Family Services, which has behavioral health clinics in Kingston and Highland in Ulster County and Rhinebeck and Poughkeepsie in Dutchess hopes to expand its clinical staff from about 30 clinicians to 47-48 clinicians by the end of June to better serve clients as demand for its services continues to increase.
Brian Doyle, the not-for-profit agency’s chief executive officer, said the hirings will allow it to reduce caseloads for each clinician allowing people to be seen more often and have longer sessions. “Instead of a 30-minute session, they can have a 45-minute session,” Doyle said. “It can be a big difference and that’s our aim.
He estimates Family Services’ behavioral health services serve about 5000 residents in Ulster and Dutchess — a number that’s only increased during the COVID-19 pandemic. “Uncertainty around COVID has created greater levels of anxiety and depression,” Doyle said. “People have become more isolated from their natural supports…All of this places great stress on the hearts and spirits of the people in the community and people we serve.”
Doyle admitted Family Services’ capability to meet demand with present staffing is limited. “We’re not always able to meet that demand because of staffing shortages,” he said. “A person who was seen once a week may only be able to be seen once every two or three weeks.”
Like many other employers, Family Services has seen an estimated 40 percent employee turnover during the course of the pandemic. “People are leaving for alternatives and people are leaving for a different professional pursuit,” Doyle said. He admitted high turnover can make giving clients the care they need more difficult. “Continuity of care is really important to the clients and to the way in which we provide services.”
Aggressive recruiting of new staff
Doyle said Family Services is trying to attack staffing shortages by working at recruiting new clinicians — raising salaries to meet raising salary demands and trying to find a balance with the desires of clinicians and providers of services who want to work remotely with the needs of clients. “We can’t move all of our clinic services to a remote platform, but we’re trying to strike that balance …”
He said recruits need to have a credential in mental health counseling or social work. “We also look for those who have either achieved or [are] working on actual licensure for their credential,” he said. Once a clinician joins Family Services they provide training and orientation with supervision by experienced and credentialed supervisors.
Doyle said they’ve also tried to find the balance between clients and staff by keeping the clinics open an extra 30 minutes to an hour in all their centers. He said the additional hours not only allow for additional appointments but also for ancillary work, such as administrative tasks, preparing documentation and perhaps making a follow-up call to a family member.
“We’re at the early stages but we’re encouraged by the extent we’ve been able to attract more clinicians,” he said.
Funding to provide these services comes from Medicaid, Medicare and private insurance. Also, Family Services has supplemental contracts with the Ulster County Department of Mental Hygiene and the Dutchess County Department of Community and Behavioral Health.
“Even then money can still be tight. The reimbursement from Medicaid, Medicare and private insurance is not keeping up with salary demands and other expenses,” Doyle said. “That’s a struggle.”
COVID-19 forces changes in delivery
Beyond staffing, the pandemic has also forced Family Services to make a number of changes in the way it delivers services. Most recently the highly-contagious Omicron variant, which has spread throughout the world and led to the highest active case counts of the pandemic locally, has forced the not-for-profit to again shift most of its services to virtual-only, echoing the early days of the pandemic in spring 2020.
Doyle said that decision will be revisited on January 27. He noted the not-for-profit had been able to bring back a good deal of in-person services in 2021 as widespread vaccination allowed.
Recalling the earliest days of the pandemic, he said the virus forced Family Services to rapidly deploy technology to the staff so they work virtually. “We were making connections to people we provide services to in different ways,” he said.
But he admits in most cases in-person services are still much better. “There is the human connection that is closer in in-person settings,” he said. “And that’s just universal to human beings. Remote means removed.”
When a therapist sees a client in person they are better able to observe the behaviors and other aspects of the person they are working with. And, he said, the in-person benefits are a two-way street. “The client is better able to read the effect of the clinician and is better able to read a sense of caring about [their own] well-being,” he said.
Remote services offer other benefits
That said, Doyle noted Family Services discovered a number of benefits from going remote and they have plans to continue remote services even after pandemic subsides. This was particularly true for clients who live far away from a clinic and face transportation issues that make it difficult to make it to appointments. He noted the schedules and routes of buses operated by Ulster County Area Transportation in Ulster County and Dutchess Loop across the Hudson don’t always work out for people. Still others were busy parenting or serving as a caregiver to other needy family members.
But with online services, those barriers were surmounted, and he noted Family Services actually saw a decrease in cancellations of appointments during the pandemic. Regulated agencies were forced to relax restrictions on telehealth during the pandemic allowed the not-for-profit greater leeway in offering treatment by virtual means.
But, though many clients were able to connect with Family Services virtually, others still struggled with online appointments due to limits on internet access or limited technical ability.
“Those hindered our efforts and we’ve doubled down to reduce or eradicate those restrictions and inhibitors,” Doyle said. Initiatives include staff who can assist individuals with technical needs and also technology. Family Services also plans to roll out the technology to its clients in part due to a grant secured by State Sen. Michelle Hinchey.
A future with more integrated services
Looking ahead Doyle envisions Family Services offering more integrated services in one-stop locations throughout Dutchess and Ulster counties.
He said Family Services’ new Poughkeepsie location features trauma-informed design and environment while housing a Sun River Health primary care clinic in the same building. “We’re finding it’s important to help treat a whole person as diabetes and other ailments impact behavioral health, and behavioral health impacts caring for diabetes.”
The site is to have a pharmacy on-site providing clients easier access to the medications they need, he said.
A similar one-stop location could be in the cards for Kingston thanks to a partnership between Family Services and Ulster County. “The county is taking a lead in the organization of integrated care,” Doyle said. Family Services presently offers one-on-one treatment by social workers and counselors, psychiatrists, nurse practitioners and group therapy of various types.
The agency also recently opened a new site in Highland on January 3, replacing a previous clinic in New Paltz. Doyle said this one is also close to a Sun River Health clinic. “We’ll be looking for collaborations,” Doyle said.
Lost beds in Ulster
Officials in Ulster County have scrambled to scale up mental health resources after HealthAlliance parent WMCHealth pulled inpatient mental health services out of the former Benedictine Hospital campus on Mary’s Avenue in Kingston and moved the beds to WMCHealth’s Mid-Hudson Regional Hospital in Poughkeepsie and other WMCHealth sites in 2020. Originally stated to be a temporary measure to free up space at the Mary’s Avenue Campus for COVID-19 beds during the first wave of the pandemic in spring 2020, inpatient mental health services have yet to return to Kingston, drawing ire from residents and County Executive Pat Ryan and the Ulster County Legislature.
“That’s unfortunate those beds have been lost,” Doyle said, while noting that most clients Family Services works with do not require inpatient stays. “Overall the community benefits from having inpatient beds close to where clients live and near their families,” he said. “Families provide support.”
For more information about Family Services visit h.