Kent Center for Human and Organization Development

Who are we?

The Kent Center (TKC) is a non-profit, comprehensive behavioral health system. TKC can provide both mental health and substance abuse services to the full age range (children through elder), prioritizing services to adult clients experiencing trauma and victimization resulting from the full range of criminal acts as outlined in the VOCA grant. The Kent Center is committed to providing services to all clients without regard to culture, race, ethnicity, disability, age, gender, sexual orientation or socioeconomic status. The VOCA grant would be used to fund services to low income, non-insured survivors (e.g., those individuals without Medicaid, Medicare or private insurance) who seek case management services to address the consequences of victimization resulting from a criminal act. TKC is committed to helping clients maintain psychiatric stability and be ready to transition back to the community. For many survivors, they experience re-victimization in other parts of the helping system and TKC is committed to providing the quality of care necessary.

Who Do We Serve, Where Do We Operate?

The Kent Center provides a comprehensive range of behavioral healthcare programs and services primarily targeted to residents of Kent County (though we do provide services to individuals and families residing throughout the state of Rhode Island). Through VOCA funded programs, TKC is focused on providing services to victims of crime and can provide a comprehensive array of counseling, psychiatric and case management services. The breadth of wrap-around services available to VOCA eligible clients include: individual, group, and family counseling services in both mental health and substance abuse; Intensive Outpatient substance abuse services; case management; 24-hour-a-day crisis intervention services; psychiatric evaluations and medication monitoring; as well as specialty programs for children, and adolescents with serious emotional and behavioral disturbances, and adult clients with severe and persistent mental illness.

As part of the Center's overall service delivery system, the addition of the substance abuse programs creates a comprehensive behavioral health system making The Kent Center truly unique. One strength of the Kent Center is that not only are we able to provide both mental health and substance abuse services to the full age range (children through elder) but we can be responsive to clients experiencing trauma and victimization resulting from the full range of criminal acts as outlined in the VOCA grant. The Kent Center is committed to providing services to all clients without regard to culture, race, ethnicity, disability, age, gender, sexual orientation or socioeconomic status. All services are provided in an atmosphere of dignity and respect.

The Kent Center has seven facilities throughout Warwick, West Warwick and East Greenwich. The two sites located in Warwick: 50 Health Lane and 300 Centerville Road are sites where most VOCA services are provided . The site at 50 Health Lane houses TKCÕs Emergency Services and Psychiatric Services. This one story building is adjacent to the Kent Hospital. The Center also occupies space on three of the four floors at 300 Centerville Road where the Counseling and Case management offices are located. Both sites provide ample parking in front of the building. TKCÕs facilities are in compliance with ADA Regulations. For example, the main Kent Center facility site has four levels with three handicap accessible entrances, an elevator and handicapped-accessible bathrooms. The facilities have been inspected by the Governor's Commission on the Handicapped and the Department of Mental Health, Retardation and Hospitals, and have passed these inspections. Additionally, our 24-hour Emergency Services are provided primarily in the emergency rooms of local hospitals. The case management services are often provided in the clientÕs home or other community settings, in addition to office settings.

The VOCA program provides services solely to victims of crime who are low-income and without health insurance. Therefore, 100% of individuals and families served by the Victims of Crime Act grant will be low income and the Center follows the Federal poverty guidelines to make this determination. The VOCA program provides TKC with the capacity, through funding counseling, psychiatric, and case management staff time, to provide assessment, mental health and substance abuse counseling services, crisis intervention, as well as psychiatric services and medication monitoring.

TKC proposes to provide services for up to 50 clients over the course of the funding cycle for case management and counseling services. Of the 50 clients, we anticipate both mental health and substance abuse services, in addition to psychiatric services. The proposal for psychiatric care includes the initial evaluation and 6 follow up medication appointments.

All VOCA clients receive a comprehensive assessment. TKC proposes to provide 60 assessments. Most clients are identified as eligible for VOCA funded services at the time of their first telephone call to TKC, the remainder are identified during the assessment session. The assessment is a comprehensive bio-psychosocial evaluation of three dimensions of the client; mental health, substance abuse, and trauma. This tri-dimension assessment allows each client to be placed in the correct level of care and with the correct program and service provider to best meet the clientÕs needs. For VOCA eligible clients, those assessed to be in need of case management services will receive a specific referral to that program as well as for any counseling as clinically indicated. Regardless of other program or service recommendations resulting from the assessment process, all clients in the VOCA Program are also eligible to access TKCÕs 24-hour Emergency Services at any point during their involvement with the Center.

TKC VOCA program provides wrap-around services to clients through individualized treatment plans which are developed based on the needs of each individual client. TKC proposes to build in the flexibility to "manage" the care, simultaneously monitoring services, treatment requirements, and the program budget. For example, TKC proposes to build in the flexibility to manage the care for VOCA clients in such a way that if several clients demonstrate a clinical need for Intensive Outpatient substance abuse program (IOP) level of care, we would then decrease the number of available hours in general counseling services to accommodate the greater costs of IOP. If a client requires a psychiatric evaluation, TKC will make arrangements to have the client seen by a TKC psychiatrist. Medication monitoring visits would be scheduled until the client could be referred back to their Primary Care Physician who could continue to follow the client on medications on a long term basis. All VOCA clients are eligible to receive case management services based on the level of need, which is evaluated on a case by case basis. Therefore, all VOCA clients would not need or receive the same frequency or intensity of case management services.

During the last full program year cycle, The Kent Center provided over 580 counseling services and psychiatric services to low income, uninsured victims of crime. This proposal seeks to continue to offer mental health, substance abuse, crisis intervention and psychiatric services to victims of crime. Of the clients who have received counseling and psychiatric services through VOCA, some were victims of assault in the community, others were victims of domestic violence in their homes, and others were victims of sexual or physical abuse or neglect as children.

The majority of VOCA eligible clients struggle with co-occurring disorders, e.g. a major depressive disorder that was self medicated with alcohol, and/or undiagnosed bipolar condition where the highs of mania are self medicated with alcohol and the lows of depression are self medicated with cocaine. These clients present challenges diagnostically and clinically, and require comprehensive wrap-around services which include not only an emphasis on the trauma experience, but attention to stabilization of mental health symptoms and the decrease or elimination of the substance use. Several clients participated in the Intensive Outpatient substance abuse program, which is a highly structured program for men and women who require more intensified services effectively addressing more severe clinical symptoms. Clients who participate in the Intensive Outpatient program receive 20 hours of treatment a week.

The following vignette illustrates the complexity of the clients accessing services through this program. (Each vignette used in this proposal is a composite of several clients served through the VOCA program. All specific identifying information has been eliminated.)

"Kevin" is a 44-year-old, single male, who lost his job and health insurance. He had suffered from depression for many years and had begun to develop a substance abuse problem. Kevin was a victim of domestic violence as a child. After losing health coverage, Kevin began self-medicating with alcohol to manage his depression. This client was able to participate in TKC's Intensive Outpatient substance abuse program where the structure helped his him abstain from alcohol which in turn helped him begin to better address his depressive symptoms. Additionally, we were able to get a psychiatric evaluation and medication monitoring to prevent a hospitalization.

The clinician addresses the emotional and psychological aspects of being victimized through weekly or biweekly counseling, the case manager helps to put the resources in place to meet the clients most basic daily living needs which have been impacted by their experience of victimization.

The following vignette describes the benefit of VOCA services. (Each vignette used in this proposal is a composite of several clients served through the VOCA program. All specific identifying information has been eliminated.)

"Chelsea" is a 53-year-old woman who lost her husband through a sudden death. As a child, she experienced sexual abuse perpetrated by her father and developed a substance abuse problem that she had learned to manage with sober supports. The unexpected death of her husband prompted a relapse and complicated bereavement where her past trauma history was triggered. Due to her drug use and depression, which led to unemployment, eight months later Chelsea was forced to move from her home as she did not have the resources to pay the bills. The case manager helped her apply for Section 8 housing, apply for food stamps and other basic needs, transported her to critical appointments to apply for benefits. In addition to case management, she received outpatient treatment with a clinician that had expertise both in mental health and substance abuse counseling. Chelsea was able to stabilize her drug use and work towards finding secure housing, benefits, and become re-involved with her sober supports as she worked on her bereavement issues. Chelsea plans to return to work in the near future.

Given the complexity of the clients served in this program, TKC individualizes each treatment plan allowing for interventions deemed clinically necessary. This would include, but not be limited to: mental health and substance abuse counseling, and psychiatric and medication monitoring services. This past year TKC found that certain clients required more services, and in some cases more intensive substance abuse or psychiatric services then the VOCA program anticipated. The individualized treatment plan allows for flexibility in the intensity, frequency and amount of care. We are not proposing a "cookie cutter" approach to care, rather an individualized plan that manages resources effectively. What is critical to both programs funded by VOCA is that although they are separate, they clearly work closely together to coordinate care for the

This VOCA proposal will enable TKC to provide services to victims of crime. The VOCA program provides the ability to fund capacity through clinical staff and a case manager who will meet the needs of this vulnerable population. The CenterÕs goal is to maintain a comprehensive array of behavioral health care services to meet client needs. This past year The Kent Center saw the increased utilization of substance abuse and mental health counseling, case management, and psychiatric services. As the Center grows as a comprehensive behavioral healthcare organization, it has developed an assessment team that provides each client with an assessment on three dimensions: mental health, substance abuse and trauma. The comprehensive assessment clinician makes recommendations based on the clientÕs clinical need. From those recommendations, treatment commences with an individualized treatment plan.

TKC seeks to continue to meet the increasing demand for counseling and case management, as well as the ability to provide psychiatric evaluations and follow-up medication monitoring to meet the needs of clients enrolled in the program who would benefit from these services. One of the real strengths of the VOCA Program is that in addition to helping the client stabilize the emotional and psychological aspects of the trauma experience, the case manager works to help the client access health insurance and other entitlements for which he/she may be eligible. This will allow TKC to move clients off the program ultimately creating availability for more individuals to be serviced by the program.

Our Action Plan

All crisis services will be delivered by a 24-hour Emergency Service department staffed with mental health clinicians and psychiatrists. Hospitalizations are arranged following evaluations by the TKCÕs crisis workers in the local Emergency Rooms. All clients have access to the 24-hour crisis hotline. After hours, clients can speak with a clinician who will help assess for risk, imminent danger, or acute needs for support. Clients without insurance access state-funded psychiatric beds and are discharged back to the Kent Center following inpatient stabilization.

Intake and Assessment

Potential referrals for the VOCA program come through Central Intake office. An intake worker gathers all the basic demographic information and the reason for referral. The intake worker orients the client to the VOCA program and explains services available throughout The Kent Center. At this time the Emergency Services telephone number is given to all prospective clients.

Comprehensive Assessment of mental health, substance abuse and trauma

A licensed independent clinician provides a thorough assessment and makes referrals to the case management services, the counseling program, and the psychiatric services program. The Assessment also reinforces options that are open to the client through VOCA.

Mental Health Counseling

Clients initially begin with 10 to 12 sessions of focused work with a treatment plan negotiated between client and clinician. After the initial treatment episode, treatment goals are reviewed with the option to continue. Clients are offered the option to participate in group therapy, which the literature on best practices indicates is a treatment modality of choice for many trauma survivors in the recovery process. The treatment plan reviewed throughout the process of treatment. This formal, written plan details the clientÕs issues and outcomes to be achieved. Though treatment plans are formulated in the first few sessions, it is a reflection of an ongoing collaborative effort between client and clinician. Client goals are linked to the outcomes that the VOCA program intends to foster. All treatment plans are reviewed by the Program Manager to insure quality and compliance.

Psychiatric Evaluations and Follow-up Medication Monitoring

All clients who enter the VOCA program will be eligible for psychiatric services. These services include psychiatric evaluation, medication management, consultation and re-evaluation, and collaboration with primary care physicians. Board eligible Psychiatrists and Clinical Nurse Specialists provide these services

GOALS

All counseling goals and objectives will be implemented and monitored by the Program Manager and clinical staff throughout the grant year.

1. To provide more than 600 counseling, crisis intervention and psychiatric services to a minimum of 50 victims of crime.

OBJECTIVES

• Identify and refer clients eligible for VOCA services at time of assessment.
• Track follow-through with services following the assessment by collaborating with the case manager to outreach clients who do not follow-up.
• Conduct satisfaction surveys on a quarterly basis and at time of discharge to measure quality and satisfaction with providers and programs.

2. Develop and implement at least 1 new group targeted to treat VOCA clients.

OBJECTIVES

• Create a referral form for all clinical and case management staff to make referrals to VOCA program groups.
• Create a 20-session DBT group model for VOCA clients.
• Continue to train staff in Dialectical Behavior Therapy, a form of treatment shown in the literature to be effective in working with survivors of victimization.
• Implement group and run at least twice during funding year
• Implement a satisfaction survey at the end of each group cycle to measure clinical effectiveness.
• Target the program to provide more services to the underserved populations including male survivors, people of color, and the Gay, Lesbian, Bi-Sexual and Transgendered (GLBT) community.

OBJECTIVES:

• Outreach and marketing will be conducted by the Program Manager to potential referral sources historically connected to these underserved populations.
• Prepare and distribute flyers regarding VOCA services that target these underserved populations.
• Create a needs assessment and/or focus group to learn more about how to reach these underserved populations from clients representing these populations that are being served through VOCA.

4. Develop and expand collaborative relationships with local law enforcement, emergency rooms and health centers to help victims obtain treatment immediately after the crime.

OBJECTIVES

Outreach the police departments for each community in Kent County as well as the State Police to develop a liaison relationship between the VOCA program and the department. Outreach the Kent County Hospital Emergency Room as well as the health centers that are currently in Kent County or set to open in the next year, to develop a liaison relationship between the VOCA program and the department.

Meet with law enforcement and health care providers on at least a quarterly basis to discuss trends, referral mechanisms, concerns regarding access, and concerns regarding mutual communication.

Develop flyers specifically targeted to the populations served by law enforcement and health care providers that can be distributed to consumers regarding VOCA services.

STAFFING AND SUPERVISION

The Outpatient Counseling Program is composed of fourteen (14) full-time and part-time mental health and substance abuse clinicians (the majority are licensed independently in the state of Rhode Island) and one full time case manager. The Psychiatric Service Program has 4 psychiatrists and 2 Clinical Nurse Specialists. Clinicians in all these programs have relevant licensure or credentialling for their area of expertise.

Cynthia Mulder, LICSW, Program Manager, is responsible for overseeing the daily operations of both the Counseling and Case Management Program. She began at TKC as a VOCA Clinician and now oversees the management of the program. The Program Manager provides direct supervision to the case manager and clinical staff. She directs the case manager to coordinate with Center staff involved in the clientÕs care as well as practitioners in the community.

Kristina Lavoie, BFA, Case Manager, has been identified to work with VOCA clients. A former volunteer at the Attorney GeneralÕs office, Kristina advocates for clientÕs rights effectively. She began in the VOCA program as a volunteer.

Clinical Staff, who are licensed at the independent level and provide brief, focused treatment for clients struggling with a range of mental health and substance abuse issues related to their experience of victimization.

Stella Hebble, LCDCS, provides clinical supervision to all the substance abuse staff and is involved in cross training staff to increase awareness of treating addiction. The clinical supervisor also oversees the outpatient and intensive outpatient substance abuse programs. Through the connections to the Department of Behavior Health, Stella coordinates bringing volunteers from AA, NA, RI-AIDS, among other local agencies to speak directly with clients.

Fay Baker, LICSW, Vice President of Counseling and Family Services, provides oversight to the outpatient adult mental health, substance abuse and childrenÕs programs, as well as the Central Intake and assessment unit. Fay supervises the Program Managers of each of these programs Fay brings over two decades of clinical and administrative experience to the Kent Center.

Clinical supervision is provided by two independently licensed MasterÕs level clinicians (LICSWs) and a Licensed Chemical Dependency Supervisor (LCDCS) with experience working with adults and families of victims of crime. This supervision is ongoing and delivered both individually and in the context of a clinical team meeting. Supervision focuses on treatment plan implementation and effectiveness, as well as ongoing treatment issues and discharge planning. Additionally, consultation is available with the staff Psychiatrists, Clinical Nurse specialists, and Clinical Program Managers through case conferences.

The Kent Center insures that staff conform to specific licensure and credential requirements as prescribed by the state. In addition to specific licensure requirements, The Kent Center requires staff to receive annual training in specific content areas. The CenterÕs Director of Training tracks the continuing education of all VOCA staff. All staff providing VOCA services are required to undergo a Background Criminal Investigation (BCI) as well as a Child Abuse Neglect Tracking System (CANTS) check.

All staff of The Kent Center undergo a thorough orientation process regarding the policies and practices of the Center. There is an on-going training program for staff in all aspects of the operations of the Center. The content areas for some of these training sessions include (but are not limited to): confidentiality and HIPAA, privacy, clientsÕ rights, safety, documentation, ethics, and cultural diversity. All trainings attended by staff are entered into a database and a computer printout of trainings are made available to staff annually and as needed in preparation for their performance evaluation. Ongoing training is supported and required for all VOCA staff. Numerous trainings are offered both within and outside of The Kent Center. For example, the Center has brought in an outside consultant to train staff on Dialectical Behavior Therapy (DBT), which has been shown in the literature to be effective in working with victims of crimes. Staff have also attended intensive training in DBT outside the Center.

Despite the prevalence of clients of Caucasian ancestry, TKC is committed to providing services for all clients in a culturally competent manner. The Kent Center is committed to continued staff education and training to reflect the cultural composition of the community it serves. Staff receive on-going training on different cultures, races, ethnicities as well as other topics pertinent to cultural competence. The Kent Center has a Cultural Diversity Committee with a mission of staff education and dissemination of information on different cultures. The Center currently has the capacity to provide services in English and Spanish (this includes counseling as well as psychiatric services). One provider is fluent in Russian, while other providers are fluent in Portuguese. One clinician in the Youth and Family Department is fluent in American Sign Language. In addition to the bilingual staff, The Kent Center has engaged in efforts to create access to culturally competent services through the translation of some of the client-related documents and materials into Spanish. These efforts are ongoing.

Improvements To The Program

The history of being involved in the VOCA program affords The Kent Center the opportunity to improve upon the delivery of services to clients. For example, systems have been created to help survivors access services immediately. When a client calls the intake office and the staff identify that the client is VOCA eligible, the Program Manager is notified and efforts will be made to schedule an immediate assessment and also to alert staff that additional time in counseling will need to be schedule to service the client. A case management referral form was developed (see Appendix G) which helps the assessment clinician identify areas of need where the case manager can begin while the client engages in counseling. Additionally, as the need for case management services are often imminent, the Programs Manager reviews all new assessments and can identify case management referrals, assigning them directly to the case manager. The client has an immediate sense of relief as they have someone helping them reduce stress and get basic needs met. In the past, the client had to wait until he or she began the counseling work to get connected to case management services.

Additionally, the Program Manager has hired counseling staff who are experienced in both mental health, substance abuse and trauma issues that can assist the client in all issues simultaneously. The Center has made a commitment to cross training staff on substance abuse, mental health and trauma disorders. Based on TKCÕs historical experience in serving victims of crime, we have found that often clients self-medicate their trauma symptoms (flashbacks, sleep disturbance, etc.) with drugs or alcohol and need to be assisted with both getting clean and managing these unpleasant PTSD symptoms. This process of hiring clinicians skilled in all three areas allows the client to stay with the same treatment provider to address the full range of their needs and goals, which reduces the need for clients to transfer to a different clinician in order to deal with different concerns. This provides a holistic approach to treating survivors of crime, reduces fragmentation of care, and diminishes clientsÕ struggles with the trust issues that are so prevalent in victims.

MANAGEMENT STRUCTURE AND ORGANIZATIONAL CAPACITY

The Kent Center is a not-for-profit, comprehensive behavioral health care organization with a defined management structure. The Kent Center has a clearly stated mission and publicly stated values and goals. The Center has both Guiding Principles and Clinical Guiding Principles which are infused across all programs and services of the agency. Being a trauma-informed system is just one of the guiding principles of the Center.

TKC is overseen by a volunteer Board of Directors who operate under specific by-laws. The Board has full authority and responsibility for the operation of the organization. The Board is self-perpetuating and has a recruitment and periodic replacement process for members to assure continuity and accountability. The Board hires, supervises, evaluates and collaborates with the Chief Executive Officer/President.

The Kent Center has recently undergone a reorganization to reflect the changing programmatic needs of the populations served. There are now four Vice Presidents who report directly to the President/CEO. The Program Manager for Outpatient Mental Health and Substance Abuse Programs (Program Manager for OMHSAP) and staff report to the Vice President for Counseling and Family Services. The programs and services under this umbrella are all geared towards mental health and substance abuse related services for children, adolescents, and adults. There is a wide array of both office-based and community-based services under this umbrella. The Vice President for Counseling and Family Service partners with the Program Manager for OMHSAP to insure the effective and efficient day-to-day operations and strategic planning for the VOCA program, as well as fiscal oversight and Quality Improvement monitoring. (see Staffing for more information)

COLLABORATION, VOLUNTEERISM

The Kent Center has a long history of collaborating with other organizations such as DCYF, probation, methadone treatment programs such as Discovery House, Phoenix House, the Elizabeth Buffum Chace House, TravelerÕs Aid, Welcome Arnold, STARR, and other agencies. Currently the Center is in the third year of a partnership grant with Phoenix House where TKC staff run DBT groups for survivors who are residents at Phoenix House. This partnership strengthens the continuum of care between agencies, and provides integrated, quality care to survivors who are substance dependent. The cultivation of collaborative relationships with organizations like EBC House allows for the staff at EBC to call the Kent Center Program Manager directly to quickly link a survivor to necessary services. In the past there was a group provided by TKC on-site at EBC to inform clients of services available Ð this is now replaced by a phone call which expedites the process. These collaborations continue to strengthen the VOCA program.

The Kent Center has an ongoing commitment to volunteerism. Given the confidentiality and the sensitive issues involved with victim work, TKC has developed areas where volunteers are involved and yet do not violate privacy laws. For example, the West Bay Senior Aid training program which helps elders find meaningful employment has had continuous involvement at TKC for more than 3 years. The Senior Aids have assisted staff involved in the Intensive Outpatient Program by creating toxicology screens, office work, and welcoming new clients. A local high school career program coordinates a placement between the school and TKC for students interested in the mental health field.

Direct service to clients from volunteers originates from having individuals or groups speak to clients to engage them with outside recovery in the form of AA, NA, RI-CARES. Other organizations such as RI-AIDS and the state committee on Hepatitis come to treatment groups to provide education and resources. Finally, Foster Grandparent Program helps clients while they are in counseling arrange for childcare during treatment sessions. If the client needs childcare while participating in a Center treatment program the case manager can arrange for this service through the Center's Youth & Family Services. The foster grandparent facilitates child playgroups and interacts individually with the children. There is also an age appropriate child-friendly space set up with toys and books for the children. TKC also has a volunteer case manager working to ensure that appropriate fiscal information and residency requirements for entitlement programs are documented properly in client's charts.

And How Do We Measure Ourselves?

Our VOCA satisfaction survey attempts to address the clientÕs experience in treatment. Additionally, we adhere to client rights that specifically address the goal to treat all clients with respect and dignity and that client satisfaction with our program is paramount.

Reviewing the treatment plan goals that are established by the counselor and client are a critical component to monitoring progress in treatment. Treatment plans are reviewed and revised accordingly.

Quarterly reports and statistics in addition to year-end reports are submitted and continue to focus on client outcomes.

The Kent Center is accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF) and all monitoring protocols are observed and maintained.

Fay Baker, Program Manager
Kent Center for Human and Organization Development
300 Centerville Road
Warwick, Rhode Island 02886-0208
Phone: 401-732-5656