P e n n s y l v a n i a s P a r t n e r

Berks County

HealthChoices

Annual Report

3

Message from the Administrators

4

Enrollment

5

Utilization - All Members

7

Utilization - Children and Adolescents

9

Service Spotlight - Telepsychiatry

10 The Recovery Model

11 Myths and Facts about Mental Illness

12 Reinvestment Plan Summary

14 Terminology

C o n t e n t s

P e n n s y l v a n i a ’ s P a r t n e r

A message from

the Berks County Mental Health/Mental Retardation Program Administrator

and the Berks County HealthChoices Program Administrator

Lydia Singley, LSW

HealthChoices Program Administrator Edward B. Michalik, PsyD

Berks County MH/MR Program Administrator

May 24, 2007

Dear Citizens of Berks County,

On behalf of the Berks County MH/MR Program, the

staff of the HealthChoices Program, and in cooperation

with the staff of the Council on Chemical Abuse, we

are pleased to present our fourth HealthChoices

Program Annual Report to the Berks County Community.

This report, for the period of October 1, 2005, through

September 30, 2006, reflects and celebrates the fifth full year

of the HealthChoices Program’s local County oversight. You

will note a continuing trend toward increased membership

and greater number of individuals served in addition to fidelity

toward continued Reinvestment in new and enhanced services.

We are excited about the dawn of the Recovery Movement as

its principles reflect the long held belief that those who struggle

with mental illness be recognized as having lives of value

distinct from their illness. Furthermore, we remain proud of our

staff and thank them, our Managed Care Partner, Community

Care Behavioral Health, our stakeholders and our Board of

Commissioners for their continued support and collaboration.

It remains a distinct privilege to be of service to our Community.

Edward B. Michalik, PsyD

Categories of Assistance:

Temporary Assistance to Needy Families (TANF) – assistance to families with dependent children who are deprived of the care or support of one or both parents.

Healthy Beginnings (HB) – assistance for women during pregnancy and the postpartum period.

State Only General Assistance – state funded program for individuals and families whose income and resources are below established standards and who do not qualify for the TANF program. This includes the Categorically Needy (CATN) and Medically Need Only (MEDN) groups.

Federally Assisted Medical Assistance for General Assistance Recipients (FGA) – federal and state funded program for individuals and families whose income and resources are below established standards and who do not qualify for the TANF program.

Supplemental Security Income without Medicare (SSI) – assistance for people who are aged, blind, or determined disabled for less than two years.

Supplemental Security Income with Medicare (SSIM) – assistance for people who are aged, blind

E n r o l l m e n t

Membership 2001 through 2006

Membership by Category of Aid

Medical Assistance is provided through the Department of Public Welfare and administered locally by the Berks County HealthChoices Program. Eligible members are assigned to specific categories based on certain criteria. TANF 25,420 49.0% Categorically Needy 1,651 3.2% Federal GA 746 1.4% Healthy Beginnings 10,978 21.2% Medically Needy 434 0.8% SSI 7,924 15.3% SSI with Medicare 4,747 9.1% 51,900 Members enrolled

Other 1,651 10% Outpatient Mental Health 8,578 52% Residential Treatment Facilities 191 1% Inpatient Mental Health 721 4% Drug & Alcohol

Services 1,960 11% Community Support Services 1,741 10% BHRS 1,591 9% Ancillary Services 455 3%

Gender

Age Groups

Members Served

Race and Ethnicity

Levels of Care

Drug and Alcohol Diagnoses

Mental Health Diagnoses

Members Served

Unduplicated Members Served: Mental Health Diagnoses: 9,904 Drug & Alcohol Diagnoses: 1,864

All Diagnoses: 10,683

0

5

10

15

20

25

30

Children & Adolescents

Members Served

Gender

Race

4,290 unduplicated children and adolescents received services

through the Berks County HealthChoices Program

Residential Treatment Facility 183 3% Other 695 10% Outpatient Mental Health &

Drug & Alcohol 3,370 46%

Inpatient Mental Health & Drug & Alcohol

179 2% BHRS 1,567 22% Community Support 990 14% Ancillary 204 3%

Level of Care

Children & Adolescents

Members Served

0

10

20

30

40

50

60

Drug & Alcohol Disorders Other Mental Health Disorders Anxiety Disorders Adjustment Disorders Autistic Disorders Attention Deficit Disorder Schizophrenia and Psychosis Depressive Disorders Bipolar Disorder 281 5% 770 13% 98 2% 2,937 51% 456 8% 950 16% 33 1% 89 2% 107 2%

Diagnostic Groups

“Other Mental Health Disorders” includes Tic Disorders, Learning Disorders, Communications

S e r v i c e S p o t l i g h t

Telepsychiatry

Access to psychiatric care has become increasingly difficult to secure for both HealthChoices and base-funded consumers in Berks County. Established members, who have consistently remained engaged with their treating psychiatrists, are generally able to secure appointments as needed because they are able to schedule them far enough in advance. Members who show a newly identified need for psychiatric assessment, or members who are connected to a treating practice but routinely do not follow through with psychiatric appointments, experience the most difficulty. These individuals may have to wait two to three months for a psychiatric assessments.

Telepsychiatry is one specific application of

telemedicine that has been researched extensively. Psychiatry is thought by many to be an ideal specialty for videoconferencing, because of the primacy of the face-to-face, question-and-answer interaction (Baer, Cukor, Jenike, Leahy, O’Laughlen, and Coyle, 1995). This interaction, researchers have contended, can be replicated by videoconferencing technology more easily than for other medical specialty applications. A 1994 report in Telemedicine Today listed 16 programs that were using or proposing to develop a telemental health component of their telemedicine program (Allen

& Allen, 1994). This number has continued to increase as telepsychiatry has proven to be beneficial for consumers in underserved or rural areas. In 2004, the Berks County HealthChoices Program implemented a pilot telepsychiatry project designed to increase access to psychiatric care through teleconferencing. Reinvestment funds were used to purchase the teleconferencing equipment and to pay for monthly

maintainence fees during the first year of operation. The actual sessions, psychiatric evaluations

and medication management, are billable to the HealthChoices program for reimbursement. Currently, two outpatient providers in Berks County participate in this project, allowing local HealthChoices members to receive services from psychiatrists located at the Western Psychiatric Institute (WPIC) in Allegheny County.

Individuals who would have had to wait longer for face to face psychiatric services on site in both outpatient psychiatric clinics were able to receive services more quickly. Both facilities report positive results in reducing or eliminating wait times for consumers. One provider reported that eight consumers were seen for completed psychiatric evaluations and six medication checks were completed; the other provider reported that fifteen consumers were seen for completed psychiatric evaluations and twelve medication checks were completed. All consumers are screened for participation and the therapists assigned to the program interview each client and review the case with the WPIC psychiatrist prior to the consumers’ contact with the doctor.

Increased access to both psychiatric evaluations and medication checks has improved the providers’ ability to maintain clients on their medications while decreasing the stressors resulting from extended wait times. This increased stability has the result of improving the overall quality of these members’ lives. Reduced wait times also result in fewer calls to the provider, improving efficiency and reducing their costs. There is also a reduction in the members’ need to access medications through emergency room visits.

Recovery Model

The Recovery Model refers to the process of recovery from a mental health disorder or substance dependence, and/or from being labeled in those terms. Recovery has been defined as “an individual’s journey of healing and transformation to live a meaningful life in a community of his or her choice while striving to achieve maximum human potential” (U.S. Department of Health and Human Services, 2005). It incorporates a philosophy of support, respect, empowerment, choice, hope, and social inclusion. Originating in programs to overcome substance dependency, the concept of recovery in mental health usage emerged from deinstitutionalization resulting in more individuals living in community settings but there being a perceived failure to support full recovery or enable proper integration into the community in a meaningful manner. The recovery model is a form of social model of disability by contrast to a medical model of disability and may involve “consumers” and

“survivors” of mental health service as well as mental health professionals. In general medicine or psychiatry, recovery has long been used to refer to the end of a particular experience of illness. In the context of long-term conditions, it might refer to a period of remission and therefore potentially relapse. The concept of full ‘recovery’ as a general philosophy first became popular in relation to substance

use programs, including 12-step approaches. Application of full recovery concepts to psychiatric disorders is comparatively recent and stems largely from two interrelated sources: the consumer/survivor movement, a grassroots self-help and advocacy initiative, and psychiatric rehabilitation, a professional approach to mental health services provision. The concept of full recovery has emerged as a significant paradigm shift in the field of mental health and became increasingly implemented in the policies and practices of mental health systems. The recovery model has been said to be based on the premise that all consumers have the capacity to improve and develop a life distinct from illness. Scientific and consumer models of recovery have differences and commonalities; the consumer model of recovery involves a nonlinear process in which an individual gradually adapts to and moves beyond what may be termed an illness, while scientific and clinical models typically view recovery as an outcome, primarily involving reduced symptoms and improved functional capacity (sustained for a particular duration, for example two years). Scientific-professional views also place

considerable emphasis on the role of treatment, especially including maintenance pharmacotherapy, while the consumer model places greater emphasis on peer support and personal experience.

Hope is a feature proposed to be important, including a realistic openness to failure, disappointment and possible relapse along the way. Recovery can be seen as an individual experience; a fundamental change in the concept of self. For many, “recovery” has a political as well as personal implication, where to recover is to find meaning, to challenge prejudice, to reclaim a chosen life and place within society, to validate the self. Recovery can thus be viewed as one manifestation of empowerment. An empowerment model of recovery may emphasize that conditions are not necessarily permanent, that other people have recovered who can be role models and share experiences, and symptoms can be understood as expressions of distress related to lack of a connection on a deep emotional level to the people around them, involving loss and trauma and interruption in social development. One such model from the US National Empowerment Center advances 10 such principles of recovery framed within a cognitive-behavioral approach. In psychiatric rehabilitation, the concept of recovery has often been used in a more limited way to refer to functional criteria and reduction of psychosocial disability. To recover is to improve and maintain personal capacity in one or more of the major domains of life, whether it be work, housing, relationships, or recreation. Psychiatric rehabilitation also focuses on individuals’ role performance. The recovery model has been supported by evidence from both quantitative and qualitative research. Long term (longitudinal) studies have shown that a psychiatric disorder does not necessarily take a course of inevitable deterioration and that, for a significant number of people, a return to full potential is possible. Other research, including studies of reports by consumers/survivors of mental health services, has identified resilience and resourcefullness, diverse and individual pathways of healing, and factors which can enhance or detract from recovery. Increasingly, recovery has become both a subject of mental health services research and a term that is emblematic of many of the goals of the consumer/ survivor movement. Specific policy and clinical strategies are currently being used to implement recovery principles although key questions remain.

Often people are afraid to talk about mental health because there are many misconceptions about mental illnesses. It’s important to learn the facts to stop discrimination and to begin treating people with mental illnesses with respect and dignity.

Here are some common myths and facts about mental health.

Myth: There’s no hope for people with mental illnesses.

Fact: There are more treatments, strategies, and community supports than ever before, and even more are on the horizon. People with mental illnesses lead active, productive lives.

Myth: I can’t do anything for someone with mental health needs.

Fact: You can do a lot, starting with the way you act and how you speak. You can nurture an environment that builds on people’s strengths and promotes good mental health. For example: Avoid labeling people with words like “crazy,” “wacko,” “loony,” or by their diagnosis. Instead of saying someone is a “schizophrenic” say “a person with schizophrenia.”

Learn the facts about mental health and share them with others, especially if you hear something that is untrue.

Treat people with mental illnesses with respect and dignity, as you would anybody else.

Respect the rights of people with mental illnesses and don’t discriminate against them when it comes to housing, employment, or education. Like other people with disabilities, people with mental health needs are protected under Federal and State laws.

Myth: People with mental illnesses are violent and unpredictable.

Fact: In reality, the vast majority of people who have mental health needs are no more violent than anyone else. You probably know someone with a mental illness and don’t even realize it.

Myth: Mental illnesses cannot affect me.

Fact: Mental illnesses are surprisingly common; they affect almost every family in America. Mental illnesses do not discriminate—they can affect anyone.

Myth: Mental illness is the same as mental retardation.

Fact: The two are distinct disorders. A mental retardation

diagnosis is characterized by limitations in intellectual functioning and difficulties with certain daily living skills. In contrast, people with mental illnesses—health conditions that cause changes in a person’s thinking, mood, and behavior—have varied intellectual functioning, just like the general population.

Myth: Mental illnesses are brought on by a weakness of character.

Fact: Mental illnesses are a product of the interaction of

biological, psychological, and social factors. Research has shown genetic and biological factors are associated with schizophrenia, depression, and alcoholism. Social influences, such as loss of a loved one or a job, can also contribute to the development of various disorders.

Myth: People with mental illnesses cannot tolerate the stress of holding down a job.

Fact: In essence, all jobs are stressful to some extent.

Productivity is maximized when there is a good match between the employee’s needs and working conditions, whether or not the individual has mental health needs.

Myth: People with mental health needs, even those who have received effective treatment and have recovered, tend to be second-rate workers on the job.

Fact: Employers who have hired people with mental illnesses report good attendance and punctuality, as well as motivation, quality of work, and job tenure on par with or greater than other employees. Studies by the National Institute of Mental Health (NIMH) and the National Alliance for the Mentally Ill (NAMI) show that there are no differences in productivity when people with mental illnesses are compared to other employees.

Myth: Once people develop mental illnesses, they will never recover.

Fact: Studies show that most people with mental illnesses get better, and many recover completely. Recovery refers to the process in which people are able to live, work, learn, and participate fully in their communities. For some individuals, recovery is the ability to live a fulfilling and productive life. For others, recovery implies the reduction or complete remission of symptoms. Science has shown that having hope plays an integral role in an individual’s recovery.

Myth: Therapy and self-help are wastes of time. Why bother when you can just take one of those pills you hear about on TV?

Fact: Treatment varies depending on the individual. A lot of people work with therapists, counselors, their peers, psychologists, psychiatrists, nurses, and social workers in their recovery process. They also use self-help strategies and community supports. Often these methods are combined with some of the most advanced medications available.

Myth: Children do not experience mental illnesses. Their actions are just products of bad parenting.

Fact: A report from the President’s New Freedom Commission on Mental Health showed that in any given year 5-9 percent of children experience serious emotional disturbances. Just like adult mental illnesses, these are clinically diagnosable health conditions that are a product of the interaction of biological, psychological, social, and sometimes even genetic factors.

Myth: Children misbehave or fail in school just to get attention.

Fact: Behavior problems can be symptoms of emotional, behavioral, or mental disorders, rather than merely attention-seeking devices. These children can succeed in school with appropriate understanding, attention, and mental health services.

Department of Health and Human Services, 2006

Respite Care

Respite is designed to serve Medical Assistance eligible adults and children who are identified through interagency planning teams, crisis intervention staff, Base Service Unit case managers, Community Care staff or inpatient psychiatric unit personnel. .

Respite services may either be provided after stabilization of a crisis situation or as a planned service. The goal of respite is to offer temporary relief to caregiver’s and/or children and adult consumers in need of a temporary change in situation or stabilization of a crisis. These services can be provided in several ways:

• service through an out of home host provider site • in home hourly staff support

• 24-hour respite care in the consumer’s home or in a community-based agency setting

Determinations on the type of respite care provided are based on individual circumstances and are geared towards honoring the preferences of the consumer and family members. Service length may vary, but, most commonly, authorizations are provided for a 24-hour period after which there is an assessment for continued need for the service. During the respite period, other interventions with the consumer or their family may also be implemented. Such activities typically include assistance with:

• connecting to other resources • locating permanent housing • attending treatment appointments • attending community activities

Housing – Flexible Funding

Through this reinvestment priority, flexible spending resources are available for the provision of rent and/or utilities deposits or rent payments. Rent payments made for more than one month, are only made if there is an expectation that a longer term income source will become available.

Service Access and Management (SAM), the Mental Health Base Service Unit, is contracted to manage the resources identified in this plan. SAM contracts directly with landlords, rental agencies and utility companies.

The target population for this reinvestment priority is Medicaid eligible, HealthChoices enrolled adult members (18 and older) who are receiving HealthChoices behavioral health services. This includes members with either mental illness or substance abuse issues or co-occurring disorders. In addition, eligible members include individuals under the age of 18 who are living independent of family or are otherwise considered homeless.

Room and Board for Community

Residential Rehabilitation (CRR)

Host Homes

CRR Host Home Service, otherwise known as Individualized Residential Treatment, is a clinically intense, individualized level of care for children with serious mental illness who are being diverted or stepped down from Residential Treatment Facilities (RTFs). Treatment and other supports available in this level of care may include:

• individual, family or group counseling for the child and family

• psychiatric evaluations • medical management • psychological evaluations • crisis intervention

• community integration services and

• residential support provided by trained foster care families

Recommendations for this service originate from psychiatric or psychological evaluations and must be supported through interagency planning processes. Community Care authorizes and reimburses providers for the in-plan treatment portion of the child’s care. Room and Board either comes from other child serving systems such as Children and Youth, Juvenile Probation or the base funded mental health system. Resources from the mental health base allocation are limited and provide funding for other services, such as summer camp.

Berks County contracts with the local Base Service Unit, Service Access and Management (SAM) for management of these resources. SAM, in turn, subcontracts with CRR Host Home Providers currently enrolled with the Office of Medical Assistance Programs (OMAP) and Community Care’s provider network for room and board reimbursement. Determinations on which provider can best meet the treatment needs of the identified child and family are determined on a case by case basis.

The target population includes Medicaid eligible, HealthChoices enrolled children and adolescents, up to age 21, who may be involved with other child serving systems, but are not adjudicated dependent or delinquent and, as such are considered “mental health only”. Children in need

of CRR Host Home/ Room and Board payments are identified through interagency planning meetings attended by the Base Service Unit’s case management staff and Community Care’s care management staff.

Resources made available through HealthChoices are

utilized as a last resort. All other available funding resources, such as SSI, are applied to room and board fees before any HealthChoices reinvestment resources are utilized.

R e i n v e s t m e n t

Reinvestment Plan History

2001-2002

Drug and Alcohol Treatment Services

Community Outreach to High Risk Populations Room and Board for CRR Host Home Services Mental Health Outpatient Expansion

Mental Health Respite Care

What is Reinvestment?

Capitation revenues from the Department of Public Welfare and investment income which are not expended during an Agreement Year may be utilized in subsequent Agreement years as “seed only” money to start up or increase service capacity, or to provide supplemental or cost-effective services.

2002-2003

Assertive Community Treatment Team for Transitional Age Youth Autism Treatment Collaboration

Emergency Room Crisis Intervention

Intensive Case Management and Resource Coordination Expansion Student Assistance Program Revitalization Project

Respite Care

Room and Board CRR Host Home Services Drug and Alcohol Transitional Housing Outpatient Treatment for Sex Offenders Drug and Alcohol Housing - Easy Does It Case Management Support

2003-2004

Access to Psychiatric Services - Telepsychiatry Respite Care

Therapeutic Community - Project Transition Extended Acute Mental Health Inpatient Community Re-Entry

Community Treatment Teams

Mental Health Substance Abuse (MISA) Outpatient Services

Reinvestment Expenditures 2001 through 2005

2004-2005 $440,728 2003-2004 2002-2003 $3,779,956 2001-2002 $1,249,679 2005-2006 (proposed) $4,257,699

Te r m i n o l o g y

The number of admissions into services per 1000 HealthChoices enrollees.

AUTHORIZATION

A process that is related to the payment of claims by which a provider receives approval from CCBH to provide a particular service. Authorizations typically limit the number of units and the time in which the service can be provided. If a service requires authorization for payment, the lack of authorization will result in an unpaid claim.

CAPITATION

A set amount of money received or paid out; it is based on membership rather than on services delivered and is usually expressed in units of PMPM (per member per month) or PMPD (per member per day). Under the HealthChoices program, capitation rates vary by categories of assistance.

CLAIMS

A request for reimbursement for a behavioral health service.

COMMUNITY RESIDENTIAL REHABILITATION (CRR) CRRs are residential programs designed and operated to assist persons with chronic psychiatric disability to live as independently as possible in the least restrictive setting. COMPLAINT

A process by which a consumer or provider can address a problem experienced in the HealthChoices program. CONSUMER

HealthChoices enrollees on whose behalf a claim has been adjudicated for behavioral healthcare services during the reporting period.

DENIAL

A denial is defined as “a determination made by a BHMCO in response to a provider’s request for approval to provide in-plan services of a specific duration and scope which (1) disapproves the request completely; (2) approves provision of the requested service(s), but for a lesser scope or duration than requested by the provider; (an approval of a requested service which includes a requirement for a concurrent review by the BHMCO during the authorized period does not constitute a denial); or (3) disapproves provision of the requested service(s), but approves provision of an alternative service( s).”

DIAGNOSIS

A behavioral health disorder based on DSM-IV or ICD-9 diagnostic criteria.

DIAGNOSTIC CATEGORIES

Subgroups of behavioral health disorders. This report contains the following groupings:

Bipolar Disorders – a group of mood disorders that characteristically involve mood swings. This group includes: Bipolar I Disorder, Bipolar II Disorder, Bipolar Disorder Not Otherwise Specified, Mood Disorder, and Mood Disorder Not Otherwise Specified. Depressive Disorders – a group of mood disorders that includes Major Depressive Disorder, Dysthymia, and Depressive Disorder Not Otherwise Specified.

Schizophrenia and Psychotic Disorders – a collection of thought disorders such as Schizophrenia, Schizoaffective Disorder, Schizophreniform Disorder, and Psychotic Disorder Not Otherwise Specified.

Anxiety Disorders – a group of disorders that includes: Panic Disorder, Social Phobia, Posttraumatic Stress Disorder, Obsessive Compulsive Disorder, Generalized Anxiety Disorder, and Anxiety Disorder Not Otherwise Specified.

Adjustment Disorder – the development of clinically significant emotional or behavioral symptoms in response to an identifiable psychosocial stressor or stressors. Impulse Control Disorders – include Intermittent Explosive Disorder, Trichotillomania, and Impulse Control Disorder Not Otherwise Specified.

ADHD and Disorders in Children – Attention Deficit Hyperactivity Disorder, Conduct Disorder, Oppositional Defiant Disorder, and Disruptive Behavior Disorder Not Otherwise Specified.

MEMBER

Eligible Medical Assistance recipients enrolled in the HealthChoices program during the reporting period. MENTAL HEALTH COMMITMENT

An involuntary admission into a psychiatric hospital as per the Pennsylvania Mental Health Procedures Act. Also referred to as a ‘302 commitment’.

OUTPATIENT REGISTRATION (OPR)

The process by which HealthChoices members are registered with CCHB to receive specific outpatient services. This process eliminates the need for

pre-authorization of services and allows the member to access mental health or drug and alcohol services with the

provider for up to one year.

RESIDENTIAL TREATMENT FACILITY (RTF)

A self-contained, secure, 24-hour psychiatric residence for children and adolescents who require intensive clinical, recreational, educational services and supervision. UTILIZATION

The amount of behavioral healthcare services used by Medicaid recipients. Utilization is based on encounter (paid claims) information.

Other Mental Health Disorders – includes Tic Disorders, Learning Disorders, Communications Disorders, and Motor Skills Disorders.

Substance Abuse/Dependence Disorders – a group of disorders related to taking a drug of abuse. The DSM-IV refers to 11 classes of substances: alcohol, amphetamines, caffeine, cannabis (marijuana or hashish), cocaine, hallucinogens, inhalants, nicotine, opioids (heroin or other narcotics), PCP, and sedatives/hypnotic/ anxiolytics.

Mental Retardation – includes Mild, Moderate, Severe and Profound Mental Retardation.

DSM-IV

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, published by the American Psychiatric Association. This manual provides a diagnostic coding system for mental and substance abuse disorders (also see ICD-9-CM).

ENROLLMENT

The number if Medicaid recipients who are active in the Medical Assistance program at any given point in time. FAIR HEARING APPEAL

A grievance process through which a HealthChoices member can file a written appeal, to the Department of Public Welfare, regarding a behavioral healthcare service decision.

GRIEVANCE

The process by which a consumer addresses a problem with a decision made about his/her behavioral healthcare service. This may include denial of a service, approving less service than what was requested, or approving a level of care different from that requested.

HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPAA) This is a Federal law that allows persons to qualify immediately for comparable health insurance coverage when they change their employment relationships. Title II, Subtitle F, of HIPAA gives the Health and Human Services Department of the federal government the authority to mandate the use of standards for the electronic exchange of health care data; to specify what medical and administrative code sets should be used within those standards; to require the use of national identification systems for health care patients, providers, payers (or plans), and employers (or sponsors); and to specify the types of measures required to protect the security and privacy of personally identifiable health care information. Also known as the Kennedy-Kassebaum Bill, K2, or Public Law 104-191.

Berks County HealthChoices

Program

633 Court Street

15th Floor

Reading, PA 19601

Staff

Edward B. Michalik, PsyD

Berks County MH/MR Administrator

George J. Vogel, Jr., MEd

Council on Chemical Abuse Executive

Director

Lydia Singley, LSW

HealthChoices Program Administrator

Tiffany Bachert, BA

Fiscal Officer

Mary Hennigh, RNC, BS

Quality Assurance Specialist

Anne Marie Kline

Administrative Assistant

Berks County Commissioners

Judith L. Schwank, Chair

Mark C. Scott

Thomas W. Gajewski, Sr.

The Berks County HealthChoices Program is jointly managed by the Berks County MH/MR Program and the Council on Chemical Abuse