Everyone has a moment where the COVID-19 public health crisis became real for them. I am pregnant, so even the idea of drinking coffee or eating sushi is a health question in my mind. So it was real right away. But as I thought about how this crisis affects me and my family, I also thought about those less fortunate. How will this massive change in our culture impact those with mental health and substance use issues?
This isn’t some morbid thought experiment. I am the technical project manager on a behavioral health initiative that is in the thick of it.
Recently, I sat down with my client, Andrea Usanga, the executive director of the Network of Behavioral Health Providers (NBHP). Her prediction is stark.
“There are going to be significant mental health and substance use disorder issues that arise as a result of what we’re going through right now,” she said.
We have to prepare.
Two years ago, NBHP kicked off the Community Coordination of Care initiative (also known as C3) to create the framework for a coordinated continuum of care that integrates medical, behavioral health, and social services. This “continuum of care” would address the totality of needs that a patient has, and help to connect the dots between providers. The goal was to come up with a way to improve coordinated care for people with behavioral health challenges in our region. In order to do this, C3 convened over sixty primary care, behavioral health, and social service organizations, as well as governmental entities and academics.
Last year, C3 implemented a pilot project based upon a new, co-created framework designed to improve outcomes, reduce service duplication, and save money. This pilot project focused on three key elements:
- A network of primary care, behavioral health, and social service providers that could support a continuum of care for clients served in the program.
- Community care coordinators, who would be separate from the network of providers, that could coordinate client care. This is especially important if the client needs services from multiple systems.
- A shared database that would allow, with client consent, all of the partner organizations and the care coordinators to share client information, track the services that the clients receive, and make referrals among partnering organizations to close the loop on services.
Taking a neighborhood-centric approach, the pilot project includes twelve organizations that serve Northeast Greater Fifth Ward and Northwest Spring Branch.
It is open to clients with a diagnosable mental illness, a social service need, and a family income that is at or below 200 percent of the Federal Poverty Level.
Three care coordinators who support this pilot program work on site at two partner locations and conduct home visits to help clients access services both inside and outside the C3 network.
The following transcript of my interview with Andrea Usanga has been lightly edited for brevity.
How has COVID-19 impacted the delivery and implementation of the C3 pilot project?
We had to temporarily suspend new enrollment to C3 as many of our partnering organizations also have closed their services to new clients. I think everyone right now, including our service providers, are trying to hold the line on the clients that they’re serving right now and to make sure that all of their needs are met in the midst of this very uncertain situation. We also have temporarily suspended home visits conducted by our care coordinators. However, the care coordinators are routinely following up with each of their clients trying to assess any needs that they have, COVID-19 related or not.
We have seen an uptick in clients who need some type of financial assistance, whether it’s because they lost their job or lost job hours as a result of this or for other reasons. We try to step up wherever we can.
We are fielding more requests for flex funding, which NBHP does provide as a part of this program. We are able to provide small amounts of funding for necessities that are related to our clients care plan.
There are some who do not have money for their gas bills. Others have outstanding payments for medical care and need to pay their bill to continue to receive medical care.
We also have clients who can’t get groceries or don’t have transportation. Some of our care coordinators actually picked up food for clients and dropped it at their door.
We’re providing a laptop to a client so she can finish school online, and a bike for someone whose bike was stolen and that’s the only means of transportation.
Many of our partners provide rental assistance but people need non-traditional things that these organizations don’t necessarily provide. We’ll probably be averaging about $250 per client in financial assistance.
How is COVID-19 impacting the C3 partner organizations?
A lot of our social service providers have had to close down physical operations. Some of them are not accepting new clients. The good thing so far is that our core primary care and behavioral health provider organizations like Vecino Health Center, The Harris Center, and Spring Branch Community Health Center are continuing to provide their services. Some have actually expanded their hours as well. The health services are still fully functioning, but some of the other support services have been curtailed.
Social services are continuing to serve their existing clients, but the majority are not accepting new clients or they have limited services for new clients. For example, Memorial Assistance Ministries has curtailed some services but are still accepting applications for financial assistance. They’ve shut down their physical operations but they’re still trying to work with their existing clients and deliver remote services to the extent that they can.
Is there any threat that social service organizations could close completely?
I think that they all know that they are the social service safety net. So I would be surprised if any of them would close down completely. Nonprofit organizations are here to serve people and I feel that they’ve been doing that and will continue to find a way to serve the community.
I think if funding became available whether it’s through government intervention or through other means these organizations would actually increase services, just like they did in the midst of our last local disaster with Hurricane Harvey.
I can’t speak for any of them, but they are a safety net. They’re here to serve. And I think to the extent that they can, they’re going to continue serving people.
What are your concerns about the long term impacts of COVID-19 on C3?
I have serious concerns about the impact of COVID-19. Not just on C3 but upon the overall health and well-being of the greater community. There are going to be significant mental health and substance use issues that arise as a result of what we’re going through right now.
It’s been an incredibly stressful time for a number of people, and if you just imagine those who are already dealing with trauma and other issues in their life, this is simply compounding it. So I do see that even when we get back to some sense of “normalcy” for the community, we are going to see a definite uptick in people who are needing behavioral health services.
My question is: are we prepared for that?
We already have significant capacity issues particularly in behavioral health and I think that this is going to exacerbate that. We need to start planning right now.
We’ll probably have a rise in homelessness. We have a temporary freeze on evictions, but are people going to be made whole by whatever the federal government does? We also don’t know what the long term medical impact of COVID-19 will be.
C3, in particular, may have some clients with more significant behavioral health needs that enroll in the program and we’ll try to address them depending upon what happens at the federal level and the level of help that they’re going to be providing to residents.
What can we do as a community right now to help?
I think being a neighbor, even though we’re socially distant, doesn’t mean that we have to be socially isolated. Check up on people in any way that you can. Not just those who have experienced behavioral health issues, but all people in general. If you know of anybody who is having difficulty, reach out to help.
Lend a (virtual) helping hand to people who are in need. Pay attention to how you feel. If you have anxiety or stress, reach out to someone for help.
If you or a loved one is experiencing heightened anxiety or stress please call the 24/7, toll free COVID-19 Mental Health Support Line: 833-251-7544.
Carly Sessions from January Advisors serves as the Technical Project Manager for the C3 pilot project.