1. Update on Broadlawns’ Behavioral Health Services
Community Conversations 2.0
July 18,2017

2. Crisis Observation Center

3. Crisis Observation Center

4. Crisis Observation Center

5. Crisis Observation Center was moved to the Broadlawns campus on May --, 2017.
The offsite location at CISS left COC staff feeling less confident about their capacity to deal with persons who have medical issues.
It also resulted in staff expressing concerns about safety issues while dealing with a relatively acute population.
The move to the Broadlawns campus means medical and security back-up are on site at all times to assist if needed.
It also provides for more opportunities for cross-training of staff and sharing of resources between various Behavioral Health settings.

6. Current location of the COC

7. Purpose of the Crisis Observation Center
To provide immediate access to evaluation and services to those individuals who are experiencing a mental health crisis.
To have individuals served in the most appropriate setting– ie- to divert away from the Emergency Department when appropriate.
To offer law enforcement an alternative to incarceration when they are working with an individual demonstrating problem behavior related to a mental health issue in the community.
To engage individuals in the moment when they are experiencing significant symptoms in order to increase the likelihood of ongoing treatment.

8. Current status The COC is currently open 24/7/365.
There is generally a nurse, therapist, and care coordinator present during the day 7 days per week.
There are psychiatric techs present at all times.
There is a psychiatric physician assistant available every day as needed to complete evaluations and prescribe medication.

9. Future plans Continue to recruit for nursing staff.
Considering increased presence of a prescriber for more timely evaluations.
Incorporation of an “urgent care” component.

10. Typical visit
Individual presents to door of the COC and is greeted by staff.
Mini evaluation completed regarding acute safety issues.
Demographics obtained and individual is registered.
Nursing evaluation completed. Care coordinator may be present.
Individual is offered an opportunity to speak with the therapist.
Physician assistant is contacted if indicated.
Individual is provided a comfortable recliner in which to rest.
Care coordinator works to ensure that adequate follow up is scheduled, and may contact community case managers and providers.

11. Questions?

12. Crisis Stabilization (McKinley)
House with nine private bedrooms.
Nursing staff available Monday through Friday during the day.
There is a therapist and care coordinator present Monday through Friday during the day.
Psychiatric techs and Certified Medication Assistants are present at all times.
The house is unlocked, and the program is entirely voluntary.
Individuals may not use drugs or alcohol on the premises and any use of substances may be grounds for discharge, depending upon the circumstances.

13. Purpose of Crisis Stabilization
To provide a safe and supportive residential setting where individuals struggling with impairing psychiatric symptoms can receive supervised medications, evaluation, therapy, and community resource linkage.
To assist individuals in stabilizing psychiatrically, and facilitating their successful re-entry into the community.
To teach and encourage use of healthy coping strategies and positive health behaviors.
To assist individuals in formulating and meeting personal goals.

14. Referrals
Information regarding making a referral for admission can be obtained by calling #
Referrals are reviewed by McKinley staff, and the Program Manager makes the ultimate decision.
Referrals must come from a mental health professional or setting. Self referrals are not accepted.
Individuals must be able to participate and cooperate with the program. They must be able to maintain their personal safety. There must be a reasonable expectation that they will be able to return to the community within 90 days.
Note that McKinley should not be viewed as an alternative to a shelter unless the individual otherwise meets criteria for admission.

15. Goal
To continue to work towards a full continuum where individuals can be assessed and treated in the setting most appropriate to meet their needs.

16. Inpatient Behavioral Health Services
Currently one unit with a census of 30.
Generally always full.
All admissions come from an Emergency Department setting (Broadlawns or an outside facility).
Broadlawns provides care for the majority of Polk County court orders.
Broadlawns admits individuals with a wide range of mental health issues with few exclusionary criteria.
Currently remodeling space with plans to open a second inpatient unit in the fall. This is directly below the current inpatient unit.
Space will include 14 single rooms and an ECT suite.
Rate limiting factor at this time is hiring of nursing staff.

17. Inpatient Behavioral Health
There are four full time psychiatrists who provide inpatient care on the Behavioral Health unit and consultation to the medical/surgical areas of the hospital
Following completion of the new unit, there will be three physician assistants who provide for the medical needs of patients hospitalized on IBH, and assist with the admission and discharge processes.
Following completion of the new unit, there will be five full time social service staff who assist with discharge planning and coordination of care as well as providing group therapy.

18. Outpatient Behavioral Health Services
Medical Plaza opened in April of Behavioral Health Services occupies the entire second floor.
Expansion is planned into the remainder of the third floor not occupied by the Dental Clinic.
There are currently eight outpatient psychiatrists with a ninth hired and scheduled to start in October.
There are seven Advanced Practice Providers (ARNP’s and PA’s) in the outpatient setting.
There are two ARNP psychiatric fellows.
There are 14 licensed therapy and counseling staff.
Broadlawns provided outpatient mental health services in 56,155 visits in FY2016.

19. Medical Plaza Outpatient Services
Medication management and therapy clinic.
New Connections– co-occurring substance abuse treatment.
Intensive Outpatient Program– therapy based treatment program.
Group therapy– STEPPS, Depression, Anxiety.
Discharge group and No-Show group.
Phone nurses.
Patient navigator– assists in care coordination, problem solving for patients presenting to the clinic with acute psychosocial needs.

20. Integrated Health
One psychiatrist and one psychologist are seeing individuals at the Broadlawns East Side Clinic.
Psychiatric medication management.
Group and individual psychotherapy.
Consultation to the Urgent Care and Primary Care providers working with patients who express mental health concerns.
Education to staff in the clinic.
Education to patients regarding positive health behaviors.
One psychologist seeing individuals in the Broadlawns Family Medicine Clinic and providing similar services.

21. Psychiatric Training
Currently provide clinical rotations for two DMU and two UIHC medical students at all times.
Advanced Practice Provider fellowship started in July 2016 and recently graduated three APP’s. Two new fellows have started and anticipate hiring a third in December.
Applications to the ACGME have been submitted to start a new psychiatry residency training program, partnering with UnityPoint Des Moines. A site visit is scheduled for August 3rd. Possible start date for the initial class in July This is a four year residency taking four residents each year (program total of 16 when up and running). (Mercy is also starting a four resident program with similar parameters).
Consideration is being given to providing advanced training to post- graduate psychologists.

22. Sobering Center (???????)
A place where persons who are acutely intoxicated can go in order to be in a safe and supportive environment while recovering from the effects of the ingestion of a substance.
No detox services are provided at the sobering center.
Staffed by a person with some medical background (ex- paramedics) to provide a minimal level of medical supervision.
Once sober, individuals will be offered information about options for further evaluation and/or treatment for substance abuse.
Environment is meant to be positive and non-judgmental.

23. Goals
Provide law enforcement with an alternative to incarceration when they are working with individuals who are acutely intoxicated in the community.
Provide an alternative to the Emergency Department where individuals are sometimes brought when there seems to be no other reasonable alternative.
Provide an environment where staff are trained in Motivational Interviewing and are invested in providing a caring environment.

24. Unanswered Questions and Potential Barriers
There is currently county funding available, but given the political climate of these times, will that remain a stable funding source (there is no MCO or other insurance reimbursement)?
Where should such a center be housed?
How are concerns regarding medical and security crises addressed?
Is it reasonable to assume that appropriate staff can be hired for the program, especially given the challenges that many of us are facing in hiring and retaining good staff?

25. Other questions? Jan Landy, MD
Section Chief for Inpatient Behavioral Health Services at Broadlawns #