The Austen Riggs Center CHNA Implementation Strategy Adopted by the Austen Riggs Governing Board on April 16, 2014 This document describes how The Austen Riggs Center (Riggs or the Center) plans to address needs found in the Community Health Needs Assessment (CHNA) published by the Center on December 31, 2013. See the CHNA report at www.austenriggs.org/community-health-needsassessment. The implementation strategy describes how the Center plans to address identified needs in calendar years 2014 through 2016. The 2013 CHNA report and this implementation strategy were undertaken by the Center to understand and address community health needs, and in accordance with proposed Internal Revenue Service (IRS) regulations pursuant to the Patient Protection and Affordable Care Act of 2010. This implementation strategy addresses the significant community health needs described in the CHNA report. It identifies significant needs the Center plans to address through various strategic initiatives and articulates why the Center does not plan to address other needs identified in that report. The Austen Riggs Center reserves the right to amend this implementation strategy as circumstances warrant. For example, certain needs may become more pronounced and merit enhancements to the described strategic initiatives. Alternately, other organizations may decide to address one or more of the significant community health needs, and as a result the Center may amend its strategies and focus on other identified significant health needs. The document contains the following information: 1. About The Austen Riggs Center 2. Definition of the Community Served 3. Summary of Significant Community Health Needs 4. Implementation Strategy to Address Significant Health Needs 5. Needs The Austen Riggs Center Will Not Address 6. Implementation Strategy Adoption 1
1. About The Austen Riggs Center The Austen Riggs Center is a small, not-for-profit, open psychiatric continuum of care located in Stockbridge, Massachusetts specializing in the psychotherapeutic treatment of psychiatric disorders. The Center is committed to supporting its mission, to improve the lives of emotionally troubled and treatment-resistant patients by providing quality and cost-effective treatment. The focus throughout the Center s programs is on the importance of human relationships and the responsibility and dignity of the individual. 1 Established in 1919, the Austen Riggs Center is known for its internationally recognized tradition of providing intensive psychodynamic psychotherapy in a voluntary, open and non-coercive community. Riggs admits between 85 and 100 patients annually, with an average daily census of about 60 patients. According to U.S. News & World Report, the Center consistently is among the top-ranked psychiatric hospitals in the United States. The clinical program at Riggs has at its core individual psychotherapy with a clinical psychologist or psychiatrist. Supporting the psychotherapy is an interdisciplinary team of professionals, including nursing staff, social workers, teachers, and experts in psychopharmacology, substance abuse, and nutrition. A sophisticated Therapeutic Community Program surrounds the individual services, offering opportunities for participation in patient government, in social and recreational activities, and in reflective process groups. Balancing the clinical work is a novel Activities Program in which working artists provide instruction in painting, ceramics, woodworking, theater, and other artistic forms. Patients can also work in the nursery school, the greenhouse, or in various jobs in the work program. Each person works with staff to find the combination of services and activities suited to them, and no two treatments are exactly alike. For more facts and information about The Austen Riggs Center, please visit www.austenriggs.org/ 2. Definition of the Community Served In defining the community to be assessed, Riggs took into account the following facts and circumstances. Riggs is licensed as a psychiatric hospital, and provides treatment for patients with mental illness. Riggs provides clinical care for patients from all over the United States and from other countries. Through the work of its Erikson Institute for Education and Research, the Center provides educational, training, and research programs to clinicians throughout the U.S. (and internationally). It also provides education and outreach programs to organizations and clinicians in Berkshire County and the Northeast (defined as New England plus NY, PA, and NJ). 1 The Austen Riggs Center. Retrieved 2013, from http://www.austenriggs.org/about-austen-riggs-center 2
Riggs also maintains relationships with health and human services agencies located in Berkshire County. Taking the above considerations into account, Riggs defined and assessed health needs in local, regional, and national communities. The local community encompasses the entirety of Berkshire County, Massachusetts. The regional community includes the New England states, New York, Pennsylvania, and New Jersey. The three communities are comprised largely of patients with complex psychiatric disorders (e.g., multiple co-morbid conditions, severe and persistent psychiatric symptoms, and functional impairment) and the professionals (and organizations) who serve them. Service to these communities includes treatment, education and training, research, and outreach. More specifically: While few of the Center s patients come from the Berkshire County, the Center offers education and outreach to clinicians and organizations in this local community. At the regional level, 52 percent of the Center s patient population is drawn from the Northeast (New England states plus NY, PA, and NJ), and a robust program of education and outreach is provided to clinicians who treat patients with complex psychiatric disorders in the region. The national population of patients with complex psychiatric disorders, and the clinicians who treat them, is the broadest and most significant community. This encompasses the Center s full patient population as well as the population of treaters served through education, training, and research efforts. Additional information regarding community demographics, identified health needs, and related issues is included in the CHNA report. 3. Summary of Significant Community Health Needs The Austen Riggs Center s 2013 CHNA identified mental health needs unique to each community and needs shared across communities. The CHNA process considered and evaluated a wide range of primary and secondary data sources including structured interviews with persons who represent the broad interests of the community and those with expertise in public health, assessments and studies prepared by other organizations regarding local and regional mental health needs, data provided by Riggs regarding patient characteristics, a literature review, and analysis of relevant quantitative indicators regarding mental health status and access to services. The CHNA report determined that seven health priorities are significant in the local, regional, and national communities, as described below. 3
Berkshire County: Significant Community Health Needs Identified in the 2013 CHNA 1. Adolescent suicide prevention 2. Adolescent and adult substance abuse (prescription drugs, alcohol, marijuana, opioids) 3. Enhanced access to quality mental health care services for: a. Low-income populations b. Children/adolescents c. Veterans and members of law enforcement with PTSD Regional/National Community: 4. More mental health (and primary care) professionals who are trained in psychodynamic psychotherapy, psychodynamic psychopharmacology, and other evidence-based practices 5. Continued development and application of research to further understanding of psychodynamic psychotherapy and psychodynamic psychopharmacology 6. Enhanced access to mental health care services for low-income and vulnerable populations, including psychiatrists and other mental health professionals 7. Enhanced awareness regarding the benefits of psychodynamic psychotherapy and psychodynamic psychopharmacology among clinicians, patients, and people at large The 2013 CHNA report conducted by The Austen Riggs Center is available at www.austenriggs.org/community-health-needs-assessment. 4. Implementation Strategy to Address Significant Health Needs This implementation strategy describes how The Austen Riggs Center plans to address the significant community health needs identified in the 2013 CHNA. The Center reviewed the CHNA findings and applied the following criteria to determine the most critical and appropriate needs for Riggs to address: The extent to which Riggs has resources and competencies to address the need; The impact that Riggs could have on the need (i.e., the number of lives Riggs can impact); The frequency with which stakeholders identified the need as a significant priority; and The extent of community support for Riggs to address the issue and potential for partnerships to address the issue. By applying these criteria, Riggs determined that it will address the significant health needs identified by Y (for Yes) in the table that follows. Issues identified by N (for No) represent issues 4
that Riggs does not plan to address during the 2014-2016 time period. Needs that Riggs plans to address indirectly (e.g., by initiatives to help educate professionals who provide treatment to low-income populations) are identified by I (for Indirect). Significant Community Health Needs Identified in the 2013 CHNA Berkshire County: Intend to Address Directly (Y/I/N) 1. Adolescent suicide prevention N 2. Adolescent and adult substance abuse (prescription drugs, alcohol, marijuana, opioids) I 3. Enhanced access to quality mental health care services for: a. Low-income populations I b. Children/adolescents I c. Veterans and members of law enforcement with PTSD I Regional/National Community: 4. More mental health (and primary care) professionals who are trained in psychodynamic psychotherapy, psychodynamic psychopharmacology, and other evidence-based practices Y 5. Continued development and application of research to further understanding of psychodynamic psychotherapy and psychodynamic psychopharmacology 6. Enhanced access to mental health care services for low-income and vulnerable populations, including psychiatrists and other mental health professionals 7. Enhanced awareness regarding the benefits of psychodynamic psychotherapy and psychodynamic psychopharmacology among clinicians, patients, and people at large N I Y This implementation strategy describes how Riggs plans to address the significant health needs identified in the 2013 CHNA. For each significant health need that Riggs intends to address, the strategy describes: Actions Riggs intends to take, including programs and resources it plans to commit; Anticipated impact of these actions and a plan to evaluate that impact; and Planned collaborations between Riggs and other organizations. 5
Needs that Austen Riggs Plans to Address Directly More mental health (and primary care) professionals who are trained in psychodynamic psychotherapy, psychodynamic psychopharmacology, and other evidence-based practices in the Regional/National Community: 1. To address this need, The Austen Riggs Center will continue providing the following program initiatives: Austen Riggs Fellowship in Psychoanalytic Psychotherapy/Psychoanalytic Studies Austen Riggs, through its Erikson Institute, offers post-graduate Fellowships in psychodynamic psychotherapy and psychoanalytic studies. The Fellowship is two years in duration with the option of an Advanced Fellowship for two additional years. A majority of Fellows opt to continue into advanced training to complete the psychoanalytic studies program. Educational Programs via the Erikson Institute The education and training programs of the Erikson Institute offer many opportunities for learning and application of psychodynamic thought and treatment. Through continuing education through conferences and presentations, the Erikson Institute provides an array of learning programs from the annual Fall Conference, the Creativity Seminar, and the regular Friday Night Guest Lecture series -- all directed toward an integrated bio-psychosocial understanding of the troubled person and their familial and social contexts. Continuing education credits are provided for a variety of disciplines (MD, PhD, MSW). Grand Rounds and Presentations Members of the clinical staff at Austen Riggs regularly provide Grand Rounds presentations and seminars to teaching hospitals, academic institutions and professional organizations on a wide range of topics related to psychodynamic psychotherapy and learning from the patient population. Austen Riggs Library The Austen Riggs Library has extensive holdings in the areas of psychiatry, psychology and psychoanalysis. These are overseen by a professional librarian. The collection is used by Riggs staff and Fellows for research, and the library is available to local professionals and visiting scholars. There is a section of the library designated for Riggs patients and their families. Evelyn Stefansson Nef Scholarship Each year, the Erikson Institute awards three $1,000 scholarships to local graduating high school seniors in Berkshire County. The scholarships are awarded to the high school students who have been selected for their academic achievements, pursuit of study in the social sciences or pre-medicine, and their leadership in the community. The scholarships are named in memory of Evelyn Stefansson Nef, an author, lecturer, patron of the arts, 6
philanthropist, Arctic explorer and psychotherapist, who was a benefactor of the Austen Riggs. Internships The Cambridge Health Alliance (CHA) Psychology Department and the Erikson Institute have formed an affiliation for the purpose of increasing training opportunities for CHA Pre-Doctoral Psychology Interns. This is accomplished through twice-yearly two-day visits of the interns to Riggs and weekly psychotherapy supervision with a senior Riggs therapist. 2. The Austen Riggs Center also plans to initiate the following programs during the 2014-2016 time period: Web Delivery of Continuing Medical Education (CME) Seminars The Austen Riggs Center is developing a clinician community on its website, scheduled to launch in 2014. A central component of the community will be the opportunity for physicians to obtain CMEs through participation in webinars on relevant topics delivered by Riggs clinicians. Possible Collaboration with Local Human Service Organizations The Austen Riggs Center plans to meet with representatives from local human service organizations to explore needs and potential for collaboration regarding education and training. Anticipated Impact: Austen Riggs anticipates that the above program initiatives will contribute to enhancing the number of professionals trained in psychodynamic psychotherapy, psychodynamic psychopharmacology, and other evidence-based practices in the Regional/National Community. The work of professionals trained in these areas has been demonstrated to be effective in addressing patient needs. These professionals themselves also will play a role in educating others in these disciplines. Evaluation Plan: Impacts will be measured by keeping records regarding the number of professionals that Riggs trains. When Riggs conducts another CHNA in 2016, the Center plans to seek input from interviewees and to review updated literature regarding the impacts associated with the specified education programs. Planned Collaboration: As outlined above, Riggs will collaborate with the Cambridge Health Alliance and local human service organizations. Ongoing collaborations with teaching hospitals, academic institutions and professional organizations for Grand Rounds presentations and seminars will continue. Enhanced awareness regarding the benefits of psychodynamic psychotherapy and psychodynamic psychopharmacology among clinicians, patients, and people at large in the Regional/National Community: 7
1. To address this need, The Austen Riggs Center will continue providing the following program initiatives: Scholarship Scholarship at the Center includes empirical, phenomenological and clinical studies and inter-institutional collaborations. Research labs on Self-Destructiveness, Psychosis and Structural Change are underway, some of which are in collaboration with other institutions. The Yale/Riggs Partnership The Riggs-Yale partnership has a long and rich history. In recent years, Riggs clinical staff members have taught a spring seminar to Fellows in Child Psychiatry at the Yale Child Study Center. Riggs staff also give an annual Erikson Lecture in the Child Study Center s Grand Rounds program. Since 2012, the Yale Child Study Center, the Department of Psychiatry at Yale University School of Medicine and the Erikson Institute have brought together their clinical and research interests to jointly sponsor annual conferences focused on issues related to parenting and child development. Grand Rounds and Presentations Members of the clinical staff at Austen Riggs regularly provide Grand Rounds presentations and seminars to teaching hospitals, academic institutions and professional organizations on a wide range of topic related to psychodynamic psychotherapy and learning from the patient population. Austen Riggs Library The Austen Riggs Library has extensive holdings in the areas of psychiatry, psychology and psychoanalysis. These are overseen by a professional librarian. The collection is used by Riggs staff and Fellows for research, and the library is available to local professionals and visiting scholars. There is a section of the library designated for Riggs patients and their families. Erikson Scholar Program This endowed scholar-in-residence program brings scholars to the Center to carry out their research projects in conversation with the clinical staff. Scholars are selected both for the centrality of their theme to the work of the staff and for the potential of that work to enrich and be enriched by interaction with the clinical program. Academicians, clinicians and other professionals are invited into the clinical and intellectual life of the Center through participation in seminars, lectures, case discussions and other interdisciplinary activities. Hosting of Professional Groups Austen Riggs provides space to relevant regional organizations to use for their meetings and conferences. Examples include the Western Massachusetts and Albany Association for Psychoanalytic Psychology (WMAAP), the Rapaport-Klein Study Group, the Lacanian Clinical Forum, Berkshire Psychoanalytic Institute, and the Boston Center for the Study of Groups and Social Systems. 8
2. The Austen Riggs Center also plans to initiate the following programs during the 2014-2016 time period: Yale/Riggs 2014 Conference on Early Childhood Adversity As part of the Yale/Riggs partnership above, the 2014 conference (May 16-17, 2014 in Stockbridge) will focus on early childhood adversity and its impact on psychopathology. Possible Collaboration with National and Local Human Service Organizations The Austen Riggs Center plans to meet with representatives from national and local human service organizations to explore needs and potential for collaboration regarding education and training. Anticipated Impact: As additional professionals, patients, and communities become aware of the benefits of psychodynamic psychotherapy and psychodynamic psychopharmacology, Austen Riggs anticipates that demand for these services will increase contributing to greater access to quality mental health services over the next few years. Evaluation Plan: When Riggs conducts another CHNA in 2016, the Center plans to seek input from interviewees and to review updated literature to assess the extent to which awareness of the benefits of psychodynamic psychotherapy and psychodynamic psychopharmacology has increased. Planned Collaboration: Collaborations will continue with the Yale Child Study Center, the Department of Psychiatry at Yale University School of Medicine, and with teaching hospitals, academic institutions and professional organizations on Grand Rounds presentations and seminars. Riggs will also continue to provide meeting space to relevant local organizations as noted above. Future collaborations with other organizations are possible. Needs that Austen Riggs Plans to Address Indirectly For each of the needs identified below, the Austen Riggs Center will continue offer a limited number of scholarships (to attend Riggs-sponsored educational programs) to local human service organizations whose missions align with these needs. Criteria will be established for these scholarships. Riggs will also consider making charitable community benefit grants to organizations that serve these populations. Adolescent and adult substance abuse (prescription drugs, alcohol, marijuana, opioids) in Berkshire County 1. To address this need, The Austen Riggs Center will continue providing the following program initiatives: College Counseling Service 9
In the last several years, college counseling services across the country have seen an increase in the number of students seeking treatment, an increase in the range and severity of student problems and a broadening of the role of the counseling service. Since 2002 Austen Riggs has been collaborating with the regional college counseling service network to deliver programs and consultation on the issues affecting college age students from substance abuse to psychiatric problems. 2. The Austen Riggs Center also plans to initiate the following programs during the 2014-2016 time period: Educational Programs for Local Human Service Organizations The Austen Riggs Center plans to meet with representatives from local human service organizations to explore needs and potential for collaboration regarding education and training. Anticipated Impact: Austen Riggs anticipates that the above program initiatives will help individuals and organizations who are working to address identified adolescent and adult substance abuse (prescription drugs, alcohol, marijuana, opioids) needs in Berkshire County enhance their effectiveness. Evaluation Plan: Impacts will be measured by documenting the Center s work to implement the above initiatives. Riggs also will seek evaluations from program participants regarding the benefits of their participation in Fall Conference, Creativity Conference and other Riggs sponsored events. Riggs also will request that Berkshire County organizations that have received charitable contributions to provide brief reports regarding the impact of grants provided. Planned Collaboration: Collaboration with regional college and university counseling programs will continue and Riggs will explore future collaboration with local human service organizations. Enhanced access to quality mental health care services for low-income populations in Berkshire County 1. To address this need, The Austen Riggs Center will continue providing the following program initiatives: See above re: Free Registration for Events 2. The Austen Riggs Center also plans to initiate the following programs during the 2014-2016 time period: Collaboration with Local Human Service Organizations The Austen Riggs Center plans to meet with representatives from local human service organizations to explore needs and potential for collaboration regarding education, training and consultation. 10
Anticipated Impact: Austen Riggs anticipates that the above program initiatives will help individuals and organizations who are working to address mental health needs of low-income populations in Berkshire County enhance their effectiveness. Evaluation Plan: Impacts will be measured by documenting the Center s work to implement the above initiatives. Riggs also will seek written evaluations from program participants regarding the benefits of their participation in conferences and other education and training provided to clinicians. Riggs also will request that Berkshire County organizations that have received cash and/or in-kind donations (e.g., the time devoted by Riggs s Director of Development) to provide feedback regarding the impact of donations provided. Planned Collaboration: Collaboration with local human service organizations. Enhanced access to quality mental health care services for veterans and members of law enforcement with PTSD in Berkshire County: 1. To address this need, The Austen Riggs Center will continue providing the following program initiatives: No current initiatives in place. 2. The Austen Riggs Center also plans to initiate the following programs during the 2014-2016 time period: Collaboration with Local Human Service Organizations The Austen Riggs Center plans to meet with representatives from local human service organizations to explore needs and potential for collaboration regarding education, training and consultation. Anticipated Impact: Austen Riggs anticipates that the above program initiatives will help individuals and organizations who are working to enhance access to quality mental health care services for veterans and members of law enforcement with PTSD in Berkshire County enhance their effectiveness. Evaluation Plan: Impacts will be measured by documenting the Center s work to implement the above initiatives. When Riggs conducts another CHNA in 2016, the Center plans to seek input from interviewees representing key local organizations to assess impact. Planned Collaboration: Collaboration with local human service organizations. Enhanced access to mental health care services for low-income and vulnerable populations, including psychiatrists and other mental health professionals in the Regional/National Community 11
1. To address this need, The Austen Riggs Center will continue providing the following program initiatives: Graduate Training Conference Austen Riggs sponsors an annual conference for individuals from psychodynamic graduate and internship programs to discuss challenges facing those programs. The first conference was held in 2013 College Counseling Service In the last several years, college counseling services across the country have seen an increase in the number of students seeking treatment, an increase in the range and severity of student problems and a broadening of the role of the counseling service. Since 2002 Austen Riggs has been collaborating with the regional college counseling service network to deliver programs and consultation on the issues affecting college age students from substance abuse to psychiatric problems. Fee Reductions This includes operating revenue, income from the patient aid endowment fund, as well as annual donations restricted to patient aid support. On average, 20-30% of patients benefit fee reductions that total approximately $500,000/year. In the past 20 years, more than 500 patients have received support. 2. The Austen Riggs Center also plans to initiate the following programs during the 2014-2016 time period: No new initiatives planned Anticipated Impact: Austen Riggs anticipates that the above program initiatives will help individuals and organizations who are working to address mental health needs of low-income populations and of psychiatrists and other mental health professionals in the Regional/National Community. Evaluation Plan: Impacts will be measured by documenting the Center s work to implement the above initiatives, including the amount of financial assistance (fee reductions) provided. Riggs also will seek written evaluations from participants in training events and the regional counseling service regarding the impact of the described initiatives. Planned Collaboration: Collaboration with regional college and university counseling programs will continue, as will collaborations with graduate training programs. Enhanced access to quality mental health care services for children/adolescents in Berkshire County 1. To address this need, The Austen Riggs Center will continue providing the following program initiatives: 12
See above re: Free Registration for Events 2. The Austen Riggs Center also plans to initiate the following programs during the 2014-2016 time period: Collaboration with Local Human Service Organizations The Austen Riggs Center plans to meet with representatives from local human service organizations to explore needs and potential for collaboration regarding education, training and consultation. Anticipated Impact: Austen Riggs anticipates that the above initiatives will help individuals and organizations who are working to address mental health needs of children/adolescents in Berkshire County enhance their effectiveness. Evaluation Plan: Impacts will be measured by documenting the Center s work to implement the above initiatives. Riggs also will seek written evaluations from staff who participate in education and training services offered by Riggs regarding the benefits of their participation. Planned Collaboration: Riggs will collaborate with local human service organizations. 5. Needs the Austen Riggs Center Will Not Address No entity can address all of the health needs present in its community. The Austen Riggs Center is committed to serving the community by adhering to its mission, using its skills and capabilities, and remaining a strong organization so that it can continue to provide a wide range of community benefits. This implementation strategy does not include specific plans to address the following health priorities that were identified in the 2013 Community Health Needs Assessment: Adolescent suicide prevention in Berkshire County: Austen Riggs specializes in the treatment of adults and believes that its resources would be more effectively applied to other identified, significant community health needs. Although Austen Riggs does not plan to address adolescent suicide prevention directly, the hospital is open to exploring opportunities for collaboration with organizations that are working on this need. Continued development and application of research to further understanding of psychodynamic psychotherapy and psychodynamic psychopharmacology in Regional/National Community: Riggs intends to explore (through working groups and other means) enhancing and applying the results of its research activities. These plans currently are in development and are not ready to be articulated at this time. It is also important to note that Riggs does not currently have a dedicated research department. 6. Implementation Strategy Adoption The Executive Committee of the Board of Trustees of the Austen Riggs Center reviewed and adopted this plan on behalf of the Board of Trustees at its April 16, 2014 meeting. 13
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