The Lackawanna-Susquehanna (L-S) Behavioral Health Intellectual Disabilities Early Intervention (BHIDEI) Program was started in 1967 under provisions of the Mental Health and Mental Retardation Act passed by the Pennsylvania Legislature.
The purpose of the Act was to create and deliver community-based mental health and intellectual disability services, in addition to those services provided in state mental hospitals and state centers for persons with intellectual disability.
Traditionally, these services were available only on an inpatient basis, generally for an extended period of time in an institution. The new law placed emphasis on diverting individuals from such inpatient care to a system which would provide services in the local community.
The monies for these services are provided by the federal, state and county governments, with the county government as the local public authority overseeing the BHIDEI Program and its finances.
The L-S BHIDEI Program is composed of two (2) counties – Lackawanna and Susquehanna, with a 2000 population of 255,533. The BHIDEI Program is responsible for providing services in two (2) service delivery areas, which are geographic areas.
Base Service Unit I consists of lower Lackawanna County, with a year 2000 population of 163,726 persons. The Base Service Unit II area consists of upper Lackawanna County (49,569) and Susquehanna County (42,238) with a combined population of 91,807.
All persons receiving Behavoiral Health or Intellectual Disabilities services through the BHIDEI Program are admitted into and monitored while in the BHIDEI Program by the Base Service Unit (B.S.U.). There are two (2) B.S.U.’s in the L-S BHIDEI Program. B.S.U. I serves lower Lackawanna County, while B.S.U. II serves upper Lackawanna County and Susquehanna Counties. B.S.U. I operates as part of Scranton Counseling Center, while B.S.U. II operates as part of NHS of Northeastern Pennsylvania.
2. Plan a comprehensive treatment program.
3. Make available the necessary services on a continuing basis.
4. Maintain a continuing relationship with the consumer and with any facility or provider responsible for services to the consumer from intake to termination. This includes individuals in state mental hospitals and state centers for persons with intellectual disabilities.
5. Facilitate and coordinate consumer movement from one service to another.
6. Maintain central files for each consumer served.The two (2) Joinder Base Service Units provide the above services under contract with the Administrator’s Office.The L-S BHIDEI Program Administrative Office does not provide direct services to consumers. Instead, it contracts with approximately forty (40) different agencies to provide various services, which include community inpatient services in local hospitals, outpatient, partial hospitalization, emergency, vocational rehabilitation, training and social rehabilitation, community residential services and case management.
The BHIDEI Program is an arm of county government. The BHIDEI Program governing body, its Advisory Board, is composed of one (1) county commissioner from each of the two (2) counties, and eleven (11) community representatives, nominated by the Board and appointed by the commissioners.Ultimate authority rests with the county commissioners of the two (2) counties. Board members are appointed by the commissioners for three (3) year terms and may serve a maximum of two (2) consecutive terms. These Board members serve without compensation, and they are selected to represent the broadest community interest of health, welfare, and education.In addition to the BHIDEI Program Advisory Board, there are a number of committees including Behavioral Health Care and Intellectual Disability Advisory Committees, which concern themselves with problems related to specific behavioral health and intellectual disability issues.
Each year, the L-S BHIDEI Program invites proposals from community agencies to provide the above services. The Planning and Proposal Review Committee of the L-S BHIDEI Advisory Board reviews these proposals and recommends to the Advisory Board that specific proposals be funded. Based on these recommendations, plus input from the general public, the staff of the L-S BHIDEI Program prepares an annual plan, which is submitted through the State Department of Health & Human Services to the Office of Intellectual Disability and Substance Abuse Services and the Office of Intellectual Diasbility for approval and funding. The monies to support the approved proposals are channeled through county government for disbursal to the BHIDEI Program, which uses the monies to pay for services rendered by the various providers.
The BHIDEI Program staff consists of an administrator; a director for intellectual disability services; a director for fiscal affairs; waiver coordinator; quality management coordinator and children’s program coordinator. In addition, there are support staff for the above functions. The Administrator’s Office is responsible for the monitoring
of provider activities as they relate to Joinder consumers, preparation of the annual plan and budget request, monitoring of the provider allocations, handling legal procedures relating to psychiatric hospitalizations and commitments, and providing statistical and fiscal reports to the appropriate state offices.
The BHIDEI Program (for fiscal year 2007/2008), through its various providers, services approximately 19,020 individuals, of whom approximately 16,475 receive mental health services, and 2,545 receive intellectual disability services.The BHIDEI Program expends approximately $92,720,719, of which 41.6% is for behavioral health services, and 58% is for intellectual disabilities services. The state and federal governments contribute approximately 94% of these funds, and the counties 6%. The remaining monies come from fees, insurance, grants, etc.Although the total revenue and expenditures generally increase from one year to the next, the percentage of the total contributed by the above entities remains essentially unchanged. It should be noted that while the BHIDEI Program is mandated by state law to provide services, it is dependent largely on the availability of federal and state dollars to accomplish its mission.
The Administrator’s Office issues an annual report. This document presents in detail the activities and statistical report of the Joinder effort. The report provides a detailed and current analysis of the Joinder efforts. In addition, the Administrator’s Office annually conducts a utilization review and evaluation of one or more of the services listed in this report. This review provides an analysis of a specific service. These reviews were initiated in 1982 and they cover a different service each year.
1. Community Services – Programs and activities made available by any staff member to community or human service agencies, professional personnel, and the general public concerning mental illness or mental retardation in order to prevent them.
2. Service Management – This refers to those activities and administrative functions undertaken by staff in order to assure the appropriate and timely use of available resources and specialized services to best address the needs of individuals seeking assistance. Services are available for all persons who are mentally ill and/or mentally retarded for the purposes of facilitating, coordinating, and monitoring a person’s access to mental health and intellectual disability services and community resources.
3. Intensive Case / Resource Coordination Management Services – ICM/RC services provide assistance to persons with serious and persistent mental illness and children at risk of serious mental illness in a variety of ways to gain access to needed resources such as medical, social, educational, and other services through natural supports, generic community resources and specialized mental health treatment, rehabilitation and support services.
4. Outpatient – This refers to treatment-oriented services provided to a consumer who is not admitted to a hospital, institution, or community mental health facility for twenty four (24) hour-a-day service. These services may be provided to an individual or his/her family and may include services prior to or after inpatient or institutional care has been provided. The services are provided on a planned and regularly scheduled basis for less than three (3) hours per day. Activities included in this service are individual, group or family therapy, medical treatment, and marital counseling.
5. Psychiatric Inpatient Hospitalization – This refers to treatment or services provided to an individual in need of twenty four (24) hours continuous hospitalization. The activities include care in a licensed psychiatric inpatient facility.
6. Day Treatment (Partial Hospitalization) – This refers to non-residential treatment services for persons with moderate to severe mental illness and children and adolescents with serious emotional disturbance who require less than twenty-four (24) hours continuous care but require more intensive and comprehensive services than are offered in outpatient treatment. The day treatment (partial hospitalization) services can be: 1) a day service designed for persons able to return to their home in the evening and/or 2) an evening service designed for persons working and/or in residential care and/or 3) a weekend program and/or a day or evening program in conjunction with or separate from school.
7. Psychiatric Rehabilitation – Allows persons to improve functioning to gain desired roles in their community. Specifically, the program supports individuals to make choices, achieve self reliance, achieve community integration, develop skills, and provides access to appropriate resources. Psychiatric Rehabilitation Services are available to anyone over 18 years of age.
8. Early Intervention is services and supports designed to help families of children from birth through two years of age who have special needs due to developmental delays or disabilities. Early Intervention services can include information, service coordination, special instruction and therapies to help families enhance their child’s potential. Early Intervention supports and services are embedded within learning opportunities that exist in a child’s typical routines at home or in the community. Supports and services are individualized for each child and family and reflect the family’s priorities for their child. Early Intervention can also include monitoring children who are at risk for developmental delays due to: low birth weight; care in a neonatal intensive care unit (NICU); born to a chemically dependent mother; identified as abused or neglected by the county children and youth agency; having confirmed dangerous levels of lead poisoning as set by the Department of Health.
9. Emergency Services/Crisis Intervention – This refers to activities available at any hour of the day or night to individuals in need of immediate care because of personal crisis or aggressive behavior. This service provides observation, psychiatric services, supervision, and protective services in order to prevent aggressive or destructive behavior on the part of an individual.
10. Adult Developmental Training (ADT) is a program which helps individuals with severe and/or multiple disabilities to develop and improve personal and pre-vocational skills. Instruction may include communication, socialization, continuing education, motor development, daily living skills and community education and recreation.
11. Community Employment and Employment Related Services – Employment in a community setting or employment-related programs which may combine vocational evaluation, vocational training and employment in business or industry or other work sites within the community. Included are competitive employment, supported/supportive employment, and industry-integrated vocational programs such as work stations in industry, transitional training, mobile work forces, enclaves, affirmative industries/business, and placement and follow-up services.
12. Facility Based Vocational Rehabilitation Services – Programs designed to provide remunerative developmental and vocational training within a community-based, specialized facility (sheltered workshop) using work as the primary modality. Sheltered workshop programs include vocational evaluation and personal work adjustment training.
13. Social Rehabilitation Services – This refers to programs or activities designed to teach or improve self-care personal behavior and social adjustment for persons with a mental disability or children and adolescents with emotional disturbance. These social rehabilitative activities are intended to make community or independent living possible by increasing the person’s level of social competency and by decreasing the need for structured supervision.
14a. Family Support Services – This refers to supportive services (Respite, Family Aid) designed to enable persons with mental illness or intellectual disability, children and adolescents, with or at risk of serious emotional disturbance, and their families, to be maintained at home with minimal stress or disruption to the family unit and supports which enable the person to live independently in the community.
14b. Family Driven/Family Support Services In the Family Driven model, families eligible for Family Support Services are given an agreed on amount of money with which the family selects a provider from whom it purchases the services the family deems best suited for the consumer.
15. Community Residential Services consists of supports designed with the goal of enabling persons with intellectual disability to live in the home and community of their choice. Support may be provided across a variety of settings according to their individual circumstances. Individuals may choose to reside in their own home or family home, accessing supported living or home based services; or choose to reside in a more structural setting, such as a community licensed facility or a licensed family living home.
16. Lifesharing through Family Living – A direct service for individuals with an Intellectual/Developmental disability Individuals line in host family homes and are encouraged to become contributing members of the family unit. Through planning and coordination, individuals and families are joined in accordance with the individuals needs.