It’s a busy morning in the waiting room of Adaptive Behavioral Services, Inc. in East Liberty. A young African-American woman is filling out paperwork for her first appointment and gives her toddler son a toy to keep him entertained. Another older black woman is thanking her daughter for coming with her for a counseling appointment. “I’m glad you’re here,” she says, squeezing her daughter’s arm. Her daughter smiles. A twentysomething-year-old checks in with the receptionist. “I had some questions on my medication,” he says. “It should only take a minute if I can talk to someone.”
For Kevin Jordan, general manager and chief administrative officer, that active waiting room is a good sign.
Jordan founded ABS, the first minority-owned behavioral health provider in Allegheny County, in 2012 with the goal of providing access to underserved communities. Central to that mission is ensuring that services are, in his words, “multi-culturally competent.”
“People engage better in treatment if they are working with people who look like them or identify with them—culturally, in terms of class and not just race,” he explains. “It’s about finding common ground.”
Such common ground has often been missing for minorities—particularly African Americans—in receiving mental health care. While African Americans share the same mental health issues as the rest of the population, study after study report they lag behind in seeking treatment.
“African Americans from what I know and read often don’t trust the mental health system,” says Charma D. Dudley, president of the board of the National Alliance on Mental Illness Southwestern Pennsylvania. “Part of it has been a lack of understanding of what therapy is or there have been misdiagnoses.
“For example, depression diagnoses are often missed,” continues Dudley, who also serves as associate director of behavioral health services for Value Behavioral Health of Pennsylvania. “Culturally, black people have a legacy of having to be strong and being able to take anything that comes their way. It’s not easy to say, ‘hey, something’s wrong.’”
According to a Surgeon General report, African Americans are over-represented in populations that are at risk for mental illness. Unemployment, violence, imprisonment and higher numbers of single-parent families are among the stressors in the black community. In Allegheny County alone, there are nearly 150,000 low-income and minority residents with mental or behavioral health needs enrolled in Medicaid. Yet, issues of stigma and access have proven to be barriers to seeking care.
That’s where ABS’ focus on cultural competency comes in, according to Jordan. “It means we relate to our clients,” he explains. “There isn’t a sense of judgment. We know that many clients are dealing with poverty, grief, the criminal justice system and we’ve seen it in our own families—so for the clients there isn’t a feeling that ‘I’m being judged or they just don’t get what I’m going through.’ Our counselors get it. They’re compassionate. They’re respectful. They can talk to patients about health concerns without cultural differences getting in the way.”
Those sentiments are echoed by ABS clinical supervisor Brooke Generett. “It’s important to break through those [cultural] barriers,” she says. “Our community needs to deal with depression and anxiety and the heavy costs they bring. Part of that is getting people to seek treatment.”
At ABS indicators are more people of all races and backgrounds are seeking treatment. The provider, still in its first year of licensure, is averaging between 120-140 clients per week. Those numbers should increase as a result of the Affordable Care Act, according to Jordan. One of the main reasons African Americans are less likely to seek treatment for mental-health care is the same reason they are less likely to find help for other health problems: economics. According to the American Psychiatric Association, for those with insurance, “coverage for mental-health services and substance-abuse use disorders is substantially lower than coverage for other medical illnesses such as hypertension and diabetes.”
ABS seeks to offer a full continuum of care, including psychological assessments and evaluations, individual therapy, medication management, family therapy and, beginning this month, drug and alcohol services.
“It was important for us to be able to provide both behavioral and drug and alcohol treatments,” says Jordan. “A lot of times people have both. If they have a substance abuse or alcohol problem there’s probably some underlying mental health issue there as well. We want to be able to incorporate holistic influences into our treatment modalities. We know that a client’s nutrition, family dysfunction, spirituality and physical health affect their chance of living productive lives.”
Lashawn Barber recently made the decision to seek treatment for her depression. The 39-year-old Oakmont resident was connected to ABS through a program she’s enrolled at through Sojourner House in East Liberty. “I thought it was time to get help,” she says of her first month of therapy. “I feel like I’m getting some help in getting my life in order. I’m feeling better about my situation.”
Another service offered is group therapy geared toward adolescents. These sessions are called JAMZ Sessions and can be adapted to cover a number of topics, from dealing with violence and trauma to building healthy relationships. The sessions, are designed to foster open discussion aimed at changing behaviors. “The thought was to make group therapy cool…like a jam session,” Jordan explains. “Let’s eliminate the fear and shame that can be associated with group therapy. Let’s provide some perspective and help these kids find some hope.”
Despite peppering his conversations with words like hope and promise, Jordan isn’t shy about pointing out that ABS is a for-profit venture. He had been approached by another entrepreneur, Dr. Omar Reid, who had been operating similar clinics in the Boston area. Reid had researched the Pittsburgh area and found a large underserved population. Jordan, 50, has a background in both the public and private sector. A Duquesne University graduate in business administration, Jordan worked for accounting firm Deloitte & Touche, held leadership positions in non-profits, including WQED, The NorthShore Community Alliance, and the City of Pittsburgh’s Housing Authority. He also served on the board of Mental Health America – Allegheny County.
His approach has been to apply many of the business practices he learned in the for-profit world to ABS. All record keeping is done electronically. Outcomes are trackable and treatments are evidence-based, making reimbursement processing more timely to improve cashflow. Systems are in place to eliminate no-shows, so that therapists can see patients and bill their time. Although he declined to disclose revenues, the team of 18 (11 clinicians, 3 medical staff and 4 management/administrators) is kept busy.
And the company is actively seeking new ways to serve the community. Because the prison population has a high percentage of minorities, Jordan targeted the Pennsylvania Bureau of Corrections and has signed an agreement to provide mental health services to the prison population. A similar contract is pending in Beaver County.
Those JAMZ sessions provide another opportunity. ABS is exploring offering the program to schools as an alternative to suspensions. Instead of suspending students—which adversely affects a school’s bottom line—enrolling troubled students in therapy programs can more effectively deal with the causes of acting up in the first place as well as give kids valuable coping strategies. Additionally, the effectiveness of school suspensions is increasingly being debated among educators.
Teletherapy—allowing a psychiatrist to connect with patients via a secure video connection—is allowing ABA to secure additional patients and to reach remote areas.
“The needs are there,” Jordan says. “We just need to think about them strategically.”
It’s a sticky hot July day. The waiting room at ABS is not quite as busy today, but Jordan is happy with the numbers so far. He is looking into opening new centers in other neighborhoods. Next up is the Hill District. A plan to open an ABS satellite office in a housing project was scrapped because it didn’t provide the type of access that would attract the entire community. “We want to go where we can be a central part of a community—and not just in Allegheny County,” Jordan explains.
But as heat index increases, Jordan steps away from thoughts of ABS’ expansion and instead heads to a nearby store that sells shaved ice. He buys $50 worth of gift cards to take back to the office and give to clients as a way to beat the heat. “It’s a little thing,” he says of the gesture, “but think about how much a little kindness means to someone struggling with all these challenges in their everyday lives. Man, it’s a shaved ice but it’s also a little hope.”