Interviews with Greg Borders & Stephen Canova of Lines for Life and Jane Erickson & Bonnie Wilson of Providence Health & Services

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

Lines for Life: From a partnership perspective, Lines for Life identified Providence as a potential partner as they are one of the largest hospital systems in the area and have a large psychiatric population who seek out services there.  They reached out to individuals at the administrative level who they already knew and received enthusiasm about the partnership and collaboration in writing the grant.  At the start of the program, Lines for Life met with the social work team at Providence to help move things forward. Internally, they had a robust follow-up infrastructure in place after being a part of Cohort 3, and did work to further expand upon it. A highly qualified and experienced team member was hired from within specifically to manage the follow-up project and act as a liaison with the hospital.  The next step was to identify the staff that would be part of the follow-up team making the contacts.

Providence: There was no issue with getting approval for the project from the hospital administration.  They have been going through an adjustment with some staffing changes of individuals who were deeply involved with the project, but Lines for Life has been enormously helpful and supportive in getting things on track again.  Lines for Life has been meeting with the social work team and in order to address low referral numbers, Providence has been working to reinvigorate the training process and plan to meet with another hospital who does follow-up.

First Successes:

Lines for Life: Despite times where referral numbers have been low, there have been social workers at the hospital who have really embraced the program and send over referrals regularly.  More than half of the patients who have enrolled in the program have gone on to enroll in the Columbia evaluation study, and that has been exciting.  Lines for Life has a great process for follow-up, with great staff and clinical contacts.  The team is doing a great job and everyone feels that they are in a great position to move forward.

Providence: A big success was when a patient came to the hospital for another reason and it became clear that he was also experiencing a mental health crisis; they were able to refer him to the follow-up program and he responded very positively to the referral.  The staff in the ED who have been making the follow-up referrals have reported that patients are relieved that someone will be following up with them and have said that it helps them to feel less alone.

First Challenges & Solutions:

Lines for Life: Meeting the goal for referrals from the ED has been challenging at times, but by increasing engagement with the hospital, both administrative and clinical staff included, this is starting to change.  Working with the reporting systems and data requirements of the grant has proved to be somewhat of a challenge, though having been a part of the grant before and taking advantage of the SAMHSA webinar on the new reporting system have helped, and they will seek out additional assistance if need be to make it work. And finally, managing the size and scope of the project has had its challenges, as well, however the follow-up project lead has taken a structured approach to managing it and the staff involved.

Providence: The change in the project leadership on the hospital side has been a challenge, which they have faced by making sure that and they are meeting with project staff of both Lines of Life and internally to make sure lines of communication are open. They have also dealt with technical issues with their fax machines, causing faxes not to go through for a period of time. Fortunately, they were able to get the issues with the fax machine addressed and are revising the process of the referral so that it includes less paperwork to be completed and is more streamlined, with a plan to make it so that the patient face sheet is printed from the EHR and attached to the referral, so very little is filled out by hand.  If it’s easier to use, they are hopeful that staff will more readily make the referrals.

Emerging guidelines and best practices:

Lines for Life: Be careful and deliberate about how you do things – there are a lot of moving parts and making sure that the right people are involved is crucial.  Planning and structuring the electronic copies of the referrals – having learned from being a part of Cohort 3, they set up different call reports for each referral so that each record of contact is easy to find, follow, and review.

Providence: Making the referral process simple is a key to increasing the number of referrals.

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

Lines for Life: In a partnership, make sure you have a large group of hospital staff who will be involved with the process at the referral stage at every meeting to ensure that everyone is on the same page with the project.  Another thing that has worked well the follow-up project has been structuring the program around the intervals of day 1, day 10, and day 30 for connecting with program participants.

Providence: It’s really important to have meetings with the crisis center early in the project, as well as allowing for staff to hear patient testimony that the crisis center receives as often as possible as it’s very motivating for them and they rarely get to see that side of the project.  Having crisis center staff come to meetings frequently, as many times as possible, and having them come at various times so that they connect with all staff in a 24/7 environment.