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Crisis Center Grantee Profile

Crisis Center: Institute for Family Health

Emergency Department: Health Alliance of the Hudson Valley

Location: Kingston, New York

Year 1, Months 1-6

Interviews with Maggie Stahlin from the Institute for Family Health and Sharon C. Miller from Health Alliance of the Hudson Valley

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

Institute: The Institute had a strong, pre-existing relationship with HAHV and have been a champion of what the Institute does, especially follow-up. The Executive Director at the Institute reached out directly to the hospital administration, and on the hospital end, they have facilitated enthusiastic buy-in from the hospital staff.  The Institute and HAHV worked together to make changes to their electronic health records (EHR) that have been helpful for record-keeping, referrals, and reminding Mental Health Evaluators in the ED about the follow-up program.  In November 2016, the Institute assisted the HAHV ED in transitioning to use of the Stanley-Brown Safety Plan (2008).  The biggest changes came as the Institute became a Lifeline Crisis Center, as they had to implement a phone system and ensure coverage for their service area of Ulster County.

HAHV: There was a lot of training done with the staff, including “read and signs” to show their knowledge, understanding, and agreement with the new policies and procedures for follow-up.  All but two of the Mental Health Evaluators had, as of February 2017, completed the Assessing and Managing Suicide Risk (AMSR) training, which has been very helpful, especially for newer team members.  A lot of the ED nurses went through SafeTalk training. They also did a lot of fine-tuning with their workflow, including the changes to the EHR.

First Successes:

Institute: The Institute has received a lot of referrals for follow-up from HAHV, and doing trainings with the staff in the ED has brought them together on the same team, created a shared language, and a sense of community among service providers. The ED psychiatrists and Manager of the Psychiatric Emergency Department did a presentation with the Mental Health Evaluators in the ED, which led to an increase in commitment and engagement on the ED-side of the follow-up partnership.

HAHV: The Mental Health Evaluators have said that they are working hard at making referrals and are hopeful that it is helpful to patients.

First Challenges & Solutions:

Institute: Sometimes the Institute has offered services to callers and patients and they have been declined, and they are working on figuring out how to better engage those referred to the follow-up program.  The technology has at times been a challenge, but were able to solve it by facilitating a connection between their two EHRs. By building the hard-stop into the EHR, they have been able to track when providers were documenting that a patient was ineligible for the program when that was not the case, and adjust their training materials to better educate Evaluators and increase referral rates. They are also still working on answering more Lifeline calls and increasing the acceptance rate for those offered follow-up services.

HAHV: Making sure that team members are adequately trained and then getting and keeping everyone on the same page can be a challenge, but by making time for meetings and reminders, the referral rate increases.  The investment of time on an administrative level has been challenging at times, as the Manager goes over all referrals on a case-by-case basis and follows-up with staff.  By delegating administrative tasks, the Manager is able to pay the attention to the program that is necessary for its success.

Emerging guidelines and best practices:

Institute: The Institute has two Care Navigators, one of whom is a Licensed Mental Health Counselor and does all of the risk assessments, and they are able to offer follow-up with a number of modalities (phone, home visit, and caring letters) to meet the needs and preferences of patients referred to the program.  Offering multiple modalities for follow-up allows the program to reach patients where they are.  And finally, having the technology in place has been vital and has increased both efficiency and quality.

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

Institute: The amount of time required to make the program successful pales in comparison to the benefits that have come from the partnership, and remembering that the effects of the program will be bigger than the project itself. Having bi-weekly meetings with the hospital staff helps increase the quality of the care through teamwork and strengthens the care offered to the community.

HAHV: Work early creating the workflow – how it will work, who will do that, how you’ll provide quality assurance, and getting needed information.  And then be prepared to adjust it several times as you get going!