ASPIN is a 501(c)(3) nonprofit behavioral health provider and education network offering access to clinical providers in over 50 locations throughout the state of Indiana.
|Affiliated Service Providers of Indiana (ASPIN)|
|Kathy Cook, CEO/President|
The mission of ASPIN is to provide innovative educational programs, resource management, program development, and network management in collaboration with all healthcare entities to address health disparities and whole health management.
Q: In a “nutshell,” how would you describe your network?
A: We are a very mature network, over 21 years old. We're made up of community mental health centers and addiction providers in rural Indiana. We have ten members within our network, all located within the state of Indiana.
We’ve accomplished a number of successful “Indiana Firsts.” We became the first clinical provider network for the Indiana Division of Mental Health and Addiction back in '95. We were the first to obtain the state contract to do peer training, which is now integrated with community health worker training. We were the first to have a private telehealth network with the VA. We were the first to have a statewide health navigator network. We've also been an education network forever.
Q: Are there any other types of organizations you're interested in recruiting for membership?
A: We really haven't focused on “new” membership. What we focus on is “partnerships.” There are organizations out there we would like to partner with on projects, such as managed care companies. One of our partnerships we've developed is with the jails through the Sheriff's Association, by assisting criminal justice consumers that are leaving the jail system with enrolling in health care insurance. We focus more on partnerships so we can diversify our network products.
Q: What benefits do network members receive?
A: Our first service line was third-party administration, and that's when we started out 21 years ago. We have the state contract with the Division of Mental Health and Addiction. The state pays us for mental health services and addiction services, and we pass that through to some of our providers.
We help them monitor their numbers and help correct their data that they submit to the state. We have performance improvement projects that go along with all that data, and so we do a lot of data mining as well. Even our providers that don't enroll through us give us the same data that they submit to the state so we can monitor any increases in some types of mental health or drug addiction diagnoses or trends. We can monitor that as a network and come up with performance improvement plans for these issues.
For instance, we monitor how many veterans go through our network. We had several coming through that were uninsured, and we questioned, "Why are the veterans coming through our mental health centers uninsured?" There's a lot of reasons they come to our mental health centers. They don't want to have a mental health diagnosis on their medical record, so they won't go to the VA. Maybe they don't qualify for the VA. Maybe it's too far to travel.
So to address this, we partnered with the VA to set up telehealth sites in five of our rural mental health centers, so that they could receive services locally. We have a telehealth unit there and a clerical person that would usher them into the room, and they would connect with the VA therapist for their mental health sessions. That was a huge success, and it was a success because it was a goal of the VA, too. They wanted to serve more people in the outer corners of the regions, and we thought, "Maybe that will help our uninsured numbers go down." It didn't. It increased the numbers. In fact, it was so successful that the VA kicked in for three more sites, so we have eight total sites throughout the state that are still up and running.
Q: How do you go about assessing the needs of your members and communities?
A: First of all, we stay attuned to what's going on in the state for mental health and addiction needs, as well as any other health needs. Our board is made up of CEOs of each of our member organizations, and so they are usually sitting in a small town dealing with the same issue. They come together on a monthly basis, and on an annual basis, we have a retreat and talk about what are the issues they're seeing in their centers. We also bring together the data and analyze it for our population. If there's a huge shift in heroin use, for instance, we'll maybe focus a project on that.
Also, by looking at our patient data as a network, we can respond to a grant application more quickly and offer a greater impact. The data allows us to focus on the network’s areas of need. Including members in grant applications allows them to feel like they are a part of the network because everyone has input, and everybody gains from that experience.
Q: What challenges do you face working in your rural environment, and how do you respond to those challenges?
A: The major one is the shortage of health professionals in the rural areas. As Indiana's unemployment numbers shrink, it's even harder and harder to get people to go into mental health fields. There's a huge psychiatrist shortage in those areas.
Through a HRSA [Health Resources and Services Administration] grant, we put together the ASPIN Recruitment and Retention Consortium. Three of our members partnered to come up with a program where we actually go out to rural colleges and recruit students that are in those soft degree programs, the human service degrees where they really don't have a job in mind when they graduate. We get them interested in mental health and offer them a three-day community health worker training program. Once they complete that, then they could go work at our providers while they're finishing their degrees. It gives them a certification, and then they can see if they like working in the mental health field. Maybe they do, and maybe they stay with our providers. That way, we've grown a new workforce in that shortage area. The CHW training is also a stepping stone to another higher-level job in the mental health field.
Q: What are the advantages of working in your rural area?
A: I think working in a rural area, you obviously can make a bigger impact. I think urban areas are too big, and it has too many environmental conditions that change. I think when you have a program working in a rural area, you can actually measure and see improvement in your project, and I think that's very positive.
We also have navigators statewide in local rural communities, and so when they help people, they know the people they impact. It's always for the positive. They know that they're going to help their kid’s fifth grade teacher, or the football coach, or the guy at the post office, or whoever needs help with their insurance or mental health services. It’s very positive to know that you're helping out a neighbor, and I think that's really positive for rural.
Q: What has been a surprising insight over the course of your network’s development?
A: I think the commitment from the rural organizations has been surprising. We've gone through several CEO changes at our member facilities, and they've remained committed to ASPIN. The network acts as a small group where they can ask questions, because as CEOs in rural communities, there's really no one there for them to relate to or ask questions. It's been a real “learning community” for them as a board.
We put together a return on investment tool, which every year we use to outline how much we've done and give a dollar amount to it. We show our members how much they get for their membership dues, because that way they can take it back to their CFO, who says, "What do we get for being a member or paying these dues?" If they have new board members, they can share what we've done for them, and usually they get back hundreds of times more than what they put in.
Another thing that's been surprising is we've been through three or four Directors of the Indiana Division of Mental Health and Addictions at the state level, and we have maintained a good relationship with them. We have built a good reputation, and they come to us with projects and questions, and come to our board meetings and ask for input on new projects.
Q: Based on your experiences as a network leader, what advice would you give to a developing rural health network?
A: Be open to change, and be flexible to accommodate member needs. We have four service lines that we put our projects under. We opened with one, and we just kept building, and building, and building, and building. Some came on two a year, three a year. If it's something your members need, then they're going to buy into everything you do. Be open to change and be flexible to accommodate their needs would be my number one.
Number two, I would say diversify your revenue. Even if it's grant funding, diversify who you get your grants from. Diversify what projects you work on. You never know when one is going to go away, and then you're out in the cold. Diversify so that you're not exposing the network, and you can continue on. Hopefully, tuck a little away so you have an investment account, too. We have membership dues as well, so that's part of our revenue diversification.
Number three: seek funding specific for rural areas or your community. We appreciate HRSA tremendously for their support of Rural Health Network Development grants, because it has helped our network. We can run a network, but we don't have the development money to develop programs, and so the HRSA grants actually give us that opportunity to develop those programs for our providers and help them. I really appreciate that. HRSA’s support allows individuals in their rural communities to come together and sort through what they need to do for their organizations to make them successful on their own.