The human services model in McKean County works, says Lee Sizemore, county human service administrator.

But both the state House and Senate are considering bills that would shift control of county services away from county employees. The proposed changes would affect behavioral health services, including mental health and addiction services, as well as physical health services.

What would those changes mean for McKean County residents?

“There are 3,112 people on Medicaid that receive behavioral health services in McKean County,” said Sizemore. “This population would be negatively impacted by House Bill 335 if this legislation would be enacted.”

The current system is simpler and it works, according to Sizemore.

“The existing Carve Out/Integrated Human Services Model successfully addresses the various behavioral health and social services needs of the Medicaid population,” she explained. “To change models at this point could do more harm than good.”

She indicated that local control means more efficient programs and services, which means programs work better for clients and are more cost-effective.

As the Warren County commissioners explained in a recent statement on their opposition to the proposed legislation, “21 years ago, the Counties in Pennsylvania were ‘carved-out’ of the Human Services Managed Care system and given the opportunity to define their own programs, contract with local agencies for services, and provide oversight and accountability to how services were provided and monitor their quality.”

That carve-out has made Pennsylvania’s human service model “both a picture of efficiency and affordability,” the Warren commissioners said.

Sizemore agrees.

She explained, “The model efficiently streamlines resources and reduces healthcare costs. The savings is reinvested back into services.”

Those dollars have meant improvements in many programs. Sizemore shared a long list of those improvements.

For individuals with mental illness, the county started a Mental Health Warm Line for people to call for support and care, started the STEPS Drop-In Center in Bradford that provides recreational and social opportunities for adults and continued a Rental Assistance and Bridge Housing program.

For substance abuse issues, the reinvestments meant a new “drug and alcohol case management position at Alcohol and Drug Abuse Services to address addictions in the community,” as well as an expansion of Maple Manor and increased short- and long-term inpatient drug and alcohol treatment opportunities, said Sizemore. This was important as the county battled the opioid epidemic.

Local youth benefitted from a new Adolescent Drug and Alcohol Program, as well as a Community-School Behavioral Health Teams (CCBH), which Sizemore said is “a coordinated approach to serving children with behavioral health disorders in the Bradford Area School District.” A new faith-government partnership — The Open Table — provides a group of seven faith-based volunteers to mentor one transition-age youth for one year, “walking alongside this person to give a hand up out of poverty,” she said.

Both mental health and behavioral health services were strengthened by reinvestment dollars when professional staff were trained in trauma therapies, and both Alcohol and Drug Abuse Services and The Guidance Center were certified as Trauma Clinics.

Additionally, “The Carve Out allows counties to focus on the social determinants of health. The best example of this is with housing,” she said. “Each year, with reinvestment dollars, McKean County is able to help homeless individuals and those needing rapid rehousing.”

Not only is there a cost savings, the current model provides services efficiently.

Sizemore explained, “McKean County has local control over the design and delivery of services. The Behavioral Health Managed Care Organization works for the county and collaborates closely with county-based human service agencies for all Medicaid enrollees streamlining service coordination and increasing service efficiencies.”

She said McKean County is on the board of the Behavioral Health Alliance of Rural PA, which is a consortia of 23 counties in the North Central area of PA. She explained, “This board is able to manage services and design and create new services.”

A few of the new or improved services, according to Sizemore, are Dual Diagnostic Treatment Teams, Trauma Therapies, Adolescent Drug and Alcohol Treatment, improved models for Crisis Services and Behavioral Health Services, Housing Supports, Peer Support Services, Medication Assisted Therapy, a Behavioral Health Home model for individuals are assisted by a nurse to improve health outcomes, Tele-psychiatry and two Bradford-based specialized residential treatment programs for youth.

It’s not just McKean County that is seeing benefits from the current human service model — it’s all of Pennsylvania, according to Sizemore. She provided statistics on a few areas Pennsylvania is leading the nation.

“Pennsylvania leads in performance in the following three key national care quality outcomes”:

• Diabetes screening rates: Pennsylvania leads at 84.6 percent; median rate is 78.6 percent

• More people with serious mental illness adhere to prescribed medications: Pennsylvania leads at 71 percent; median rate is 61 percent

• Fewer youth receiving multiple antipsychotic medications: Pennsylvania leads at 1.6 percent; median rate is 3.0 percent

She added, “Physical Health/Behavioral Health integration is occurring in behavioral health led via the Behavioral Health Home Plus model, which shows that 83 percent of members served had at least one visit with their PCP in the past six months.”

Sizemore is concerned at how changes would affect Pennsylvania’s ability to continue to battle the opioid epidemic from a human services standpoint.

She explained, “The existing Carve Out/Integrated Human Services Model has been addressing the Opioid Crisis both from the behavioral health and physical health perspective and to change models at this point could have a potentially detrimental effect.”

She noted that in the 23-county North Central contract, access to evidence-based Medication Assisted Therapy (MAT) for opioid addiction has dramatically increased.

In 2015, more than 5,000 members were accessing MAT, and by 2016, that number had jumped to over 7,000. More than 8,000 members were accessing MAT in 2017.