FIG1 A group of Quakers founded
Horizon House in 1952 to provide support for people who had been released from
psychiatric hospitals in the Philadelphia area.
Jeffrey Wilush: "After all these decades, we know what
That small band of volunteers was considerably ahead of its time. More than
a decade was to pass before President John F. Kennedy urged the country to
share his vision of community-based mental health treatment.
Since 1952, Horizon House has received awards and national acclaim for its
psychosocial rehabilitation programs. And it almost went bankrupt during a
difficult period in the early 1990s.
Today the agency has a budget of $45 million and a staff of more than 800
The corporate office in downtown Philadelphia houses a partial hospital,
day treatment and other psychiatric rehabilitation programs, case-management
services, and administrative staff.
Horizon House also operates an extensive network of residential facilities,
including transitional and supported housing, throughout the city and in
southeastern Pennsylvania. The reach of its services extends into
The agency offers cutting-edge programs such as a "housing
first" model that recruits among homeless people on the basis of their
previous refusal to accept services.
It also provides more conventional programs, including supported employment
and a clubhouse, that have long since proved their worth as methods of
integrating people with mental illness into the community.
Psychiatric News had an opportunity to meet with many staff
members and program participants over a three-day period at Horizon House.
This overview and interview with the agency's medical director will be
followed by stories about specific programs in a subsequent issue.
Chief Executive Officer Jeffrey Wilush looks out at the loading dock of a
nearby postal facility from his spartan first-floor office. "We keep
administrative costs as low as possible," he explained. "The
consumers on the third floor get the view."
He obviously is a man who thrives on the challenges of his job.
"After all these decades, we know what works," Wilush said."
Our task is to find funding sources that enable us to offer those
services that have proved effective."
Wilush, a certified public accountant, came to Horizon House in the early
1990s to help resolve one of the agency's biggest challenges. As a result of a
prolonged period of budgetary excesses, Horizon House was about to go into
Instead, Wilush and Wayne Chiodo, the new executive director, managed to
stabilize the situation and rebuild.
The agency has benefited from a period of strong local leadership for
mental health services led by Estelle Richmond, who was Philadelphia's
managing director under former Mayor Edward Rendell (D) and now serves as
secretary of public welfare in his gubernatorial administration.
Philadelphia County administers Medicaid funds and contracts with Community
Behavioral Health, which functions as a carveout for mental health services.
That arrangement allows agencies flexibility in the provision of services
because savings can be used to support activities that might not otherwise be
Those advantages do not, however, result in a problem-free life for Wilush.
Like other CEOs, he deals with multiple funding sources, each with its own
purpose and administrative requirements, and tries to find ways of matching
needs with available funds.
Wilush explained, "I look at the puzzle of finding resources and
think, `Who can I talk to about a fix for a problem?'"
Funding agencies will help if they are able when they have confidence their
money is being used well, he said.
When asked about his dream for Horizon House, Wilush replied, "I'd
like to find out how much more we could do with $50 million in unrestricted
funds. [The public] could find out what a motivated and experienced
organization could do to provide services if the strings were
In the meantime, he tries to find ways to strengthen the organization and
its staff while maintaining quality services.
The UPenn Collaborative on Community Integration is one such method that
makes use of local expertise to strengthen Horizon House's services and
document their effects.
The collaborative is based at the University of Pennsylvania and is a
partnership among the university, Horizon House, and the Mental Health
Association of Southeastern Pennsylvania. The five-year project is funded by
the National Institute on Disability and Rehabilitation Research.
Director Mark Salzer, Ph.D., said that the collaborative is the first of
its kind to focus on community integration as it applies to people with
Salzer described his work with a Horizon House program that provides peer
and other kinds of support for people with psychiatric disabilities who are
enrolled in community colleges. He offered ideas for improvement as a result
of his research and also provided staff with outcome measures. The positive
outcomes helped Horizon House secure a continuation of funding from a local
The recent collaboration is part of a long tradition of research at the
agency. In fact, Horizon House's first executive director began to develop
research capability in the emerging field of community-based mental health
services more than 50 years ago.
Staff helped state officials with needs assessments, planning, and
training. In 1972 Horizon House created a separate nonprofit research and
training center, the Matrix Research Institute (MRI), because of the volume of
that kind of work.
For the next 30 years, MRI received federal funds for service-demonstration
and field-initiated research projects and continued its training and technical
assistance activities. In 2003 MRI was brought back into the Horizon House
administration as the Matrix Center.
Wilush and other senior staff regard investment in workforce development as
a top priority.
Horizon House was the first human-service agency in the country to adopt
WorkKeys, a tool used by for-profit companies to assess the job-related skills
of employees and to develop customized training programs.
About two-thirds of the agency's total of 800 full-time-equivalent
positions are employed in six direct-care residential positions and two
first-level supervisory positions in residential care and treatment.
Director of Workplace Development Larry Kurtz said that he became an
authorized WorkKeys job profiler and, with the help of position incumbents,
analyzed those positions to determine the necessary skills and begin
development of a career ladder.
They found four skills necessary to all positions: teamwork, listening,
writing, and reading.
Teamwork is important because staff of residential programs must be able to
respond quickly to crises and support each other. Listening, reading, and
writing skills are necessary because staff must understand and communicate
about such matters as medication dosages and compliance.
Horizon House embarked on an agencywide effort to foster teamwork.
Ultimately, more than 800 staff members received training that involved pre-
Current residential staff were offered a financial incentive to take the
WorkKeys tests. Using grant money from the state, Horizon House increased the
base salary level of those who met minimum requirements and offered training
to those who did not. New hires are given WorkKeys listening and writing tests
and training specific to their needs.
What about the future for Horizon House and the people it serves?
Medical Director Cordula Holzer, M.D., recounted problems that likely would
be exacerbated in the event of Medicaid funding cuts. "Many people come
here with multiple and severe medical problems that have not been treated by
primary care doctors. We must address those medical needs before we can begin
to deal with their cognitive problems."
Other problems result from abbreviated stays in psychiatric hospitals.
Patients are usually released within three to four days, although it takes
considerably longer to assess the effect of new medications. Those medications
might be difficult to obtain after the patient leaves the hospital and could
interact with medications prescribed for other illnesses.
Rendell has proposed restrictions on access to medication through the
establishment of a preferred-drug list, an increase in copays, and a limit on
the number of hospitalizations.
These or any other funding cuts will certainly weaken the agency's ability
to respond to the needs of people with mental illness. But staff appear to
possess an unusual ability to focus on how to make things work.
"You have to be able to respond effectively to change," replied
Wilush, when asked about the qualities necessary for his job.
Information about Horizon House is posted online at<www.hhinc.org>.▪