LAKESIDE WELLNESS PROGRAM - PBHCI LEARNING COMMUNITY REGION #3 ORLANDO, FLORIDA, RUTH CRUZ- DIAZ, BSN EXT. 2529

Lakeside Behavioral Healthcare are providers of inpatient and outpatient behavioral healthcare services. The purpose of this grant is designed to improve the physical health status of people with serious mental illnesses through primary and behavioral health integration. All clients of Lakeside are treated regardless of age, race, gender, sexual orientation, financial level, or disability. Nearly 100 percent of the clients served have minimal or no income and do not have a source of primary health care services.

In total, 100 percent of our patients are clients of Lakeside Behavioral Healthcare. We target individuals who may be facing the following heath issues. They include:  Hypertension  Cardiovascular Disease  Obesity  Smoking Cessation  Diabetes We offer a series of primary care services, Wellness Health Education classes, and initiatives to gain enrollment of the program. With the help of the Peer Support Specialists we are able to grasp clients who may face similar struggles managing mental and physical health complications. Staff are able to assist the clients’ needs through the Avatar system to help coordinate care and accomplish goals that are set mentally and physically.

Medical Director  To ensure clients receive the same level of care in a behavioral and primary health care setting. Nursing Coordinator  Monitors staff performance, appearance, and training to ensure patient care is integrated throughout the Lakeside community. Also, ensure safety and compliance. ARNP  Provide medical assessments, treatment, and order any necessary laboratory testing or specific medical attention. Case Management Team  Assist clients in collaborative processes, through coordination of care, communication, health education, and resource management. Integrated Health Specialist Team  Organizes and documents wellness group classes, and life style education effective for Serious Mental Illness (SMI) populations which focuses on the five targeted areas. Business Office Specialist  Provide administrative/ fiscal support to the clinical programs. Conducts registration of clients through client interviews, financial assessments, scheduling, and data entry. Responsible for all contacts made for the Wellness Program via phone, , or person.

To increase our enrollment and the attendance of reassessments, we offer initiatives to motivate client participation and increase stability. We include various incentives occasionally such as: -Wal-Mart gift cards -1 day bus passes -Wellness Bucks (healthy free meals) This past quarter we have gained a total of 54 new clients/ assessments. Also, 67% of our clients checked in for their appointments, leaving our no show rate at its lowest of 33%.

The Wellness program has selected three individuals to help manage the Wellness group classes, which are held three times a week (M,R,F). They assist health integrated specialist by completing weekly tasks, such as, calling group members reminding them for class, come up with ideas to help recruit new members, and conducting physical exercise and aerobics. With the help of the peers, we are able to connect with the clients on a more personal level to obtain and achieve goals. We have accounted a number of individuals losing weight on a daily basis, group attendance has jumped, and the level of blood pressures has declined during the third and ninth month follow up.

The Avatar system allows the behavioral health team to address the primary health care needs of each client. Overall, every health care professional from the Medication Clinic, the Psychiatrist, Scheduling, Case Management and other departments are able to access all information electronically. With the addition of the Wellness Program, we have made preparations to locate and document everything via web without the use of tangible charts. Also, the psychiatrist and the ARNP are able to eliminate med errors and drug interactions with the list of agency and non agency medication listed on the EHR.

SUSTAINABILITY  Meetings with Lakeside CFO and the Billing Department are continuously done to evaluate and consider establishing codes, licensures and IT ways in order to start the process for sustainability. Staff is included in the participation of webinar related sustainability and the possibility of establishing a partnership with FQHC in our premises. COMMUNITY RELATIONS  Recruit behavioral health clients from Florida Hospital and other entities to assist with enrollment and intervention between behavioral and primary care facilities. Health Information Technology  Director from the IT Department within Lakeside Behavioral Health will be participating in the next meeting in Baltimore, Maryland in order to increase knowledge of the program. The IT Department will assist in expansion of the client monitoring record system in Avatar and provide greater integration between behavioral health and primary health care services within the Primary Behavioral Healthcare, Inc. (PBHCI). OTHER  Include a dietician to assist with careful meal planning for the clients and families. Due to the indigence of our population, the dietician will design a weekly meal plan to assist with clients who are on a set budget.