Lenape Valley Foundation (LVF) began a year-long celebration of its 50th Anniversary in 2008. In fact, the seminal origins of LVF extend 9 years further back to 1949. That year, psychiatrist Dr. Arthur Noyes, Superintendent of Norristown State Hospital (NSH), established satellite after-care clinics, one of which was located in Doylestown. These clinics retained their affiliation with NSH into 1958, even though they incorporated as a separate entity in 1950 known as the Tri-County Mental Health Clinics, serving Bucks, Montgomery, and Delaware Counties.
By 1958, Bucks County mental health advocates understood that there was tremendous benefit for consumers if they could remain connected to their families and communities while receiving treatment. Additionally, these advocates believed that locally-delivered care could best be designed using local expertise and governance. This was formally accomplished on May 28, 1958, when Articles of Incorporation of a new independent agency were approved. Its purpose was to provide “competent psychiatric diagnosis and treatment. . . for the community at large, psychiatric evaluation and treatment of emotional disturbances and their prevention, consultation service. . . training for professional clinic personnel, and research.” The new corporation was named the Mental Health Guidance Center of Bucks County (MHGC). Although under a different name, this was the birth of what is now Lenape Valley Foundation. State officials were delighted with this solution, and promptly closed the Tri-County Mental Health Clinic in Bucks County.
MHGC became operational on July 1, 1958. It was headquartered in Doylestown at 80 North Main Street, and had a satellite location at 120 South Bellevue Avenue, Penndel. Sixty-three outpatient clients were treated by psychiatric residents on loan one day per week from NSH and a handful of other clinical and support staff.
As with most new enterprises, the first few years were a struggle as MHGC was plagued by underfunding that contributed to short staffing and staff turnover. Having to move the Doylestown headquarters to 135 East State Street in October, 1958 added to the instability. The Board of Directors had responsibility for the MHGC business operations as they had yet to retain a clinic Director. Nonetheless, an appreciative community responded as evidenced by there being 25% more outpatient contacts within the first 18 months of operation.
In January, 1960, the Board was successful in hiring its first paid staff psychiatrist, Dr. George Russell, who simultaneously became the first true LVF Agency Director. While this was of major importance to the clinic’s development, the search for an identity continued as evidenced by MHGC changing its name on May 22, 1961, becoming known as the Bucks County Psychiatric Center (BCPC). The community continued to respond positively, however, and by 1963 BCPC provided the fifth highest total of outpatient services of all Pennsylvania clinics. The 4 more prolific clinics were all in either Philadelphia or Pittsburgh, making LVF the leading non-urban provider.
BCPC needed to grow and evolve in order to meet the community need. Plans were developed to build or purchase new offices at both sites. Land was purchased at 1517 Durham Road in Penndel in 1966 and a new site in Doylestown was identified. Eventually the latter became too expensive, however, so proceeds from a capital campaign went toward the new construction in Penndel which opened in May, 1969. For Doylestown, increased space was leased in Chalfont at Bristol Road and Route 202 beginning in November, 1967, even though the long-term goal remained ownership.
In 1966, Pennsylvania passed its landmark Mental Health and Mental Retardation Act which delineated the responsibility of the Commonwealth and its counties in assuring access to affordable mental health (MH) and mental retardation (MR) services for those persons with the greatest need. Because of its commitment and success in delivering such services to the community even before they had been mandated, BCPC was selected by Bucks County to be one of its Base Service Units (BSU). The County was to be divided into catchments (i.e., geographical areas defined by population), each to be assigned a BSU which would have the primary responsibility for providing the services mandated by the 1966 Act. The newly developed Bucks County MH/MR Department asked that each of the two BCPC sites be developed as a BSU. The Chalfont site would cover Central Bucksand the Penndel site would cover Lower Bucks. Neither site provided all the requisite services but an interim contract was signed with the County in July, 1969, with the understanding that all BSU services would be established by 1975.
BCPC took some steps toward this goal immediately. It became a Medical Assistance licensed provider in 1968; formalized the Consultation and Education programs that existed, in fact, from the agency’s birth in 1958; named full-time medical directors for both sites; and added MR services. In 1971, the BCPC Board of Directors decided to create separate Board Committees to focus on each site to facilitate the necessary changes. To meet federal requirements pertaining to Community Mental Health Centers, fiscal operations became site-specific in 1972. Given the site-specific development and consistent with its historical commitment to local governance of MH and MR services, the BCPC Board incorporated each site as independent agencies in 1973. The Penndel site was re-named Penndel Psychiatric Center. The Articles of Incorporation approved August 21, 1973 by the State of Pennsylvania re-named the Chalfont site Lenape Valley Foundation. Most of the BCPC Board (17 of 24 active members) became the new LVF Board, with Dr. William Moore becoming Board President at the first Board Meeting under the new name of Lenape Valley Foundation, which was held September 11, 1973.
Over the next several years, under the leadership of Medical Director, Edwin Knopf, M.D., the development of LVF was rapid. LVF officially became a BSU on May 28, 1974. By 1975, besides Outpatient Services, LVF was delivering Mental Retardation Case Management, Substance Abuse Treatment, Partial Hospital Programming, and Crisis Intervention Services. In 1978, LVF helped create and began to manage the Doylestown Hospital Inpatient Psychiatric Unit. Residential programming developed at the same time. Clearly, due to the dedication of its Board and staff along with the support of the communities it serves, Lenape Valley Foundation had survived early struggles and name changes to become a major provider of MH and MR services in Bucks County.
The organizational dream of ownership of its main facility was achieved in 1987, when LVF re-located to its own building, constructed under its direction on the grounds of Doylestown Hospital. A second construction project completed in 2005 more than doubled the size of the main facility. Both construction projects required financial support derived from going to its communities with capital campaigns. The 1987 Anchor Fund Chairs were Board Members Geri McMullin and Nancy Perry. The Branching Out Campaign for the 2005 construction was Co-Chaired by Board Members Sandi Fickes and Heather Cevasco. Many other Board Members, however, filled vital roles in these campaigns. Their collective efforts on these two projects are simply a microcosm of the leadership and commitment of LVF Board Members over the 50 years of the organization.
The small outpatient clinic in 1958 has transformed into an extensive array of services for individuals with mental health, substance use, intellectual and developmental issues. While the specific services have evolved over the past 5 decades, currently there are more than 30 distinct programs. The combined caseloads of these programs total more than 9000 per year, requiring more than 300 full and part-time staff members to deliver services. The LVF annual budget has grown from $38,000 in 1958 to approximately $13 million. In addition to its main facility, LVF offers multiple services at three other Bucks County sites. These are located in Doylestown Hospital, in Warminster and on the grounds of Lower Bucks Hospital in Bristol. The latter is noteworthy, as it brings LVF services back to Lower Bucks in a substantial way for the first time since 1973. Crisis and Outpatient Services are now available in Lower Bucks, with other service modalities planned.
Many of the services offered by LVF, however, are integrated within the fabric of Bucks County communities. More than ever before, we are providing services outside the office, in natural settings. No fewer than 13 LVF programs have staff delivering services in homes, schools, workplaces, camps and social settings. Sometimes it is the office of the personal physician, medical specialist, acute care hospital, nursing home, prison, state hospital or center. This echoes our history of offering a real alternative to institutionalization while fostering the belief among consumers of LVF services that challenges can be managed successfully in the community of their choice.
This underlying credo is evident even when site-based care is unavoidable, such as when a consumer enters the LVF residential program. Currently, housing is available in 15 different condos and houses, all but one of which is owned by LVF. A continuum of residential services from respite to transitional to permanent housing is available. All of these sites are embedded in neighborhoods, thereby enhancing the possibility of meaningful community integration and facilitating the transition to independent living.
LVF continues to provide leadership in the provider community. Our high fidelity Assertive Community Treatment (ACT) Program, established in 2002, is the first such evidence-based program established in Pennsylvania and has been recognized by the Pennsylvania Office of Mental Health and Substance Abuse Services (OMHSAS) as perhaps the premier such program in the Commonwealth. Our Crisis Service is the only OMHSAS licensed program in the County and one of the few in Pennsylvania. Our use of telepsychiatry for select consumers in crisis is the first in Bucks County. LVF has the only 24 hour on-call on-site psychiatry coverage in the County. We were the first agency in the region to apply to the Commonwealth to obtain certification as a Co-Occurring Competent Provider (mental health and substance use). We are leading the way in the use of peer specialists. We offer unique forensic services in the County, including evaluations of adult and juvenile offenders, as well as evaluations of youth identified as at risk for fire-setting. LVF is one of only two agencies in the County that acts as a BSU for persons with intellectual disabilities and for children aged 0 to 3 years requiring early intervention services. The above is not comprehensive, but even these examples speak to the remarkable breadth and continuing quality of LVF services.
As since its inception, LVF continues to find strength and direction in its bonds with critical stakeholders. A variety of community leaders from all walks of life continue to volunteer as LVF Board Members. We still rely on the many Bucks County legislators willing to champion the needs of the consumers of LVF services (special thanks to Pennsylvania State Senator Chuck McIlhinney, Jr., and his Chief of Staff, Heather Cevasco, who served as LVF Board President, 2006 - 2009). The Bucks County MH/MR Office has and continues to provide vital financial support allowing LVF to pursue its mission. In the past 10 years, with the implementation of the Pennsylvania mandatory medical assistance program (i.e., HealthChoices), LVF has enjoyed a new source of support in the Bucks County Behavioral Health System office. The LVF relationship with Doylestown Hospital is as strong as ever, forged by mutually held values concerning community care. In recent years, LVF also has grown as a result of dialogue with consumer and family advocates (e.g., Voice and Vision, NAMI). The support and collaboration with other providers in the County (e.g., Joint Administrative Committee) and across the Commonwealth (e.g., Pennsylvania Community Providers Association) also continue to nurture our vision and agenda. These and others in our network of support have contributed to our history, share any success we currently enjoy, and will be critical to our future.
Perhaps most important, LVF continues to draw inspiration from those who come to us for service. The unique paths of recovery they blaze, the resiliency they demonstrate in the face of adversity and the pride they display in living an everyday life remind us constantly that they are the greatest asset we have in trying to be of assistance. LVF now is focusing on how consumers helping each other can supplement and improve the results of LVF programming. LVF has been one of the first providers to use peer support staff, with one of our programs employing such staff for the better part of 15 years. Now that Pennsylvania has added Certified Peer Specialist services to its Medical Assistance benefit plan, LVF has taken the step to encourage our consumers to consider pursuing this certification and has hired and embedded a number of such specialists within multiple programs. Nonetheless, we are just beginning to learn the value of this new service and set of employees, which speaks to the future for LVF.
The foreseeable future of LVF will mimic our history of responding to ever-changing knowledge about advances in services and what our stakeholders are identifying as unmet needs. One such endeavor is implementation of the evidence-based Crisis Intervention Team (CIT) Model. This collaboration among local police, consumer and family advocates, and LVF is designed to improve the outcomes when police are confronted with someone in crisis or acting out due to behavioral problems. Such a program is likely to result in reducing incarceration due to behavioral health and/or intellectual disability issues, quicker access to appropriate behavioral health services in crisis situations, and fewer occasions of death or injury in such situations. The LVF Acute Care Center in Bristol is the provider hub of the Bucks County CIT, with implementation likely in 2009.
Another anticipated change entails LVF assuming the role of a state-wide consultant for the first time. OMHSAS recently announced that they had selected LVF as the sole Pennsylvania-based consultant for those counties and providers interested in establishing high fidelity ACT programs. ACT is a comprehensive treatment program for persons with the most serious mental illnesses who have not been successful in more traditional treatment modalities. High fidelity ACT programs, including the LVF ACT, have demonstrated remarkable outcomes, not only in reducing institutional admissions and stays, but also on vocational, social and family measures. The opportunity to facilitate the development of such programs throughout the Commonwealth opens a new door for LVF.
LVF also is planning to expand the use of telepsychiatry, in which a psychiatrist at a remote location will meet with a consumer who is at LVF via the use of real-time audio-video technology. Telepsychiatry is a tool for improving the access and quality of care, especially in crisis situations when otherwise a psychiatrist would not be available and for specialty populations (e.g., a person with both an intellectual disability and a mental health issue) requiring an expertise that most psychiatrists may not have. To increase the use of this modality will require collaboration not only with psychiatrists, but also with hospitals and legal and regulatory parties involved with involuntary commitment procedures.
Sometimes change in the landscape of our services has to be more immediate. The global economic downturn and recession that became apparent in 2008 resulted in tremendous adverse change in life circumstances and increase in stress for many in our communities. Unfortunately, it appears that this also made it more difficult for these same individuals to afford services from LVF. In response, LVF developed and is starting to present a free program to the community entitled, “Surviving the Economic Downturn 101.” LVF has recruited a legislator (special thanks to State Representative Marguerite Quinn), attorney, financial advisor, and other human service agency leaders, besides our own staff, to volunteer their time to provide helpful information at a critical time. We will continue to repeat this series until conditions change in the communities served by LVF.
Predicting beyond the immediate horizon seems folly. Who among the MHGC Board that sought a two room office 5 decades ago envisioned the dynamic growth in services this organization has achieved in its first 50 years? Given the pace of advances in scientific knowledge, biogenetics and technology, the potential for change in how we respond to developmental delays, intellectual deficits, substance use, and mental health issues 50 years from now is staggering. While the LVF profile of services will undoubtedly change, it is essential that the core of LVF services remain immutable. We are here to serve our consumers with compassion, respect and the best available practices. Their achievements will strengthen not only the quality of their life but also that of their local community. This path promises another 50 years of relevance and success for Lenape Valley Foundation.