Behavioral health care: New center responds to growing need
The nurses knew something was wrong.
When representatives of CHI St. Joseph Children’s Health met with school nurses around Lancaster County two years ago to talk about the growing youth dental program operated by the East Lampeter Township nonprofit, it was an opportunity to hear about how the program could better serve the needs of area children.
What they heard in response was evidence of a growing local health crisis.
“Every nurse, pretty much without missing a beat, talked about behavioral health, that they were seeing levels of stress and anxiety in kindergartners that they had never seen before in their careers,” CHI president Philip Goropoulos said. “And these were not new nurses.”
The nurses’ experiences confirmed what CHI and other community health organizations were hearing and reading elsewhere: An increased need for behavioral health services in the county — among children and adults — and a shortage of facilities to meet the demand.
A 2014 study by Philadelphia-based Robert Wood Johnson Foundation Health and Society Scholars found that Lancaster County had one mental health professional for every 1,379 residents. A healthy community ideally would have one provider for every 521 residents, the study said.
CHI’s response came to fruition this month. The agency opened a new behavioral health center on Lincoln Highway East, next to its administrative and program center. The nonprofit spent $570,000 to renovate a former kitchen and bath showroom, also creating space for a second dental office.
It’s not the first behavioral health facility to open recently in the region, nor will it be the last.
WellSpan last month opened an enlarged $3.4 million inpatient behavioral health unit at Ephrata Community Hospital, intended for patients 18 and older.
This spring, Lancaster General Health/Penn Medicine broke ground on a 126-bed, $30 million behavioral health hospital in Lancaster City. Expected to open in 2018, the hospital’s services will include treatment for adolescents and women who have suffered abuse, officials said.
In Dauphin County, PinnacleHealth System last year opened a children’s mental health unit at the Pennsylvania Psychiatric Institute’s Landis Building in Harrisburg. Designed for youths ages 4 to 18, the unit was designed to address capacity limitations that resulted in more than 120 children who needed inpatient mental health support being turned away in 2015, PinnacleHealth spokeswoman Kelly McCall said.
Scooter Haase, executive director of nonprofit organization Mental Health America of Lancaster County, sees expansion of facilities as a step in the right direction.
“According to ‘The State of Mental Health in America 2017,’ a study conducted by Mental Health America, Pennsylvania ranks 12th in the nation regarding access to care, with one mental health worker for every 580 individuals,” Haase said when WellSpan’s expanded facility opened.
“The need is growing. Population in Lancaster county continues to grow, and services have not kept pace so far,” he added.
Focus on youth
CHI’s facility, which is an outpatient treatment center, will serve patients up to age 26, although Goropoulos expects most will be 18 or younger. He expects a caseload of about 600 patients at any one time.
The patients’ needs are distinctive, but also reflect trends in society at large, according to Goropoulos and Dr. Thomas Foley, who along with certified registered nurse practitioner Mary Jo Hanley, will lead the Center’s behavioral health team.
“The prevalence of anxiety, depression and other mental health-psychiatric diagnoses in the younger population is increasing,” Foley said.
He and Goropoulos see science and social issues combining to drive that need.
“The economy always plays a role in that. You’ve seen a shift, even with the recovery, where people are in lower-paying jobs, working longer hours, so there’s a lot of strain on families,” Goropoulos said. “The changing environment, the infusion of technology into every aspect of our lives, as well as changing academic expectations in schools, all of these are contributing factors.”
Research shows that external stress can turn certain genes on and off, Foley explained, resulting in behavioral health issues.
Because the causes can be complex, the center’s approach to treatment takes into account not just the patient, but the needs of their family members.
“Traditional behavioral health treatment and care models often do not place enough emphasis on this relationship,” Foley said.
Psychiatry is the centerpiece of the model used at CHI, Goropoulos said, supplemented by counseling and other support services, including referrals for other services.
Some patients will be referred through family doctors and other health providers, but the center also has established partnerships with three school districts — Lampeter-Strasburg, Penn Manor and Pequea Valley — to provide referrals and to collaborate on assessments and treatment strategies for children and families. Other districts have expressed an interest in collaborating, Goropoulos said, and he ultimately would like to see all 16 of Lancaster County’s school districts participate.
Assembling a team
CHI’s behavioral health team is composed of nine people: two psychiatric clinicians, two counselors, two wellness counselors working with families in homes — with a third to be added — and case managers. Goropoulos said the organization ultimately could employ between 30 and 34 people.
Finding qualified clinicians and counselors is one of the challenges that contributes to the dearth of services, he explained.
“There is just a lack of providers, and providers tend to cluster,” Goropoulos said. “If you have your choice of anywhere to go to practice when you just come out of your residency, Lancaster or southcentral Pennsylvania isn’t necessarily on the top of your list, unless you came from here originally.”
Foley did not come from the midstate.
A Bucks County native, he completed his fellowship at the Children’s Hospital of Philadelphia (CHOP) in 2010 and began looking for a place to practice where there was a clear need for more physicians.
During a career fair, he learned about Lebanon-based behavioral health system Philhaven (later acquired by WellSpan). An offer there, combined with having a sister nearby in Manheim Township, brought him to the area.
“I really wanted to work with the most vulnerable patient population,” Foley said.
His experiences at CHOP also left an imprint. The urban hospital only accepted patients with private insurance, Foley recalled. After several years with Philhaven, Foley was attracted to CHI when he learned of its plans for the new center.
CHI has a sliding fee scale for families and patients, Goropoulos said. An uninsured family earning up to 200 percent of the federal poverty level can access care at no cost, he explained. Current government guidelines set that level at $16,240 for a family of 2, increasing by $4,180 for each additional family member. Uninsured families with a household income of between 201 percent and 300 percent qualify for discounts of between 95 percent and 50 percent on the costs of services, based on their income.
The ability to make that care available is rooted in CHI St. Joseph Children’s Health’s history and nationwide resources.
Its parent, Colorado-based Catholic Health Initiatives, was founded in 1996 when three congregations of female religious orders brought together their respective health systems.
In 2000, the sisters sold Lancaster’s St. Joseph’s hospital to a for-profit chain. It became Lancaster Regional Medical Center, and earlier this year was sold to nonprofit PinnacleHealth.
Catholic Health Initiatives used the proceeds of the 2000 hospital sale to create St. Joseph Health Ministries, now CHI St. Joseph Children’s Health, a community health service organization.
The behavioral health center has an annual budget of roughly $1.2 million, Goropoulous said.
“During its start-up, the program is being funded in part by a Mission and Ministry Grant from Catholic Health Initiatives, donor support and revenue from a portion of the investment fund created as a result of the sale of the hospital in 2000,” he added.
Estimated patient billing revenue during the first year is approximately $216,000, or roughly 18 percent of revenue.
While CHI St. Joseph Children’s Health anticipates increases in patient revenue after the first year, the organization’s budget anticipates that a high percentage of uninsured and underinsured children and families will access the program, Goropoulos said.
“All of our facilities are built so that anybody should feel welcome and accepted here. Whether you have the best insurance or whether you have no insurance, you will receive the same treatment,” Goropoulos said.