case management services to individuals with mental illness, mental retardation or developmental disabilities. ICL's programs are located in Brooklyn, Manhattan, the Bronx, Queens and Montgomery County, PA. For more information, please visit www.ICLinc.net.

 

The Bridge, Inc. is a 501(c)(3) community-based organization serving New Yorkers in need.  Founded in 1954, it has evolved into a multi-service, multi-site and multi-borough agency serving 1,100 men and women annually.  The Bridge serves persons with mental illness, the homeless, people with substance abuse problems and those with HIV/AIDS. Through a comprehensive array of mental health, housing and rehabilitation services, it assists clients to live productively and as independently as possible in the community.

 

Federated Employment and Guidance Service, Inc. (FEGS) was established in 1934 by the Federation of Jewish Philanthropies of NY to find employment for unemployed men and women, and it has evolved to become the largest and most diversified private, not-for-profit health-related and human service organization in the United States. With operations in over 258 facilities, residences, and off-site locations, F*E*G*S has since its inception  served more than two million people in the Jewish and general communities who have mental, developmental and physical disabilities or who are economically disadvantaged, new émigrés, youth, older adults and others. Services are delivered in the areas of Employment & Training, Education & Youth, Career Development, Behavioral Health, Developmental Disabilities, Residential, Rehabilitation, Family Services and Homecare. F*E*G*S operates programs throughout the metropolitan New York area, and provides consultation and technical assistance to government, organizations, and businesses throughout the United States and abroad. To serve individuals and families 

 

The Jewish Board of Family and Children's Services, Inc. (JBFCS) has been a trailblazer in treating social problems for more than 110 years. Today, JBFCS is one of the nation's largest and most respected nonprofit mental health and social service agencies. JBFCS serves over 65,000 New Yorkers annually from all religious, ethnic, and economic backgrounds through a comprehensive range of 185 community-based programs, residential facilities and day-treatment centers. Its work is built upon the professionalism of 2,200 employees, including professional social workers, licensed psychologists and psychiatrists, as well as a cadre of clinical support personnel in continuing day treatment and residential treatment centers. 

 

Services for the Underserved, Inc. (SUS) has been providing residential and support services to individuals with special needs, in New York City since 1978. In the past twenty-five years, SUS has grown from serving 340 people annually to serving over 2,000 people with special needs in New York City, mostly in the Bronx, Brooklyn and Queens. Our consumers are elderly and/or disabled individuals; persons with a mental illness; families living with HIV/AIDS; teens and adults with a developmental disability; and homeless and marginalized individuals. Its mission is to provide services and supports for individuals with special needs to live with dignity in the community, direct their own lives and attain personal fulfillment. 

 

The William F. Ryan Health Center, Inc. (Ryan Center) is dedicated to providing high quality, affordable, comprehensive, linguistically and culturally competent health care services to medically underserved populations. All patients are treated equally with dignity, respect, courtesy, confidentiality, and concern for safety. The family of Ryan Centers is committed to maintaining its role as essential community-based providers and leaders in the Community Health Center movement.  As a team of dedicated individuals, the staff of the Ryan, Ryan-NENA and Ryan/Chelsea-Clinton Centers is responsive to the needs of the community and continually enhance and improve services in order to ensure the highest quality of care. 

 

The Urban Institute for Behavioral Health, founded in 2006, is a consortium of 21 behavioral health agencies which specializes in multi-agency implementations of best practices. Its creation was initiated by the Institute for Community Living.

-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://kilakwa.net/pipermail/nyaprs_kilakwa.net/attachments/20071217/f529bfd4/attachment.html>