By BETSY TAYLOR
Cincinnati-based Catholic Health Partners has reenvisioned how it provides behavioral health services. The system is a year and a half into work to standardize evidence-based treatment across continuums of care. It has increased the amount of group therapy behavioral health patients receive, so that they may benefit from increased structured time in treatment. It also is working with care providers in its communities in Ohio and Kentucky to encourage routine depression screenings for certain patient populations and with area organizations to better link patients to the appropriate type of care.
CHP says patient satisfaction, staff satisfaction, treatment outcomes and quality measures have shown "significant improvement" when compared with preprogram scores.
Sr. Donna Markham, OP, left, president of Catholic Health Partners' Behavioral Health Institute, confers with Carol Parke, the institute's chief of nursing services and operations.
Sr. Donna Markham, OP, the president of CHP's Behavioral Health Institute and a doctor of clinical psychology, has been leading the transformation of the delivery of psychiatric services across the system's seven geographic regions. For that effort, she recently received the 2014 Harold S. Bernard Group Psychotherapy Training Award from the International Board for Certification of Group Psychotherapists. The award recognizes an individual or organization whose work in group training and/or education "contributes to excellence in the practice of group psychotherapy."
Sr. Markham said CHP transformed its behavioral health services because of its commitment to the Gospel message to care for the most vulnerable. She explained that after about two decades of financial cutbacks nationwide, many behavioral health programs were left without the resources necessary to address serious and persistent mental illness. "Interestingly, as these programs have been cut, more and more patients then have had to use the emergency department as their primary access point when they are in an emotional crisis," she said. Sr. Markham said this is usually the most costly and least effective way to treat a patient suffering an acute crisis.
CHP's board allocated funds for the redesign and enhancement of the behavioral health services treatment in 2012, and the changes are still being rolled out. The system did not release financial information related to the changes, which include significant capital expenditures toward renovation and building projects at its behavioral health facilities. Last month, the system announced it will build a $21 million behavioral health institute next to its Mercy St. Charles Hospital in Oregon, Ohio. It will have 90 inpatient beds and provide outpatient services.
Flexible design
CHP is using "smart design" to create safe, aesthetically pleasing and versatile space in Lorain, Clermont County and Toledo, Ohio, and Paducah, Ky. "Our facilities are being redesigned. They're open; they're bright; they're beautiful," Sr. Markham said. CHP facilities now are locating acute care programs proximate to partial hospitalization programs. In partial hospitalization behavioral health programs, a person attends structured programs throughout the day, as many as seven days a week, and returns home in the evenings.
"If down the road, acute care programs diminished and partial hospitalization programs grow in size, we have the ability to repurpose space without having to do any kind of significant capital work," Sr. Markham said.
Increasing touch points
CHP is trying to reach patients in need of behavioral health services before they show up in crisis at an emergency department, through better links between behavioral health specialists and primary care physicians. While this initiative is still in its early stages, CHP is working with primary care practices in its service regions to screen patients over the age of 65 for depression. (It may extend this screening service to other populations in time.) It is also working to integrate behavioral health specialists with primary care teams, so the specialists would have a presence in primary care offices, particularly the larger ones. "It's really part of the effort to identify early on people who may need mental health care, but are going to their primary care doctor because of a physical illness," Sr. Markham said.
Physician leaders with the system are working with other doctors, both those who are employed by CHP and those who are not but have ties to CHP, and behavioral health specialists on how this program will work in office settings. Patients who are depressed will be directed to appropriate behavioral health care.
CHP is reaching out to other community partners, such as mental health agencies and clinics that specialize in addiction, to create more cohesiveness among providers and ensure patients are directed to the best type of care for their needs, Sr. Markham explained.
Group time
With its own behavioral health patients, CHP is increasing the structure in the treatment day, including by adding group therapy time.
CHP's behavioral health programs previously didn't provide small group psychotherapy, Sr. Markham explained. Patients now receive at least four hours a day in group modalities run by certified therapists, she said. CHP is using resources from the American Group Psychotherapy Association to assist clinical psychologists and master's-level clinical social workers working toward national certification in group psychotherapy. CHP says extensive research indicates that group psychotherapy led by certified therapists is as effective as individual psychotherapy in nearly every instance.
Day planner
John Strachan is network director of program excellence at Lourdes Hospital in Paducah. The CHP facility has a 26-bed acute inpatient unit and a partial hospitalization program that serves about 10 patients a day.
Strachan said in keeping with the system's new emphasis on group therapy, patients now set their daily goals in a group. In a typical day, patients participate in group psychotherapy, an intense time to focus on personal issues; a group meeting where nursing staff offer instruction on topics like medication management; and recreational group, where patients engage in an activity with a therapeutic value, like an art project or group exercise. Patients see clinicians one-on-one for treatment, as well.
Patients do not need to have the same diagnoses to take part in group therapy together, Sr. Markham said. The groups usually consist of eight patients and are led by two co-therapists. Inpatients and partial hospitalization patients do not join together for group therapy.
Strachan said patients are responding well to having more structure in their days and to their time in the group therapy. He said patient satisfaction and other metrics indicate patients are benefitting from the treatment. "We see a whole lot more engagement and involvement by our patients," he said.