Programs For Mentally Ill Threatened
Continuing Adult Day Treatment (CDT) Programs that experts say have been helping the mentally ill in Rockaway since the 1980s, are on the verge of being phased out as a result of new regulations instituted by the commissioner of the New York State Department of Mental Health.
"Medicaid mental health reform was launched successfully last year, with changes in the financing, regulation and emphases of clinic mental health care," said Michael Hogan, the commissioner for OMH, when he testified before the Legislative Budget Committee on January 29.
He added, "We do not seek to dramatically reduce capacity of this program [CDT], which is an outdated model that, nonetheless, provides essential supervision in some communities."
Yet, according to a spokesperson for Assemblywoman Audrey Pheffer's office, OMH is in the process of changing how it treats the mentally ill.
"They're changing it from CDT to a different model [called PROS]," said Joanne Shapiro, Pheffer's chief of staff. "We will be having future meetings and conversations. We're finding out about it."
More than 20 years ago, Assemblywoman Audrey Pheffer was in the forefront in establishing CDT programs in the state.
"We know the importance of continuing care," said Shapiro. "Now, 22 years later, for us to learn the programs are under the gun [is disturbing]."
She did say that Pheffer would be keeping an open mind on the issue.
OMH has also introduced a new, changed Medicaid payment structure for CDTs that includes a 5 percent deduction in reimbursement rates. Continuing Day Treatment programs get the majority of their revenue from Medicaid.
"All CDT programs will convert to the new half-day/full day rate methodology [as opposed to duration based on one-hour increments] as originally scheduled starting April 1, 2009," Jill Daniels, a spokesperson for OMH, said in an email.
The 5 percent rate reduction, which went into effect earlier this year, has been suspended until July 1, 2010 as a result of $2 million being restored in the 2009-2010 state budget for OMH.
Rockaway has several CDT Programs including Transitional Services, Catholic Charities Rockaway Continuing Day Treatment Program, New Horizon Continuing Day Treatment Program and St. John's Episcopal Hospital's Continuing Day Treatment Program.
Larry Gruber, the CEO for Transitional Services, has been working with CDTs since 1981. He believes the programs are effective in helping the mentally ill.
"CDTs have proven to stabilize the consumer over the long term, decreased hospitalizations and helped assimilate patients into the community," said Gruber. "It would be devastating for them to be phased out."
Gruber said that the 5 percent rate reduction could put the 4,000 people in New York currently using CDTs in jeopardy.
"I would have to lay off staff, cut services and clients would be forced to seek more expensive services such as in-patient hospitalization and emergency rooms."
A person involved with CDTs in Rockaway, but not authorized to speak to the press, spoke about the differences between the clinic-focused care that OMH is moving toward and CDTs.
"The problem is, when you have a chronically mentally ill, severely and persistently mentally ill population, they need more services," The Wave was told. "They need to know there are going to be people who are taking care of them if they're not going to be feeling well. The two times a week to go to a clinic - [perhaps] the one time for individual therapy or one time for group therapy - is not going to be enough to make sure they don't decompensate."
The source also said that people have to understand the population CDTs serve - their emotional difficulties and their needs.
"That's what a continuing day treatment program does," we were told.
CDTs also offer social workers, psychiatric help, case managers, and daily activities.
Representatives for Catholic Charities and St. John's Episcopal Hospital said hours and services have not changed, and no changes are envisioned.
Eric Matza, vice president of Development for SJEH said, "Our goal, as it has always been, is to get the [patient] out of continuing day treatment and into a clinic."
The director of New Horizon was on vacation and could not be reached for comment when this article was being written.
In addition to PROS, there will be a new program of people in recovery helping people in recovery.
"In the 2009-2010 budget we will initiate a peer leadership development effort that will train and support consumers for leadership roles across New York State," said Daniels. "OMH will also work with providers who may seek to transition their current CDT programs in the direction of more efficient clinic models, or the rehabilitation oriented Personalized Recovery Oriented Services (PROS)."
The Coalition of Behavioral Health Agencies, Inc. was among those who pushed for the restoration of funds for CDTs.
On its website, the Coalition was critical of the PROS saying "Some PROS programs in other parts of the state reported a drop-out rate as high as 30 percent of consumers that transition their programs to PROS."
While some patients come from adult homes and hospitals, the majority of those who attend CDTs live with their families, in foster homes or live on their own.
CDTs are designed to provide mentally ill individuals with active treatments and support in hopes of developing better socialization and community oriented skills. They aid individuals with illnesses such as obsessive compulsive disorder, anxiety and depression.