Interviews with Stephanie Lessmeier of Provident, Inc. and Amy Alexander of Hyland Behavioral Health

What steps did you have to take to get your program off the ground?

Provident, Inc.: Provident had a pre-existing relationship with Hyland after being a part of Cohort 4 and built off of that program (Hope After Phase II), and upon receiving the grant, worked together to draw up on the contract.  They also built on their pre-existing Hope After program structure and aligned their practices with current research, including time between referral receipt and first contact, training, and implementing feedback received from patients/clients.

Hyland: Hyland’s Executive Director of Behavioral Health and Home Health was on-board with the program and has pushed the program with those who are hands-on in the emergency department.  And once everyone was on-board, the importance of the program was emphasized to everyone involved from administration down to line staff.  Adding the enhancement of a “hard-stop” to the electronic health record (EHR) asking if the patient was suicidal and if they were referred to the Hope After program also helped by reminding busy ED staff about the new initiative, as well as having ongoing staff meetings with everyone involved at the ED-level to discuss the program.

First Successes:

Provident: Clients have reported that the program is helpful, they feel cared about, and they enjoy speaking with Provident’s Hope After counselors.  The relationship with Hyland is getting stronger through increased interaction and staying in touch.  The programs updates based on research, such as basing first contact time on patient needs and adding supportive letters and texts, have been well-received.

Hyland: Building the relationship with Provident has been a big success, as well as getting the reporting side of the partnership up and running.  They are looking forward to getting more data and analysis from the crisis center side so that they can begin to better understand the program’s impact.

First Challenges & Solutions:

Provident: Continuing to develop the relationship with Hyland and figuring out the best ways to communicate and ensure that referrals keep coming in. In response, Provident has increased the number and frequency of emails to Hyland staff responsible for follow-up, put up posters about the program at the hospital, and worked together to add a prompt in the Electronical Health Record that asks if the patient was referred to the follow-up program, and if not, requiring that a reason is entered.   It has been difficult at times to engage clients post-hospital discharge, and in response, Hope After clinicians call the patient ASAP after discharge, instead of applying the standard 24-48 hour window.  They also “changed their perception of engagement,” as they received feedback that “just seeing that someone cared enough to reach out, even if they [the patient] couldn’t answer” was helpful and meaningful to patients.

Hyland: They have found that consistent reminders at staff meetings and reinforcements about the purpose of the program have helped to address the barrier of staff working very busy ED shifts.

Emerging guidelines and best practices:

Provident: Working with clients to help them avoid the hospital whenever possible because risk can go up with repeated hospital visits.  Provident and its Hope After program use the Columbia Suicide Severity Rating Scale (C-SSRS), document risk very carefully and thoroughly, and have a postvention plan in place for their counseling team in the event that a patient does die by suicide while in the program.

Hyland: Having Provident come in early on in the project to meet with staff was, and remains, very important to the success of the program.  The more training and education around follow-up and its impact that can be provided to staff, the better.

What advice would you give to others who are looking to establish a follow-up program and partnership?

Provident: It’s important to focus, first of all, on the relationship between the crisis center and the emergency department – it needs to be solid and both need to be committed to the project.  Use research, best practice, and guidelines to create your program; and, if they don’t exist, try to make some.  And finally, listen to feedback and update procedures as needed.

Hyland: The follow-up program is beneficial to patients, the crisis center, and the ED, and it’s worth it to put in the work and effort.