Fairwinds – Nantucket’s Counseling Center, Inc. (formerly Family & Children’s Services of Nantucket County, Inc.), is the only licensed private not-for-profit mental health and substance abuse agency on Nantucket. For sixty-five years, the agency has provided affordable treatment to those that need it the most. The agency has thirty staff and has been covering a big need within Nantucket currently serving about 29,500 direct client hours annually with 500 or more clients at any given time. While there are private therapists on-island, Fairwinds is the only provider for those with no insurance and those who are under-insured. Fairwinds is also the primary source for behavioral health for our immigrant population speaking French, Spanish and Portuguese. Fairwinds serves the vast majority of people who have Mass Health insurance. The agency believes that the goal is to support a viable, healthy, and sustainable community by serving all who need our assistance. We serve people of all ages.
We continuously seek support for Fairwinds’ uninsured/underinsured clients receiving outpatient mental health and substance abuse therapy; community-based therapy; psychological testing; psychopharmacology; child psychology; court-ordered treatment; access to a drop-in Family Resource Center; and community-based resources. Our goals are: that youth and adults refrain from substance abuse and other risky and unhealthy behaviors; youth and adults develop skills needed to lead a positive and productive life; individuals, families and the elderly access services and resources for their physical and behavioral needs, and to provide access to these services regardless of insurance or ability to pay.
The reasons for this gap in coverage are complex. Some of the wealthiest people in the world maintain homes on Nantucket; it has become a mecca for fine restaurants, world-class entertainment and culture, designer goods, some of the best golf courses in the world, and a vibrant tourist economy. At the same time, there is a perfect storm of economic stress: the median house price on Nantucket is an astonishing $2,020,000 (compared to $313,500 for the US), way beyond the reach of two wage-earners. House-sharing, informal housing arrangements, and temporary housing are a way of life, even for those with good jobs. At the same time, employment peaks in the summer and shoulder months, but crashes in the winter months.
The result of this stressful environment is that Nantucket has sadly become a center for intense mental health disorders, including both suicide clusters and heroin overdoses. Fairwinds – Nantucket’s Counseling Center logged in 29,500 (not a typo) patient visits last year. Patients cover the entire socioeconomic and ethnic spectrum. Mental health and substance abuse/alcohol disorders have been identified by the entire community as two of the four most pressing health needs. Fairwinds is the largest, oldest and only non-profit agency on Nantucket that focuses on treatment of these needs. After changing over to an Electronic Medical Records System last year, Fairwinds has access to ongoing and past data regarding the need for supplementing insurance payments for services.
In addition to office-based individual, couples and group therapy, we serve our patients in the community and in the home. We do a full needs intake with every patient and determine their treatment plan, and what insurance they might be eligible for, if not already receiving. We also have sliding scale fees, down to $0, based upon income. We have a dedicated department that focuses on contract and insurance reimbursement, as well as private billing. This revenue stream is backed up with major fundraising efforts, including professional grant writing.
All of our therapeutic programs are evidence-based, managed by licensed therapists and supervisors. We have an ongoing and very exciting professional development program to support ongoing license and informational requirements of licensees, supported in part from the Blue Cross Blue Shield Foundation.
Outcomes and Evaluation: Our anticipated impact is that the behavioral health needs of the community will be met; that as we grow and offer more prevention services, that the health of the community will improve. For example, we just merged with Mentor Youth Nantucket, which offers the only mentorship programs to at-risk students in partnership with the Nantucket Public Schools.
How much did we do? We have in place an Electronic Medical Records Management System that tracks all our appointments, billing, diagnoses and treatment. We now serve about 500 individuals at any given time, with about 29,500 direct client hours annually.
How well did we do it? We hope and expect to be able to generate reports showing improved diagnoses and a lower frequency of interventions.
Is anyone better off? Every therapist has been issued a personal laptop which links to our EMR system. We’ve adopted the Baldrige Performance Excellence Framework, which is designed to improve an organization’s overall performance and get sustainable results and are working on improving our processes and performances on ManageHub, a Baldridge-based cloud system with the assistance of a top Baldrige consultant and Partners in Performance Excellence, our regional Baldrige association. In addition we are just completing translating all of our forms into Spanish and will offer a feedback survey and follow-up to our clients.
Sustainability Plan: In order to understand the funding gap need, it is important to look at agency’s latest financials and budget. In looking at our projected (not guaranteed) income against projected (not guaranteed) expenses, one can see that Fairwinds is projected to be sustainable. While the amount of funding we are requesting for any one grant is a small fraction of our budget, it is absolutely essential for demonstrating local support for the larger grants we have written and are planning to write.
In addition we apply to other foundations for program-specific grants that cannot be applied to the uninsured/underinsured funding gap. In the future, we will continue to look to foundations, large and small, to cover the insurance gap; we will take advantage of any state-sponsored programs that improve coverage, if they exist, and continue to reach out to local year-round and part-time residents.
Collaboration, Innovation and Modeling Potential: Fairwinds collaborates with virtually every non-profit and public agency on Nantucket, including the Nantucket Public Schools and private schools, Nantucket Cottage Hospital, police, fire, as well as individual practitioners who need specific support for their patients. We are thought leaders within the state and participated in the recent Certified Community Behavioral Health planning grant. We are innovative in that we are leading the way in the state as a practice designed to serve all individuals, regardless of ability to pay, language spoke at home, insurance coverage, or immigration status.
Our practice is the embodiment of the United Nations Universal Declaration of Human Rights (Article 25) which asserts that health is a human right. It is difficult to embrace a philosophy of service which has negative cash flow, but Fairwinds has successfully demonstrated that providing healthcare as a human right is not only the morally right thing to do, but can be sustainable as well.
 Nantucket Cottage Hospital Community Health Needs Assessment (http://nantuckethospital.org/2015-nantucket-community-health-needs-assessment/)