RHN Director Survey

The 2004 analysis of New York State’s Rural Health Networks brought together a number of recommendations from NYSARH’s 2003 Strategic Plan and the subsequently developed organizational work plan. The recommendations included the development of a process by which to provide value and services to our members, noting that such products/services should enhance, or work in conjunction with products and services that provide value to our members and help the Association fulfill its mission.

Rural Health Networks (RHN’s) in New York State, a large constituency group of NYSARH, were looking to conduct an analysis of individual and organizational variables to assess the relationship between these variables and compensation practices. This project however, is more than just a Rural Health Network Survey. It is a tool to guide the Association in determining what kinds of programs and services it should provide and how to finance these products. Furthermore, it is a template for a process to provide surveys such as this, to other constituencies.

Thirty four survey questionnaires were distributed and 28 were returned, a response rate of 82.4%. When possible, the information garnered from this 2004 survey was compared to the NYS RHN survey conducted in 1999 by the Herkimer County RHN to give a fuller picture of current trends. According to the survey:

NYS RHN Characteristics:

• 50% of responding networks are independent, not-for profit organizations
• 28% are non-profits affiliated with a larger organization
• 10% are county government based
• 10% are not incorporated and affiliated with some other organization
• 43% reported being small (annual budgets under $200,000)
• 21% reported being medium (between $200,001-$300,000)
• 7% reported being medium-large (between $300,001-$400,000)
• 9% reported being large (over $400,000)

Summary

Those with large, medium-large, and medium annual budgets are independent not-for profits; except for one large not-for-profit affiliated with a larger organization.The survey also assessed:

• sources of RHN funding
• staffing patterns by size
• director compensation packages by education, gender and years of service

A copy of the survey can be purchased through NYSARH administration for $10.

Tele-Psych Committee

There is a critical shortage of behavioral healthcare professionals in rural New York counties resulting in a lack of treatment, and/or incorrect, incomplete or non-existent diagnosis of behavioral health issues for youth and adolescents. New York State is one of the most service wealthy states in the country. However, many rural families find that timely access to appropriate services is extremely difficult and often impossible. The New York State Association for Rural Health (NYSARH) first identified the need for behavioral health services at its 2003 Strategic Planning Retreat. Further research indicates the limited access to behavioral health services is a national issue and access will continue to decrease unless innovative strategies are implemented.

Child and adolescent psychiatry is the only board certified medical specialty that trains physicians to treat the disorders of childhood and adolescence. A national workforce analysis identified 7,000 child and adolescent psychiatrist in the US , whereas it would take 33,000 to meet the need for services. At the same time, the number of child and adolescent psychiatry training programs and the number of residents has decreased significantly over the past decade. Currently a mere 300 child and adolescent psychiatrists complete training each year. Along with the lack of providers other barriers to treatment include: limited insurance benefits, lack of affordability, and stigma. Several national studies identify access to behavioral health services in rural areas as one of the nations most significant health needs.

In June 2004, the NYSARH Board of Directors voted to support the development of a Tele-Psychiatry task force to l ook at Tele-Psychiatry as a viable option for increasing timely access to quality behavioral health services for youth and adolescents. The New York Statewide Tele-psychiatry Task Force currently includes NYSARH, NYS AHEC System, NYS Public Health Association, North Country Children’s Clinic, North Country Behavioral Health, Columbia Memorial Hospital, Four Winds Adolescent In-patient Treatment Center, eight Rural Health Networks and representatives from educational institutions. The NYS-wide Task Force has met with representatives from the New York State Conference of Mental Hygiene Directors, the Office of Mental Health, the NYS Department of Health Medicaid Unit and the Governors Office. All of the agency representatives have indicated an interest in the efforts of this task group and a willingness to continue discussions. The all volunteer task force has made great strides in a short time, including developing clear goals and establishing sub-committees to help us achieve those goals:

NY Statewide Tele-psychiatry Task Force Goals

• Establish Relationships: The Task Force will work with any organization or association that is willing to work collaboratively in developing solutions, that will increase access to behavioral health services for rural youth and adolescents, which could be generalized throughout the State.
   
• Seek Potential Funding Sources: The Task Force works collaboratively and thinks creatively to find ways to ensure funding that will back solutions recommended.
   
• Improve Access to Child and Adolescent Behavioral Health Services: The Task Force uses its relationships and draws upon the members’ common goal and creative thinking to identify options for improving utilization of tele-health technology, including efforts to establish public and private reimbursement.

 NY Statewide Tele-psychiatry Task Force Sub-Committees

The Grant Writing Team (GW Team) has identified several grants as potential funding sources for the development and formation of a tele-psychiatry network.

The Survey and Research Committee surveyed Tele-psychiatry Networks across the nation to assess potential reimbursement rates, utilization, start up and maintenance costs, human resource needs, and fiscal impact.

The Regulatory Reform Committee is tracking legislation that will allow for reimbursement of tele-psychiatry services by public and private insurances. On January 13, 2005 the New York State Rural Health Council, a governor appointed advisory council to the Commissioner of Health, recognizing the importance of children and adolescents receiving timely access to appropriate screening and treatment for behavioral health issues and the current lack of access, unanimously passed a resolution that calls for

“The State of New York (to) move forward in developing a new means of delivering effective psychiatric health care services to rural communities including, but not limited to, publicly reimbursable video-teleconferencing technology.”

NYSARH is seeking funds for technical assistance from experts in tele-health technology, to assist the New York Statewide Tele-Psychiatry Task-Force in producing a Demonstration Project Proposal for a Tele-Psychiatry Network that will help ensure timely and affordable access to necessary mental health services for all children and adolescents residing in the rural areas of New York State . Given the current need for services and the future looming decrease in specialists we will need to use technology to help span the growing gap between supply and demand.

There are some great opportunities with the emerging interactive telecommunication technologies to improve access, quality and efficiency in the health sector to better meet the needs of the population we serve, especially those that are rural, isolated and underserved. It is the intent of those involved, that the focus of this initiative will be to integrate primary care and behavioral health through the means of telemedicine; and, to collaborate with RHNs, mental health providers, primary care providers, and other key stakeholders throughout New York State, thus laying the foundation for information and communications technology.