Keeping Safe in Summer

Proper attire and hydration reduce risk.

Did you know that people diagnosed with mental illness or substance abuse problems can be at higher risk during the summer?

Psychotropic medications make people especially sensitive to heat. If you have loved ones in this condition, it’s good to know that PLACES takes extra care to make sure residents are properly attired and hydrated for the day’s activities. All staff at PLACES group homes are trained to help residents pick the right clothing for a particular day’s weather forecast and what they’ll be doing, whether indoors or outside.

PLACES also makes sure that everyone in its Supportive Living and Opening Doors programs has access to air conditioning or a fan. Case managers help tenants and clients choose the proper attire to avoid heatstroke. Heat can be a particular problem for substance abusers, too, as alcohol use leads to dehydration.

“We keep an extra eye on substance abusers, since heat adds to the severity of a situation,” said Director of Client Services Janet Johnston. “We practice a harm reduction model. This means that while we employ techniques such as motivational interviewing to move people towards recovery, if they are going to use, we want them to do it in the safest environment possible, not in a building unfit for habitation or on the street.”

Johnston also said that PLACES makes tenants and clients aware of emergency heat shelters through their case managers during periods of extremely high temperatures.

Behavioral Health Redesign is Coming

Ohio Strives To Bring Medicaid Billing In Alignment with National Standards, Enabling New Services

The administration of Governor John Kasich undertook an initiative during state fiscal year 2016/17 to rebuild the capacity of Ohio’s behavioral health system and modernize our state’s Medicaid program. In 2016, Ohio spent nearly a billion dollars on drug and alcohol treatment services. Montgomery County is especially hard hit, with easy access to the flow of illegal substances on interstate highways. There were 160 overdoses in the first quarter of 2017, and the county is on pace to exceed last year’s 355 conclusive or suspected deaths from overdose, according to an article published in the Dayton Daily News in March.

With the goal of improving health outcomes for Ohio citizens diagnosed with mental illness and/or substance abuse while staying accountable to taxpayers, Behavioral Health Redesign seeks to develop new services for those with intensive needs and bring the coding of Medicaid services in Ohio into alignment with national standards.

Originally scheduled to launch July 1, new Ohio Medicaid benefits have been delayed a bit as providers prepare themselves for the change. “Behavioral Health Redesign is still in the developmental stage,” said Director of Client Services Janet Johnston. “At PLACES we’re practicing as though it is in effect now so we’ll be ready when the time comes.”

One aspect of Behavioral Health Redesign that greatly impacts PLACES is how services for Psycho-social Rehabilitation (PSR) will be documented and billed. This includes functional living skills, such as laundry, bathing, taking medications, cooking, being able to work, as well as recreational social skills.

PLACES group homes have always provided activities designed to build living and social skills. “Improving social skills allows residents to further integrate into society,” Johnston explained. “Part of recovery is achieving life balance. Now PLACES will have an opportunity to offer more services to its residents since individual activities can be billed if properly documented in the person’s chart.”

At the current time, most of the funding for PLACES group homes is provided by the local Alcohol, Drug Addiction and Mental Health Services Board as a fee-for-service contract. The fee-for-service contract is for a set amount and provides no room for an increase. With new Medicaid fee-for-service billing, PLACES can potentially expand the services it provides because it can recapture the cost of the additional staff time needed to provide those services.

“Behavioral Health Redesign frees up community providers to give the level of care that people need,” Johnston said. “Previous funding models had a cap that created a barrier to providing more intense services in the community. The system said, ‘Here’s a certain amount of money to reimburse you for a certain number of hours of service, and that’s all you get.’ Or you had to appeal. Redesign lets us break out and bill for intensive services separately so each issue a resident has can be addressed more individually.”

All staff at PLACES group homes are licensed to bill for services. PLACES plans to license overnight aides in its other programs, too, which could open up the chance to bill for services there as well.

New billing procedures require additional documentation that adds work for already busy staff. With the new PSR model, Medicaid doesn’t allow for billing of group activities. Each individual who participates must be documented separately, detailing how they functioned in the activity. This has the risk of eating into client care. However, that risk is balanced with the chance to earn additional reimbursements, which can support more service, so it’s a balancing act.

Redesign also supports greater collaboration among behavioral health providers. “We’re interested in the total wellness of the people we serve, and that means taking a look at the whole system, including their primary care physician or specialist,” Johnston said. “For example, we know that diabetes and mental illness go hand in hand. Someone with mental illness may struggle with medical interventions like shots, so this supports our working with other caregivers in a more collaborative way.”

Much More Than a Job

PLACES Administrators Look Back Over Two Decades of Service to This Mission-Driven Organization

Kathy Nickell (left) and Stacy Graham.

They started out thinking it was just a job, a way to get back home to Dayton or a chance to try office work after a stint in retail. But today, two decades later, office manager Kathy Nickell and human resources lead Stacy Graham hold key positions that keep the organization running smoothly in the face of tremendous change.

There at the Start

When Kathy Nickell joined PLACES as a part-time clerical worker in 1991, her office was in a basement in Springboro. “We were very small, with just one facility on Linden Avenue, later to relocate,” she said. That group home grew from 12 residents in 1989 to two more 8-bed facilities that housed 28 when she joined the agency. By the time Stacy Graham was hired in 1996, the employee population had grown to about 25 – 30 staff, and it stands around 75 today.

“It didn’t take me long to go full time,” Kathy said. “I enjoyed the fast pace. There was always something happening – like remodeling the office to make it more professional.”

Stacy considered her first job – assistant manager in a group home – as a stepping stone. “I had never worked with mentally ill people before this,” she said. “I grew up here essentially. I’m 48 years old, so I’ve been here half of my life.”

Leadership and Change

Both women welcomed the positive changes that came with PLACES’ growth and increasingly professional approach to management. They both cite Roy Craig’s hiring as interim executive director in 1997 as a watershed for the firm. “With Roy came consistency, normalcy, leadership, fairness,” Stacy said. “He had a very business-like approach. I’m not sure PLACES would have continued without Roy stepping in.” The organization has had to adapt to continual change over time, and this year is no exception. When asked about the biggest change they’ve seen since joining the company, both said simultaneously and without hesitation, “Medicaid!”

“Ever since I’ve come here, we have contracted for our services,” Kathy said. “This is the most major change I’ve seen in the 26 years I’ve been here. Now we are preparing to bill for Medicaid services as soon as November. It’s not about the activity now, like taking someone shopping, it’s about showing how and what we are doing for a client to improve their quality of life.”

“Behavioral Health Redesign and Medicaid will have a big impact,” agreed Stacy. “It’s hard to say exactly what that impact will be. In the past, extra funding was tied to particular programs and services. Now with Medicaid, extra money could go to administrative salaries, overhead or supporting future projects. This gives us the flexibility to manage our programs as needed. Our administrative team is very thin now, and we need more people to do a quality job. This means our hands are no longer tied.”

Making Friends, Making a Difference

When asked what they like best about working at PLACES, both talked about the workplace culture and camaraderie. “Because we’re so lean, you know personal things about everyone, so it’s like we’re a family,” Stacy said. “It’s ‘put your nose to the grindstone,’ but I can go into anyone’s office and chat when I need a break.”

Kathy explained what PLACES means to her in this way: “I guess I was sheltered, growing up on a farm in a small town with one homeless person. Daddy always said, ‘Give him a dollar to get a hamburger.’ We always gave him a dollar.

“I never realized in my whole life that people live on the street. The biggest eye-opener for me was driving to work and seeing someone sleeping under a bridge or on a bench, covered with maybe a blanket and using a stuffed trash bag for a pillow. When I’m in my nice warm bed and it’s below zero outside, you think about who is sleeping under a bridge or looking for a cover for the night.”

“It makes you humble,” Stacy said.

“More grateful,” Kathy agreed.

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