Sullivan County


Division of Health and Family Services
April 2018 Monthly Report


Department:Division of Health & Family ServicesSponsors:


  1. Printout
  2. 2018-04 Stats Rpt


Adult Care Center:

·              Throughout this period the facility has been functioning well we have made many advances in attaining a 4 star rating from CMS. Clinically we have attained elevated standards in resident care, planning and we are commiserating on ways we can be an active participant in clinical issues by being recognized by our peers in the community. In doing so we have developed affiliations with Ellenville Regional Hospital Case Management Team, forging a relationship with Liberty Medical Group so that we can be recognized as a contender and player in the healthcare market in the region and institutions in our catchment area. This is evident by opening up new horizons where we can be seen and heard. To further elaborate, a roster of our endeavors is outlined below:

o              Ad placed in the Democrat  “Nurses Week” edition 

o              4 star rating article  published in Sullivan County Democrat and the Times Herald Record

o              Researched cost and process of a billboard

o              Researched cost and process of a commercial

o              Outreach to Ellenville Regional Hospital Case Management Team

o              Outreach to Liberty Medical Group

o              Promoted and worked in advertising with all vendors / volunteers via the monthly newsletter

o              Continue discussion regarding new logo for facility

o              Conducted tours to potential family members of residents

o              Conducted tour to deputy county manager regarding changes to the facility

o              Implemented changes to the facility, both inside and outside.

o              Had ACC join the Health and Wellness Committee

o              Outreach to Ellenville Regional Hospital public location

o              ADN did outreach to SCCC - high school students regarding employment

o              Placed ad in Sullivan County Democrat BOCES School Scene

o              Placed ad in Sullivan County Democrat SCCC School Scene

o              Working on a list of directives from deputy county manager regarding facility and name change.


Community Services:

Ongoing Operations:

·              The “Just-In-Time” scheduling seems to be going well, as well as the blended Behavioral Health Clinic.  The management team has been monitoring this process which is running smoothly.  The combined group mental health/alcohol & drug therapy sessions also seems to be going well.         

·              The care management unit continues to actively engage with both of the Health Home agencies and the HARP Services (Health and Recovery Plans) which is a Medicaid and Medicaid Managed Care health plans.  Our Care Managers are enrolling those people who are eligible in Care Management programs.

·              Our Community Services Coordinators have now switched roles.

·              April: Our first Community Services Coordinator is split between DCS and OFA has done the following: 1.) at the Adult SPOA Committee meeting on April 12, 2018, reviewed the status/updates of seven (7) prior referrals.  Nine (9) new Adult SPOA referrals were received and reviewed by the SPOA Committee at the meeting.  Coordination of referrals and ongoing collaboration with service providers continue. Clients were recommended for/linked to various services, including:  behavioral health treatment providers, RSS housing (apartment program and community residences), Access: Supported Housing, Sullivan PROS Program, OFA, Action Toward Independence, Independent Living, Inc., and Care Management services.  Coordinator organized and facilitated the monthly Adult SPOA Committee meeting, (review of incoming referral packets, typing the case presentations, agenda, meeting minutes, waiting lists).  Coordinator also conducted follow up throughout the month and completed monthly SPOA related data reports.   Coordinator attended the High Risk Client Committee meeting.  The Coordinator attended two (2) meetings on Privacy and Safety at the Government Center; plus sat in on two (2) webinars: Children’s Medicaid System Transformation Update and New Timeline Review.  Coordinator also spent 25% of time with NYConnects through Office for the Aging.  2.) At Children’s SPOA Committee held on April 26, 2018, reviewed the status/updates of four (4) prior referrals.  The status of four (4) new referrals were received and reviewed by the SPOA Committee.  Communication with families and referral sources continue as well as ongoing coordination of referrals and linkage to/collaboration with services providers.  Children/families were recommended for/linked to various services, including:  Parents for Parents Family Support, Children’s Health Home Care Management services, Home and Community Based Services Waiver, respite services, RSS Recreation, behavioral health providers, Preventive Services/MST, the RSS Crisis Stabilization Program for Youth, and Independent Living, Inc. for their Peer Parent Specialist.  Coordinator organized and facilitated the monthly Children’s SPOA Committee meeting - (review of incoming referral packets, preparing case presentations, agenda, meeting minutes, waiting lists).  Coordinator conducted follow up throughout the month and completed monthly SPOA related data reports.

·              The mental health housing wait list from our monthly SPOA meetings are as follows: nineteen (19) people for RSS Pleasant Street Community Residence, twenty-four (24) people for RSS Revonah Hill Community Residence, thirty-nine (39) people for RSS Supportive Apartment Program, seventy-four (74) for RSS Supported Housing, zero (0) for RSS Long Stay beds at RSS, twenty (20) people for RSS Invisible Children’s Program and twelve (12) people for Golden Ridge Supported Housing.  The RSS Crisis Respite bed is not available at this time.  The Transitional Residence in Middletown has two (2) people. 

·              There are four (4) Adult Homes in the county which are as follows: Arcadia has fifty-nine (59) people with a capacity of one hundred fourteen (114) and 76.27% of residents have mental illness (MI); Jeffersonville has sixty (60) people with a capacity of sixty (60) and 90.00% have MI; Narrowsburg has seventy (70) with a capacity of seventy-nine (79) and 94.43% have MI; and Swan Lake has twenty-seven (27) with a capacity of twenty-seven (27) and 74.07% have MI.  There are six (6) people waiting for a vacancy in an OMH/Family Care residence.

Local Government Units Activities:

·              The department is still working with the NYS Regional Delivery System Reform Incentive Payment programs (DSRIP) which was implemented in 2015 for the development of patient provider service networks.  The county has had agreements with Westchester Medical Center and Montefiore for the DSRIP in Sullivan County for the past couple of years. 

·              Our other Community Service Coordinator during the month of April attended the following meetings: Housing Task Force Committee meeting, DCS open access meeting, DCS manager’s meeting, the Drug Task Force Committee meeting, Community Services Board meeting, the Adult and Children’s SPOA Committee meetings, and a meeting with DCS management staff and the Deputy County Manager and Deputy Commissioner of Management and Budget.  Coordinator also attended the HIPAA Security Training and the Children’s Medicaid System Transformation Update and New Timeline Review webinar.  Coordinator worked on our plan for mobile crisis response services (NYS Behavioral Health Crisis Response Initiative), the Mental Hygiene Planning Committee Survey questionnaire on estimated need, and a modification agreement between Sullivan County and NYU regarding MSW interns.  Coordinator continued to work on the Crisis Stabilization Center proposal along with related research and organization.  Coordinator also conducted research related to CCOs and MAT.  Coordinator assisted with the New York Tobacco Treatment Systems and Practices study being conducted by the Health Policy Science and Tobacco Research Center.  Monthly agency reports were submitted to OMH. The HVCS MOU, HealthlinkNY, Inc. agreement, and agency contracts continued to be processed (Action Toward Independence, Catholic Charities, NAMI, Hudson Transit, United Way, and Independent Living, Inc).  Coordinator continues participation in the Sullivan County Chamber of Commerce Foundation’s Leadership Sullivan program.

·              The Department continues to work with local providers in finding funding/grants to provide help to families whose children have been diagnosed with serious emotional disturbances, like SullivanArc and New Hope Community.  The Department continues to monitor the family peer support workers with the Independent Living Center Inc.’s (ILC) peer services to Sullivan County residents.  The Peer Bridger plan continues to do very well at Catskill Regional Medical Center (CRMC).  The Peer Bridger program is also utilized at the SC Jail when needed and also seems to be working well there.

Other activities participated in:

·              Community Services is still heavily involved with the Hudson River Regional Planning Consortium Advisory Group.  The group also reviews and discusses issues, suggestions and/or concerns from the data collected from the previous meetings.  The group collaborates together to resolve the issues, suggestions and/or concerns identified within their region and also bring them to the Conference of Local Mental Hygiene Directors (CLMHD) in Albany. The board is meeting on a quarterly basis, and members will serve as an access point for providers and consumers to bring concerns. 

·              Meeting with various providers/agencies to discuss the Crisis Stabilization Center Plan for Sullivan.

·              DCS is continuing to work on the Goal Setting needs and had a meeting updating Dan & Darrin.

·              Attended a HIPAA Training & Security training for Management.

·              Attended a webinar for the LGU SPOA and MAPP process.

·              Attended the following Monthly Meetings:

o              All Staff Meeting.

o              Drug Taskforce meeting.

o              SALT meeting.

o              S.C. Jail meeting.

o              Opioid Epidemic Taskforce meeting.

o              Housing Taskforce meeting.

o              Public Health POD meeting.

o              Toured with Sullivan Leadership.

o              Medical Review Committee.

o              Meet with Dan Hust regarding the new website for the County.

·              Meet with the following agencies:

o              District Attorney’s office.

o              Family Court Judges

Other regular activities performed were:

·              the meeting of the internal corporate compliance committee reviewing internal operations, Office of People with Developmental Disabilities (OPWDD)/DDRO, Conference of Local Mental Hygiene Directors Executive and Directors meetings and the annual spring conference, OMH Behavioral Health Services Advisory, Legislative committees & actions, the Community Services Board and its Behavioral Health Subcommittee.


·              To our billing staff (Tina, Therese, Lisa, Donna & Kyle {who was on loan from DFS 2 days a week}) who got caught up with the billing.  DCS was almost to the limit of the 90 day billing and now is less than a week behind the actual billing dates.  This has been a process since December.


Family Services:


·              Basic Workload -In April 2018 this office began with 88 active DFS agreements in place. Resolutions were prepared this month for the Family Violence Response Team, HONOR EHG and Dispute Resolution Center. Contracts were developed for the Center for Workforce Development, Westchester Institute for Human Development, KeyBank, and Rehabilitation Support Services. A modification was developed this month for Safe Homes of Orange County. One contract was terminated this month for Emergency Reserved Accommodations.

·              Contract Monitoring Welfare to work transportation data was reviewed for the contracted providers of Rolling V Bus Corporation and the Center for Workforce Development. Several meetings took place this month on contract development and/or new service implementation. This office received data for compliance from Rehabilitation Support Services, the Sullivan County Child Care Council for their two contracts, Dispute Resolution Center, the Center for Workforce Development and the Town of Wallkill Boys and Girls Club. Also, exclusion screening for all contractors was completed-.


Special Investigations

·              As of 4/1/18 the Special Investigations Unit had 343 Active Investigations. During the month 125 total Fraud Referrals were received resulting in 69 investigations assigned to the Unit and 56 were dismissed. The Fraud Investigators completed 73 investigations. As of 4/30/18 the end of the month total was 338 active investigations.

·              The unit received 33 referrals and closed 17 Front End Detection and Eligibility Verification Review investigations.  3 of the closed investigations were denied/withdrawn due to the investigation which resulted in a $31,314 Monthly Cost Avoidance.

·              The unit collected $12,880 for Accident Lien Recovery, $1,149 for Property Lien Recovery, and $14,380 for Estate Claim Recovery, a total of $28,408 in Resource Recovery.

·              The Unit received 11 requests for indigent burials resulting in 7 burials being approved, $18,736 total indigent burial costs.


Child Support Enforcement:

·              The Child Support Enforcement Unit Collections for the month of April 2018 were $728,536. The total TANF collections were $40,443 and the total DFS NON-TANF collections were $8,157. The DFS total amount collected was $48,600. There were 37 petitions filed in the month of April 2018 and 27 Paternity Establishments (including acknowledgements). Total CSEU cases open as of April 2018 are 5070.



Foster Care/Adoption

·              As of April 30, 2018, there are 94 children in foster care; 56 children are placed in regular and therapeutic community foster homes or home on trial, 37 additional children are in congregate care placement, and there was 1 child AWOL. In the month of April, there was one adoption finalized. Of the total number of children in foster care, 17 are freed for adoption, and 6 of those children have a goal other than adoption. There was one child, with the goal of adoption, who was placed in an adoptive home, and 10 children are currently awaiting placement. There is on-going activity to reduce the number of children in foster care through discharge to a parent or other appropriate resource, discharge to independent living or adult custodial care as well as adoption.

Child Protective Services

·              The CPS unit received 164 new reports alleging child abuse and/or maltreatment in April 2018.  Twenty-six of these reports were assigned to the FVRT.


·              The preventive unit has 159 open cases at the end of April 2018.  Of the 159 open cases, 52 are active referrals that are receiving assessments and/or short term services.  There were 25 new referrals received during the month of April.

Adult Services

·              The Adult Services unit has 202 open PSA cases at the end of April 2018.  Of the 202 cases, 121 are representative payee cases, and 30 cases are guardianships. 

·              Personal Care Aide services are provided to 37 cases. 

·              There are 8 PERS (personal emergency response) cases and no long term care cases.


Temporary Assistance (TA)

As of 4/30/18, the breakdown of Temporary Assistance active cases was as follows:

·              259 PA TANF cases (Public Assistance, Temporary Aid to Needy families)

·              322 PA SN cases ( Public Assistance, Safety Net)

·              5803 NPA FS (Non- Public Assistance, Food Stamps)

Medical Assistance (MA)

As of 4/30/18, the breakdown of Medical Assistance active cases was as follows:

·              3169 MA cases (Medical Assistance)

·              2721 MA/SSI cases ( Medical Assistance/ Supplemental Security Income)

Department Updates:

·              Received approval from OCFS for the Child Care portion of the County’s 5 year CFSP.  Approval is pending for the Domestic Violence Non-Residential Services portion of the plan.

·              The County’s Biennial Employment Plan for 2018-2019 was approved.

·              Attended a meeting to discuss content for the County website redesign.  Reviewed content for benefit programs: Medicaid, SNAP (Food Stamps), and Temporary Assistance

·              Attended HIPAA Security and Privacy Training at the Government Center.

·              Participated in a work group for the completion of a Runaway and Homeless Youth Plan addendum to the County’s 5 year Child and Family Services plan.

·              The 2017-2018 HERR component is still active and is scheduled to run until 9/28/18.

·              The Clean and Tune component opened on April 2, 2018.  It is anticipated to run until November 2, 2018.

·              The HEAP Regular benefit, first emergency benefit, and second emergency benefit are scheduled to close on 4/27/18.

·              A Cooling Assistance benefit is scheduled to open on 5/1/18.



Office of the Aging:

·              No report.



Public Health Services:


·              The Director attended monthly legislative committee meetings and was busy with flu prevention planning and health emergency planning meetings in preparation for the May 1 regional exercise at SUNY Sullivan.  Attended NYSACHO monthly meeting, planning meetings with various community organizations, conference calls and outreach regarding public health issues, the opioid crisis, drug task force, and flu prevention. Attended the county manager’s monthly meeting, the county HIPAA administrative oversight committee meeting, and held various staff meetings.

·              Work continued on Quality Improvement initiatives; centralizing forms and held supervisory meetings and monthly management meeting. Chaired the Rural Health Network meeting and drug prevention Task Force meetings, preparation of various grant renewals, work plans, budget and reports consumed a great deal of administrative time this month, including reviewing list of department’s contracts and identifying those that need to be renewed, working with purchasing and the county attorney’s office, personnel.

·              Working on several IT related projects to update the operations of the CHHA and other program areas needing IT support. 

·              Attended the annual NYS Public Health Association conference April 18-21 and spoke at a workshop as a guest presenter on collaboration with elected officials on public health issues.

·              Preparing for reapplication of Rural Health Network grant for another 5 year cycle, met with RHN Steering Committee to explore goals and objectives to include in the application, and scheduled a meeting for May with the grants department.

·              We will be piloting the county’s electronic 428 process and have started.


CHHA Technology Improvement Projects



Quality Assurance/Performance Improvement/HIPAA Compliance:

·              Quality Goals Progress

o              Goal: All employees will have introductory understanding of QI concepts and practices

o              Objective/Activity: By July 1, 2018, all (100%) employees will receive introductory education to QI

o              Status: In progress. In all, 34% of employees have completed the learning module “Basics of Quality Improvement for Public Health Practitioners” on the NYS DOH Learning Management System.

o              Goal: Begin the process of formalizing QI infrastructure

o              Objective/Activity: By March 1, 2018, establish SCPHS Quality Council

o              Status: Complete

o              Objective/Activity: By April 1, 2018, adopt agency-wide QI plan and share with all staff.

o              Status: Complete


·              HIPAA Compliance

o              Annual HIPAA training update: A total of 8 employees attended the HIPAA Privacy and Security Trainings with Bonadio Group at the Government Center on April 19 and 20th 2018. 3 supervisors and 5 general staff. We are awaiting notification from the Privacy and Security Officers that the recordings of the trainings are available. Once available, the remaining employees will be scheduled to watch the recordings in the PHS building and proof of attendance will be documented for compliance.  Complaints/issues: None this month.


Epidemiology/Disease Control:

·              Influenza

o              Governor Cuomo- Executive Order declaration 1/25/2018 - Influenza public health emergency: remains in effect

o                NYSDOH Commissioner of Health Influenza prevalence still remains in effect; mandatory mask policy for HCW still in effect.

o                NYSDOH Commissioner of Health -Declaration of an Imminent Threat to Public Health for Seasonal Influenza Virus- effective February 8, - April 30, 2018.

o              Two additional Influenza clinics were held this month

o              Increased hours of operational flu clinic time at SCPHS continued.

o              Influenza surveillance tracking reports of flu cases continued to be sent to SCPHS EPI department from HCP’s; 

o              Influenza tracking of confirmed Flu Lab reports monitored; 

o              School surveillance survey sent to superintendents & nurses to report rates of absenteeism related to flu weekly continued

o              Public Educational outreach to the community and at Health fairs on influenza continued.

·              Communicable disease

o              1- confirmed case of Measles (March) - continued case investigation and monitoring of exposed persons continued into April ; NYSDOH notifications had been sent to local HCPs;

o              6 cases of Shigella investigated - specific population affected within the county which included investigations from other surrounding counties. Education materials provided to local HC provider(s).

·              Rabies

o              Rabies clinic held for the public on April 24, 2018 - 144 animals vaccinated

·              Emergency Preparedness:

o              Full Scale Regional Medical Countermeasures Point of Dispensing Exercise planning meetings held in preparation for the exercise to be held May 1, 2018 continued throughout April, including staff training.


Early Intervention

·              The new Account Clerk/Database employee started on March 5, 2018. She is currently working on vouchers to assist in the backlog. Additional staff are being utilized from PHS Billing to work on outstanding vouchers. In April, we received the following revenue: EI $98.80; YTD total $1505.80; SED-MA - $10,234.45; YTD total $50,930.52. We have submitted $1,053,918.93 on AVLs in 2018. We have not received payment on the AVLs to date.



Health Education:

·              Our two public health educators are busy providing many types of educational presentations on tick borne disease prevention (Tick-Talk), which has become very popular.  Also outreach on tobacco cessation support, information, and referral. April through Sept is the busiest time of year for requests. Over 25 presentations, meetings and targeted outreach events were held, including during Public Health Week in April and at various locations and at organizations, schools, the government center, CRMC, SUNY Sullivan, Morgan outdoors, food pantries, libraries, as well as at the Sullivan Renaissance spring market. We utilized our public health nurses to also provide blood pressure screening and provide education on various topics on Thunder 102 throughout the month.


Certified Home Health Care Agency/ Long Term Care:

·              In April 2018, the Certified Home Health Care Agency (CHHA) patient census averaged 152 active patients, with 24 of those being Long Term patients and 16 Maternal Child Health patients.  A total of 162 referrals were accepted, 8 more than in March.


Average Census - April 2018


Long Term


Maternal Child Health


#Referrals accepted


#Referrals unable to accept *


# new patients accepted for home care



·              Twenty-one referrals were not accepted, 5 for lack of capacity of the agency to provide services due to low staffing (for patients with private insurance,)  2 because the patients had insurance that is not currently accepted, 5 who didn’t reside in Sullivan County, and 2 due to not having an MD who would sign home care orders. Other reasons for not accepting referrals included no skilled need, the referral cancelled by the source, requests for Personal Care Aide evaluation (which SCPHS does not provide, except for MLTC exempt patients for the Department of Family Services), other home care providers already in place, patients who were deemed unsafe in their homes, and patients who were not discharged from their facilities.  Eighty-four new patients were opened to home care services in April, 13 more than in March. Of these, 3 patients had Medicaid as the payor, 29 3rd party insurance, and 52 Medicare. Six were aged less than 10 years old, and 58 were 65 years or older.


Healthy Families Program:

·              Healthy Families currently has 71 families enrolled in the program.  FSW’s have completed 151 visits for the month and 192 hours of direct service time. There were several discharges in March due to participants unavailable due to work and completing the program as well as moving out of state.   Supervisor Stacey Wizwer is now fully trained in Kronos and is assisting with timekeeping issues. Healthy Families also attended, S.A.L.T meeting, Breastfeeding Coalition meeting and MISN MICHE meeting and FSW Ericka is attending the Latino Service Provider meeting. Program manager and supervisor participated in Public Health Week by doing Radio Interviews and spreading the word about our programs at Healthy Families, home visiting as well as the CRIBS program and Car seat program at Public Health.

·              Our first parenting group was in Monticello on April 18th at 1st way Life center on Prince Street. The topic was “making simple soup with purchased WIC items”. Everything went very well and participants enjoyed themselves and are looking forward to our next one; TBA. We have also tentatively secured locations in Liberty and Fallsburg as needed.  Healthy Families also continues to collaborate with multiple departments such as:  DFS, SNAP and TA and WIC programs to provide needy families with referrals to Healthy Families. Program Manager, Pat Bennett and supervisor Stacey Wizwer interviewed nine applicants for FSW position. We have hired a FSW for the position; she speaks, reads and writes a fair amount of Spanish.  She started on April 30th. She also participated at the SSSC campus during the POD exercise with the Healthy Families staff.   We hope to increase our program caseload by twenty families. We have completed 6 assessments this month and have a Healthy Families Advisory Board was held on March 8th at Public Health Services. Program Manager Pat Bennett and Supervisor also did a presentation for Crystal Run doctors and shared information about the Healthy Families program, hoping that they will recommend patients to our program. It went very well.


Women Infants and Children (WIC Program):

·              Sullivan County Public Health Services WIC Program: (per our annual data)

o              1)  Was ranked number one in New York State for providing nutrition services to high risk participants 100 percent of the time by qualified nutritionists.

o              2) is ranked number six in NY State with regard to the amount of infants exclusively breastfeeding at six months Starting July 9th, our hours of operation are expanding to assure weekly evening appointments. Farmer’s market vouchers will be distributed to participants starting June 1. Looking forward-in December, 2018, Sullivan County Public health services WIC Program will begin transitioning from paper checks for nutritious foods to a debit type of card for each family.

·              WIC continues to promote and maintain the health and well-being of nutritionally at-risk women, infants, and children. We are gearing up for Farmers Market promotion- and distribution of vouchers starts June 1. We are working on promoting and scheduling appointments in our new weekly expanded hours for working families-starts July.

·              Our WIC Program served 1525 Participants in April 2018

o              Liberty: 639

o              Monticello: 786

o              Wurtsboro: 62

o              Jeffersonville: 38

·              The breastfeeding initiation rate: 78.3 %.



Youth Bureau:

·              No report.