By NANCY FRAZIER O'BRIEN
Trinitas Regional Medical Center in Elizabeth, N.J., has stepped up to help address a statewide gap in mental health services to older adults, especially those living in nursing homes, assisted living or residential elder-care facilities run by the New Jersey Division of Mental Health and Addiction Services, an agency of the state's Department of Human Services.
The state contracted with Trinitas to run a program called Statewide Clinical Outreach Program for the Elderly, or S-COPE, in collaboration with the New Jersey Institute for Successful Aging at RowanUniversity in Stratford, N.J.
S-COPE is based on Trinitas' Statewide Clinical Consultation and Training Program. The latter program serves adults with a dual diagnosis of mental illness and developmental disabilities who are in a mental health or behavioral health crisis. It dispatches mobile crisis teams from regional offices so patients can remain in their private or group home while receiving clinical intervention services. Its staff trains local mental health service providers in crisis management techniques and connect clinicians and family members of patients to appropriate mental health resources. They follow a patient for up to six weeks from the onset of their contact.
S-COPE extends that model with a similar set of services for adults 55 and older who are living in elder-care facilities and are at risk of psychiatric hospitalization because of escalating dementia-related behaviors or an acute episode of mental illness.
S-COPE services are available 24 hours a day, seven days a week, by calling a central intake line at (855) 718-2699. A triage system then dictates whether a staff member will be sent to see the patient immediately or whether a face-to-face meeting will be scheduled later.
Lucille Esralew, a clinical psychologist, is clinical administrator for both crisis response programs. Staff from both programs share regional offices scattered across New Jersey; and, both programs have clinical counselors trained and available for crisis response in all of New Jersey's 21 counties.
S-COPE staff includes a consultant geropsychiatrist from the New Jersey Institute for Successful Aging, geriatric nurse practitioners, a geropsychologist and master's-level clinicians. S-COPE staff provide services at screening centers, inpatient psychiatric units and long-term care facilities. For example, a S-COPE clinician may be dispatched to a long-term care facility to do a clinical consult with a patient whose mental condition is worsening. The clinician can recommend behavior modifications to the patient and coach facility staff in ways to de-escalate problematic behaviors.
There is a "tremendous need" for the new S-COPE service, which began in April 2012 and was "fully rolled out to all 21 counties" of New Jersey by December, said Esralew.
The state had found that a large number of nursing home residents "were presenting to the emergency room without a good mental health assessment," she said. "A lot of nursing home residents were being sent unnecessarily to the ER or not receiving the level of mental health support that they needed.
"A large number of seniors have dementia or behavioral problems" caused by mental illness, Esralew said. "The emergency room or medication should not be the first way to deal with these behaviors. There are strategies the staff can learn, and personal care practices that can reduce problems."
Education of those who care for the elderly is central to the program's goal. "The biggest need is to educate the nursing facility staff to non-pharmacological approaches to behavioral or psychological problems," she said. "We want to reduce the overuse of pharmacological approaches and the underuse of non-pharmacological approaches."
In November, Trinitas will host its second annual S-COPE conference to train and inform frontline caregivers, social workers and family caregivers. It will be held at the Holiday Inn in East Windsor, N.J.
Esralew said original projections were that the program would see 600 people a year, "but we exceeded that number just in the April to December period" of 2012, she said.
"We are getting about 70 referrals a month," she added. And as more people become familiar with the program and its benefits, that number seems destined to grow.
Esralew, who holds a doctorate from Columbia University and has done postdoctoral training in cognitive behavioral therapy and clinical neuropsychology, has been with Trinitas for 15 years. She was among the core group who developed the Statewide Clinical Consultation and Training Program there in 2000.
She said S-COPE is a natural fit for Trinitas as a Catholic teaching hospital. "We have a very large behavioral health component to our services," she said. "A big part of the hospital's mission is caring particularly for the underserved, and this is very much in line with that."
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