In a rare opportunity, Mental Health News Education, publisher of Autism Spectrum News and Behavioral Health News, has brought together the Commissioners of the NYS Office of Mental Health (OMH), The NYS Office of Addiction Services and Supports (OASAS), and The NYS Office for People with Developmental Disabilities (OPWDD) to address critical healthcare issues currently affecting the New York State community. Topics addressed in this interview-style article include: COVID-19 and vaccinations; the workforce crisis; federal funding; diversity, equity, and inclusion; and the collaboration between the three state offices. We are delighted to present to you the following responses from OASAS Commissioner Arlene González-Sánchez, LMSW, OMH Commissioner Ann Sullivan, MD, and OPWDD Commissioner Theodore Kastner, MD.
COVID-19 and Vaccinations
Can you comment on your department’s current thoughts on vaccination and mask mandates? How can we further protect staff (whose vaccinations are seriously lagging) and clients?
The New York State Office of Addiction Services and Supports (OASAS) conforms with the CDC and NYS DOH COVID-19 guidance with respect to masking. Vaccination acceptance by the OASAS-regulated system staff and clients is slightly lower than the vaccination acceptance numbers for NYS residents in general. However, many clients may receive their vaccinations outside of the OASAS system, so these vaccinations are not monitored by OASAS.
The agency is also addressing vaccine hesitancy with weekly webinars for OASAS staff and clients and will also be hosting a webinar with a panel with OASAS provider staff who have overcome their vaccine hesitancy to share their experiences in doing so.
The pandemic is not over, and now, as we experience the effects of the Delta and other variants, we must do everything possible to keep our patients, staff, and clients safe. NYS Governor Kathy Hochul recently implemented a series of universal mask requirements that apply to all facilities and programs licensed, certified, or funded by The New York State Office of Mental Health (OMH) as well as those programs overseen by the Office of Addiction Services and Supports (OASAS), the Office for People With Developmental Disabilities (OPWDD), Office of Children and Family Services (OCFS), and the Office of Temporary and Disability Assistance (OTDA). This requirement will protect healthcare workers as well as our patients and clients and our communities.
OMH has promoted the safety and effectiveness of the COVID-19 vaccine through a series of videos featuring union leaders as well as OMH executives and staff. We have also produced posters, fact sheets, and other educational materials on the vaccine and on the importance of other infection mitigation protocols that we know to be effective – such as wearing masks, maintaining distance, and frequent hand washing.
These initiatives have helped us to educate individuals and address misinformation, fear, and mistrust. Focusing on actions that individuals can take to reduce the risk of infection also helps to alleviate anxiety which has become more prevalent in the past 18 months.
Now that the vaccine is available to all New Yorkers aged 12 and over, we encourage all who are eligible to get vaccinated to protect themselves, their families, and communities. OMH has administered vaccines through our O-Agency Link-Outreach-Vaccinate program (O-LOV). OMH-operated and O-LOV sites have administered over 77,000 vaccines since December 23, 2020. In addition, OMH Psychiatric Centers have provided more than 400 mobile clinic and pop-up events throughout New York State since January – allowing us to reach some underserved communities. We have been very successful in our efforts with more than 70 percent of our staff and inpatients receiving the vaccine to date.
The New York State Office for People With Developmental Disabilities (OPWDD) is committed to ensuring the safety and security of the people we support and the workforce who support them. We have worked closely with the NYS Department of Health throughout the pandemic to ensure that our guidance is in line with masking, vaccination, infection control and social distancing requirements at the state and federal level.
The majority of people we support within residential settings have received their vaccination. While our staff vaccination numbers lag behind, we continue to work on ways to incentivize the workforce to get vaccinated and are waiting on final federal approval of New York’s American Rescue Plan proposal to provide bonus pay to those workers who receive the vaccination. In addition, NYS has recently mandated vaccinations or testing for all state workers beginning September 27th, 2021.
The Workforce Crisis
Many providers have reported critical staff shortages due to the pandemic, in part due to salary disparity, fatigue and burnout. What is your department’s strategy to address the workforce crisis that the field is experiencing?
OASAS is rolling out grant programs to our providers to assist them with a host of workforce agendas, including staff recruitment and retention. We plan on using a portion of a Federal Substance Abuse Prevention & Treatment Block Grant Supplemental award and additional funds received for Medicaid services to help with these efforts at our prevention, treatment, and recovery providers.
OASAS also offers resources on our website to assist providers with training, credentialing, and clinical support for their staff, including helping staff who are facing mental health issues such as fatigue or burnout.
First, it is important to recognize the incredible dedication and commitment of our mental health workforce throughout this pandemic. They have been terrific.
But there is a serious workforce crisis in many areas of the labor market– health care and mental health being one of them. OMH is planning a wide range of recruitment and retention initiatives to increase community- based capacity and create a mental health career pipeline. Another goal is to target recruitment and retention efforts to diverse and multilingual individuals to expand culturally competent mental health services in underserved communities.
This requires an approach that includes both short and long-range solutions. In the short term, OMH is using funding from the Mental Health Block Grant (MHBG) and Federal Medical Assistance Percentages (FMAP) to enhance, expand and sustain these services by providing a combination of targeted rate increases to eligible programs and flexible workforce recruitment and retention funds to support a wide range of activities to build capacity.
Long-range planning includes recruitment strategies such as working with schools on behavioral health curriculums and formalizing and enhancing the vocation of community mental health workers. One possibility is strengthening the housing workforce through the development of a training curriculum for all housing types that can be implemented statewide. Also developing a workforce from the community where our clients live and providing them with training and a potential career ladder is a step towards strengthening and building a more diverse and sustainable workforce.
Another critical element of strengthening the workforce is investing in peers. One of our workforce priorities is to expand certified and credentialed peer workforce (inclusive of adult, youth, and family) including resources for recruitment, retention, education/training, and career pipeline investments.
The pandemic has brought on stress and focused a spotlight on the importance of physical and mental wellness. Despite our training and understanding of the importance of wellness, we sometimes forget to address our own needs and should be sure to help our workforce remember that their wellness is vital. Simple self-help practices can be effective such as practicing mindfulness, stress relieving desk exercises, and reaching out for additional support when needed. OMH has provided wellness trainings and coping tips and resources to State and community partners throughout this challenging time. Additionally, NY Project Hope has provided crisis counseling in communities and the Emotional Support Helpline available statewide to anyone needing support.
As with all human services fields nationwide, COVID-19 has had a significant impact on an already shrinking field of available direct support workers and OPWDD is taking an active role along with our providers of services on finding solutions to the workforce issues faced by our field. We recognize that our direct care workforce is the backbone of a strong service delivery system, which is why New York State has made substantial and ongoing investments in wage increases for our direct care workforce over the past several years, including three targeted initiatives to increase compensation to staff of service providers: two 2% increases in 2015, two 3.25% increases in 2018 and another round of two 2% increases in January and April of 2020. In addition, not-for-profit service providers also received a 1% COLA increase as part of the 2021-2022 Budget.
OPWDD has an additional opportunity to make investments in our workforce through the one-time American Rescue Plan funding and are currently awaiting approval from the federal Centers for Medicare and Medicaid Services on our proposed spending plan.
In addition to funding wage increases, OPWDD has worked with our provider partners by funding the Regional Centers for Workforce Transformation, which is a network of workforce champions who provide training, curriculum development, technical assistance, and recruitment and retention support. OPWDD is also approved by the Veterans Administration to take part in their financial benefits program which enables veterans to leverage military benefits for direct support training. Additional efforts are underway to expand recruitment to high school students interested in the field of direct support through partnerships with BOCES and SUNY.
How can enhanced Federal Medical Assistance Percentage (FMAP) be used, not just as a one-shot influx of support that temporarily props up systems that are already in crisis, but instead is as a down payment towards a longer-term investment in the overall system of care and support? Specifically, how will the federal funding be used for infrastructure support, enhancing technology, provider rate increases, salary support, and program enhancements?
We plan to use this funding to make a significant investment in workforce development initiatives including tuition support, loan forgiveness, and training, which we are hopeful will have positive long-term effects even after this temporary funding runs out. We are also investing in our residential system to ensure these providers have the support they need to address longer term substance abuse treatment.
It is our hope that we can establish a strong foundation to support continued strengthening of the entire prevention, treatment, and recovery service continuum throughout New York State in the coming years.
The federal funds enable OMH to invest in strengthening and expanding capacity to address increases in demand, adjust to the realities of post-pandemic service delivery, and build workforce capacity for long-term sustainability of the community mental health system.
As part of system transformation, OMH has prioritized the development of a comprehensive array of rehabilitation services to promote access to prevention and recovery-oriented supports for adults and children. While the eFMAP resources are one-time, OMH will be advancing strategies to use the funds to enhance, expand and sustain these services by increasing rates, providing workforce recruitment and retention funds to allow providers to build capacity, and targeting funds for infrastructure investments including training in evidence-based practices and resources to improve the quality and efficiency of services in the more immediate term. The rate increases for rehabilitative services will be continued with support from reinvestment savings.
With extensive input from stakeholders, OMH’s plan prioritizes the following investments:
Strengthen Rehabilitation Programming: OMH will implement permanent rate increases for Assertive Community Treatment (ACT), Personalized Recovery Oriented Services (PROS), and rehabilitation services in Community Residences which will be continued in the out-years supported by reinvestment savings.
Workforce Investments: OMH will include temporary rate increases for federally eligible programs to support a wide range of provider workforce recruitment and retention strategies including recruitment and retention incentives.
System Capacity Building: OMH will provide one-time resources to significantly expand certified peer and family support capacity, support training and implementation of evidence-based practices (EBP), and the implementation of alternative payment methodologies to drive outcome based, quality-of-care oversight, and incentivize value based payment.
Expanded Access to Children’s Services: The State will be advancing temporary rate increases to grow and expand the new Children and Family Treatment Supports and Services (CFTSS) and Home and Community Based Services (HCBS) as well as infrastructure and workforce funds to build capacity.
There is also a significant increase in Federal Block Grant Funding that will help make possible the development of a truly robust and effective crisis system across NY state. This is part of the exciting implementation of the 988 mental health crisis number that will make it easy for anyone to receive the help they need in a crisis.
OPWDD’s FMAP initial plan initiatives targeted more than 76% of the anticipated funding to workforce initiatives ($554 million) including 70% to payments to increase the wages of direct support professionals (DSPs) and supervisors (more than $514 million). Other workforce funding is targeted towards increasing the quality of DSPs through advanced training and credentialing programs and recruitment and retention strategies to help retain and recruit DSPs.
Additional initiatives planned for the remaining 24% ($173.8 million) of anticipated eFMAP funding is targeted to the following: $120 million to increase, expand or strengthen HCBS services; $11.4 million to expand and strengthen crisis supports; and $42.4 million to strengthen the OPWDD information technology infrastructure.
Diversity, Equity, and Inclusion
We need more professionals of color in our systems: social workers, physicians, nurses, nurse practitioners, etc. In addition, critical improvements are needed in access to care and workforce diversity. What is your department’s strategy to address persistent racial disparities in the care and support systems?
Among CASACs (Credentialed Alcoholism and Substance Abuse Counselors) in New York State, which make up approximately 97% of professionals certified by OASAS, racial demographics are comparable to the overall population of the state.
We are always working with our providers to increase opportunities for all New Yorkers, regardless of their background, to find employment in the substance use disorder (SUD) field. We are in the process of establishing initiatives to assist with workforce diversification, which we hope to roll out in the near future.
OMH has publicly declared racism a public mental health crisis and is implementing policies to reduce disparities in access, quality, and treatment outcomes for marginalized populations. We are utilizing a multi-faceted strategy to address and reduce disparities, grounded on the concept that organizational change and self-reflection are key to creating and sustaining long-term success. We are doing this, in part, by implementing the National Standards for Culturally and Linguistically Appropriate Services in Health and Health Care (The National CLAS Standards).
We are currently pilot testing a “Vital Signs Dashboard” to depict racial, ethnic, and gender-based disparities in NY’s mental health system. It’s currently in OMH clinics, and the full system release is expected in early 2022. The dashboard will contain 10-15 metrics in four domains and will be used to identify and implement strategies to mitigate disparities in access, quality, and treatment outcomes for marginalized populations. We also recently included equity components into all Requests For Proposals released by the Agency.
We are also working with the Center for Research on Cultural and Structural Equity in Behavioral Health to do a multi-level assessment of policies and practices at the Agency, both internal and external – for structural racism.
To address long-standing issues involving the lack of a culturally diverse workforce in the public mental health system, OMH’s Bureau of Inspection and Certification, in close collaboration with the Office of Diversity and Inclusion, will be reviewing organization’s diversity, inclusion, equity, cultural and linguistic competence plan more rigorously than before. Any organization seeking OMH license or operating OMH licensed programs is expected to demonstrate efforts to ensure data-informed diversity recruitment in initial and ongoing inspection and certification activities.
OMH has also created a number of resources and tip-sheets to increase information sharing and educate individuals on vital topics impacting our communities. These topics include:
Our Office of Diversity and Inclusion has hosted a number of “Race Dialogues”, which involved difficult but necessary conversations around the importance of recognizing biases, celebrating diversity, and working to be a more inclusive environment for all individuals. These are important action-based discussions that allow for a safe-space to share and discuss personal experiences and promote agency-wide changes in the way we interact and engage with one another.
We have also experienced through our work with NY Project Hope the need to actively engage individuals within their communities. Our Emotional Support Helpline was not as effective at providing services to people of color, but when our workers began conducting grass roots outreach into communities, we found that we were much more successful.
Additionally, OMH will look to expand workforce training opportunities, including the training of law enforcement in diversion techniques, to best support underserved and emerging populations, such as justice-involved individuals and older adults with mental illness, as well as our current service population, to ensure the workforce is adequately equipped to provide effective mental health services to all New Yorkers.
OPWDD is committed to creating an environment that values diversity, promotes an inclusive culture, and provides equitable services to the public and people with developmental disabilities. In 2021, OPWDD launched the agency’s Diversity, Equity, and Inclusion Strategic Plan to advance our mission of a diverse workforce that promotes equity and inclusion for all. The plan includes a four-year timeline and measurable outcomes for the agency and the larger developmental disabilities service system. OPWDD is committed to further advancing our mission with the establishment of a new Chief Diversity Officer executive-level position. The Chief Diversity Officer will drive change through the examination of current OPWDD policies, workforce, and equity practices as well as overseeing the Diversity, Equity, and Inclusion (DEI) program.
Some proposed examples of practical and impactful system DEI projects OPWDD will initiate include: developing workforce strategies that address cultural competence guidelines for staff, including care managers; compensating staff for bi-lingual or tri-lingual ability; developing outreach strategies to diverse groups for policy development; and, creating a family-centered, culturally competent approach in developing truly person-centered supports.
As a participant in the federally funded National Community of Practice (CoP) on Cultural and Linguistic Competence, OPWDD is also identifying systemic, regional, and local needs to address multiple dimensions of equity and access concerns. Initial efforts indicate the need for further work with an equity lens to include data analysis, policy review and impact studies, stakeholder engagement and service delivery. To this end, OPWDD has committed to providing FMAP funded grants to non-profit service providers, local government authorities, and/or institutions of higher education with demonstrated expertise in addressing the needs of underserved and historically marginalized populations.
NYS O-Agency Collaboration
So many service recipients have multiple conditions that span your three Offices. How can the Offices enhance your collaborative efforts to address this issue?
OASAS works collaboratively with other agencies on a regular basis. We have multiple ongoing projects with OMH, and in all OASAS-certified settings, individuals are screened for mental health risks and directed to services if needed. We have worked closely with OMH in expanding services for both SUD and mental health through Certified Community Behavioral Health Clinics (CCBHCs), a federal demonstration program that offers a full spectrum of care to anyone who qualifies. This care includes a full range of SUD and MH clinic services, case management, crisis, and psychiatric rehabilitation services.
Our agencies also collaborate with the Department of Health (DOH) on regulation and oversight of Integrated Outpatient Services, as well as issues related to pregnant and parenting persons with substance use disorder, and with the DOH’s Office of Drug User Health (ODUH) on overdose prevention. We are also working with OMH on crisis stabilization centers which are intended to provide an alternative to ERs and incarceration for those experiencing a behavioral health crisis. We are in discussion with OPWDD to determine how to meet the needs of individuals with developmental disabilities that may seek services in these settings. Other joint projects include efforts to improve parity for payors of SUD and mental health services, such as regulations and enforcement. Many of our integration efforts have faced challenges due to statutory barriers, reimbursement shortfalls, reporting requirements, contracting, and funding issues.
As we move forward, OASAS is fully committed to working with our sister agencies to enable our providers to deliver integrated services that bypass these pitfalls and allow them to support people with both substance use disorders and mental health challenges.
OMH is committed to integrated care across the lifespan, including individuals with co-occurring mental health issues and substance use challenges, intellectual and developmental disabilities, physical health needs, and justice involvement. We are working with public and private partners to create programs and services for these vulnerable populations to ensure they do not continue to fall through the cracks of bureaucracy and end up requiring more costly and restrictive inpatient services.
One of our priorities has been to expand beds and services for children who are dually-diagnosed with a developmental disability as well as behavioral health needs. We recently announced a collaboration with OPWDD and SUNY Upstate Medical University to develop a specialized inpatient unit for children and youth from 12 to 17 years old who are dually-diagnosed and at risk of being separated from their families because the treatment they need is only available far from home, often out-of-state.
We have also worked with OPWDD to develop a dually-diagnosed residential treatment program with Baker Victory Services at Erie County Medical Center in Buffalo, as well as an acute care unit at Kings County Hospital for adults living with a mental illness and a developmental disability.
We also frequently collaborate with OASAS, including on the development of regulations for Crisis Stabilization Centers prepared to serve all New Yorkers regardless of disability. By improving crisis services and expanding programs such as Certified Community Behavioral Health Clinics (CCBHCs) and Integrated Outpatient Services (IOS), we can work together to reduce unnecessary hospitalizations and enable individuals to recover and thrive in services in their community.
And, together with the NYS Department of Financial Services, OASAS and OMH initiated the Community Health Access to Addiction and Mental Healthcare Project (CHAMP) which is helping to ensure parity by educating individuals, families, and health care providers on their legal rights to coverage and helping them to access treatment and services. CHAMP will investigate and resolve complaints regarding denial of health insurance coverage.
Another important collaboration with OASAS is enhancing the capacity of the public mental health system to identify and treat opioid use disorders. Together we have launched several large-scale initiatives through the Psychiatric Services and Clinical Knowledge Enhancement System (PSYCKES) including:
- PSYCKES Opioid Use Disorder Quality Measures and Alerts were added to PSYCKES (launched 2018-2019) to support quality improvement by providers, counties, and managed care plans, and to increase clinician awareness of individuals at risk for overdose.
- Building Capacity for Best Practice Treatment of OUD within Mental Health Clinics which was mandated for all 485 OMH licensed mental health clinics statewide and was launched in early 2019. All clinics are required to implement best practices including screening for OUD, providing naloxone to all individuals at risk, improving referral practices, and initiating medication assisted treatment for OUD.
- High Behavioral Health Risk Quality Collaborative for Emergency Departments has engaged 94 Emergency Department services statewide to implement best practices in screening, assessment, treatment, and referral and follow-up for individuals with emergent behavioral health crises.
Overdose Prevention Quality Improvement Collaborative, launched April 2021, has engaged 130 mental health clinics in a quality improvement project to accelerate best practices in the treatment of OUD, including screening, therapy, and medication assisted treatment.
OPWDD works with several state agencies to collaborate on service provision, workforce issues and building awareness. Currently, OPWDD collaborates with OMH and OASAS specifically on high needs cases in which people being supported have dual diagnoses and need a range of supports provided by our respective agencies. OPWDD is also currently working with OMH to expand the availability of children’s crisis services and expand the use of specialized treatment facilities and specialized inpatient psychiatric units for the dually diagnosed. In addition, multiple agencies are involved in the Employment First Commission, Most Integrated Settings Coordinating Council (MISCC), and other multi-agency initiatives related to workforce and raising awareness for people with disabilities. We are continuously looking for ways to support people across systems to ensure people have access to the best supports to meet their individual needs.
Collaboration with MHNE Publications
So many service recipients have multiple conditions that span your three Offices. How can the Offices enhance your collaborative efforts to address this issue?
We always appreciate the opportunities offered by Behavioral Health News to publicize our ongoing initiatives at OASAS and assist with outreach to people who are in need of our services. We look forward to continuing to work with the publication to support our goal of reaching all New Yorkers with help and resources for substance use disorders, whether they themselves are personally impacted, or are the family member or friend of an individual in need of assistance.
Behavioral Health News has already been extremely helpful in promoting and encouraging access to mental health services and we look forward to continuing and enhancing our partnership.
An ongoing focus of our media and community relations work has been the promotion of anti-stigma messaging. We always seek new methods and new messengers to spread the word that mental health is as important as physical health and that they should be viewed in the same way. Most people wouldn’t hesitate to see a dentist if they had a toothache, and they certainly wouldn’t have to think twice about seeing a doctor if they fell and broke their arm.
We want people to think the same way about their mental health. If anyone has concerns about anxiety, depression, or any aspect of their mental health, we want them to be comfortable talking to their doctor or to a behavioral health specialist. That’s the message we are working to spread through social media, public service campaigns, and through partnerships with agencies and organizations across the state.
We are also seeking to engage minority and culturally diverse communities, which, as we saw during the rise of COVID-19, are often underserved and have less access to physical and behavioral health services.
Behavioral Health News can be a tremendous help with both those efforts. Your work to address and reduce stigma is commendable, and we would be happy to discuss helping you to create partnerships with organizations in different communities that could help share your publication with people who need to hear our message!
OPWDD and our providers are continuously hiring to fill direct support roles all across New York State. Given the current workforce crisis, shining a spotlight on the role of Direct Support Professionals and the amazing work that they do would be incredibly helpful in not only elevating the role of this selfless workforce, but also driving interest in this career path.