Preserving and enhancing critical ccbhc services in adirondacks region, NY - ST

Joseph's rehabilitation center, INC. (SJRC) cbhc-IA will bring care coordination directly to individuals in rural northern NY (including remote areas of the adirondacks) in order to expand access to integrated services, address comprehensive health needs and complex medical issues, and preserve critical services in rural regions with limited resources. SJRC ccbhc-IA anticipates serving 2,925 unduplicated individuals throughout the project period. SJRC ccbhc-IA intends to target populations of focus identified through the prior ccbhc community needs assessment (CNA) including children, families, justice-involved individuals, and lgbtqi+ communities in essex and franklin county where access to health care is a crosscutting priority. Based on NYS chirs data, in 2018 in franklin county, there were 59 primary care physicians (PCPS) and 274 mental health (MH) providers per 100,000 population compared to 82 and 289 respectively for NYS as a whole. In essex county the shortages were even more pronounced, in 2018 there were 42 PCPS and 155 MH providers per 100,000 population. The ccbhc-IA program will allow SJRC to address needs identified through the ccbhc-E FY20 CNA while enriching service delivery. SJRC intends to target populations of focus identified through the CNA including children, families, justice-involved individuals, and lgbtqi+ communities. The CNA also identified the need for integrated comprehensive care that addresses sdoh - many ccbhc-E consumers indicated sdoh needs (housing instability, food insecurity, unemployment) and feelings of limited social connectedness. The ccbhc-IA funding will support additional partnerships and in-community/embedded care with cbos serving the identified populations of focus. SJRC intends to expand relationships with county DSS, jails and local hospitals to provide critical behavioral health services to justice-involved individuals with the goal of reducing relapse and recidivism. Relationships with school districts, the TRI-lakes prevention coalition (spearheaded by SJRC), and county DSS will support SJRC's goals to expand services to children and families, targeting those at-risk of separation. Additionally, SJRC will enhance the intentional outreach to persons who identify as lgbtqi+ through a specialized advisory committee (supported by the ccbhc-IA project director).