NYAPRS Note: After US District Judge Nicholas Garaufus finally lost patience with New York’s extremely slow progress in complying with a 2013 legal settlement to support thousands of adult home residents with psychiatric disabilities into the community, state and legal rights negotiators reached a supplemental settlement a few weeks ago that comes with long awaited details and deadlines to make that happen.
The following piece summarizes some of the new terms and highlights the addition of a new adult home peer bridger model to provide residents with an engaging, encouraging and dedicated peer supporter to help them develop the hope and provide the supports to take that next step. This approach was proposed by NYAPRS as an adaptation of the original state hospital to community peer bridger model we developed in the mid 1990’s. Governor Cuomo has pledged $5 million in this year’s state budget to launch the program. Stay tuned for more details in the coming months.
A key figure in the longtime effort to help the residents get their rights to live in the community, the Bazelon Center’s Jennifer Mathis, will be a featured speaker at NYAPRS’ upcoming April 19-20 Executive Seminar, as part of a panel of national experts who will be responding to the keynote remarks of new HHS Assistant Secretary for Mental Health and Substance Use Dr. Elinore McCance-Katz. See program and registration details at www.nyaprs.org.
Supplemental Agreement To N.Y. Adult Home Landmark Settlement Filed
Mental Health Weekly March 26, 2018
Nearly five years following a landmark settlement in New York state to ensure that adult home residents with serious mental illness have an opportunity to live in integrated settings, lawyers for those residents and the state on March 12 filed a supplemental agreement to improve the process for helping them transition into the community.
The Bazelon Center for Mental Health Law; Disability Rights New York; Mobilization for Justice (formerly MFY Legal Services); Paul, Weiss, Rifkind, Wharton & Garrison; and the U.S. Department of Justice and the State of New York filed the proposed settlement in federal court.
The class action lawsuits, United States v. State of New York and O’Toole et al. v. Cuomo, are two separate cases that function as one complaint, Jota Borgmann, senior staff attorney for Mobilization for Justice, told MHW. When the U.S. Department of Justice joined the lawsuit, it became involved in order
to ensure enforcement of such laws as the Americans with Disabilities Act, she said.
At the time of the original agreement, New York mental health advocates had fought for a decade against the state for segregating people with serious mental illness in adult homes rather than integrated settings (see MHW, July 25, 2013; Sept. 14, 2009).
The 2013 agreement called for at least 2,500 people to be assessed and, if appropriate, transitioned within four years, and for remaining adult home residents with serious mental illness to be offered the chance to transition to the most integrated setting appropriate by the end of five years, Jennifer Mathis, director of policy and legal advocacy for the Bazelon Center, told MHW.
Mathis added, “There are many reasons why the state’s implementation of the initial settlement has proceeded at such a slow pace — including, for example, a fragmented process of helping individuals transition from adult homes to supported housing that results in long delays, inreach that does not always actively support adult home residents in making decisions concerning where to live, poor care management and service planning, among other things.”
The U.S. District Court must approve the settlement. There is not a specific deadline for that to happen; however, the court has been very concerned about ensuring prompt remedies for adult home residents, said Mathis. “We expect the judge will approve the supplemental agreement quickly,” she said.
Assessing needs of residents
The new supplemental agreement makes improvements to the process for engaging adult home residents, assessing their needs and assisting them in concerns about delays and ineffective engagement, poor care management and other breakdowns in the process of implementing the original settlement.
Among the provisions in the supplemental agreement: At least 85 percent of NYC adult home residents who are referred for assessment shall be assessed (or have the assessment closed out) within 60 days of being referred for assessment.
Additionally, at least 98 percent of NYC adult home residents shall be enrolled in care management at a 12:1 ratio, and the creation of a person-centered care plan shall begin, within 90 days of being referred for assessment, according to court documents.
What’s different about the supplemental agreement versus the initial settlement is that it provides for greater accountability and imposes specific time frames and goals for each step of the process, from engaging a person through “inreach” to helping the person successfully transition to supported housing or another community setting, explained Mathis. “It also adds enhancements that will facilitate better engagement, assessment, planning and transitions,” she said.
The agreement puts in place specific services, standards and timelines for a layer of services and supports to help the residents move into their next life into the community,
Harvey Rosenthal, executive director of the New York Association of Psychiatric Rehabilitation Services, told MHW. “This is a real step forward,” he said.
Rosenthal, a member of the New York State Coalition for Adult Home Reform, said he’s encouraged after many years of waiting. “I hope this will allow many more residents to enjoy life independently in the community with the right array of supports,” he said.
A long-time concern involves adult home operators who have been discouraging residents from moving or transitioning into the community. “Operators can’t be accountable if they try to discourage a person from leaving,” he said. The settlement addresses this concern, he noted. Residents are required to report if they are discouraged or experience any obstacles to transitioning to the community, said Rosenthal.
Rosenthal noted that since the settlement agreement in 2013, 650 adult home residents with serious mental illness have been transitioned into the community. Of that number, only five have gone back to the adult homes. The figures, he noted, were provided during recent budget testimony by NYS Office of Mental Health Commissioner Ann M. Sullivan, M.D.
“We’re in the fifth year of the settlement,” Borgmann told MHW. “We anticipated many more would have moved by now,” Borgmann said of the more than 600 out of 2,500 who have moved since 2013.
“That’s one of our concerns,” she said. Over the years, there have been many delays and roadblocks, Borgmann noted. “We’re trying to get at some obstacles and frustrations with
this draft agreement,” she added.
After Sept. 30, 2018, an adult home resident with a serious mental illness would not be part of the class action suit, she said. The settlement, however, will continue to be implemented through 2020, said Borgmann.
“Because the state was willing to settle with us and make improvements to the process, we settled with them,” she said.
Baumann added that the move would avoid spending the next two years in litigation, she said, adding that all parties will make sure to move as many people as possible over the next two years. The state must assess everyone in the class action lawsuit and move them into community housing, she said.
Moving forward, three dates are important, said Borgmann. “In 2018, by September we will know who all the parties are in the class action suit. By September 2019, those people will have had to make a decision — ‘Am I going to move?’ — and by 2020, the state must move all people eligible for release,” she said.
Part of this process involves decisions by adult home residents about whether to leave a home they’ve lived in for 5, 10 or even 25 years, said Borgmann. “It’s a hard decision,” she said. “They’ve been institutionalized for so long; they don’t trust their skills to live on their own. That’s the reason for the peer bridger program. We think that will help people who’ve lived in adult homes for so long and are hesitant to take that leap. They’re risk averse.”
Regarding important next steps, the parties are already beginning to plan for implementation of the supplemental agreement and to work out the details of some of the new structures that will be put in place, including training for the peer bridgers, the composition of a case review committee that will be set up to address and resolve individual issues of concern, the content of new reporting to the state and other issues, said the Bazelon Center’s Mathis. “The supplemental agreement will help ensure that implementation proceeds in a much more efficient and more timely way,” she said. •
New Peer Bridger Program To Be Created
A new peer bridger program at each of the homes that are part of the settlement will provide engagement and mentoring of adult home residents by peers who have lived experience with the mental health service system, and these peers will stay engaged with residents throughout the entire process through transition to community settings, said Mathis.
“The assessment process will also be streamlined by having the same agencies that conduct inreach also assess the residents with whom they engage in the inreach process, rather than having a separate entity perform these assessments,” she said. A new quality assurance process will provide for scrutiny of assessments, care management, service planning and transitions, she noted.
The bridger model was created by NYAPRS in the 1990s, when patients would transition from state hospitals into the community, added Rosenthal. “The model is being adapted for this population,” he said.