JSA Health and the Burke Center are honored to have been chosen to present at the National Council for Community Behavioral Healthcare Conference in Orlando, Florida in March of 2010. This is a significant achievement as it recognizes at a national level the merit of using on-demand, emergency telepsychiatry. The following is the documentation submitted to NCCBH.
Title: From Triage to Treatment: Innovative Crisis Care
Collaboration and Technology create a new approach to psychiatric emergency services in a rural setting
Description:
The Burke Center is a community mental health center that serves twelve counties in rural east Texas. The Center’s 11,000 square mile service area is high in poverty, low in population density, and is designated a medical and mental health provider shortage area.
In the past ten years, all of the psychiatric hospitals in the area shut their doors. The shortage of psychiatric staff along with the high number of medically indigent made the business model of the freestanding psychiatric hospital unworkable. The erosion of psychiatric resources reached a tipping point with the twin disasters of Hurricanes Katrina and Rita. The surge of mental health emergencies overwhelmed available resources. This galvanized local law enforcement and hospital administrators. They came together with Burke Center to seek a sustainable solution to the shortage of psychiatric care.
The result was the creation of a regional psychiatric emergency service. It is unique in two respects: First, the program provides around-the-clock emergency services to the region solely using telepsychiatry. Individuals receive a full psychiatric assessment and are released, transferred to an available inpatient bed, or followed in treatment in the program’s voluntary crisis residential setting. Video teleconferencing technology makes psychiatric expertise available on demand and makes this resource more affordable in a rural setting. The other unique aspect is the program’s funding mix. It is financed through a blending of revenue from the state, all twelve counties, and each major hospital. A model for measuring stakeholder return on investment will be discussed.
Learning Objectives:
Objective One: Participants will gain an understanding of the critical role video teleconferencing can play in the provision of psychiatric care in an underserved area. Participants will learn about the types of equipment that can be used effectively, the type of network connectivity necessary, and some of the techniques presenters can use to enhance consumer satisfaction with this approach.
Objective Two: Participants will participate in an interactive discussion regarding the development of local collaboratives to expand care. Participants will hear what did—and did not—work to get stakeholders to the table to invest in this program.
Objective Three: Participants will explore with the presenters issues surrounding the provision of services to acutely ill individuals in this setting, including issues of seclusion and restraint, medical clearance, and involuntary commitment.
Documented Results:
The program began providing services in December, 2008. As of the end of August, 2009, the program served over 600 individuals, markedly reduced hospital inpatient usage, diverted over 60% of those in crisis away from hospital emergency departments and reduced law enforcement transport time. Results of studies presently underway to document hospital and law enforcement cost offsets will be presented.
Stephen F. Austin State University School of Social Work did an in-depth behavioral health needs assessment for the region in 2006. This included formal surveys and focus groups with doctors, nurses, hospital administrators, mayors, advocates, police, sheriffs, mental health professionals, and persons served in each of the twelve counties of the Burke Center’s service area. The profound disconnect between stakeholders and the lack of services is well documented. The same needs assessment process was conducted post program implementation in 2009. The study documents the vastly improved system and the alignment of and cooperation between stakeholders across the region. The study also identifies the scale of turnover among stakeholder personnel and the ongoing need to educate and reinforce those involved in the wider mental health system.
Tools you can use:
- Creating a groundswell: organizing frustrated stakeholders into a force for change
- Telemedicine: what it can do, what you need to get started, what cool new gadgets can be used to expand access to care.
Presenters’ bios:
Susan Rushing is CEO of Burke Center and has served in that role for twenty years. Ms. Rushing has worked closely with local stakeholders to develop a collaborative not only to provide emergency mental health services but also to address enhanced communication and data exchange between and among health care and law enforcement entities in the region. Burke Center has been using telemedicine extensively for over ten years.
Avrim Fishkind, MD is the President and Chief Medical Officer for JSA Health. He currently serves as President of the American Association of Emergency Psychiatrists. He has designed multiple comprehensive psychiatric emergency programs.
