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Working Together for a Healthy New York 1998
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Mental Health and Substance Abuse
North Country Behavioral Healthcare Network
The Coalition for a Tobacco Free Erie-Niagara Region
Vytraís Tobacco Free Program, Nassau-Suffolk Counties
Mission/Purpose
Mental health and chemical dependency providers were first called to meet together in January 1996 through the efforts of Arthur M. Johnson, S.A. Fr. Johnsonís visionary leadership brought together providers from throughout a five-county region to discuss and assess the value of network formation. Network participants agreed that the formation of the network would facilitate and make more efficient the channels of communication between primary health care providers and behavioral health care providers, which will ultimately serve the best interests of the community.
The purpose statement developed and agreed upon by the participating agencies during the early stages of development reads as follows:
The North Country Behavioral Healthcare Network [NCBHN] is established to be a provider network in the Northern Tier of New York State (counties of Essex, Franklin, St. Lawrence, Jefferson, and Lewis) to provide and insure a continuum of quality behavioral health care services from prevention and early intervention, through treatment and aftercare/follow-up, and that it is available, competitively priced, accessible to all, and responsive to the emerging environmental realities, including contracting with health care payers.
The NCBHN further elaborated on its values in the adoption of a value statement that articulates the networkís vision of a healthy community by stating:
NCBHN values the individuals and communities served by responding to behavioral health care needs through a full continuum of accessible quality-driven services. We value each communityís preservation, development, and local control of its health care services through a coordinated and collaborative effort involving all stakeholders. We value the dignity of those we serve regardless of ability to pay, and we are devoted to a stewardship of excellence.
Both of the foregoing statements were revisited and adopted by the membership in May 1996.
NCBHNís work plan and business plan, approved by the then 24 member organizations, attests to and defines the strategies and consensus of the group.
Identified as key to the network formation and development were the involvement and input of the community, consumers, key local/county/state leadership, and relevant stakeholders.
Leadership Role
Recognizing the need for change and collaboration, Fr. Johnson, CEO of St. Josephís Rehabilitation Center, Inc., an inpatient and outpatient alcohol and substance abuse provider agency, invited all behavioral health care providers within the five-county region to come together in January 1996 to ìtake a proactive stance and position ourselves for the new reality.î The call to action also suggested that it would be the groupís desire and decision to determine if interest was sufficient to develop a unified strategy.
Fr. Johnson committed his energies and that of St. Josephís to accomplishing what he knew would be necessary to ensure that all people, in particular the poor and disenfranchised, would receive responsive and effective quality behavioral health services, while at the same time addressing the very real political and economic realities. Throughout network formation, his approach was to be inclusive and open.
Through Fr. Johnsonís commitment of time and resources, a wealth of educational opportunities were brought to the group. Individuals recognized throughout the state for their skills and expertise on topics of relevance to the network members were brought in to address the group and to assist them so that decisions reached were made based upon up-to-date knowledge of subjects where knowledge and experience were acknowledged to be limited. Group participation was encouraged through the formation of work groups to address all issues of shared interest including, but not limited to, technology, political realities, and quality as well as utilization matters. The work groupís conclusions and recommendations were brought back to the full group for consensus. The creation of a steering committee, subcommittees, and, subsequently, officers of NCBHN, was consistent with Fr. Johnsonís philosophy and understanding that building a strong foundation and providing ample opportunities for participants to take ownership would support the networkís goals and the eventual transition of leadership essential to NCBHNís ability to effectively carry out its purpose and values.
Key Partners/Stakeholders
At the outset of network formation, every behavioral health care agency was invited to participate and become involved in network activities. In the early stages of development the agencies invited did not include private agencies. The group discussed this concern and voted to support the inclusion of interested private agencies.
The decision to apply for a DOH Network Development grant was made in December 1996. All of the organizations that had participated to date were required to declare their commitment by signing a letter of intent which stated a willingness to participate and support the activities of the network. Twenty-four member agencies made the commitment.
Recognizing a need to further clarify commitment to NCBHNís purpose and future viability, the membership agreed by vote to a recommendation of the finance committee to require modest dues from participating agencies. To date, 16 agencies have paid dues. Those agencies include: Canton-Potsdam Hospital Alcoholism Services; Champlain Valley Family Center; Clinton County Mental Health Association; Community Center for Alcoholism of Jefferson County; Credo Foundation; Families First in Essex County; Mental Health Association in Essex County, Inc.; North Country Freedom Homes; North Star Industries; Northern NY Center for Mental Health Care, Inc.; Rose Hill; St. Francis/Adirondack Experience; St. Josephís Rehabilitation Center, Inc.; Lewis County Alcoholism and Substance Abuse Treatment Center; and North Country Transitional Living. Several agencies have verbally expressed a desire to join the network and at least one has indicated that its dues are forthcoming.
Regardless of level of commitment throughout the past two years, all remained on the mailing list and were consistently issued invitations to attend the network meetings. Many indicated their interest but advised that for a variety of reasons they were unable to make a commitment at that particular time. These interested others continued to be included in all invitations to network meetings and information sharing.
NCBHN has identified in its work plan the need to assess the continuum of behavioral health in the five-county region; to identify gaps, accessibility, and so on; and to seek out appropriate providers to fill those gaps based upon the members agreed-upon criteria for membership.
Impact/Effectiveness
Since NCBHN has invested a significant amount of its time and resources in the development of a work plan, the success in accomplishing the steps outlined will be critical to the networkís evaluation. Close monitoring of the work planís objectives by the steering committee is continually occurring. Prior to the arrival of the recently hired project director, many of the work plan objectives were acted upon and accomplished through the efforts of Fr. Johnson and the steering committee as the work plan was a call to action that could not wait for one individual alone to accomplish.
All network participants, in particular those most intimately involved through their work on the steering committee, clearly have an enhanced understanding of the economic and political issues that impact their ability to provide service. In keeping with their mission, all NCBHN providers serve the public good (e.g., Medicaid), and in some instances NCBHN is the only provider available to the Medicaid client and those with little or no resources.
Much of the NCBHNís previous effort has been mobilized by receipt of the NYS/DOH Rural Health Care Network Development grant. At this stage of development, community support has been sought through open lines of communication with county Community Service Board (CSB) directors, other area networks, and dialogue with primary health care facilities. Broadening the community involvement and interest will be forthcoming.
The NCBHN has accomplished a number of its goals, including:
- the creation of a forum in which all behavioral health care providers in the five-county area have had an opportunity to educate, define strategies, and collaborate on matters that will influence the construct and availability of behavioral health care services in northern New York.
- the development of a business plan, which has allowed the members to dialogue and agree upon what they wish to accomplish.
- incorporation status as the North Country Behavioral Healthcare Network Development Corporation.
- the completion of a survey of member services and other nonmember services (business plan) as a step toward determining need, gaps, and potential efficiencies.
- preliminary discussions with a network outside of NCBHNís five-county region to assess viability of collaboration that might lead to further efficiencies.
- the hiring of a project director to facilitate and lead the initiatives defined by NCBHN through its work and business plans.
- the application for and receipt of a NYS/DOH Rural Health Care Network Development Grant.
- its ability to provide substance and clarity of purpose in bringing the membership to agree on a dues structure that would reflect the membershipís initial commitment to achieving network goals.
- the bringing together of mental health and chemical dependency providers to begin to discuss shared concerns and strategies surrounding what were previously considered distinct and separate service provider issues.
Restraints on resources exist in the form of an overtaxing of the personal energies required of the committed leadership of NCBHN. Individuals and their respective agencies are required to dedicate a great deal of time, travel, and other resources to accomplish the network goals, in addition to carrying out leadership roles within their own agencies. It is hoped that the hiring of a project coordinator will facilitate the more efficient and appropriate use of NCBHNís leadership.
Formation financial issues were preliminarily resolved through the securing of the DOH grant and the institution of dues, reflecting the membersí good faith and willingness to invest in the long-term viability and success of NCBHN.
As all involved in network development are aware, there are sensitivities among like providers, other health care providers, and the public, which tend toward the belief that all changes taking place in health care are bad and are certain to impact them negatively. These perceptions all require thoughtful strategies with an openness to collaborate and communicate. NCBHNís membership are actively involved in their communities, relevant government entities (e.g., CSBís), and other health care networks where the message conveyed is one of cooperation and open communication. In this era of health care uncertainties, intensifying both public and provider fear and resistance to change, NCBHN is proactively taking the necessary steps to shape the future in recreating the health care community so that persons in need of mental health or chemical dependency services will be assured that the full continuum of quality, cost-effective treatment services will be available to them and their families.
Contact: Barry Brogan, Project Director, North Country Behavioral Healthcare Network, P.O. Box 891, Saranac Lake, NY 12983. Telephone: (518) 891-9460. Fax: (518) 891-9461.
Mission/Purpose
The Coalition for a Tobacco Free Erie-Niagara Region is a collaborative effort of 35+ member agencies and 1,000+ advocates who work together to improve community health by reducing the prevalence of tobacco use in their community. The Coalitionís priorities are to address public health policy, tobacco industry accountability, and public awareness of the dangers of tobacco use/exposure to secondhand smoke.
The Coalition is part of the America Stop Smoking Intervention Study (ASSIST) program. The purpose of ASSIST is to reduce smoking through public awareness campaigns. The ASSIST program was created by executive order and is administered by the National Cancer Institute. Tobacco kills more Americans each year than alcohol, cocaine, crack, heroin, homicide, suicide, car accidents, fires, and AIDS. Smoking trends continue to be an issue in New York, as teen-agers pick up the deadly habit daily.
The Coalition develops objectives and work plans through member input on priorities and needs within the community. The Coalition works with policymakers to accomplish changes in health-enhancing policy (e.g., Clean Indoor Act policy, advertising policy).
The Coalitionís vision of a healthy community is one in which children grow up as nonusers of tobacco because they understand that tobacco use is an addictive deadly behavior. A healthy community also includes support systems for smokers to quit smoking and for nonsmokers to be in a smoke-free environment.
Leadership Role
The Coalition is led by the elected volunteer chairperson and cochairperson (Philip L. Haberstro, Wellness Institute/ Bonnie Soley, Niagara County). There is a paid coordinator who helps facilitate subcommittee meetings, media events, and daily communications of the Coalition. The Coalition members attend monthly meetings to update one another on their progress and to discuss ideas for future projects. The issues surrounding tobacco are dynamic and in the news. The Coalition works to react to, prepare for, and build public awareness about the dialogue surrounding current tobacco issues.
The Coalition maintains community visibility through health fairs, attendance at other agenciesí meetings, press releases, and mailings. These efforts build upon the Coalitionís relationships with advocates and members. Members can join free of charge and are sent information and minutes from monthly meetings. The Coalition is housed in the nonprofit 501(c)(3) Wellness Institute of Greater Buffalo and Western New York, Inc.
Recently the Coalition has reached out to partner with and/or support other health coalitions in the community.
Key Partners/Stakeholders
The principal and most active partners of the Coalition are Roswell Park Cancer Institute, American Cancer Society, Hudson and Associates (Business/Public Relations), American Lung Association, New York Public Interest Research Group, Western District PTA, Erie and Niagara County Departments of Health, Erie County Senior Services, the Wellness Institute of Greater Buffalo and WNY, New York State Department of Health, and the National Cancer Institute, the Coalitionís national funder. The coordinator is the key person in charge of communicating with members and advocates.
The majority of the population are nonsmokers, and most smokers would like to quit and do not want their children to begin smoking. Therefore, health initiatives designed to counteract the devastating effects of tobacco are broadly supported. Polls conducted in the community regarding clean indoor air legislation and restriction of self-service displays of tobacco show support for these efforts.
The Coalition recently worked with the City of Buffalo to restrict tobacco billboards and outdoor advertisements within 1,000 feet of schools, playgrounds, day care centers, and places where children congregate. Outdoor tobacco advertising is especially a challenge in the inner city.
To help gain community support for its actions, the Coalition has given presentations at block club meetings, grassroots organizations, and churches to get community stakeholders involved.
The Coalitionís annual meeting often features a well-known community activist or expert who speaks to the group about tobacco industry tactics. The Youth Partnership for Health group works on antitobacco pro-health issues of importance to youth, reaching out to students in local schools. The involvement of various groups is solicited in an effort to match market and action.
At the end of each year, Coalition members decide what objectives they would like to work on. Decisions are made by consensus.
Members are invited to attend Coalition meetings and have their voices heard. Representatives who are not at meetings where decisions are made regarding the stance of the Coalition are faxed information for their review. The many groups at the table are all very concerned about health issues and work hard to achieve the Coalitionís objectives. The Coalition leadership works diligently to create shared ownership of its work.
Impact/Effectiveness
The Coalition develops approximately ten yearly objectives predominantly aimed at changing policy that can have an impact on the health of the community. The objectives are followed throughout the year and are generally achieved at a rate of 80ñ90 percent. A list of 1998ñ1999 objectives is available for further information. Some projects that end up needing more time to complete are carried over to the next year.
Members take great satisfaction in working on key issues to better the health of the community. Beyond being satisfied, members also enjoy the results of such effortsófor example, clean indoor air. The Buffalo inner-city community will be positively affected by the restriction of tobacco billboards and outdoor advertisements in this community. The Coalition also helped to pass local legislation to restrict self-service displays of tobacco, which are very accessible to students. This legislation affects youth access to tobacco and will contribute to a reduction in its use.
The Coalition is funded through the National Cancer Institute. A modest budget is used to carry out its initiatives. There is a paid coordinator who works part-time. All other partners volunteer their time. The Coalition reports to the New York State Health Department and National Cancer Institute for financing. Coalition members are continually asked for input on development/direction. In 1998ñ1999 the Erie County Coalition merged with the Niagara Coalition, bringing to 1.2 million the number of citizens within the Coalitionís reach.
The Coalitionís advocate list has grown tremendously, with many respondents who are willing to write letters, make phone calls, and appear at hearings to speak for health. Thanks to the tremendous community support and mobilization in Erie County, the Coalition has succeeded in passing a strong clean indoor air law for the City of Buffalo and Erie County, restricting self-service displays, decreasing the sale of tobacco to minors, and, very soon, restricting outdoor advertisements and instituting a local licensing law for retailers who sell tobacco. The Coalition also helped to get ìJoe Camelî out of Buffaloís football stadium and its public transit system!
Political challenges have arisen from public officials who are afraid to take a stand for health. After education, many politicians have come around to support pro-health initiatives. Tobacco marketing is a heated issue, and many smokers are resistant to change. Through hard work the Coalition has been able to overcome many barriers. The Coalitionís budget is limited; however, it is attempting to increase its marketing/advertising activities in order to create media events that will help get the pro-health message out.
The Coalition has done great things over the six years of its existence. It has truly matured to a working coalition whose partners are determined to make positive changes in the health status and environment for the citizens of Erie and Niagara Counties.
Contact: Philip Haberstro, Coalition for a Tobacco Free ErieñNiagara Region, 65 Niagara Square, Room 607, Buffalo, NY 14202. Telephone: (716) 851-4052. Fax: (716) 851-4309.
NASSAU-SUFFOLK COUNTIES |
Mission/Purpose
Vytra Healthcare exemplifies the principles of Communities Working Together in its efforts to significantly improve the health of the residents of Nassau-Suffolk through coordinated action in identifying and responding with multipronged strategies to combat tobacco use. Tobacco use is one of the New York State Public Health Councilís 12 priority areas for improving community health.
Vytraís mission is ìTo make a measurably significant contribution to the quality of life in the Long Island region through the management of health care systems that offer superior service and consistent value.î That mission is supported by Vytraís smoking cessation programs, offered to its members as well as to all Long Islanders. It has always been Vytraís policy to make a variety of programs available to its members to help break the psychological and physical addiction to tobacco.
Vytra encourages its members to take an active role in maintaining their health and rewards them for their efforts. Educational seminars and literature are made available to members to enable them to make better choices to stay healthy for life.
Smoking accounts for one out of every five deaths in the U.S. Approximately 25 percent of adult Americans smoke cigarettes, and 70 percent of those surveyed report a desire to quit. Vytraís Health Assessment Surveys for new members indicate the percentage of its members who smoke:
- 15.4 percent of the commercial population
- 9.1 percent of the Medicare population
- 40.0 percent of the Medicaid population
Smoking cessation is such a priority to Vytra that it reimburses all costs for all members who complete the program. It also subsidizes the cost for members who complete approved smoking cessation programs offered by others.
Leadership Role
Vytra is proud of its emerging role as a leader in the prevention and reduction of tobacco use on Long Island. Vytra Healthcare initiated a Smoking Cessation Program in 1996 at the request of the American Lung Association (ALA). The ALA indicated that it could not meet the growing demands for smoking cessation programs on Long Island. The ALA also indicated that numerous requests for the program came from Vytra members. The American Lung Association trained Vytraís health educators to facilitate smoking cessation programs in order to help meet the growing demands for smoking cessation workshops on Long Island.
Vytra Healthcare is an active and well-respected member of the Nassau-Suffolk Tobacco Control Task Force and joins the community in its efforts to reduce morbidity and mortality attributed to tobacco. Vytra is the only health plan to participate in this effort.
Through the Nassau-Suffolk Tobacco Control Task Force, Vytra participated in a conference titled ìWomen, Girls, and Tobaccoî held on March 27, 1998. Over 100 people attended. Vytra displayed information promoting its smoking cessation programs and statistics as well as upcoming workshops. Through this poster display Vytra was able to educate additional members of the Long Island community about its programs.
Many community agencies, school personnel, and others are aware of Vytraís presence in providing smoking cessation workshops. Positive feedback from participants in these workshops has helped to expand the population that will refer Long Islanders to these programs.
Key Partners/Stakeholders
The key personnel involved in the development and implementation of the partnership were Alice Tully and Eve Berger of Vytra Healthcare, Marianne Zacharia of the American Lung Association of Nassau-Suffolk, and Nancy Hemendinger of the Suffolk County Department of Health. All participants have extensive experience with the delivery of health care to a variety of populations.
Vytra has established close ties with the ALA and the American Cancer Society (ACS) in many ways. Due to government restrictions, Medicare and Medicaid members cannot be charged for programs. Thus by collaborating with the ALA and the ACS, Vytra arranged to offer smoking cessation programs at their sites at no cost to Vytra Medicare and Medicaid members. As a community service, Vytra accepts referrals from the ALA and the ACS. Vytra maintains frequent contact with these organizations, and members are referred to one of the three programs in an effort to meet the demand.
After a successful year and a half of offering smoking cessation programs to members, employees, and the public via referrals, Vytra broadened its own approach to tobacco reduction. The decision to expand the program is a direct result of increased demands from Long Islanders for additional programs and a demand for more convenient locations throughout Nassau and Suffolk Counties. Another factor in the decision to expand the Tobacco Free Program was due to cutbacks in other programs that resulted in limiting access.
Vytra recognized an opportunity to help fill this void and took action. Vytra surveyed employer groups and confirmed their need and interest in offering smoking cessation programs in the workplace. Vytraís plan was to gather employees from a variety of businesses and train them to conduct their own smoking cessation workshops.
To overcome ALA bylaws prohibiting it from conducting a train-the-trainer program for a for-profit company, Vytra arranged for the Suffolk County Health Department to facilitate a program to include training employer groups as well as physicians. The first training program for employers took place on June 29, 1998, with 19 employer groups participating. It was successful. Vytra, along with Suffolk County Health Department, will provide direct assistance in helping employees initiate their first smoking cessation program. The first physician education program for tobacco reduction was offered in September 1998 at the site of a busy practice.
In addition to offering smoking cessation programs, Vytra recognized the importance of preventive education campaigns and tobacco restriction efforts and joined the Nassau-Suffolk Tobacco Control Task Force. Vytra is the only health plan to participate. The efforts of this organization are focused on restricting access and exposure to tobacco products and advertisement.
Impact/Effectiveness
The Vytra Healthcare Smoking Cessation Program has been in operation for approximately two years. Eight programs have been held since July 1996.
In the fall of 1997, Vytra designed a survey to determine whether the workshops were successful and if the participants needed additional support. After the survey was designed, it was reviewed by the ALA and the ACS for comment and was copyrighted because of its unique, long-term perspective.
In November 1997 Vytra mailed the Smoking Cessation Survey to all of its members who had participated in one of the Vytra Smoking Cessation Workshops. Participants were surveyed at least six months after completing the course. The response rate was 70 percent. Fifty-nine percent of the participants reported being smoke-free after six months. All of the participants reported experiencing benefits since quitting. These include better breathing, fewer colds, more energy, no longer feeling embarrassed, more time, more money, and better overall health. They reported less coughing, more exercise, and better sleep.
Of those who resumed smoking, the reasons listed were vacation, weight gain, stress, craving, depression, and moving.
All of those who resumed smoking reported that they would like to quit again. They all received additional program information, and two have reenrolled. This report will be updated every six months.
Conclusion
The benefits of this program are measured by membersí immediate response and by a six-month follow-up survey. Vytraís success with its Tobacco Free Program is measured by the collaborative relationships that it has established within the community. Vytra continues to work with public health professionals and employer groups to educate people on lifestyle risks and disease prevention in order to improve the health and well-being of all Long Islanders.
Contact: Alice E. Tully, Vytra Healthcare, 395 North Service Road, Melville, NY 11727. Telephone: (516) 844-2649. Fax: (516) 694-5780.
The Milbank Memorial Fund is an endowed national foundation that has contributed to innovation in health and social policy since 1905. The Fund supports nonpartisan analysis, study, and research on significant issues in health policy.
The New York State Community Health Partnership, founded in 1997, is a collaboration among leaders and organizations from the public and private sectors to improve the health and well-being of New Yorkís communities. Collectively and individually, members of the NYSCHP serve as catalysts and facilitators for health improvement activities throughout New York State. For information on becoming a member of the NYSCHP contact:
State Communities Aid Association
150 State Street, 4th Floor
Albany, New York 12207
(518) 463-1896, Ext. 29
e-mail: scaa@empireone.net
Additional copies of this report may be requested from the
Milbank Memorial Fund
645 Madison Avenue, 15th Floor
New York, NY 10022
(212)355-8400
e-mail: mmf@milbank.org
