Crisis Center Grantee Profile
Crisis Center Grantee Profile
Interviews with Lori Carnahan of DuPage County Health Department and Daniel Doebler of Northwestern Medicine
What steps did you have to take to get your program off the ground?
DuPage: DuPage, as part of the county, has had relationships with many hospitals due to providing crisis services for the county, including mobile crisis services, and already had contracts on the state level for services across the lifespan. As a previous member of Cohort 4 of the SAMHSA follow-up grant, they also had a relationship with all 6 hospitals in the area, and Northwestern was enthusiastic about getting on board with the project, so the next step was to formalize the process. Northwestern is invested in this project, so while some of the contractual pieces have been complicated due to the size of the organizations involved, there has been no lack of enthusiasm about getting the project and partnership off of the ground. To help with partnership engagement, linkages to services, and project integration, the lead clinician from DuPage goes on rounds every week at Northwestern; the clinician is backed by the entire crisis team at DuPage.
Northwestern: Northwestern already had a strong working relationship with DuPage from some time and therefore had pre-existing processes in place and had been making referrals without a formal partnership; the referrals are simple and are mutually beneficial. The next step was to get the compliance team involved regarding data-sharing and developing a business associate agreement; developing the contractual agreement has been more time consuming. They worked to specify what steps needed to be taken, trained everyone on the parameters of the grant, provided those involved with the appropriate documentation, pre-populated the electronic health record with certain information, and finally, provided consent and release information.
DuPage: The goal that was set at the start of the project was 10 referrals per month from the ED and they have met it every month. They are also accepting referrals from the inpatient unit, as well, and are receiving close to 20 referrals per month between the two units. The partnership between DuPage and Northwestern is very strong and has grown since Cohort 4 – the project has deepened the relationship between the two, both partners are deeply invested and have bought into the project and its goals.
Northwestern: “Success is any time that we are able to link a patient with follow-up services.” By and large, patients have been expressing happiness with being referred. Working with DuPage County has been great.
First Challenges & Solutions:
DuPage: The primary challenge has been contractual – a lot of back and forth, especially with the Columbia research data pieces as all of the legal concerns have to be ironed out. Internally to the program, their lead clinician was out for a time so another clinician has been standing in and learning the ins-and-outs of the project. With both challenges, being flexible and patient, figuring out the best ways to be helpful, and working closely to keep things moving has been key.
Northwestern: Getting the data agreement in place has been a challenge, but this will be coming soon. The grant project is 24/7/365, and in a busy environment with a tight staff due to some openings, even 10-15 minutes can be a hurdle for the referral process. They are working hard to fill staff positions and once this happens, it will help with the referral process and making sure that anyone eligible for follow-up is offered the opportunity to enroll in the follow-up program
Emerging guidelines and best practices:
DuPage: Within the grant, “engagement is the key on all levels”- getting to the patient quickly (within 24 hours), and pushing for face to face contact through their mobile crisis team whenever possible has helped them see a much higher success rate, and the 24-hour turnaround between referral and contact has allowed for rapid engagement.
Northwestern: It is still early in the process, but with additional staff, it will allow them to better understand patients who are slipping through the cracks and improvements to the process will be carried out, as well as improvements to assessments and dispositions.
What advice would you give to others who are looking to establish a follow-up program and partnership?
DuPage: Patience is vital! You have to make sure that the right people are at the table, not just from a behavioral health perspective, but also from a leadership perspective as you need buy-in from the top-down to make sure that the project will be a success. Quick engagement with patients is one of the most important things when it comes to follow-up. And finally, getting inpatient units involved early.
Northwestern: “Stick with it – it’s worth it. If you’re even thinking about it, it’s worth it to do the legwork. It can feel like a long process to get up and running and that’s normal, and the value of follow-up outweighs the difficulties involved with getting started.”