National Council Magazine - Winter 2009 - 43

Thresholds Finds that Patients Respond Better to Holistic Care Kristin Davis, PhD, Assistant Research Director, Thresholds Institute; Emily Brigell, MS, RN, Director of Integrated Healthcare, Institute for Health Care Innovation, University of Illinois at Chicago; Ann Hruby, MA, Coordinator of Integrated Healthcare, Thresholds, Inc., Chicago, IL kdavis@thresholds.org T hresholds, a large psychosocial rehabilitation center in Chicago, serves 7,000 patients annually. For the past 10 years, it has offered physical healthcare to its members through a partnership with Integrated Health Care, part of the University of Illinois at Chicago’s Mile Square Health Center, a Federally Qualiﬁed Health Center. Each of the three IHC clinics serves different regions of the Chicago metropolitan area. One of the clinics serves one of Thresholds’ most important subpopulations, women suffering from mental illness and their children. The clinic provides preventative care for women and their children, ensuring that the children are up to date with immunizations and that they receive annual physicals. All three IHC clinics are staffed by advanced practice nurses who are faculty with the UIC College of Nursing. An advisory committee composed of leadership from Thresholds and IHC provides a vehicle for ongoing collaboration. The partnership between Thresholds and the UIC nurses began 10 years ago with a small demonstra- tion project that placed a one-exam-room clinic in a program on the south side of Chicago. The clinic was originally open for 4 hours a week but demand was so great that it added another exam room and now operates 40 hours a week. As one long-time staff member put it, “We started as a little storefront, momand-pop operation.” Since the clinic has been open, exam rooms have been added, and the clinic’s scope of care has expanded to meet the changing needs of the consumers it serves. Clinic staff has learned many lessons about effective approaches to healthcare and healthcare system design over the past 10 years. Perhaps the most important lesson is that holistic care makes sense. When asked how using the clinics and working with the nurses has changed her perspective, one Thresholds staff member put it well: “For many trained as mental health providers, it is easy to ﬁnd ourselves focusing on what we perceive to be the ‘mental health’ issues our members present, when in fact it is far more productive to approach treatment more holistically by understanding symptoms within the context of the whole person. We need to move away from compartmentalizing symptoms and toward providing effective integrative health services.” Addressing the physical health conditions of people with serious mental illness is the foundation for recovery-oriented services. Patients like the idea of holistic care more than they do mental health services because it seems more “normal.” At the systemic level, coordination among physical and mental healthcare providers is fundamental to success, and it takes support at upper levels. It therefore requires buy-in throughout the hierarchies of both systems. Steering committees that work bilaterally and regularly hear concerns from frontline staff work best. Thresholds also found that a jointly funded coordinator to span the two systems on the ground was crucial to ensuring high levels of integration, problem solving around new issues that invariably arise, and conducting ongoing cross-training. UBHC Provides Medical Care to Uninsured and Underinsured Shula Minsky, Director of Quality Improvement, University Behavioral Healthcare, Piscataway, NJ / minsky@umdnj.edu U niversity Behavioral Healthcare is a major provider of comprehensive mental health services to people suffering from severe and persistent mental illness who also have multiple physical health problems and face difﬁculties in obtaining physical healthcare. The difﬁculties are owing to multiple factors — limited ﬁnancial resources and insurance coverage for people with SPMI; the scarcity of providers who accept Medicaid; and the difﬁculty people with SPMI may have navigating the complex healthcare system, given illness-related cognitive and motivational deﬁcits. Although some charity and public clinics could provide physical healthcare to UBHC patients, the clinics typically are overwhelmed and have long waits for service, because they serve several other neglected populations as well as the mentally ill. In 2008, UBHC received an anonymous donation earmarked for improving physical healthcare services for people with SPMI. Using these funds, UBHC developed a collaboration with the St. John’s Health Clinic (part of the Catholic Charities system), which serves uninsured, immigrant, and poor populations in New Brunswick, N.J. This collaborative effort, named the Yaffa-Rose Project, hired a full-time physician assistant and a medical assistant and opened for business in September 2008. The project began by targeting UBHC clients who had no insurance or had difﬁculty accessing medical care in a timely fashion. By the end of January 2009, UBHC had referred about 165 new patients to the Y-R Project. The projected number of clients to be served each year is 350. To track patients and services, we designed several Microsoft Access tools. These databases included one to track the number and program of origin of UBHC patients referred to the Y-R Project and another, a program evaluation database used at the Y-R Project, to track all appointments as well as pertinent health information, such as diagnosis, test results, body mass index, blood pressure, diet, smoking, and emergency room visits. A noteworthy outcome observed to date is a reduction in the number of ER direct referrals from UBHC. One problem we have encountered and addressed involved scheduling, which needed to be streamlined. The donors visited both sites recently and were impressed by the dedication and level of service provided by the physician assistant at the Y-R Project and by the enthusiasm and appreciation expressed by professional staff at UBHC. New initiatives planned include a system to assist clients in need of dental care and an expansion of the project to a second site in Newark. NATIONAL COUNCIL MAGAZINE • WINTER 2009/ 39

National Council Magazine - Winter 2009

Table of Contents for the Digital Edition of National Council Magazine - Winter 2009