Systems Implications of Parachute NYC - Back to the future: Moving to Home and Community Based Services

Background: Parachute NYC intends to change the system from within through a community-based treatment model for psychosis. Parachute includes peer run Respites, Mobile Crisis Teams that integrate peers, a peer run telephone support line and Peer Health Navigation. Since these are emblematic of 1915i-like Home and Community Based Services (HCBS) that will be available in NYS Medicaid Health and Recovery Plans (HARPS) designed for high need people with significant behavioral health conditions, Parachute experience can guide HCBS services going forward.

 Methods In 2012 NYC Department of Health & Mental Hygiene received a three year federal grant to adapt 3 mobile crisis teams operated by NYC Visiting Nurse Services throughout NYC to treat people in crisis at home with their family of choice for up to one year. The new teams integrated peers and coordinated with respite centers, presenting challenges and opportunities for local government and behavioral health.  

 Results This presentation will describe from a policy maker’s perspective, the rationale for NYC to lead this project, government’s role as an agent for change and the model’s sustainability.

 Implications The process evaluation provides a window on the implementation challenges HARPS services might face in bringing these innovative HCBS service categories to scale. Results point to the need for the leadership and structure that a Parachute Practice Community could provide for all stakeholders to develop practical guidance for integrating peers into clinical mobile teams and for developing business models to sustain services as defined in Medicaid 1915i waivers.