Founded in 1953, Astor Services for Children & Families (Astor) is a community-based, non-profit provider organization that provides mental and behavioral health and education services for children and families in New York. The organization is accredited by the Joint Commission.
The mission of Astor is to provide “behavioral health and educational services offering children the opportunity to meet life’s challenges, pursue their dreams, and reach their full potential.” Their vision is to “be the preeminent provider of behavioral health and educational services through high quality, comprehensive services to children and families in New York State.”
Headquartered about 80 miles north of New York City in Rhinebeck, New York, Astor provides services throughout the Mid-Hudson Valley region and the Bronx. Astor serves about 9,000 youth and families annually and employs more than 800 staff. Since its inception, Astor has served more than 200,000 individuals.
In 2019 through 2020, Astor had $61.2 million in revenue and $60.1 million in expenses, ending the year with a $1.1 million surplus. Comparatively, in 2018 through 2019, Astor had $62.2 million in revenue and $61.0 million in expenses, ending the year with a $1.2 million surplus. About 50%, or $30.2 million, of Astor’s income is from government support, 24% from Medicaid, 19% from managed care, private, and commercial insurance fees, 3.1% from non-government support, and 4% from other sources.
Astor offers a full continuum of in-home, community-based, and site-based programs and services that promote the well-being of children, adolescents, and families, with total program revenues amounting to approximately $61.3 million annually. The three service lines that constitute the majority of Astor’s annual revenue include outpatient services, out-of-home placement, and early childhood.
Outpatient Services Astor’s outpatient offerings include an array of counseling programs, as well as home- and community-based services offered through the Serving Youth iN Their Communities (SYNC) program for children eligible for Medicaid, from birth through age 21, who have significant emotional- and behavioral-health challenges. Astor’s outpatient services account for approximately $14.9 million in annual revenue. Astor operates four outpatient clinics in total, serving 6,019 clients, including 1,661 at Astor’s Bronx Clinic, 1,160 at the Bronx School Clinic, 2,894 at the Hudson Valley Clinic, and 304 at the Hudson Valley School Clinic. Payers include the New York Office of Mental Health, Medicaid, New York Department of Health, Dutchess County, Managed Care Organizations, commercial insurance, private self-pay, Ulster County, community-based organizations, and the New York City Department of Health and Mental Hygiene.
Out-Of-Home Placement Astor’s out-of-home placement program offers a therapeutic out-of-home placement serving children aged 5 through 13 who have emotional challenges that exceed community-based interventions. Its residential services account for approximately $14.5 million in annual revenue, serving 146 individuals in FY 2020. Services are offered through Astor’s Residential Treatment Facility, which served 29 youth, Residential Treatment Center, which served 55 youth, and Therapeutic Foster Boarding Home, which served 62 youth. Payers include the New York State Office of Children and Family Services, Office of Mental Health, Medicaid, and the Department of Health.
Early Childhood Astor’s early childhood services include Early Head Start and Head Start programs, pre-kindergarten, a therapeutic preschool that promotes children’s social and emotional skills, and special education services through the Special Class Integrated Setting program. These services account for approximately $12.2 million of Astor’s total revenue. In fiscal year (FY) 2020, Astor served 599 children, including 65 through its Early Head Start program, 366 through its Head Start program, and 168 children through home-based services. Payers include New York State Education Department, Dutchess County, Head Start, and IDEA.
Education & School-Based Programs Astor’s enhanced schools and school-based programs served 511 individuals in 2020, accounting for approximately $8.3 million in annual revenue. These services include day treatment and behavioral health services such as assessment, training/education, identification and referrals, classroom and group interventions for at-risk students, and evidence-based treatment, case planning, cognitive behavioral therapy, psychotherapy, and crisis intervention. Astor operates three enhanced schools, the Hudson Valley Residence – Astor Learning Center (served 102 youth), Bronx Day Treatment (served 230 youth), and Hudson Valley Day Treatment (served 179 youth). Payers include Dutchess County, Medicaid, New York City Department of Education, and the New York State Education Department.
Care Management Astor’s care management team served 1,563 individuals in 2020. Care management services account for approximately $5.9 million in annual revenue and are offered through Astor’s Health Homes Care Coordination program for individuals enrolled in a Health Home with Medicaid. Care coordinators oversee and provide access to all necessary services for youth with chronic conditions and complex needs. A total of 565 individuals were served through Astor’s Bronx Health Home program, 639 individuals through the Hudson Valley Health Home program, 78 individuals through Bronx Prevention, 44 individuals through Hudson Valley Prevention, and 237 individuals through Bronx Transitions. Payers include Managed Care Organizations, Orange County, Dutchess County, New York City Department of Health and Mental Hygiene, and Ulster County.
Prevention Placement Astor’s prevention placement program ranges from four to six months and uses a home-based model to address the child welfare and clinical needs of families, such as individual and family counseling, weekly home visits, psychiatric evaluation referrals, education advocacy, social skill development, and parental education and support services. This service line accounts for approximately $2.8 million in annual revenue.
Other Clinical Programs Astor served a total of 739 individuals through its additional clinical programs, including NYS Children and Family Treatment and Support Services (CFTSS) and crisis response services. Astor’s CFTSS target population includes adjudicated youth, persons in need of supervision (PINS), those at risk of out-of-home placement, and youth in a diversion program to avoid PINS and/or out-of-home placement. Astor’s crisis intervention services account for approximately $1.2 million in annual revenue and include a mobile crisis stabilization center, home-based crisis intervention, and a partial hospitalization program. Payers include Dutchess County, Orange County, Medicaid, Managed Care Organizations, commercial insurance, the New York City Department of Health and Mental Hygiene, and the Office of Mental Health. Additional support services account for approximately $1.1 million in annual revenue.
In 2018, Astor received the Joint Commission’s Gold of Approval and has been accredited by the Joint Commission since 1974. As a result, the organization was featured in “Benchmark” as a case study in its approach to improving efficiency and performance using Lean/Six Sigma, and featured by the Joint Commission as a leader in the use of Evidence-based Practice and Outcomes Management. Although, the accreditation is not an organizational requirement, Astor has committed to the high standard and rigorous process to provide high quality services in New York State.
With a commitment to provide high quality services, in 2016, Astor became the first behavioral health organization in the Bronx to use tele-mental health services in their free-standing clinics and schools within the borough. Astor expanded tele-mental health services to its Hudson Valley facilities in 2019 and, as a result of loosened government restrictions due to the COVID-19 pandemic, the organization is exploring options to expand tele-mental health services in the future to extend its current catchment area (the Bronx and Hudson Valley) to statewide. Since the start of the public health emergency in March 2020, Astor has provided over 90,000 tele-mental health sessions and has more than 2,300 new clients.
In addition to extending its geographic reach, Astor is also targeting new populations as an area of future exploration and expansion. Astor has expanded its definition of “children” to birth to age 26. In addition to providing services to children, adolescents, and young adults, Astor is looking to encompass the family unit, as well as work with children suffering from substance abuse and eating disorders.