There is nothing more concerning to me at this moment than ensuring our financial health.  As you all have no doubt been following, we are in the midst of a global economic readjustment which ultimately trickles down to national, state and local budgets.  In the 4th quarter of 2008, the Governors of both Massachusetts and Rhode Island enacted varied forms of fiscal cutbacks for services to the disabled. 

Here in Massachusetts, a further round of cuts was announced in late January but thus far they have not been fully enacted.  Reasonable speculations suggest that both MA and RI are awaiting final federal “stimulus budget’ allocations to determine what Health & Human Services budget cuts will remain and be enacted, along with those which may be rescinded.  As such, my leadership team and I have prepared contingency responses to any eventual direct clinical service cuts.  In turn, I’m also well aware of the new fiscal architecture surrounding administrative costs and am in the process of finalizing contingency plans in this regard as well.

A specific example of a potentially devastating MA budget cut that has been announced is a curtailment of “family support” funding to over 11,000 Massachusetts families as of July 1, 2009.  These “family support” dollars assist families to obtain respite care, homemaker care for the disabled, self-advocacy programs, and other such means which allow families to maintain their loved ones at home in lieu of seeking more expensive state care.

Given the plethora of reading and trend analysis I have read in regards to ‘economic trends’ which may affect Seven Hills Foundation, it is abundantly clear to me that this recession is much more systemic of what I refer to as the “new architecture” of our economy, as opposed to a cyclic adjustment as we witnessed in the early 1980’s. 

We have entered a new era-a paradigm shift if you will, in which global economics have become manifest and may trump the long held dominance of the United States.  We need to consider such an implication in terms of our national entitlement programs, (Medicare & Medicaid) in parallel with the ‘demographic trends’ of an aging U.S. and developed world workforce. 

The algorithm is clear: aging U.S. demographics →an increased need for chronic care services → fewer “legal” workers contributing to Medicare and Medicaid beneficiaries = significant cuts or leveling of U.S. entitlement programs and the resultant “new architecture” of our health and human services system.

There are answers to this, but these solutions require changing the systems of care and reimbursement which we have become accustomed to and have learned to expect. They include:

• A reduction in the number of providers who each take anywhere between 10-14% off the top of clinical service dollars for overhead.  Fewer providers would help consolidate overhead (Seven Hills Foundation’s overhead is only 7%).



• “Managed care” allocation ‘buckets’ offered to families in lieu of our current plan of care/need based service system.  Fewer dollars given to families but greater choice in care provider selection.



• “Lead agencies” who serve as “Super Providers” replacing the bloated state oversight system (i.e. local state offices, area offices, regional offices etc., are duplicative, expensive, and unnecessary).



• “Outcome based” performance payment to providers of care. Gone (soon) will be the days when unsophisticated providers, who can show no meaningful outcome standards, will exist.  Healthcare and human services systems will begin to migrate closer in terms of demonstrating health/service outcomes and payment will be based on measurable results.

The above are just a few of my thoughts concerning the “new architecture” of human services we are entering.  It is incumbent upon us to remain focused, strategic in our planning, and nimble in our actions as we mitigate the challenges we face over the next 18-36 months.

Over the past two weeks I’ve written to our staff and legislators concerning further budget cut proposals for developmental services ( e.g. Family Support Funds, certain respite services, etc.) being recommended by Governor Patrick in his July 1st State Budget submission to the State Legislature.  We are, of course, working aggressively to have these funds restored prior to the July 1st fiscal year; we serve far too many individuals and families through our Family Support programs to allow this to go unchallenged. 

Here at Seven Hills Foundation, we have been aggressively involved with our varied legislative delegations throughout the Commonwealth and have been successful in having over 120 state representatives sign a petition requesting that the Governor restore the Family Support funds. 

We now ask for your help – our 3,000 Seven Hills employees at over 150 locations throughout Massachusetts.  IF YOU ARE SO INCLINED, call AND write your state legislators ( both your State Representative and State Senator) and ask that they make a call to the Governor’s Office seeking his full funding of these important Family Support dollars AND – when the time presents itself – that they vote to fully restore the Governor’s proposed budget line items 5911-2000 ( Community Programs – cut by $45 million),  line item 5920-2000 (Residential Programs – cut by $8 million), and line item 1599-6901 (Salary Reserve – cut by $23 million).  

I am pleased to report that after many months of staff planning and actual construction, our new Seven Hills Behavioral Health Methadone clinic is completed and open.  This is particularly significant to me in that it truly signifies what we as an organization value; that is, promoting dignity and respect for all people regardless of their physical or mental condition. 

The new clinic replaces the antiquated facility we inherited when we took over the ‘Center for Human Services, Inc.’ agency 3 years ago.  In the brief time we have been open our daily enrollment has skyrocketed to 650 patients per day.  In the late spring we will be holding a formal dedication of the facility for directors, staff, local and state officials, and those we serve who are in recovery from throughout southeast Massachusetts.

I am very pleased to publicly announce the appointment of Dr. Robert Carl as my selection for Vice President of Seven Hills Behavioral Health. With the departure of Gouri Datta, MD nearly a year ago, I have left this position unfilled while the day-to-day management has been in the able hands of our two Assistant Vice Presidents at SHBH: Jo-Anne Newton, AVP for Operations and Karen Blanchette, AVP for Clinical Services. Bob assumed consolidated oversight for all SHBH operations effective April 1, 2009 while maintaining his duties at The Homestead Group. I am very pleased to both know and have worked with Bob Carl; he brings a wealth of clinical expertise and leadership acumen to the Foundation and in his new responsibilities in managing two of our operating affiliates: The Homestead Group Inc. and Seven Hills Behavioral Health, Inc.

In response to the needs of our own growing number of international employees-- and the clinical desperation of many children and adults in need of care in those countries reflected in our own Seven Hills staff--we began on October 1, 2008 a new affiliate called “Seven Hills Global Outreach, Inc.” (SHGO). 

The event was quite literally “national news” as TV and newspaper coverage in Accra followed the work of our delegation from a place in the USA called ‘Seven Hills Foundation’. We now anticipate collaborating with our own Seven Hills staff-originally from Kenya and Sierra Leone, to determine if there is an opportunity to assist some small humanitarian healthcare need in these countries.

Of the 15,000+ nursing facilities newly ranked by U.S. News & World Report only 27 merited their “honor role” status in the first version of “Americas Best Nursing Homes”.  “All 27 garnered a perfect five stars in each of the four yardsticks the federal government applies to nursing homes: overall rating, health inspections, nursing staff, and quality measures of individual care” (U.S. News).

My congratulations are extended to Holly Jarek, Vice President of SHPC, and our entire staff at our Groton site for the excellence in care offered to those medically fragile children and young adults we serve. As you may know, we assumed responsibility of SHPC five years ago from Children’s Hospital/Boston.

Each morning, on my to the Worcester office, from my home in New Hampshire, I turn a corner at the intersection of Ashby Road and John Fitch Highway in Fitchburg and as I turn, I generally pull over to view the construction currently underway at our long anticipated CAFS Child Enrichment Center. 

This new facility will soon be the home to over 85 children, as young as 1 year old, who generally come from low income families, in our CAFS daycare program.  This new facility will be bright, modern, and a safe place, as compared to the older building CAFS has occupied for years, less than 2 miles away.  The old site used for years is in the middle of one of the most challenging neighborhoods in Fitchburg, where it is not uncommon to hear fights, shootings, and obscenities outside while children try to learn to be kind and empathetic inside our program. 

This juxtaposition between what we were attempting to teach the children and the environment we surrounded them with led us to conclude early in 2008 that a move was absolutely required.  While our new facility is under construction we are searching for a buyer of our old site and conducting a $500,000 Capital Campaign. To date, we’ve raised $300,000.

It has been a very busy time for the Human Resources Department!  In February 2009, we selected a new health insurance carrier, Fallon Community Health Plan (FCHP), effective March 1, 2009. The change to FCHP will allow Seven Hills to offer our employees a plan very similar to the Tufts plan, without the need to increase employee contributions. We anticipate that the change to FCHP will also result in reduced overall health insurance costs. 

The FCHP plan subjects all expenses, with the exception of preventative services, office visits and prescriptions, to a $2,000/$4,000 deductible which Seven Hills will fund through a Health Reimbursement Account (HRA).  Seven Hills has partnered with UltraBenefits, Inc. to process all HRA eligible claims.  For the 2nd year in a row we have not passed along any increases to our staff in terms of additional health insurance payroll co-pays.

Diversity Committee - The 2009 Seven Hills Foundation Diversity Calendar has arrived!  Copies have been distributed to Affiliates.  We will continue with the quarterly diversity activities and this year we hope to get more staff involved. We’ll soon send out the first quarter diversity activity and do some follow up to assist teams and groups doing the exercises.

A segment on diversity will be added to our employee orientation.  We will be ready with this diversity training in early spring and a pilot will be presented to the Diversity Committee in April.  The next Diversity Committee meeting is scheduled for May 27th.

I am pleased to announce Judith Drew, Ph.D. CRC, LRC has joined the Seven Hills Foundation and accepted the position of Chief Learning Officer.  Judi has over 25 years of experience in rehabilitation, education, training and career counseling services.  She received her B.A. in Special Education and M.A. in Rehabilitation Counseling from Rhode Island College, and her Ph.D. in Rehabilitation Services from The Ohio State University. 

Dr. Drew comes to us from the Massachusetts College of Pharmacy and Health Sciences, where she held the position of Interim Coordinator of Disability Services.  She maintains a private practice in vocational expert testimony, vocational assessment, ADA consultation and assessment and job placement training in RI, MA and CT.  Judi currently serves as Adjunct Faculty at Salve Regina University and Assumption College.

The Massachusetts Providers' Council maintains an active legislative agenda. On January 15, 2009 the Council filed three bills for the new legislative session.  Dr. David Jordan and I are active members of the Council’s public policy and executive committees and worked in conjunction with the Council to get many of our own local legislators to sign on as co-sponsors of the bills. Here is a brief description of these bills, which do not have numbers assigned to them yet:

1. An act relative to access to health insurance for human service providers and their employees - Sponsored by Representative Kay Kahn.  This bill amends the legislation of the Group Insurance Commission (GIC) and will expand the eligibility requirements to "persons who are employed by private human service providers that deliver human and social services under contracts with departments within the executive office of health and human services and the executive office of elder affairs." This bill will give you access to the GIC for the purchase of group health insurance at the same rates the state has negotiated for its employees.

2. An act relative to tuition remission - Sponsored by Senator Karen Spilka.  This re-submission (which operates at NO expense to the Commonwealth) expands the current program to include graduate level and continuing education courses.  Benefits would also apply to the spouse of any employee of a program funded by EOHHS. 

3. An act establishing an education loan repayment program for social workers and credentialed direct care human service workers - Sponsored by Senator Marian Walsh and Representative William "Smitty" Pignatelli.  This bill seeks loan forgiveness for "credentialed direct care human services workers" and licensed social workers.  Eligibility is limited to persons with incomes that do not exceed 500% of the federal poverty level with a repayment rate not to exceed $250 per month for a period not to exceed 48 months (subject to appropriation).  We are filing this with the National Association of Social Workers - Massachusetts Chapter. 

Even though legislative hearings have yet to be scheduled for these bills, it is never too early to notify your own state legislators about the importance of them to you. Please call your legislators today. Broad support early on increases our chances for success. 

Dr. David A. Jordan, President of Seven Hills Foundation, has been elected to the National Board of Directors of the Mental Health Corp. of America.  MHCA represents top behavioral health organizations throughout the country.

We have had a great deal of activity in terms of our marketing and branding efforts.  Holly Jarek and I have been meeting with case managers at area hospitals, as well as having conversations with contacts that can refer children to our sub-acute wing.  We’ve developed a new marketing piece that highlights our sub acute services which has been sent to case managers, pediatricians, discharge planners, NICU/PICU, orthopedic personnel and insurance liaisons.

Our goal with Seven Hills Pediatric Center (SHPC) marketing is to break away from “me too” marketing, and set the stage to be the state’s experts in pediatric long term/sub acute care.  We were recently able to visit an institution in New York State that had gone through a similar transition.  Their business development team works with hospital contacts to continue to create a pipeline of referrals.  The Advancement Office is looking at developing a similar approach.  To prepare for this, our intern, Allie Page, has been conducting research and refining our database.

Dr. Kate Cleary and I have been working on expanding the marketing efforts of Clinical Associates.  Drawing on Clinical Director Dr. Joe Ricciardi’s professional stature and expertise, we will be putting together a series of Info Sheets that provide information on Autism-related topics.  These sheets will be mailed to our stakeholders as well as placed as PDFs on the Clinical Associates web site.  We will also make these available at conferences and workshops.

Our Home-Based Counseling program continues to expand. We have recently recruited and hired two fee-for-service therapists in the Southeast, one in the Northeast and two in the Central Region (including our first bilingual therapist).

Our roles have expanded to include more than 20 clinical staff all with proven expertise in the areas of Cognitive-Behavioral Therapy, Applied Behavioral Analysis (ABA), Sexuality Education as well as a variety of other specialty counseling areas. We are also now able to provide the full range of psychological treatment and psychiatric services throughout the state.

Seven Hills has always been at the forefront of program development with individuals with significant behavioral challenges in community settings. We are now on our way to becoming a leader in providing behavioral health services to individuals with mental health issues and developmental disabilities.

We are adding patients to our roles in each of our three clinic areas on a daily basis. Currently we have more than 200 patients and produce over 600 units per month. Our staff provides services in a variety of settings--at vocational sites, in day programs, in nursing homes and rehabilitation facilities, in our patient homes as well as in our therapy offices at Hope Ave. and at West Boylston Street. During the aftermath of the recent storm and power outages, many of our staff met with patients in homes running on generators using battery-driven shop lamps, demonstrating the commitment and dedication of our home-based therapy staff to meet the clinical needs of our clients!

The past few months have been exceedingly busy for the CAFS Family Counseling Center.  We received notice in November that we would lose the use of the site on South Street.  The United Way has been very generous over many years in allowing the Center and CAFS to use this site; however, the United Way decided to sell this building and a buyer was found quite quickly.

Accordingly, much of our time in January was spent in looking for new space.  After a few attempts, a beautiful new location was secured at 110 Erdman Way in Leominster, MA.  This space has already been configured with ten offices and a reception/waiting area, perfect for the needs of the Family Counseling Center.

The move to the new location was completed during the week of February 23, 2009.  The new site is now fully functional.  The offices are a good size; there is now room for us to provide family therapy and to grow.  Thanks to Rich Martel of our Foundation Building & Facilities Department for his work in finding this new location and assisting with the details.  Many thanks to Ms. Carolinda Warter and the Counseling Center staff who expertly coordinated and executed the many details of this move.

As you may know, the Department of Mental Retardation has been ordered by the court to place several hundred individuals currently residing in nursing homes into community placements.  Seven Hills Community Services was selected by DMR to design, develop and operate three homes in various regions of the state. 

These include the Cape, Lowell and Worcester areas.  Each house will be a home for five, medically intensive individuals.  There will be a 3:4 or 3:5 staff to individual ratio during waking hours and two staff during the overnight.   On each shift there will be either one RN or LPN. 

My staff and I have worked closely with the “Group 7 Design” architects and have designed what we anticipate to be the most attractive and functional home in the Commonwealth.

• In mid-February the three ladies residing at Elizabeth Court, Saugus relocated to a beautiful new home on Haverhill Street, North Reading.  The women and their families are ecstatic about their new home.
• Last November I reported that SHCS was opening a new home in Andover for “turning 22” individuals with intensive behavioral challenges.  The gentlemen are doing remarkably well and are enjoying their new home.

During the past month, the IT Department worked on numerous projects throughout the organization.  Activities included upgrading existing software and hardware as well as exploring how new technologies might support the mission of the organization.  Activities included:

•Assuming responsibility of the utilization of cell phones by Seven Hills staff

•Supporting the efforts of SHGO as the Ghana Team prepared for its visit

•Assuming responsibility for assuring that the AlertNow programs meets the needs of the organization

•Updating the staff web page; www.sevenhillsstaff.org with daily news items

•Relocating CAFS from South Street, Fitchburg to Erdman Way, Leominster

•Ordering the technology and communication equipment needed for the Child Enrichment Center at 1470 and 1780 John Fitch Highway, Fitchburg

•Working with the Homestead Group to integrate their IT functions into our systems (e.g., TACS, Navison, email)

•Installing a new telephone system at 81 Hope Avenue    

     
•Presenting computer training sessions for staff on Word, Excel, etc. each month

•Supporting the development of plans for the Stafford Street property

•Completing the move of equipment into the new Gifford Street facility   

  
•Support the SHCS move from Elizabeth Court, Saugus to Haverhill Street, N. Reading

•Providing a monthly Databases and Systems Training for Front Line Supervisors

•Addressing over 300 IT service requests in February

•Piloting Sequest’s TIER software with the Home Based Counseling program

•Overseeing the implementation of Massachusetts mandates on record privacy

The computer center at 81 Hope Avenue was funded by Fidelity Investments seven years ago.  Since the initial construction, we have upgraded the equipment several times, but have maintained the same basic design.

As a result, we are currently working with Building Services to make modifications in the lab’s layout to better support our new missions.  In addition, we have researched and installed various software and internet solutions that will assist supervisors to manage resources in situations like natural disasters.