March 3, 2021 • 42 mins
The mission is simple: Help people to live the healthiest and fullest lives possible. With 1500 employees, Access: Supports for Living supports 11,000 people in the Hudson Valley each year through a broad range of programs including behavioral and mental health services, substance abuse counseling and support, children and family services, services for individuals with intellectual and developmental disabilities, longterm residential services, respite care, affordable permanent housing, and employment services (to name a few!). This week we're talking about the challenges this incredible organization faced during the early days of the pandemic, how they pivoted, and how they're moving forward.
This week's episode features Ron Colavito, President & CEO at Access: Supports for Living.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:03):
We are experiencing a paradigm shift, a fundamental
change in the way we usually dothings.
We are intentionally choosing tosee the silver lining
opportunity arises.
We can shine a light on thethings that weren't working well
(00:25):
on those things that weren'treally working at all, we can
regroup reevaluate andre-engineer it's time to explore
new patterns and paradigms thosethat inspire us to rise above
the chaos and explore how theconditions of today and take us
(00:47):
to a better tomorrow patternsand paradigms the pattern
podcast from Hudson Valleypattern for progress.
You're listening to season twoepisode nine, access supports
for living with your hostpattern, president and CEO,
Jonathan Dropkin.
Speaker 2 (01:05):
Thanks for joining us for another episode of patterns
and paradigm.
Um, I hope you enjoyed our lastone with Barry Roth bell.
Barry's one of the trulyaccomplished members of the
media profession.
Um, I hope you enjoyed hisinsight.
If you did, please remember toask someone to take a, listen to
(01:27):
one of our podcasts.
You can find it on Apple orSpotify and wherever else you
find your podcasts, this week'strend or bubble.
I keep returning to this, thisbusiness of electric cars.
So there've been a lot ofannouncements coming out of
(01:48):
Washington from Ford, fromgeneral motors about what the
United States is doing.
So pattern and paradigm took alook at what was happening in
China, Europe, Japan.
And it's interesting someaspects of the search for that
(02:09):
affordable electric vehicle thatmakes everyone happy are
advanced.
Tesla has been added for 14years, but China's ability to
throw money at this and theirability to automate.
You know, they're not reallyworried about unions and we are
(02:30):
because they're good wagepositions, as long as we can
protect them.
This is without a doubt a trend.
But if there is a race to find avariety of electric vehicles,
Europe, Japan, China are goingto quickly outpace the United
(02:53):
States unless there is somethingreally dramatically different in
how we approach the creation ofsuch vehicles.
So this one's a trend, not abubble it's going to happen, but
we're going to need to beaggressive or imaginative in a
way in terms of how to produceit.
(03:14):
One of the point of, you know,China, for instance, supply
chain, you know, the batteriesthey have, the supply chain
issue completely figured out.
They just don't have enoughproduction vehicles yet.
Let me ask, uh, what's up JD,and I'm going to ask myself,
this question is what pattern isworking on this week.
(03:35):
I wanted to just briefly mentiona large project that we're
working on in orange County.
It has a lot to do with conflictresolution.
And I wanted to just clarify forour listeners who may know
something about this project, itwas designed.
It had been five years in themaking.
And initially it was birthed outof the conflict between the
(03:58):
ultra Orthodox population andthe rest of orange County.
This project is not going tosolve that tension.
This project is going to attemptto find a piece of that tension
and create a pilot program forhow mediation conflict
(04:22):
resolution can possibly resultin a better way than litigation
or anger.
Does it solve the big picturecompletely?
No.
And at the same time, we'restill in the process of looking
at one that is a piece of thesocial justice issues.
(04:44):
And we're looking at a number oftopics and we hope to have the
second one of those settled on,we did find one involving water
in the town of Woodbury.
And that's what we're going tobe looking at as a way to bring
the ultra Orthodox or Haredicommunity to the table, along
(05:08):
with the decision-makers in thetown of Woodbury.
Um, so more on that one to comethis week, we're really excited
to have Ron Colivida thepresident and CEO of access
supports for living.
Ron is a long time employeethere.
(05:29):
And in 2019 was elevated to bethe president and CEO.
For those of you that don't knowaccess, it's a hundred million
dollar organization.
It has well over 1500 employees.
It touches all nine of thecounties and lots of Valley that
pattern works on.
They work with people with bothmental and physical
(05:53):
disabilities.
And, um, I think you're going toenjoy the conversation with Ron
as Ron really tried to look veryhard at where they were before
the pandemic, what the pandemicdid to change their model for
service delivery, and then whataspects of it might be in the
(06:13):
future to remain.
And that's very much the themeof patterns and paradigms.
Hi, Ron, how you doing?
And, and, and ha how have youbeen managing through the
pandemic and your staff?
You know, I'm just curious, likeon, I ask all of my guests, hi,
how are you doing?
Speaker 3 (06:32):
Um, well, well, thanks Jonathan.
Thanks for having me.
Um, I mean, I think we're, youknow, we're doing where we've,
we've pivoted, um, in a numberof waves over the last several
months, and I think things, youknow, continue to adapt, but,
um, we have a great team that's,um, that's working, I would say
kind of beyond full speeds still.
So, um, you know, everythingfrom our frontline staff or who
(06:53):
are right there in the trenches,leading the work to the
leadership team is making sure,you know, we're getting
resources and safety and nowvaccine management, um, and, you
know, access to vaccineavailable, um, to the, to all
the individuals that we supportas well as, um, you know, to our
staff.
So, I mean, I think, um, we're,we're doing a, I guess as well
(07:16):
as can be expected, I thinkwould be the, probably the best
way.
And in some cases, um, I wouldsay better than expected, still,
still growing and still findingopportunities.
Speaker 2 (07:25):
Well, and I think doing as well as could be
expected or better than expectedputs you well above many other
organizations, so kudos to youand the whole team at access
for, for doing that, um, for thebenefit of our listeners, why
don't we just take a step backand describe the mission of
(07:47):
access and why don't you correctme?
Because my natural inclinationwould be the people that you
serve or clients, but that maynot be the right term.
Speaker 3 (07:59):
Sure.
So, I mean, just starting there,um, we just refer to them as
people.
Um, the, there are people likeyou and I, um, and they happen
to utilize different, um,different supports and different
services that the organizationprovides.
Um, you know, tying to mission,um, access and mission is, is
simply to help people live thehealthiest and full of slides
(08:21):
possible.
So that happens in a lot ofdifferent ways and in a lot of
different points along one'sjourney, but, um, that really
ties to finding areas of unmetneed and looking to fill them,
um, throughout the Hudson Valleyand, and, and beyond, probably
in the, not too distant future.
Speaker 2 (08:40):
So you have a full array of services.
When I was looking through thewebsite there's mental health
services, there's substanceabuse services, maybe walk us
through a little bit of, uh, allthe different, because I don't
think people have any idea ofthe
Speaker 4 (08:56):
Total, the vast array and even the size, I mean,
you're a hundred million dollarorganization.
Yeah.
Speaker 3 (09:03):
So th so the organization from a revenue
perspective is right around thatMark the a hundred million
dollar Mark.
So it's a pretty largeorganization.
Um, we operate in nine counties,um, throughout the Hudson Valley
, um, and with a wide variety ofservice areas, as you mentioned.
So, um, and I, and I shouldmention in about 1500 staff, so
(09:24):
quite large, a large number ofstaff supporting, um, supporting
the work, but we operate on, wekind of break it down into a
handful of core areas.
So, um, you started to mentionour behavioral health services,
which focus on mental health andsubstance use.
Um, so there's a number ofthings that, um, that we do
there from counseling centers toprograms, um, supporting, um,
(09:46):
that early onset, um, first,first diagnosis of psychosis
with individuals withschizophrenia, um, as well as,
um, more intensive day programs,um, mobile, mental health, um,
that happens in both UlsterCounty and orange County.
Um, and then additionally, um,in Rockland County now for
children.
Um, and then, um, one of thenewer services over the last
(10:09):
couple of years, um, that kindof wraps around a lot of this is
a 24 seven urgent care, um, formental health and substance use.
So those services are available24 seven and, um, went virtual,
um, um, right at the start ofthe pandemic and continue to
operate, um, in a mixed modeltoday, virtual available
(10:30):
anytime, anywhere, but also somein-person, um, access to
services.
So that's kind of behavioralhealth in a nutshell, um, other,
uh, Mo Mo most significant partof the organization, um, is
services for individuals withdevelopmental disabilities or
intellectual and developmentaldisabilities.
So those range from, um,residential settings to services
(10:51):
in the community, um, and alsoservices, um, supporting, um,
employment and respite at times.
Um, we also have children andfamily services.
So those, um, are working, um,often with, um, preventive
services for families, um, withyouth at risk, um, but also
support, um, there's programsthat support expecting mothers,
(11:13):
as well as, um, foster care anda children's diagnostic center,
um, which is doing, um, courtplaced assessments, um, for
children, um, you know, all inan effort to, um, for safe
return home and if not, um, forstabilization, um, process until
someone can return home.
Um, the other parts of theorganization focus on housing.
(11:34):
Um, housing has been, um, uh, aservice that's really grown with
us over the last decade, um,including, um, I think we're on
our 10th project now inaffordable housing supporting,
um, um, permanent housing forindividuals with developmental
disabilities and, um, homelesspopulation.
Um, there may also be, um, amental illness, um, um, which
(11:56):
is, which is common, but, um,also with that population to
provide permanent housing and,um, the last area, which I, I,
which is really goes back, um,to the, to the roots of the
organization when it wasoriginally named occupations,
Inc, is around employment.
Um, so we have, um, accessbusiness solutions is part of
what we do, and that is where we, um, employ around 300 plus
(12:20):
individuals, um, that have adisability.
Um, and they work in a varioussettings.
We manufacture products.
Um, we provide service contracts, um, to government customers,
to commercial customers fromanything from food service to
custodial, to facilitiesmanagement, um, and on the
manufacturing side, um, one ofthe larger areas we do is we are
(12:42):
, um, a manufacturer of hearingprotection, um, and a
distributor of safety products.
Um, some of which we do inpartnership with, um, a little
company called 3m out ofMinnesota.
So that's the, that's kind ofthe, the, the breadth, you know,
quickly, there's a ton ofservices under the hood that
make all that up though.
Speaker 4 (13:01):
Well, and, and, and that the full panoply of
services, I think most peoplehave no idea that it is so
broad.
So let's say a hundred milliondollar organization, 15, roughly
1500 employees.
And how many people do you thinkyou touch?
Have you ever tried to
Speaker 3 (13:21):
It's about 11,000 people a year?
Um, the, the, the predominanceof that is in behavioral health
services, um, because that'swhere we're seeing many people,
um, in shorter stays smallervisits, um, on the, if you were
to look at the developmentaldisability side, um, a much more
intensive service, particularlywhen you talk about 24 seven
(13:43):
residential supports.
So, um, you know, those are,those are costly services, um,
but well, but needed for some,you know, individuals who are
perhaps some of the greatestcomplexities, um, that we serve.
Speaker 4 (13:55):
So we're almost at March 12th and, and that's an
important day for me, becausethat was the day that I said,
that's it, I'm going home.
I'm packing up, I'm leaving theoffice.
Um, that was my aha moment.
Do you reckon or recall whenthat moment occurred for you and
you said we've got to do thingsdramatically differently?
Speaker 3 (14:19):
I, I believe, I believe it was actually the same
day if I, if I recall, if Irecall, I think that was a
Thursday and it was a Congressand I was on a, um, a phone call
, um, um, with Nyeem our, ourchief program officer, where we
were having a conversationaround closing, um, our day
programs and no longer havingthat and starting to, um,
(14:43):
dramatically change what, how weoccupied space and use space and
started, you know, and, andconversations around PPE and all
those things were just that,that was the conversation with
that day.
And, um, from that pointforward, things have been, um,
dramatically different.
Um, you know, that was thefirst, I would say at that
(15:04):
point, everyone was justscrambling.
So there was like, you know, allthose activities were happening.
If I had to say the moment thatkind of it's set in a bit more,
and I probably don't rememberthe date of this, but, um, we
had had our first couple, thefirst couple of people, um, that
we serve, who were dying, whohad a COVID diagnosis.
(15:25):
Um, didn't if you remember,early on hospitals were
overwhelmed and not prepared,and people were being sent home,
um, in, uh, in, in health thatthey ordinarily would not leave
the hospital, um, because thereneeded to be room for, for
others who are much more acute.
Um, so we had, um, in about a 48hour period made a decision
(15:47):
because we didn't have, uh,there was no other planning at
that point from government toactually turn, um, part of our,
the middle of our administrativebuilding.
So just down the hall from whereI'm sitting today, um, into
essentially a hospital step downisolation unit for, um, two of
our individuals who are going tobe released from the hospital,
but we felt not, um, not strongenough and still, um,
(16:10):
symptomatic, not wanting toreturn to, um, to their
residences, um, for fear ofinfection of others and their
own and their own health andsafety.
And we essentially created alittle mini, you know, step-down
ward, um, out of a day programspace right here in the middle
of our building.
So, um, that being set up andstaffing that, um, and having
(16:31):
that happen, you know, down thehall, I would say was probably
one of the more significantevents that I can, you know,
that I can recall as far as anaha moment.
Um, you know, um, second onlyinsignificance to those that we
lost.
We lost some staff, we've lostindividuals we serve, um, as
many have.
So, um, those were the mostchallenging moments and continue
(16:54):
to be as they occur.
Speaker 4 (16:56):
And I think that, um, for most people that don't
understand the nature of yourwork, it is that there is a very
large labor intensive,interactive nature to it.
And there was no playbook forthis.
This was, you know, I know thatyou guys are really good at sort
(17:18):
of thinking through the deliveryof services, but at this moment
in time, what was happening,where there, you know, crash
meetings of all senior staff,um, I'm always kind of curious
what, what happened a year ago.
Speaker 3 (17:36):
Um, there were, there were a lot of these types of,
you know, like zoom and othermeetings that were happening at,
um, let's just say later hoursthan they may have normally been
occurring, because particularly,I would say in the first two or
three weeks, um, stuff waschanging so dramatically within
the course of a day, that beingsure everyone was on the same
(18:00):
page that evening was importantto start the next day and what
we were, what we were learning,including, um, you know,
starting with safety because PPEwas so hard to come by.
Um, and we actually wereprocuring PPE, not just for
access, but on behalf of some ofour partners where we were able
to, just because we domanufacturing and we do
(18:21):
distribution, we had some, some,we had some different mechanisms
and channels to, to resourcethat stuff, but that was, you
know, that was constant as wellas, um, ensuring safety, you
know, primarily, mostimportantly with our residential
settings, um, you know, wesupport about 170 people in
residential, you know, groupsettings where those were the
greatest risks and often, um,because of the need for that
(18:45):
type of setting for the, for theindividually support, um,
there's other complicatingmedical factors.
So not only is there the groupnature of the living that
creates, you know, potentialexposure, there's also, um, the,
the much higher risk aroundsomeone, um, acquiring COVID and
what that would look like.
So there was, there was, yeah,there was constant planning and
(19:07):
meeting and adjusting, um, inaddition to, um, much greater
communication from, from myoffice with the leadership team,
but with staff at general, um,you know, it was actually a
great opportunity to be outthere more with staff routinely
talking, um, you know, multipletimes a week at times with
various groups to make sureeveryone heard stuff.
(19:27):
Everyone had a chance to askquestions and make sure any
safety concerns primarily werepro right to the forefront.
Speaker 4 (19:34):
So a couple of things, first of all, um, you're
owed a thank you for everythingthat you did with your masks,
um, uh, your story about how yougot that to not just access, but
to other organizations and otherpeople, you truly to be
commended for that, but thenlet's divide this a little bit
into, so you have 1500employees, that's one set of
(19:59):
issues.
Then you have the people thatyou work with that have a
completely other set of issues.
So there's like your workforcewhile it might come into work,
am I not coming to work?
And then you have the peoplethat you serve, you gotta serve,
uh, I, this, this must have beenan incredible period in which
(20:24):
you had to think through themanagement of an organization,
such as access
Speaker 3 (20:30):
First and foremost, you know, I referenced the
residential population as wellas people we S we support in the
community, the, our, our directworkforce.
Didn't miss a beat those on thefront lines, you know, continue
to work.
Um, we did everything we couldpossibly to make sure they were
safe and protected andsupported.
Um, but that's, that's wherereally all the, all the kudos
(20:54):
and all the, um, you know, uh,all the celebration of the good
work should be, um, you know,the rest, the rest of us did
what we could to support them.
So that that's first andforemost, and that network
continued and continues totoday.
Um, you know, the different, youknow, in a different area of
supporting, um, on thebehavioral health side and
(21:14):
family and children's side inparticular was, um, I guess,
similar for both the people, um,and the staff, um, in that
telehealth and tele and workingwith zoom and different types of
communication really is whatmade the difference there.
Um, that was a, you know, arapid change, um, including
(21:35):
procuring, you know, equipmentthat we didn't have, um, you
know, making sure we got extraof things.
So we were, we were fairly wellprepared, but needed to do some
more of that over the, you know,the first few weeks.
And, um, that was, that was, Iwould say, a tremendous success.
Um, we saw in our, in our stillcontinuing to see about a 30%
uptick in utilization ofbehavioral health services since
(21:59):
the beginning of the pandemic.
Um, and I can tell you that thechanges in tele-health and, and
the relaxed regulations haveallowed people to, um, to
continue to have those supports,um, when needed and, and have
them more flexible than they dideven pre pandemic, which I think
is really important.
Um, so we know we are lookingforward to a time where, you
(22:21):
know, as we're just starting tohappen, as those things start to
mix in, and we start to have amix of in-person and telehealth,
because there are still pointsof which in person are, are
really important.
Um, but tele-health is proven toreduce no show rates for people
that, that really need to, youknow, maintain schedule and
utilize services.
Um, and they're enjoying it.
(22:41):
They're actually participatingand sometimes engage better, um,
in services when it's on theirown WhatsApp when it's on their
own, you know, schedule to somedegree.
So I think that telehealth wasreally a big one for, um, staff
and for, um, and for people thatwe support.
And then of course, um, thefrontline staff that were out
(23:02):
there all the time, it wasreally just, you know, main
focus was, was safety and safetyof them.
And so that they could be safely, um, um, supporting those
people that would live with usin some of our residential
areas.
Speaker 4 (23:15):
So let's, let's talk about tele-health, which has
been one of the themes of thispodcast, which is this great,
um, awakening to the idea thatthere are services that can be
conducted through telemedicine.
And yet at the very beginning,we were not equipped.
(23:36):
I mean, people had to discoverplatforms.
There was, uh, HIPAA issues.
There were, um, insurance issueswhere insurance companies said,
well, we don't reimburse forthat.
How did this all play out?
And, and how did you manage toincorporate it into your
delivery of service?
Speaker 3 (23:58):
So, I mean, the first thing was, you know, we've been,
we've been fortunate throughsome federal, um, some federal
grant funding through, um,through SAMSHA too, that really
helps help create the urgentcare.
And before it even went virtualthat created this urgent care
model that wrapped around.
So, um, when we went virtual on,I think it was the 23rd of
(24:23):
March, so within a week or so ofall this happening, we had the
virtual model standards stood upand we, and we went that
provided us, I would say thebuffer for government to catch
up with relaxed regulations thatwe had support that wasn't, you
know, contingent on, on beingable to bill and get paid per se
, like we had, we had thatbuffer that really helped us
(24:46):
balance that, but I would say,you know, um, to the benefit of
government, they did add prettyquickly to reduce the burdens
that had been in place for along time, because the
utilization in our field oftele-health pre pandemic, I
believe, was in the singledigits.
So, you know, when we talkabout, you know, how often it
was used and that may even bebeing generous.
(25:07):
So, um, you know, now it's, youknow, to, to imagine, um,
operating without tele-healthnow just about a year later is,
um, almost just as hard, um, to,to think about.
So that was, that was, you know,I would say that's how it kind
of came to be, and then, youknow, working out, um, you know,
some of the other, some of theother people that deserve some
(25:28):
credit behind the scenes and allorganizations, um, you know, I
think across healthcare are thepeople that are working behind
the scenes, trying to figure outhow to bill and get paid for all
of this, because rules werechanging, um, daily, weekly at
best, um, for months.
So, um, that process is stillcatching up with itself in a lot
(25:51):
of areas.
But, um, first and foremost, youknow, we were able to have
enough support out there andreduce regulations to get people
the services they needed, um,despite, um, shutdowns and, and,
uh, you know, the pandemic thatwas, you know, really, um,
really heightened back in, youknow, in, in March, April, may.
Um, and then again, you know,near the end, you know, the end
(26:13):
of 2020 into 2021,
Speaker 4 (26:16):
So pardon the pun access.
So if we're going to talk abouttele-health, even this morning,
as we were getting online forour discussion, my broadband in
Sullivan County was notcooperate.
How have you found as we pivotto this world of telehealth,
(26:38):
have your, the people that youserve did have the appropriate
amount of access, or even theknowledge for how to get online
and how did that work?
Speaker 3 (26:55):
Yeah, I mean, I think it was mixed, I think largely it
was successful.
One of the, um, the biggestthings that we think remains out
there because, well, so we couldget on the soapbox around making
sure everyone has adequateaccess to broadband, which, you
know, should just be at thispoint.
Um,
Speaker 4 (27:12):
That's not so Fox, it's a reality.
Speaker 3 (27:15):
I mean, that, that, that should be, you know, that
that's clear, but until thathappens, you know, one of the
things that we think isimportant and advocating for is
that telephone only basedcommunication for some services
needs to be allowed to continuebecause not everyone, as you
said, has the ability, whetherit's the, whether it's the
(27:37):
connection being strong enough,whether there's the device and,
you know, the affordability ofhaving it, um, or the knowledge
of how to use it, to be able tonavigate all those things and
have those expectations ofpeople who may be utilizing
services to support crisisevents in their life.
So, um, telephone, telephoneonly, um, still needs to remain,
(28:00):
um, supported, um, in some ofthese cases, um, particularly,
you know, if we have medicalprofessionals, um, you know,
assessing that that's, thatthat's effective and needed
because, um, we're not thereyet.
I wish, I wish I could say we'rethere that everyone has, you
know, adequate access to this,that that's not the case.
And, and the Hudson Valley is a,is a great example of, um, how
(28:26):
different access can be from,you know, five miles.
Speaker 4 (28:31):
Yeah.
And you operate in a piece ofnine counties, predominantly
orange, predominantly others,but, and does the broadband
connectivity vary greatly fromcommunity to community
throughout the Valley?
Speaker 3 (28:47):
Yeah, I mean, Sullivan County, I think would
be a good example of, um, whereit's not where it's not the
strongest, but you know, there'salso rural parts of Ulster
County in Duchess County wherewe serve, um, you know, so, and,
you know, even, um, orangeCounty where most of our
services are there, there'splenty of, you know, you drive
around here, but you're going tofind some dead spots.
(29:08):
So this is not, um, you know,this is not well covered,
whether it's from a cell basedsignal or, or, um, you know,
direct connections into, youknow, into homes.
Speaker 4 (29:19):
Um, it, it's interesting that pre pandemic
pattern does a lot of work ininfrastructure.
So traditional infrastructure,roads, sewer bridges, and then
the infrastructure needed forbroadband or 5g connectivity.
(29:39):
Um, we just put to the top ofthe list and what has occurred
during the pandemic has proventhat that is no, you know, I
think as you were saying, right,it's almost like electricity,
every house has to have this.
And especially for the peopleyou serve, um, you know, in
reading about access, one of theareas that is mentioned is that
(30:04):
you are a metrics drivenorganization.
So any, any examples, I mean,you've had a long history of
working your way up to theposition you have as the CEO of,
uh, access.
How do you use metrics?
Pattern is a metricorganization.
So we, we love to talk about,uh, you know, wonky stuff like
(30:26):
this.
Speaker 3 (30:27):
I, this, I thought you said, this is only 45
minutes, so no, um, no, wait, weare.
Um, and, and actually, um, youknow, we take pride in it and
don't shy away from the factthat we, you know, we measure
and we want to prove lots ofthings because, um, you know,
we've, we know it works, whatyou, you know, what you measure
(30:48):
is kind of what you do.
Um, so, you know, to start with,so, um, but we, you know, we
measure, I mean, there'shundreds of things, I'm sure
they know, but there's, there'sabout a hundred and twenty-five
or so like really formal thingsthat we keep track of.
But, um, the way that it'sorganized is we organize it
through, um, a series of about12 value streams, so different
(31:10):
portions of the organization.
So I've mentioned some today,things like behavioral health
for adults or children anddevelopmental disabilities,
employment, housing, um, but allof those areas are how we're
kind of organized.
They all kind of cross, theykind of cross reference, um,
different metrics and goals fromeverything from customer service
(31:31):
to quality metrics, to, um, um,measurements around, um, um,
financial matters.
So revenue and cost and surplus,um, as well as safety and
wellness for staff.
So there there's many differentthings, but they, we, the one
thing we've done is created somemore like vision type goals that
(31:53):
everything has to point to.
So, you know, we were talkingfor just a bit, um, on access,
you know, access to, you know,we were talking about, you know,
tele-health and some of thoseservices, but one of those core
areas is, um, what we just callaccess 24 seven, how do we
continue to evolve our servicesthat are available whenever and
wherever, um, they're needed?
(32:14):
Um, so that that's a core area.
You know, other core areas arearound, um, reaching greater
numbers of, of people, um,achieving employment.
So today that that number withpeople we directly support and
in the community is around 450.
You know, our goal is athousand.
Um, we want to increase ourdonor base of people that know
the organization participate inthe organization.
(32:36):
Um, we want to be, you know,both, um, known, um, more for
the work we do and the work wedo in public education, in the
state and on a national level,those are, those are some of the
areas.
And then of course we want to befinancially viable.
So there's goals around, youknow, financial metrics, but
also one which, um, soundspretty boring, but it's reducing
(32:58):
our administrative rate becausewhat we want is we want more
dollars directly hitting programservices.
So if we continue to be moreefficient with the
administrative costs of theorganization, um, that we can
continue to, that we cancontinue to be better and better
stewards of, of public dollars,that large enough to support the
organization
Speaker 2 (33:17):
As we continue to move, um, in a positive
direction, the infection ratesgoing down more vaccines are
getting out there springtime ishopefully arriving.
How is the vaccination processworking for you for your
employees and for the people youserve?
Speaker 3 (33:38):
So, I mean, I think it's been mixed.
Um, you know, it's obviouslythis is a, this is a challenge.
I think, unlike any, anylogistics challenge that's been
faced.
So, so, um, we were, we werefortunate our, uh, our team
really worked early on, onpartnering, um, with local
organizations to get access forour, our, you know, our one, a
(34:00):
priority one, a folks.
So we actually, um, were verysuccessful quickly in getting,
um, our, our residential, um,individuals that we support
serve or vaccinated.
So, so that, that was strong tothe point that, you know, today
that group is in the, you know,over 90% has received their
first, uh, first, uh, firstshot.
(34:22):
And I think we're actuallyprobably close to like 70%
having received a second shot.
So that was, that was criticalas it related to those that had
the greatest risk of acquiringCOVID and, and, um, you know,
potential for really pooroutcomes.
Um, that said the staff thatsupport, um, those individuals
(34:44):
and frontline staff generallyspeaking have been, um, slower
to adopt and be willing, not,not for necessarily a lack of
access that we had early on,which is becoming harder now
because other groups are mixedin.
So now it's kind of more open,but, um, that's been, um, that's
been the biggest challenge and,and a challenge that I think has
been heard, not just withaccess, it's a, it's a not
(35:08):
nationwide, um, issue aroundreally, um, you know, and I, I
thought a lot of it resideswith, you know, um, generational
distrust of the health systemfor a whole host of reasons that
now is, you know, playing out.
So, um, I'm hopeful.
Um, we're starting to see alittle bit of an uptick in
participation in those areas.
(35:29):
And, you know, I am hopeful that, um, things like the Johnson
and Johnson vaccine gettingapproved, you know, with a
single shot, um, may make this,you know, more, um, um, more
likely to be adopted by others.
But, um, you know, otherwisewhen we start to get outside of
the core priority groups, um,then it's a bit, you know, then
(35:50):
it's a bit more, it's a bit morechallenging, you know, you're
kind of, you know, trying to runfrom place to place and sign up
here and sign up there.
And someone's got five shots andsomeone's got 10 shots today.
And, and how do you do it?
Like that stuff is where I think, um, some of the, you know, the
centralization of this could be,could be stronger, but, um, but
(36:10):
we have seen really, you know,really strong efforts around
larger clinics and things,including, um, direct clinics at
some of our homes beingperformed through CVS, um, where
they're actually coming out anddo clinics on site.
So, you know, a lot of it todayis I think it's really about
supply.
So as we start to see the supplynumbers, um, I think some of
this will be, we'll be kind ofin the rear view mirror,
(36:33):
hopefully.
Um, but the biggest, the biggestchallenge has been, you know, uh
, for, for portions of, of, of,of our staff, um, really, um,
willingness to, to get thevaccine is probably the most
important thing.
So we've been doing everythingwe can on education around that,
and, you know, providing updatesand staff that are willing and
have done a telling their storyand why and why it's important.
(36:55):
Um, but those are, those are,those are that, that's the
number one issue, not thelogistics.
Speaker 2 (37:01):
Um, so hopefully this brings us to what some might
call a new normal.
And, and what does the worldlook like host?
Um, COVID I know we're not outof the woods yet by any stretch
of the imagination.
So one thing I was thinking is,you know, telemedicine or
telehealth is one area thatyou've mentioned, are there
(37:23):
others that you had to adjust topivot to that you may say, you
know, something, we weren'tdoing that before, but we should
continue doing it.
It, it, it actually is not a badway for us to provide our
services.
Speaker 3 (37:40):
Yeah.
I mean, I, I think, um, justsimply, you know, greater work
from home or work fromalternative sites, flexibility
is important.
Um, you know, attracting talentinto our field is important.
So the ability to have moreflexible work schedules and
arrangements across, uh, youknow, a wide variety of, of
positions that we have, I thinkif something that we're, you
(38:02):
know, that we're figuring outwhat that looks like post
pandemic, because it's not goingto be the same as it was.
And, um, nor does it need to be,um, that in turn also may allow
us to have a smaller footprintas, as it relates to physical
space, um, which is, you know,which is also important if we're
not, you know, having the dollarspent on paying for those
(38:24):
spaces, maintaining those spacesand all of those, all of the
things that go with it, thosedollars can drive back to, you
know, to direct supports, um,you know, for services.
So that, that to probably standsout as, as one of the, um, one
of the key things.
Also, I think some of the, um,the other things that just need
to continue as a result of this,um, is the planning, the
(38:48):
pre-planning the, how do yousupport people?
You know, I mentioned theisolation center that we
created, well, how do thoseplans, how do we keep those
plans active so that ifsomething happens, we're once
again, ready to start thatimmediately, do we have
stockpiles of PPE and thingslike that?
And, you know, I think it's morekind of worst case disaster
(39:08):
scenario planning needs to bemore at the forefront because
even if it's not, you know, weshould all be fortunate that we
don't need to pull out thatplaybook for another, you know,
50 years.
But, um, the likelihood is, youknow, the world is getting more
crowded and more complicated.
It's probably more than likelyit's not going to be, um, you
know, another hundred yearsbetween pandemics.
(39:30):
So I think those are, those areimportant things that need to
stay, but, you know, the, thethings that have been learned
that have been positive, I thinkreally our use of space work can
be done in lots of differentways and forums.
And, and of course, um, ofcourse tele-health,
Speaker 2 (39:44):
Let me just ask you that one magical question, which
probably was a question beforethe pandemic, but maybe the
pandemic has changed yourpriorities.
So if there was this magic oneand money was no longer the
object, it was somehow flowingto you, where would you spend
it?
What would be the most effectiveuse of found money or new
(40:09):
sources of funding?
Where do you think you'd put itif, if it came your way?
Speaker 3 (40:15):
So, I mean, I mean, I think it's the same pre pandemic
and post it's just beenhighlighted to a greater degree.
It's investing in the wages andsalaries, benefits, and training
of the frontline staff, um, notpaid nearly what they should be
for the work andresponsibilities that they
carry.
Um, so I think that's, that'sabsolutely the number one, the
(40:38):
number one use as far as, youknow, if it's about different
models and if, and if thingscould change is how we, you
know, how we get paid and how weearn dollars for the work that
we're doing.
I think that would be thecontinued transition, um, with,
with some speed, um, to movingtowards models where we're being
reimbursed for the qualityoutcomes that, that people are
(41:02):
achieving, as opposed to oftenlots of regulatory things,
checking boxes and forms andplans being done by some date or
that somebody's, somebody's headwithin a bed as opposed to how
is, how is their life going?
How are there, how are theirhealth outcomes, how are their,
you know, their, their socialoutcomes?
How are those things going?
(41:22):
That's a dramatic shift fromwhere we are today to really pay
for value as opposed to, um,paying for kind of checking off
certain requirements.
So that would be the, you know,from, uh, just, uh, how it would
happen.
That would be number one, butthe, you know, the open, the
open, uh, checkbook, uh,question would, you know, I
(41:43):
think it's definitely, you know,supporting the, supporting the
frontline workers, um, in allthe different areas of the
organization, both in wage, butalso, you know, in, in training,
um, and making sure that they'reprepared for the work, um, the
best that they possibly can be.
Speaker 1 (41:58):
Ron, thank you so much for joining us on patterns
and paradigms.
We wish you nothing but, uh,success and good fortune and
continuing to deliver theservices that you do,
Speaker 3 (42:12):
Same to you, Jonathan.
Thanks for having me.
Speaker 1 (42:14):
Thank you for tuning in to patterns and paradigms the
pattern podcast.
For more information about thisepisode, visit our website
pattern for progress.org forwardslash podcast.
(42:43):
[inaudible].
We are experiencing a paradigm shift, a fundamental
change in the way we usually dothings.
We are intentionally choosing tosee the silver lining
opportunity arises.
We can shine a light on thethings that weren't working well
(00:25):
on those things that weren'treally working at all, we can
regroup reevaluate andre-engineer it's time to explore
new patterns and paradigms thosethat inspire us to rise above
the chaos and explore how theconditions of today and take us
(00:47):
to a better tomorrow patternsand paradigms the pattern
podcast from Hudson Valleypattern for progress.
You're listening to season twoepisode nine, access supports
for living with your hostpattern, president and CEO,
Jonathan Dropkin.
Speaker 2 (01:05):
Thanks for joining us for another episode of patterns
and paradigm.
Um, I hope you enjoyed our lastone with Barry Roth bell.
Barry's one of the trulyaccomplished members of the
media profession.
Um, I hope you enjoyed hisinsight.
If you did, please remember toask someone to take a, listen to
(01:27):
one of our podcasts.
You can find it on Apple orSpotify and wherever else you
find your podcasts, this week'strend or bubble.
I keep returning to this, thisbusiness of electric cars.
So there've been a lot ofannouncements coming out of
(01:48):
Washington from Ford, fromgeneral motors about what the
United States is doing.
So pattern and paradigm took alook at what was happening in
China, Europe, Japan.
And it's interesting someaspects of the search for that
(02:09):
affordable electric vehicle thatmakes everyone happy are
advanced.
Tesla has been added for 14years, but China's ability to
throw money at this and theirability to automate.
You know, they're not reallyworried about unions and we are
(02:30):
because they're good wagepositions, as long as we can
protect them.
This is without a doubt a trend.
But if there is a race to find avariety of electric vehicles,
Europe, Japan, China are goingto quickly outpace the United
(02:53):
States unless there is somethingreally dramatically different in
how we approach the creation ofsuch vehicles.
So this one's a trend, not abubble it's going to happen, but
we're going to need to beaggressive or imaginative in a
way in terms of how to produceit.
(03:14):
One of the point of, you know,China, for instance, supply
chain, you know, the batteriesthey have, the supply chain
issue completely figured out.
They just don't have enoughproduction vehicles yet.
Let me ask, uh, what's up JD,and I'm going to ask myself,
this question is what pattern isworking on this week.
(03:35):
I wanted to just briefly mentiona large project that we're
working on in orange County.
It has a lot to do with conflictresolution.
And I wanted to just clarify forour listeners who may know
something about this project, itwas designed.
It had been five years in themaking.
And initially it was birthed outof the conflict between the
(03:58):
ultra Orthodox population andthe rest of orange County.
This project is not going tosolve that tension.
This project is going to attemptto find a piece of that tension
and create a pilot program forhow mediation conflict
(04:22):
resolution can possibly resultin a better way than litigation
or anger.
Does it solve the big picturecompletely?
No.
And at the same time, we'restill in the process of looking
at one that is a piece of thesocial justice issues.
(04:44):
And we're looking at a number oftopics and we hope to have the
second one of those settled on,we did find one involving water
in the town of Woodbury.
And that's what we're going tobe looking at as a way to bring
the ultra Orthodox or Haredicommunity to the table, along
(05:08):
with the decision-makers in thetown of Woodbury.
Um, so more on that one to comethis week, we're really excited
to have Ron Colivida thepresident and CEO of access
supports for living.
Ron is a long time employeethere.
(05:29):
And in 2019 was elevated to bethe president and CEO.
For those of you that don't knowaccess, it's a hundred million
dollar organization.
It has well over 1500 employees.
It touches all nine of thecounties and lots of Valley that
pattern works on.
They work with people with bothmental and physical
(05:53):
disabilities.
And, um, I think you're going toenjoy the conversation with Ron
as Ron really tried to look veryhard at where they were before
the pandemic, what the pandemicdid to change their model for
service delivery, and then whataspects of it might be in the
(06:13):
future to remain.
And that's very much the themeof patterns and paradigms.
Hi, Ron, how you doing?
And, and, and ha how have youbeen managing through the
pandemic and your staff?
You know, I'm just curious, likeon, I ask all of my guests, hi,
how are you doing?
Speaker 3 (06:32):
Um, well, well, thanks Jonathan.
Thanks for having me.
Um, I mean, I think we're, youknow, we're doing where we've,
we've pivoted, um, in a numberof waves over the last several
months, and I think things, youknow, continue to adapt, but,
um, we have a great team that's,um, that's working, I would say
kind of beyond full speeds still.
So, um, you know, everythingfrom our frontline staff or who
(06:53):
are right there in the trenches,leading the work to the
leadership team is making sure,you know, we're getting
resources and safety and nowvaccine management, um, and, you
know, access to vaccineavailable, um, to the, to all
the individuals that we supportas well as, um, you know, to our
staff.
So, I mean, I think, um, we're,we're doing a, I guess as well
(07:16):
as can be expected, I thinkwould be the, probably the best
way.
And in some cases, um, I wouldsay better than expected, still,
still growing and still findingopportunities.
Speaker 2 (07:25):
Well, and I think doing as well as could be
expected or better than expectedputs you well above many other
organizations, so kudos to youand the whole team at access
for, for doing that, um, for thebenefit of our listeners, why
don't we just take a step backand describe the mission of
(07:47):
access and why don't you correctme?
Because my natural inclinationwould be the people that you
serve or clients, but that maynot be the right term.
Speaker 3 (07:59):
Sure.
So, I mean, just starting there,um, we just refer to them as
people.
Um, the, there are people likeyou and I, um, and they happen
to utilize different, um,different supports and different
services that the organizationprovides.
Um, you know, tying to mission,um, access and mission is, is
simply to help people live thehealthiest and full of slides
(08:21):
possible.
So that happens in a lot ofdifferent ways and in a lot of
different points along one'sjourney, but, um, that really
ties to finding areas of unmetneed and looking to fill them,
um, throughout the Hudson Valleyand, and, and beyond, probably
in the, not too distant future.
Speaker 2 (08:40):
So you have a full array of services.
When I was looking through thewebsite there's mental health
services, there's substanceabuse services, maybe walk us
through a little bit of, uh, allthe different, because I don't
think people have any idea ofthe
Speaker 4 (08:56):
Total, the vast array and even the size, I mean,
you're a hundred million dollarorganization.
Yeah.
Speaker 3 (09:03):
So th so the organization from a revenue
perspective is right around thatMark the a hundred million
dollar Mark.
So it's a pretty largeorganization.
Um, we operate in nine counties,um, throughout the Hudson Valley
, um, and with a wide variety ofservice areas, as you mentioned.
So, um, and I, and I shouldmention in about 1500 staff, so
(09:24):
quite large, a large number ofstaff supporting, um, supporting
the work, but we operate on, wekind of break it down into a
handful of core areas.
So, um, you started to mentionour behavioral health services,
which focus on mental health andsubstance use.
Um, so there's a number ofthings that, um, that we do
there from counseling centers toprograms, um, supporting, um,
(09:46):
that early onset, um, first,first diagnosis of psychosis
with individuals withschizophrenia, um, as well as,
um, more intensive day programs,um, mobile, mental health, um,
that happens in both UlsterCounty and orange County.
Um, and then additionally, um,in Rockland County now for
children.
Um, and then, um, one of thenewer services over the last
(10:09):
couple of years, um, that kindof wraps around a lot of this is
a 24 seven urgent care, um, formental health and substance use.
So those services are available24 seven and, um, went virtual,
um, um, right at the start ofthe pandemic and continue to
operate, um, in a mixed modeltoday, virtual available
(10:30):
anytime, anywhere, but also somein-person, um, access to
services.
So that's kind of behavioralhealth in a nutshell, um, other,
uh, Mo Mo most significant partof the organization, um, is
services for individuals withdevelopmental disabilities or
intellectual and developmentaldisabilities.
So those range from, um,residential settings to services
(10:51):
in the community, um, and alsoservices, um, supporting, um,
employment and respite at times.
Um, we also have children andfamily services.
So those, um, are working, um,often with, um, preventive
services for families, um, withyouth at risk, um, but also
support, um, there's programsthat support expecting mothers,
(11:13):
as well as, um, foster care anda children's diagnostic center,
um, which is doing, um, courtplaced assessments, um, for
children, um, you know, all inan effort to, um, for safe
return home and if not, um, forstabilization, um, process until
someone can return home.
Um, the other parts of theorganization focus on housing.
(11:34):
Um, housing has been, um, uh, aservice that's really grown with
us over the last decade, um,including, um, I think we're on
our 10th project now inaffordable housing supporting,
um, um, permanent housing forindividuals with developmental
disabilities and, um, homelesspopulation.
Um, there may also be, um, amental illness, um, um, which
(11:56):
is, which is common, but, um,also with that population to
provide permanent housing and,um, the last area, which I, I,
which is really goes back, um,to the, to the roots of the
organization when it wasoriginally named occupations,
Inc, is around employment.
Um, so we have, um, accessbusiness solutions is part of
what we do, and that is where we, um, employ around 300 plus
(12:20):
individuals, um, that have adisability.
Um, and they work in a varioussettings.
We manufacture products.
Um, we provide service contracts, um, to government customers,
to commercial customers fromanything from food service to
custodial, to facilitiesmanagement, um, and on the
manufacturing side, um, one ofthe larger areas we do is we are
(12:42):
, um, a manufacturer of hearingprotection, um, and a
distributor of safety products.
Um, some of which we do inpartnership with, um, a little
company called 3m out ofMinnesota.
So that's the, that's kind ofthe, the, the breadth, you know,
quickly, there's a ton ofservices under the hood that
make all that up though.
Speaker 4 (13:01):
Well, and, and, and that the full panoply of
services, I think most peoplehave no idea that it is so
broad.
So let's say a hundred milliondollar organization, 15, roughly
1500 employees.
And how many people do you thinkyou touch?
Have you ever tried to
Speaker 3 (13:21):
It's about 11,000 people a year?
Um, the, the, the predominanceof that is in behavioral health
services, um, because that'swhere we're seeing many people,
um, in shorter stays smallervisits, um, on the, if you were
to look at the developmentaldisability side, um, a much more
intensive service, particularlywhen you talk about 24 seven
(13:43):
residential supports.
So, um, you know, those are,those are costly services, um,
but well, but needed for some,you know, individuals who are
perhaps some of the greatestcomplexities, um, that we serve.
Speaker 4 (13:55):
So we're almost at March 12th and, and that's an
important day for me, becausethat was the day that I said,
that's it, I'm going home.
I'm packing up, I'm leaving theoffice.
Um, that was my aha moment.
Do you reckon or recall whenthat moment occurred for you and
you said we've got to do thingsdramatically differently?
Speaker 3 (14:19):
I, I believe, I believe it was actually the same
day if I, if I recall, if Irecall, I think that was a
Thursday and it was a Congressand I was on a, um, a phone call
, um, um, with Nyeem our, ourchief program officer, where we
were having a conversationaround closing, um, our day
programs and no longer havingthat and starting to, um,
(14:43):
dramatically change what, how weoccupied space and use space and
started, you know, and, andconversations around PPE and all
those things were just that,that was the conversation with
that day.
And, um, from that pointforward, things have been, um,
dramatically different.
Um, you know, that was thefirst, I would say at that
(15:04):
point, everyone was justscrambling.
So there was like, you know, allthose activities were happening.
If I had to say the moment thatkind of it's set in a bit more,
and I probably don't rememberthe date of this, but, um, we
had had our first couple, thefirst couple of people, um, that
we serve, who were dying, whohad a COVID diagnosis.
(15:25):
Um, didn't if you remember,early on hospitals were
overwhelmed and not prepared,and people were being sent home,
um, in, uh, in, in health thatthey ordinarily would not leave
the hospital, um, because thereneeded to be room for, for
others who are much more acute.
Um, so we had, um, in about a 48hour period made a decision
(15:47):
because we didn't have, uh,there was no other planning at
that point from government toactually turn, um, part of our,
the middle of our administrativebuilding.
So just down the hall from whereI'm sitting today, um, into
essentially a hospital step downisolation unit for, um, two of
our individuals who are going tobe released from the hospital,
but we felt not, um, not strongenough and still, um,
(16:10):
symptomatic, not wanting toreturn to, um, to their
residences, um, for fear ofinfection of others and their
own and their own health andsafety.
And we essentially created alittle mini, you know, step-down
ward, um, out of a day programspace right here in the middle
of our building.
So, um, that being set up andstaffing that, um, and having
(16:31):
that happen, you know, down thehall, I would say was probably
one of the more significantevents that I can, you know,
that I can recall as far as anaha moment.
Um, you know, um, second onlyinsignificance to those that we
lost.
We lost some staff, we've lostindividuals we serve, um, as
many have.
So, um, those were the mostchallenging moments and continue
(16:54):
to be as they occur.
Speaker 4 (16:56):
And I think that, um, for most people that don't
understand the nature of yourwork, it is that there is a very
large labor intensive,interactive nature to it.
And there was no playbook forthis.
This was, you know, I know thatyou guys are really good at sort
(17:18):
of thinking through the deliveryof services, but at this moment
in time, what was happening,where there, you know, crash
meetings of all senior staff,um, I'm always kind of curious
what, what happened a year ago.
Speaker 3 (17:36):
Um, there were, there were a lot of these types of,
you know, like zoom and othermeetings that were happening at,
um, let's just say later hoursthan they may have normally been
occurring, because particularly,I would say in the first two or
three weeks, um, stuff waschanging so dramatically within
the course of a day, that beingsure everyone was on the same
(18:00):
page that evening was importantto start the next day and what
we were, what we were learning,including, um, you know,
starting with safety because PPEwas so hard to come by.
Um, and we actually wereprocuring PPE, not just for
access, but on behalf of some ofour partners where we were able
to, just because we domanufacturing and we do
(18:21):
distribution, we had some, some,we had some different mechanisms
and channels to, to resourcethat stuff, but that was, you
know, that was constant as wellas, um, ensuring safety, you
know, primarily, mostimportantly with our residential
settings, um, you know, wesupport about 170 people in
residential, you know, groupsettings where those were the
greatest risks and often, um,because of the need for that
(18:45):
type of setting for the, for theindividually support, um,
there's other complicatingmedical factors.
So not only is there the groupnature of the living that
creates, you know, potentialexposure, there's also, um, the,
the much higher risk aroundsomeone, um, acquiring COVID and
what that would look like.
So there was, there was, yeah,there was constant planning and
(19:07):
meeting and adjusting, um, inaddition to, um, much greater
communication from, from myoffice with the leadership team,
but with staff at general, um,you know, it was actually a
great opportunity to be outthere more with staff routinely
talking, um, you know, multipletimes a week at times with
various groups to make sureeveryone heard stuff.
(19:27):
Everyone had a chance to askquestions and make sure any
safety concerns primarily werepro right to the forefront.
Speaker 4 (19:34):
So a couple of things, first of all, um, you're
owed a thank you for everythingthat you did with your masks,
um, uh, your story about how yougot that to not just access, but
to other organizations and otherpeople, you truly to be
commended for that, but thenlet's divide this a little bit
into, so you have 1500employees, that's one set of
(19:59):
issues.
Then you have the people thatyou work with that have a
completely other set of issues.
So there's like your workforcewhile it might come into work,
am I not coming to work?
And then you have the peoplethat you serve, you gotta serve,
uh, I, this, this must have beenan incredible period in which
(20:24):
you had to think through themanagement of an organization,
such as access
Speaker 3 (20:30):
First and foremost, you know, I referenced the
residential population as wellas people we S we support in the
community, the, our, our directworkforce.
Didn't miss a beat those on thefront lines, you know, continue
to work.
Um, we did everything we couldpossibly to make sure they were
safe and protected andsupported.
Um, but that's, that's wherereally all the, all the kudos
(20:54):
and all the, um, you know, uh,all the celebration of the good
work should be, um, you know,the rest, the rest of us did
what we could to support them.
So that that's first andforemost, and that network
continued and continues totoday.
Um, you know, the different, youknow, in a different area of
supporting, um, on thebehavioral health side and
(21:14):
family and children's side inparticular was, um, I guess,
similar for both the people, um,and the staff, um, in that
telehealth and tele and workingwith zoom and different types of
communication really is whatmade the difference there.
Um, that was a, you know, arapid change, um, including
(21:35):
procuring, you know, equipmentthat we didn't have, um, you
know, making sure we got extraof things.
So we were, we were fairly wellprepared, but needed to do some
more of that over the, you know,the first few weeks.
And, um, that was, that was, Iwould say, a tremendous success.
Um, we saw in our, in our stillcontinuing to see about a 30%
uptick in utilization ofbehavioral health services since
(21:59):
the beginning of the pandemic.
Um, and I can tell you that thechanges in tele-health and, and
the relaxed regulations haveallowed people to, um, to
continue to have those supports,um, when needed and, and have
them more flexible than they dideven pre pandemic, which I think
is really important.
Um, so we know we are lookingforward to a time where, you
(22:21):
know, as we're just starting tohappen, as those things start to
mix in, and we start to have amix of in-person and telehealth,
because there are still pointsof which in person are, are
really important.
Um, but tele-health is proven toreduce no show rates for people
that, that really need to, youknow, maintain schedule and
utilize services.
Um, and they're enjoying it.
(22:41):
They're actually participatingand sometimes engage better, um,
in services when it's on theirown WhatsApp when it's on their
own, you know, schedule to somedegree.
So I think that telehealth wasreally a big one for, um, staff
and for, um, and for people thatwe support.
And then of course, um, thefrontline staff that were out
(23:02):
there all the time, it wasreally just, you know, main
focus was, was safety and safetyof them.
And so that they could be safely, um, um, supporting those
people that would live with usin some of our residential
areas.
Speaker 4 (23:15):
So let's, let's talk about tele-health, which has
been one of the themes of thispodcast, which is this great,
um, awakening to the idea thatthere are services that can be
conducted through telemedicine.
And yet at the very beginning,we were not equipped.
(23:36):
I mean, people had to discoverplatforms.
There was, uh, HIPAA issues.
There were, um, insurance issueswhere insurance companies said,
well, we don't reimburse forthat.
How did this all play out?
And, and how did you manage toincorporate it into your
delivery of service?
Speaker 3 (23:58):
So, I mean, the first thing was, you know, we've been,
we've been fortunate throughsome federal, um, some federal
grant funding through, um,through SAMSHA too, that really
helps help create the urgentcare.
And before it even went virtualthat created this urgent care
model that wrapped around.
So, um, when we went virtual on,I think it was the 23rd of
(24:23):
March, so within a week or so ofall this happening, we had the
virtual model standards stood upand we, and we went that
provided us, I would say thebuffer for government to catch
up with relaxed regulations thatwe had support that wasn't, you
know, contingent on, on beingable to bill and get paid per se
, like we had, we had thatbuffer that really helped us
(24:46):
balance that, but I would say,you know, um, to the benefit of
government, they did add prettyquickly to reduce the burdens
that had been in place for along time, because the
utilization in our field oftele-health pre pandemic, I
believe, was in the singledigits.
So, you know, when we talkabout, you know, how often it
was used and that may even bebeing generous.
(25:07):
So, um, you know, now it's, youknow, to, to imagine, um,
operating without tele-healthnow just about a year later is,
um, almost just as hard, um, to,to think about.
So that was, that was, you know,I would say that's how it kind
of came to be, and then, youknow, working out, um, you know,
some of the other, some of theother people that deserve some
(25:28):
credit behind the scenes and allorganizations, um, you know, I
think across healthcare are thepeople that are working behind
the scenes, trying to figure outhow to bill and get paid for all
of this, because rules werechanging, um, daily, weekly at
best, um, for months.
So, um, that process is stillcatching up with itself in a lot
(25:51):
of areas.
But, um, first and foremost, youknow, we were able to have
enough support out there andreduce regulations to get people
the services they needed, um,despite, um, shutdowns and, and,
uh, you know, the pandemic thatwas, you know, really, um,
really heightened back in, youknow, in, in March, April, may.
Um, and then again, you know,near the end, you know, the end
(26:13):
of 2020 into 2021,
Speaker 4 (26:16):
So pardon the pun access.
So if we're going to talk abouttele-health, even this morning,
as we were getting online forour discussion, my broadband in
Sullivan County was notcooperate.
How have you found as we pivotto this world of telehealth,
(26:38):
have your, the people that youserve did have the appropriate
amount of access, or even theknowledge for how to get online
and how did that work?
Speaker 3 (26:55):
Yeah, I mean, I think it was mixed, I think largely it
was successful.
One of the, um, the biggestthings that we think remains out
there because, well, so we couldget on the soapbox around making
sure everyone has adequateaccess to broadband, which, you
know, should just be at thispoint.
Um,
Speaker 4 (27:12):
That's not so Fox, it's a reality.
Speaker 3 (27:15):
I mean, that, that, that should be, you know, that
that's clear, but until thathappens, you know, one of the
things that we think isimportant and advocating for is
that telephone only basedcommunication for some services
needs to be allowed to continuebecause not everyone, as you
said, has the ability, whetherit's the, whether it's the
(27:37):
connection being strong enough,whether there's the device and,
you know, the affordability ofhaving it, um, or the knowledge
of how to use it, to be able tonavigate all those things and
have those expectations ofpeople who may be utilizing
services to support crisisevents in their life.
So, um, telephone, telephoneonly, um, still needs to remain,
(28:00):
um, supported, um, in some ofthese cases, um, particularly,
you know, if we have medicalprofessionals, um, you know,
assessing that that's, thatthat's effective and needed
because, um, we're not thereyet.
I wish, I wish I could say we'rethere that everyone has, you
know, adequate access to this,that that's not the case.
And, and the Hudson Valley is a,is a great example of, um, how
(28:26):
different access can be from,you know, five miles.
Speaker 4 (28:31):
Yeah.
And you operate in a piece ofnine counties, predominantly
orange, predominantly others,but, and does the broadband
connectivity vary greatly fromcommunity to community
throughout the Valley?
Speaker 3 (28:47):
Yeah, I mean, Sullivan County, I think would
be a good example of, um, whereit's not where it's not the
strongest, but you know, there'salso rural parts of Ulster
County in Duchess County wherewe serve, um, you know, so, and,
you know, even, um, orangeCounty where most of our
services are there, there'splenty of, you know, you drive
around here, but you're going tofind some dead spots.
(29:08):
So this is not, um, you know,this is not well covered,
whether it's from a cell basedsignal or, or, um, you know,
direct connections into, youknow, into homes.
Speaker 4 (29:19):
Um, it, it's interesting that pre pandemic
pattern does a lot of work ininfrastructure.
So traditional infrastructure,roads, sewer bridges, and then
the infrastructure needed forbroadband or 5g connectivity.
(29:39):
Um, we just put to the top ofthe list and what has occurred
during the pandemic has proventhat that is no, you know, I
think as you were saying, right,it's almost like electricity,
every house has to have this.
And especially for the peopleyou serve, um, you know, in
reading about access, one of theareas that is mentioned is that
(30:04):
you are a metrics drivenorganization.
So any, any examples, I mean,you've had a long history of
working your way up to theposition you have as the CEO of,
uh, access.
How do you use metrics?
Pattern is a metricorganization.
So we, we love to talk about,uh, you know, wonky stuff like
(30:26):
this.
Speaker 3 (30:27):
I, this, I thought you said, this is only 45
minutes, so no, um, no, wait, weare.
Um, and, and actually, um, youknow, we take pride in it and
don't shy away from the factthat we, you know, we measure
and we want to prove lots ofthings because, um, you know,
we've, we know it works, whatyou, you know, what you measure
(30:48):
is kind of what you do.
Um, so, you know, to start with,so, um, but we, you know, we
measure, I mean, there'shundreds of things, I'm sure
they know, but there's, there'sabout a hundred and twenty-five
or so like really formal thingsthat we keep track of.
But, um, the way that it'sorganized is we organize it
through, um, a series of about12 value streams, so different
(31:10):
portions of the organization.
So I've mentioned some today,things like behavioral health
for adults or children anddevelopmental disabilities,
employment, housing, um, but allof those areas are how we're
kind of organized.
They all kind of cross, theykind of cross reference, um,
different metrics and goals fromeverything from customer service
(31:31):
to quality metrics, to, um, um,measurements around, um, um,
financial matters.
So revenue and cost and surplus,um, as well as safety and
wellness for staff.
So there there's many differentthings, but they, we, the one
thing we've done is created somemore like vision type goals that
(31:53):
everything has to point to.
So, you know, we were talkingfor just a bit, um, on access,
you know, access to, you know,we were talking about, you know,
tele-health and some of thoseservices, but one of those core
areas is, um, what we just callaccess 24 seven, how do we
continue to evolve our servicesthat are available whenever and
wherever, um, they're needed?
(32:14):
Um, so that that's a core area.
You know, other core areas arearound, um, reaching greater
numbers of, of people, um,achieving employment.
So today that that number withpeople we directly support and
in the community is around 450.
You know, our goal is athousand.
Um, we want to increase ourdonor base of people that know
the organization participate inthe organization.
(32:36):
Um, we want to be, you know,both, um, known, um, more for
the work we do and the work wedo in public education, in the
state and on a national level,those are, those are some of the
areas.
And then of course we want to befinancially viable.
So there's goals around, youknow, financial metrics, but
also one which, um, soundspretty boring, but it's reducing
(32:58):
our administrative rate becausewhat we want is we want more
dollars directly hitting programservices.
So if we continue to be moreefficient with the
administrative costs of theorganization, um, that we can
continue to, that we cancontinue to be better and better
stewards of, of public dollars,that large enough to support the
organization
Speaker 2 (33:17):
As we continue to move, um, in a positive
direction, the infection ratesgoing down more vaccines are
getting out there springtime ishopefully arriving.
How is the vaccination processworking for you for your
employees and for the people youserve?
Speaker 3 (33:38):
So, I mean, I think it's been mixed.
Um, you know, it's obviouslythis is a, this is a challenge.
I think, unlike any, anylogistics challenge that's been
faced.
So, so, um, we were, we werefortunate our, uh, our team
really worked early on, onpartnering, um, with local
organizations to get access forour, our, you know, our one, a
(34:00):
priority one, a folks.
So we actually, um, were verysuccessful quickly in getting,
um, our, our residential, um,individuals that we support
serve or vaccinated.
So, so that, that was strong tothe point that, you know, today
that group is in the, you know,over 90% has received their
first, uh, first, uh, firstshot.
(34:22):
And I think we're actuallyprobably close to like 70%
having received a second shot.
So that was, that was criticalas it related to those that had
the greatest risk of acquiringCOVID and, and, um, you know,
potential for really pooroutcomes.
Um, that said the staff thatsupport, um, those individuals
(34:44):
and frontline staff generallyspeaking have been, um, slower
to adopt and be willing, not,not for necessarily a lack of
access that we had early on,which is becoming harder now
because other groups are mixedin.
So now it's kind of more open,but, um, that's been, um, that's
been the biggest challenge and,and a challenge that I think has
been heard, not just withaccess, it's a, it's a not
(35:08):
nationwide, um, issue aroundreally, um, you know, and I, I
thought a lot of it resideswith, you know, um, generational
distrust of the health systemfor a whole host of reasons that
now is, you know, playing out.
So, um, I'm hopeful.
Um, we're starting to see alittle bit of an uptick in
participation in those areas.
(35:29):
And, you know, I am hopeful that, um, things like the Johnson
and Johnson vaccine gettingapproved, you know, with a
single shot, um, may make this,you know, more, um, um, more
likely to be adopted by others.
But, um, you know, otherwisewhen we start to get outside of
the core priority groups, um,then it's a bit, you know, then
(35:50):
it's a bit more, it's a bit morechallenging, you know, you're
kind of, you know, trying to runfrom place to place and sign up
here and sign up there.
And someone's got five shots andsomeone's got 10 shots today.
And, and how do you do it?
Like that stuff is where I think, um, some of the, you know, the
centralization of this could be,could be stronger, but, um, but
(36:10):
we have seen really, you know,really strong efforts around
larger clinics and things,including, um, direct clinics at
some of our homes beingperformed through CVS, um, where
they're actually coming out anddo clinics on site.
So, you know, a lot of it todayis I think it's really about
supply.
So as we start to see the supplynumbers, um, I think some of
this will be, we'll be kind ofin the rear view mirror,
(36:33):
hopefully.
Um, but the biggest, the biggestchallenge has been, you know, uh
, for, for portions of, of, of,of our staff, um, really, um,
willingness to, to get thevaccine is probably the most
important thing.
So we've been doing everythingwe can on education around that,
and, you know, providing updatesand staff that are willing and
have done a telling their storyand why and why it's important.
(36:55):
Um, but those are, those are,those are that, that's the
number one issue, not thelogistics.
Speaker 2 (37:01):
Um, so hopefully this brings us to what some might
call a new normal.
And, and what does the worldlook like host?
Um, COVID I know we're not outof the woods yet by any stretch
of the imagination.
So one thing I was thinking is,you know, telemedicine or
telehealth is one area thatyou've mentioned, are there
(37:23):
others that you had to adjust topivot to that you may say, you
know, something, we weren'tdoing that before, but we should
continue doing it.
It, it, it actually is not a badway for us to provide our
services.
Speaker 3 (37:40):
Yeah.
I mean, I, I think, um, justsimply, you know, greater work
from home or work fromalternative sites, flexibility
is important.
Um, you know, attracting talentinto our field is important.
So the ability to have moreflexible work schedules and
arrangements across, uh, youknow, a wide variety of, of
positions that we have, I thinkif something that we're, you
(38:02):
know, that we're figuring outwhat that looks like post
pandemic, because it's not goingto be the same as it was.
And, um, nor does it need to be,um, that in turn also may allow
us to have a smaller footprintas, as it relates to physical
space, um, which is, you know,which is also important if we're
not, you know, having the dollarspent on paying for those
(38:24):
spaces, maintaining those spacesand all of those, all of the
things that go with it, thosedollars can drive back to, you
know, to direct supports, um,you know, for services.
So that, that to probably standsout as, as one of the, um, one
of the key things.
Also, I think some of the, um,the other things that just need
to continue as a result of this,um, is the planning, the
(38:48):
pre-planning the, how do yousupport people?
You know, I mentioned theisolation center that we
created, well, how do thoseplans, how do we keep those
plans active so that ifsomething happens, we're once
again, ready to start thatimmediately, do we have
stockpiles of PPE and thingslike that?
And, you know, I think it's morekind of worst case disaster
(39:08):
scenario planning needs to bemore at the forefront because
even if it's not, you know, weshould all be fortunate that we
don't need to pull out thatplaybook for another, you know,
50 years.
But, um, the likelihood is, youknow, the world is getting more
crowded and more complicated.
It's probably more than likelyit's not going to be, um, you
know, another hundred yearsbetween pandemics.
(39:30):
So I think those are, those areimportant things that need to
stay, but, you know, the, thethings that have been learned
that have been positive, I thinkreally our use of space work can
be done in lots of differentways and forums.
And, and of course, um, ofcourse tele-health,
Speaker 2 (39:44):
Let me just ask you that one magical question, which
probably was a question beforethe pandemic, but maybe the
pandemic has changed yourpriorities.
So if there was this magic oneand money was no longer the
object, it was somehow flowingto you, where would you spend
it?
What would be the most effectiveuse of found money or new
(40:09):
sources of funding?
Where do you think you'd put itif, if it came your way?
Speaker 3 (40:15):
So, I mean, I mean, I think it's the same pre pandemic
and post it's just beenhighlighted to a greater degree.
It's investing in the wages andsalaries, benefits, and training
of the frontline staff, um, notpaid nearly what they should be
for the work andresponsibilities that they
carry.
Um, so I think that's, that'sabsolutely the number one, the
(40:38):
number one use as far as, youknow, if it's about different
models and if, and if thingscould change is how we, you
know, how we get paid and how weearn dollars for the work that
we're doing.
I think that would be thecontinued transition, um, with,
with some speed, um, to movingtowards models where we're being
reimbursed for the qualityoutcomes that, that people are
(41:02):
achieving, as opposed to oftenlots of regulatory things,
checking boxes and forms andplans being done by some date or
that somebody's, somebody's headwithin a bed as opposed to how
is, how is their life going?
How are there, how are theirhealth outcomes, how are their,
you know, their, their socialoutcomes?
How are those things going?
(41:22):
That's a dramatic shift fromwhere we are today to really pay
for value as opposed to, um,paying for kind of checking off
certain requirements.
So that would be the, you know,from, uh, just, uh, how it would
happen.
That would be number one, butthe, you know, the open, the
open, uh, checkbook, uh,question would, you know, I
(41:43):
think it's definitely, you know,supporting the, supporting the
frontline workers, um, in allthe different areas of the
organization, both in wage, butalso, you know, in, in training,
um, and making sure that they'reprepared for the work, um, the
best that they possibly can be.
Speaker 1 (41:58):
Ron, thank you so much for joining us on patterns
and paradigms.
We wish you nothing but, uh,success and good fortune and
continuing to deliver theservices that you do,
Speaker 3 (42:12):
Same to you, Jonathan.
Thanks for having me.
Speaker 1 (42:14):
Thank you for tuning in to patterns and paradigms the
pattern podcast.
For more information about thisepisode, visit our website
pattern for progress.org forwardslash podcast.
(42:43):
[inaudible].
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