Coalition Partners on the Front Lines: Thresholds

Every week, Illinois Partners will be sharing stories from our Coalition Partners who are on the front lines of responding to the COVID-19 Crisis. We know the interconnections between health and human services are all the more evident in this time of crisis — to better understand this, we spoke with the team at Thresholds. Thresholds operates in Chicago and the surrounding counties that provides services and resources for persons with serious mental illnesses and substance use disorders. They work with many populations, including youth and young adults, veterans, young mothers, the deaf, and individuals experiencing homelessness, among others. With more than 30 programs, they provide services that include assertive outreach, case management, housing, employment, education, psychiatry, primary care, substance use treatment, and research.

Threshold staff receiving donations of hand sanitizer and PPE, and working with their partner Howard Brown Health to administer critical medication in clients homes.

How is the COVID-19 crisis affecting the populations you serve?

A majority of Thresholds’ 10,000+ clients are in high-risk categories for COVID-19. We serve people who are living with serious mental illnesses and substance use conditions, many of whom are homeless. People with serious mental illnesses die 25 years young on average than the rest of the population, largely due to comorbid physical health conditions like diabetes, heart disease, and lung disease. We are working hard to ensure that our clients are getting vital medications, essential health care, and support they need to stay healthy while there is enormous disruption to all of our daily lives. We are also educating and reminding our clients about social distancing guidelines to help them reduce their chances of being infected with the coronavirus. Our clients who are homeless need resources as they try to shelter in place with no permanent place to live, and we’re also helping them find ways to practice social distancing and appropriate hygiene in this environment.

A large part of recovery and mental health for our clients, as for many of us, are the social ties and routines they have through group programming, drop-in centers, art classes, and other hobbies and jobs they pursue. We are trying to support them as they adjust to these programs being cancelled for social distancing.

How has this crisis affected your ability to serve your community? How have you adapted to meet the evolving needs of your community?

This uniquely challenging time has caused us all to drastically change how we live and work. Our staff have risen to the challenge of delivering services under the constraints of our new circumstances.

Our work is community-based, so our hundreds of front line mental health workers usually spend their days visiting clients in their homes and their neighborhoods. We have greatly reduced in-person visits for safety of both our staff and clients. Most clinical teams are doing daily telephone check-ins to assess the clients’ needs, much of which was previously done in person. In the daily phone check ins, the strategy is to focus on making sure basic needs are met before moving on to other clinical interventions: medications, money, food, housing, hygiene products. And when a client is at risk or in need, we are still making in person visits to ensure our clients stay well.

Our health center partners have worked with us to ensure that our clients have access to essential healthcare services, including the medication injections they need, even if that means using a mobile health van to make visits instead of having clients come to the health center.

Many of our clients are experiencing food insecurity, but as high-risk individuals also need to stay home as much as possible. To meet this need, we have formed new partnerships with food pantries, grocery stores, and local restaurants to accept donations, deliver hot meals, deliver groceries, and generally do whatever we can to help them stay home and stay safe.

As a nonprofit organization of over 500 employees, how has this affected your daily operations and workforce?

In addition to modifications to clinical care, we have very quickly transitioned as many staff as can to telework, and our Information Systems staff have worked overtime to ensure that we have tech solutions for our more than 1,200 employees to be able to meet and work remotely.

Much of our work is still essential health care that must be done in person. We have been sourcing appropriate PPE for those staff, and securing masks for the entire workforce when CDC guidelines shifted. Our housing and facilities staff are utilizing enhanced cleaning and sanitation protocols, particularly in our residential buildings.

Our most important resource are our incredible staff. We are trying to support them however we can. We have enacted a number of new, more flexible temporarily policies around sick time, leave of absence, telework, and benefit time. In addition, we have provided additional pay for employees who must spend the majority of their workday in onsite, face-to-face roles to recognize them for their efforts. We know that it is of utmost importance that we maintain our workforce to continue to deliver services, and we are committed to working with our staff to ensure that this happens.

What do you need from your elected leaders and other key decision makers?

Thresholds, like many service providers, is facing enormous financial uncertainty. We are certainly worried about the loss of Medicaid billing revenue. We also cancelled our Gala scheduled for May 7, an annual event that raises almost $1 million each year, and fundraising can be adversely affected by economic turmoil. We have very sudden increases in expenses for IT hardware, software, cleaning supplies, PPE, essential client needs like cell phones, and more.

We are counting on our state and local government leaders to ensure that service providers have access to funds to make up for lost revenue so we do not lose providers in an already frayed social service safety net.

One policy that could be a huge help to larger nonprofits like Thresholds would address a gap in the recently passed federal CARES Act. While the CARES Act provides forgivable loans for nonprofits with fewer than 500 employees to maintain payroll expenses, larger nonprofits are required to secure low-interest loans instead. Most social service providers, including Thresholds, operate on razor-thin or negative margins regardless of size. Access to these forgivable loans would be a crucial lifeline during this crisis, and we hope that future relief bills include larger nonprofits.

We are so appreciative of the donors, foundations, elected leaders, and other decision makers who have shown so much support for our work in a time of need. We will continue to show up for our clients, and we are relying on them to show up for us to ensure that Thresholds can continue to provide life-saving mental health and substance use treatment during this crisis and well into the future.