In-person workshop sessions
TOWN HALL — The Behavioral Health Roadmap for reform: Successes and next steps
The Roadmap for Behavioral Health Reform helps people in Massachusetts get the mental health and substance use care they need, when and where they need it. Through a 24/7 Behavioral Health Help Line (BHHL) and statewide network of Community Behavioral Health Centers (CBHCs), and various other initiatives to support strengthening of the behavioral health system, the Roadmap connects people with supportive services right in their communities.
Beginning January 2023 residents of the Commonwealth can access the Behavioral Health Helpline 24/7 through phone, chat, or text, and receive direct connection to mental health and substance use care.
Also in January of 2023, 25 Community Behavioral Health Centers were stood up to offer an additional front door to treatment available through phone or walk-in across every community in Massachusetts. In addition to the front door to treatment, CBHCs offer a fully mobile crisis team, access to psychopharmacology (including medication for addiction treatment), and urgent and routine behavioral health care for youth and adults.
This town hall session will focus on the implementation of the BHHL and CBHCs, and conversations about future innovations to continue to support Massachusetts residents. Learn more about the Roadmap for Behavioral Health Reform, Community Behavioral Health Centers, and Behavioral Health Help Line.
This session will be a participatory town hall in which state, accountable care organization, and delivery system leaders and consumers will provide an overview and then engage in conversation with participants. This session is geared towards individuals in Massachusetts with first-hand experience working with the Behavioral Health Roadmap who can speak to both what’s working well and what might be improved.
- Patti Boozang, Manatt Health (moderator)
- Madelyn Murphy, Deputy Director, Policy, Office of Payment & Care Delivery Innovation, MassHealth
Centering community and wellbeing: Shifting power and healing systemic harms
We all have a universal drive for well-being and our systems often undermine that drive. To work with people’s innate drive for well-being, we must center community. What would it look like for systems, institutions, and services to meaningfully and responsibly engage with community? This interactive session will introduce the Community Bill of Rights — a starting point for centering community, shifting power, and healing systemic harms, developed by community leaders from around the country. Hear the perspective of a community leader with lived experience, examine your own practices for centering community, and spark new ideas and approaches that you can apply to your work.
- Tanya Tucker, Chief of National Engagement and Partnerships, Full Frame Initiative
- LaRae Cantley, Sr Manager, Full Frame Initiative
- Deshanae Cantley, Community Leader/Advocate, OFLA
Contracting for collaboration: A guide to healthcare- CBO contracts
Healthcare organizations are increasingly contracting with community-based organizations, including networks of CBOs organized by a community care hub (CCH), to deliver social care services (such as CalAIM’s Community Supports) as part of a whole person care approach. Differences between the sectors can make the contracting and implementation of these partnerships challenging. This session will discuss the experiences of both health plans and CBO/CCHs in the contracting process and introduce a new four-part guide recently developed by the Partnership to Align Social Care for healthcare organizations seeking to contract with CBOs and CBO networks.
- Mark Humowiecki, Senior Director, Camden Coalition
- Beau Hennemann, RVP, Local Engagement and Plan Performance, Anthem
- Anwar Zoueihid, Vice President, Long term Services & Supports, Partners in Care Foundation
Evidence-based approaches for integrating substance use disorder treatment into mainstream medicine
As the evidence base on substance use disorder treatment grows – and the scale of the overdose crisis continues to rise to historic levels – it is critical for providers, payers, and policymakers to learn how to incorporate innovative treatment models into mainstream healthcare settings. The Better Care Playbook, in partnership with the Center for Health Care Strategies, will host this multidisciplinary panel of experts/practitioners to share examples from their work across different care settings (EDs, bridge clinics, primary care, inpatient). They will explore the challenges and opportunities for increasing the prevalence of these innovative designs in more general medicine settings.
- Hadley Fitzgerald, Senior Program Officer, Center for Health Care Strategies
- Dr. Sarah Wakeman, Medical Director for Substance Use Disorder at Mass General Brigham (MGH); Medical Director for the MGH Substance Use Disorder Initiative; Director of the Program for Substance Use and Addiction Services, MGH Division of General Internal Medicine; Associate Professor of Medicine at Harvard Medical School.
- Michael Askew, Executive Director, The Center for African American Recovery Development
- Lori Hooley, RN-CARN, Office Based addiction Treatment RN, Mass General Hospital
How a safety net health system and social service agency collaborate to address housing insecurity
Live streamed from the conference to the virtual platform
Access to stable housing is a foundation for improvements in health and the effective use of medical services. Cambridge Health Alliance, a safety net health system, and Vinfen, a human services organization, have partnered to provide comprehensive housing support to a diverse community in Massachusetts through a MassHealth (the Massachusetts Medicaid program) Section 1115 Waiver. By addressing the social drivers of health, the housing program works to reduce healthcare costs. The workshop will discuss the housing program design process and best practices in care delivery and cross-sector collaboration. An individual who has completed the housing program will share their lived experience with the program.
- Hallie Tosher , Manager, Population Health Program Development, Cambridge Health Alliance
- Laura Palmer, Flexible Services Program Coordinator, Cambridge Health Alliance
- Lisa Goldsmith, Vice President of Integrated Care, Vinfen
- Stefanie Gamse, Flexible Housing Program Manager, Vinfen
Kids Health Harbor: Compassionate, collaborative care for children in the foster care system
This multi-faceted, interactive learning experience allows participants to discover innovations in achieving care collaboration when working within a unique complex care ecosystem: foster care. Youth in care are at the center of this relationship-powered, data-driven, evidence-based practice in the Kids Health Harbor program with SIU Center for Community and Family Medicine. Kids Health Harbor uses an integrative approach to address physical and mental health needs and to close gaps in access to care for this underserviced population in rural Illinois. Participants will learn from stakeholders who are elevating whole-person care and emerge with transformative designs to implement in practice.
- Andrea Peterson, Integrated Care Provider/LCSW, Southern Illinois University School Of Medicine
- Rebecca Howard, Director-Kids Health Harbor, APRN, CPNP-PC, Southern Illinois University School of Medicine
Promoting integrated behavioral health in pediatrics: Rhode Island efforts
Integrated behavioral health (IBH) is an effective way to expand access to behavioral health services centered in primary care. This panel presentation will highlight the policy and system levers that promote IBH in Rhode Island, specifically for children. Three different projects will be discussed that demonstrate how an IBH approach has been used to 1) strengthen practice infrastructure needed deliver IBH services, 2) address health inequities affecting infants and families in low-income communities, and 3) tackle pediatric weight management concerns. Each of these projects required a team-based approach to effectively deliver IBH services.
- Linda Cabral, Sr Program Mgr, Care Transformation Collaborative of RI
- Dr Nelly Burdette, PsyD, Associate Vice President, Integrated Behavioral Health, Providence Community Health Centers/CTC-RI
- Swanette Salazar, Certified Community Health Worker, Family Service of RI
- Dr. Beth Lange, Lifespan
- Debra Hurwitz, MBA, BSN, RN, Executive Director, Care Transformation Collaborative of RI
TOWN HALL — Coordinating care for MassHealth members
MassHealth, in partnership with the Massachusetts Medicaid and Children’s Health Insurance Program (CHIP), provides health coverage to more than 2.4 million members, over 30 percent of the Commonwealth’s residents. MassHealth’s 2017-2022 1115 demonstration restructured the Commonwealth’s Medicaid delivery system toward integrated, value-based, and accountable care. Between 2017 and 2022, more than 1.3 million MassHealth members were enrolled in Accountable Care Organizations (ACOs) and received coordinated, high-quality care, and ~50,000 members with complex behavioral health and long-term services and supports needs received enhanced care coordination from Community Partners (CPs). MassHealth recently procured 17 new ACOs and launched 20 new Community Partners in April of 2023.
MassHealth’s 2022-2027 1115 demonstration builds on previous reforms by continuing to support integrated, outcomes-based care for MassHealth members and bringing a new focus on improving coordination of members’ physical health care, behavioral health care, and health-related social needs. This care coordination approach aims to advance health equity, build on lessons learned in the previous five-year demonstration period, improve quality outcomes, and deliver a better member experience.
This Town Hall session will focus on:
- Successes and lessons learned from MassHealth’s previous demonstration
- How MassHealth is working with ACOs, providers, and community-based organizations to structure and streamline care coordination efforts
- Perspectives from the state, as well as ACOs and community-based organizations
- How organizations involved in MassHealth are innovating to coordinate care for members
This session will be a participatory town hall in which state, accountable care organization, and delivery system leaders and consumers will provide an overview and then engage in conversation with participants. This session is geared towards individuals in Massachusetts with first-hand experience working with the 1115 demonstration who can speak to both what’s working well and what might be improved.
- Edith Stowe, Manatt Health (moderator)
- Mandy Ferguson, Manatt Health (moderator)
- Caitlin Towey, Deputy Director, Policy, Office of Payment & Care Delivery Innovation, MassHealth
All that jazz: Making the case for interprofessional behavioral health complex care teams
Complex Care Management (CCM) models have a unique opportunity to integrate behavioral health-focused, interdisciplinary teams to address the clinical complexity and wider community context of some of our communities’ most vulnerable patients. The Behavioral Health CCM team was established in 2019 in an effort to optimize care and support for patients with significant behavioral health complexity including mental health and substance use disorders. Learn how the team fits into the health system and operationalizes across disciplines. Additionally, hear key data points and review a case study illustrating how the team works in conjunction to achieve patient-centered outcomes.
- Claire Davies, LCSW, Behavioral Health Complex Care Manager, Boston Medical Center
- Chris Fagbote, PharmD, BCACP, Clinical Pharmacy Specialist, Boston Medical Center
- Shayla Parker, Community Wellness Advocate, Boston Medical Center
- Yvonne Mayor, BSN, RN, Boston Medical Center
Approaches to integrating community voice into program design and delivery
Programs to address social drivers of health and support individuals with complex needs can improve health and reduce disparities. To be most effective, it is critical to engage those with lived experience in program design, delivery, and improvement to ensure the program meets needs and leverages strengths. The aim of this workshop is to help program implementers develop strategies for including people with lived experiences in order to promote a person-centered, community-driven, equitable and inclusive approach to program design and delivery.
- Jennifer McLean, Community Engagement Program Manager, Activate Care
- Jenna Berent, Senior Program Manager, Community Engagement, Activate Care
From invisibility to action: Unleashing the power of segmentation
New York City Health + Hospitals serves >50,000 patients experiencing homelessness annually. Segmenting unhoused patients into clinically actionable groups helps us target programming across our system. In this session, we use patient segmentation to understand how to best serve different groups. For example, unhoused patients with COPD are under-connected to primary care (24%) and seek care largely for behavioral health (37% of visits). We will identify how segmentation is shaping ongoing care navigation pilots in our system. Finally, we’ll teach segmentation strategies to participants looking to unlock population insights, using validated case definitions and analysis techniques.
- Angelica Bocour, Senior Director of Clinical Analytics, NYC H+H
- Amanda Johnson, Assistant Vice President, NYCH+H
Providers as advocates for evidence-based SUD care: Lessons from New Jersey’s MATrx Initiative.
In 2019, New Jersey launched MATrx, an initiative focused on increasing access to suboxone for Medicaid enrollees across the state. One critical component of New Jersey’s approach has been the role of health care champions in launching and supporting the implementation of the model. This panel will reflect on lessons learned from the MATrx rollout, and specifically how Medicaid, providers, and CBOs were able to establish direct feedback channels, leverage the relationships to continuously improve the model, and use their experiences building out complex care services to advocate for increased social services for people with chaotic substance use.
- Laura Sorensen, Senior Program Manager, Substance Use, Harm Reduction and Behavioral Health Initiatives, Camden Coalition
- Clement Chen, Clinical Pharmacist/Academic Detailer, Rutgers New Jersey Medical School, The CARE Center: Northern NJ Medication-Assisted Treatment Center of Excellence
- Ms. Rachel Haroz, Co-Director Southern NJ CoE for MAT, Emergency Medicine Physician Division Head, Toxicology and Addiction Medicine, Medical Director at Center for Healing, Cooper University Hospital, Center for Healing (Southern NJ COE for MAT)
- Iris Jones, Manager Clinical Ops, Center for Healing Therapist, Addiction Medicine Org Dev Consultant, Cooper University Health Care, Cooper University Hospital, Center for Healing (Southern NJ COE for MAT)
- Jana Lang, OBAT Program Manager, New Jersey Department of Human Services, Division of Medical Assistance and& Health Services Office of Managed Health Care
- Dayna Fondell, Healthcare Innovation Consultant, Camden Coalition
Racial trauma: A deep dive into complex care core competencies
Complex care for individuals experiencing post-traumatic stress disorder and the effects of chronic traumatic stress requires that race-based traumatic stress and foundational aspects of white supremacy in systems of care are explored and addressed explicitly. This workshop adds to our collective knowledge base by exploring how structural racism and historical trauma have created harm that is often unrecognized and invisible. When acknowledged, racial trauma is key to understanding and validating the complex care needs of consumers. This interactive workshop is designed to expand systemic awareness, educate healthcare providers, and support consumers in the process of anti-racist system transformation.
- Laura Hernandez, MSW, LCSW, Clinical Director, Nuna Behavioral Healthcare
- Brenda Wiewel, DSW, LCSW, Program Development, Innovation, and Teaching, Brenda Wiewel Consulting
Understanding and responding to participant engagement barriers in complex care interventions
A fundamental task of complex care team members is to foster engagement with participants through interactions aimed at building authentic, trusting relationships that are responsive to individual participant’s needs and priorities. Yet, a variety of factors can lead to disengagement, including circumstances in the participant’s life or challenges on the part of the intervention itself. In this interactive workshop, we will explore systemic and program level factors that contribute to uneven participation in complex care programs and will begin to collectively build a “typology” of engagement to help programs identify engagement challenges and solutions.
- Dawn Wiest, Director For Research & Evaluation, Camden Coalition
- Jinesa Howard, Community Health Worker, Boston Medical Center
- Dr. Lauren Kearney, General Internist and Instructor of Medicine, Boston University Chobanian & Avedisian School of Medicine
- Danielle Hodges, Senior Program Manager, Data & Quality Improvement, Camden Coalition
- Giselle Morales-Schossig, Program Manager, Camden Coalition
Bridging the Gap: Delivering whole person mental health care in complex scenarios
One in every eight people around the world live with a mental health condition, with anxiety and depressive disorders as the most common. Despite a growing need for care, access continues to be a significant challenge, especially for marginalized communities. Together, The Family Van and Partners In Health are working to bridge this gap locally and globally. Through an interactive workshop, we will share lessons learned from adapting an innovative, whole-person care model for communities with complex care needs. Using real-life scenarios, we will guide participants through a case study to build skills and strategies, and identify new opportunities for care.
- Rainelle Walker-White, Associate Director, Health Equity Programs, The Family Van
- Piper Derenoncourt, Assistant Director, Mental Health Equity Programs, Harvard Medical School
- Stephanie Smith,MD, Co-Director of Mental Health, Partners in Health
- Amruta Houde, Senior Manager, Monitoring, Evaluation, and Learning, Partners In Health
Caring for care providers: A workshop to co-develop strategies to strengthen the behavioral health workforce
The COVID-19 pandemic created increased need for behavioral health services, further straining a workforce experiencing challenges with capacity and care access. Behavioral health leaders must now focus on developing solutions that refine services to be more flexible, responsive, and accessible and support the workforce to deliver that care. Participants in this workshop will engage with field leaders in small-group facilitated discussions to develop strategies to strengthen the behavioral health workforce. Upon completion of the workshop, participants will receive a written compilation of identified strategies to take back to their organizations.
- Amy Herschell, Senior Director, Research Strategy & Outcomes Management, Community Care Behavioral Health Organization, UPMC Insurance Services Division
- Lyndra Bills, Senior Medical Director, Community Care Behavioral Health Organization
- Tracy Carney, CPS, CPRP, Senior Recovery/Resiliency Specialist, Community Care Behavioral Health
Knowledge Café: How can we ensure social drivers of health screenings are impactful and effective?
Asking about, reporting on, fully understanding, and positively impacting a patient’s social drivers of health is a multifaceted challenge. Especially in interactions that frequently happen under the influence of power dynamics and a history of mistrust. In this session, we’ll discuss co-designing screening programs and addressing the social drivers of health – utilizing the National Academy of Medicine’s “5 A’s” framework. We will explore the benefit of co-designing SDOH screening programs with patients, family caregivers, and community members so the screenings will effectively help the patients who need them most.
- Lindsey Galli, VP Of Programs, PFCCpartners
- Naomi Williams, PFE Specialist, PFCCpartners
Readiness assessment for consumer partnership
CACP will lead a live, interactive workshop that demonstrates the value of consumer partnership and Voice of Consumer (VOC) initiatives, with a specific focus on objectives, methods, and best practices for engaging consumers as meaningful and valued partners who have lived experience. The workshop will include a mock readiness assessment to help participants determine their readiness to stand up a consumer engagement program, with the goal of involving consumers in planning, executing, and measuring critical business objectives and decisions.
- Heidi Aylward, Director & Senior Consultant, The Center to Advance Consumer Partnership
- Shekinah Manigault, Manager, Consumer Participation and Engagement, The Center to Advance Consumer Partnership
Vicarious trauma & Housing First: Emphasizing trust & connection
Populations challenged by substance use, homelessness and mental health concerns experience trauma at high rates. As a result of the empathic engagement necessary to practice harm reduction at the intersection of these experiences in Housing First settings, helping professionals can expect to experience vicarious trauma. Vicarious trauma decreases the quality of services provided by limiting the ability to support connection and build trust. Providers and organizations using a framework of complex care must have the ability to identify signs and symptoms of vicarious trauma and execute concrete strategies to improve client outcomes.
- Ryan Villagran, Training Specialist, Pathways to Housing PA
- Andrew Spiers, Director of Training Technical Assistance, Pathways to Housing PA
Whole person for the whole nation: Success modeling California’s historic Medicaid reform
In 2021, California set out to improve quality outcomes and reduce health disparities by launching historic reforms to overhaul its Medicaid system. These bold initiatives worked to move California towards a population health approach that prioritizes prevention and whole person care, and the nation has watched with anticipation to learn the answer to one core question: Do these reforms have the potential to be modeled? We’ll discuss how these reforms have worked to address behavioral health through improved complex care coordination, key considerations and investment areas for success-modeling Medicaid reforms, and the sustainability measures required to equitably scale programs.
- Alexis Taylor, Senior Program Manager, HealthBegins
- Sadena Thevarajah, Managing Director, HealthBegins
- Nayung Kasick, Vice President Medicad Program, Health Net
- Natascha Garcia, Program Manager, Whole Person Care, San Joaquin County
- Anthony Moreno, Program Manager, CalAIM Community Supports, Champions Recovery
A national strategy to improve household food security through Medicaid
Anti-hunger organizations have an opportunity to engage Medicaid to implement food-related policies and strategies as a way to reduce inequities and improve health and food security for children and families. This workshop highlights Medicaid policy opportunities and the development of a National Medicaid Food Security Learning Action Network (LAN), which helps anti-hunger advocates and state Medicaid programs, payers, providers, and advocates collaborate to successfully implement effective and equitable Medicaid-based food security programs. Presenters will discuss Medicaid policy levers and initial LAN elements. Attendees are invited to provide feedback and signal interest in joining the Network.
- Kelleen Zubick, Senior Director, Share Our Strength
- Kathryn Jantz, MSW, MPH, Senior Associate, Steadman Group
- Jamila McLean, Senior Healthcare Policy Manager, Benefits Data Trust
- Katie Ettman, Food and Agriculture Policy Manager, SPUR
Brand new baseline: Building an effective housing-related training series for frontline complex care teams
All healthcare teams serving complex care patients struggle with lack of affordable, healthy housing and most feel ill-equipped to meet the need. Kaiser Permanente (KP) launched housing-related trainings as part of its national Health, Housing & Justice Project (HHJ), which established six medical-legal partnerships (MLPs). Through HHJ, legal aid programs delivered a series of standardized housing-related trainings to navigators, case managers, nurses and other patient-facing staff to (1) increase awareness and knowledge about housing-related legal topics; and (2) increase quality referrals to MLP legal teams. The trainings can be adapted and deployed as part of complex care training activities.
- Ellen Lawton, Senior Fellow, Healthbegins
- Cory Warren, JD, Staff Attorney, Maryland Legal Aid
- Marisa Conner, Kaiser Permanente
Can community- & health system-based care coordination truly be integrated? Lessons learned over five years
Consumers with complex care needs often struggle to navigate the “complex care ecosystem” due to fragmentation of care coordination offerings. Individuals may have multiple care managers – via the Department of Mental Health, community-based organizations, or clinics for instance. In 2018, Massachusetts launched an ambitious experiment to address this via the “Community Partners” Medicaid program, requiring Accountable Care Organization health systems to partner with community-based organizations to coordinate care for individuals with complex behavioral health needs. In this session, presenters describe practical challenges and lessons learned over five years with Community Partners, including pitfalls and factors key to successful collaboration.
- Priscilla Wang, MD MPH, Associate Medical Director, Primary Care Health Equity, Mass General Brigham
- Maryann Vienneau, Director, Clinical Operations, Mass General Brigham
- Katherine Schiavoni, MD MPP, Associate Medical Director, Care Management, Mass General Brigham
Commonwealth Care Alliance: Building innovative, tailored services for patients with severe and persistent mental illness
Commonwealth Care Alliance (CCA) develops innovative, tailored services to meet the needs of patients with severe and persistent mental illness. Behavioral health is integrated into CCA’s care delivery system, starting with our keystone service, our specialty primary care clinic. A patient story highlights how our interdisciplinary care management teams support patients and provide specialized services for acute, residential, and SDOH support – such as CCA’s Primary Care clinics and Engagement Centers, CCA’s Crisis Stabilization Unit, and Hospital to Home program. We also highlight our low threshold temporary supportive housing Cottage Community developed in partnership with the Commonwealth of Massachusetts.
- Lauren Easton, Vice President, Integrative Program Development and Clinical Innovation, Commonwealth Care Alliance
- Bijana Simikic, Senior Medical Director, CCA Primary Care, Commonwealth Care Alliance
- Alice Karanu, Clinical Nurse Practitioner, Psychiatric, Commonwealth Care Alliance
Deepening relationships and sparking motivation through avoidance behavior mapping
Patients with the most complex needs, representing five percent of all patients, use about 50 percent of resources. We engaged 100 complex Medicaid patients using a ‘relationship first’ approach, focusing on rebuilding trust and increasing self-esteem and self-efficacy as the most important key tasks, rather than focusing first on transactional solutions to specific problems. Relationships deepened by working together to develop awareness of painful emotions, and their corresponding habitual behaviors. Through this lens, barriers to care were dismantled by individuals and the supporting care system. Our results showed a significant financial impact that was sustained through a full year, while also demonstrating large increases in autonomy, belonging, hope, and well-being. We believe this approach, centered on the development of a healing relationship, is vital for individuals with complex needs.
- Patrick Runnels, Chief Medical Officer, Population Health, University Hospitals
- Trygve Dolber, MD, Internal Medicine/Psychiatry, University Hospitals
- Nicole Martin, Consultant, University Hospitals
- Katherine Gerken, University Hospitals
One tool across the care continuum: Narrative leadership in the delivery of complex care
Delivering complex care requires technical approaches and leading in a relational way. Narrative Leadership is a foundational relational skill that fosters connection with others, including patients, colleagues, and key stakeholders in systems initiatives. Authentic connections are associated with improved patient outcomes, positive changes in employee mental health, and motivating systems change. Given its power and broad applicability, Narrative Leadership is an essential tool for delivering complex care, especially where behavioral health is a priority. This session will demonstrate and encourage participants to practice relational skills through Narrative Leadership in service of connection and collaboration across the continuum of complex care.
- Jane Cooper-Driver, Chief Programs Officer, Intend Health Strategies
- Kyle Turner, Vice Chair of Clinical Practice in the Department of Pharmacotherapy, University of Utah
Voices of parents in recovery and their adult children as a catalyst for change
Parents with mental health and/or substance misuse challenges often feel shame and stigma from their communities and healthcare providers when it comes to their role as parents. This shame and stigma discourage parents from seeking support and increases feelings of isolation. Our presentation highlights the importance of having a team to address the complex needs of these parents, and how barriers can impede recovery, parenting skills, and relationships with health providers. We created two videos to highlight the personal experiences of parents with mental health and/or substance misuse challenge and adult children of parents in recovery.
- Anne Whitman, Senior Peer Consultant, Massachusetts General Hospital’s Center Of Excellence In Psychosocial & Systemic Research
- Sandi Whitney Sarles, Peer Consultant, Massachusetts General Hospital’s Center of Excellence in Psychosocial & Systemic Research
- Jacquie Martinez, Peer Consultant, Massachusetts General Hospital’s Center of Excellence in Psychosocial & Systemic Research
- Ziona Rivera, Outreach Coordinator, Brockton Area Multi-Services Inc.