Clinical Services Manager Presentation

Jerry Phelps, Ph.D.

Clinical Experience

Licensed Psychologist for 19 years

Experience in a variety of clinical settings:

Crisis line

Inpatient Mental Health

Outpatient County Mental Health

Veterans

Primary Care Mental Health

Adolescent Treatment Center

Rehabilitation Psychology

Counseling Center

Management Experience

Successfully led and managed multiple teams

Delivered high quality outcomes

Solved problems and worked creatively

Hiring, Supervising, Training, Mentoring

Collaborative implementation of initiatives,

Policies and procedures

CAPS, SHWB, UCSD and UCOP administration

Prepared reports, staff and customer surveys

Strong relationships with UCSD Departments

Mental Health Technology

Integration into CAPS and UCSD

Interactive Screening Program

Screened more students all other UC’s combined

Mobile Help Center App

Integrated Self Management Skills

Red Folder Mobile App

Promoted and tracked using Google Analytics

Assisted Dr. Remoter in creation of CAPS

mobile technology on UCSD App

SAFE Survey – Online Personalized Feedback

Supervision

Licensed Psychologists

Post-Doctoral Fellows

Pre-Doctoral Interns

Paraprofessional Trainees

Non-mental health staff

Student workers

Orientation

Supervision and Management

Strengths

Growth

Self Determination Theory – The importance of intrinsic motivation

Autonomy

Competence

Relatedness

Clinical Positive Psychology, Student Development, Motivational Interviewing, Social Justice, Strengths, Growth, Resilience, Mindfulness, Lifestyle Mental Health and Health Technology.

Relationships with San Diego

Mental Health Community

• Veterans Administration Healthcare System

• UCSD Department of Psychiatry

• UCSD Family Medicine

• Scripps Behavioral Health

• Aurora Behavioral Health Care

• San Diego College Recovery

• Practical Recovery

• Others

• Motivational Interviewing Trainer for 15 years

• Alcohol Issues and Policy Committee Member

• Lead CAPS Clinician for Alcohol and Substance Abuse issues

• Initiated the CAPS/SHS SUDS Clinical Committee

Alcohol and Substance Abuse Expertise

Personal Attributes

• Calm Under Pressure

• Strengths Focused

• Service Oriented

• Student Facing

• Collaborative and Consensus Building

• Work Life Balance a Priority

• Problem Solving

• Fun and Positive Style

Problem:

Example: SAFE (2001-2008)

• Mandatory Substance Abuse Referrals clogging CAPS intake system (2000)

Solution: • Train specialty providers in Brief MI

• Integrate behavioral health technology

• Utilize trained peer educators

• Develop a stepped care approach

Outcome: • Developed Peer and Pro SAFE program

• Created a web-based, personalized feedback application

• The SAFE Survey

• Developed, tested and implemented policy for mandatory alcohol

referrals in collaboration with student affairs, student conduct

and CAPs

A 2001-2002 study tested the effectiveness of Peer SAFE (SAFE),

the alcohol class (AC), and Computerized Motivational Interviewing (CMI)

for mandated students.

Peer SAFE: Effective

6 week follow-up: Total number of drinks (36)

SAFE = decrease of 23.6 drinks (SD = 24.5) CMI = decrease of 1.8 drinks (ns) AC = increase of 5.25 drinks (ns)

Binge drinking episodes (4) SAFE = decrease of 2.5 binges (p <.01)

CMI = no change AC = increase of 1.7 (ns)

8 Professional Presentations Phelps, J. & Jimenez, J. (2008). Brief Motivational Interviewing in College Counseling Centers. Presented at the Organization of Counseling Center Directors in

Higher Education.

Phelps, J. & Taylor, L. (2007). Motivational Interviewing and Brief Screening in a Single-day Campus Alcohol Outreach Program. Presented at the Department

of Education,

National Meeting on Alcohol and Other Drug Abuse and Violence Prevention in Higher Education.

Phelps, J. (2007). Peer-Facilitated Motivational Interviewing With Mandated High-Risk College Student Drinkers. Presented at the BACCHUS Peer Education

Regional Conference.

Phelps, J. & Bacio, G. (2005). Peer-Facilitated Motivational Interviewing With Mandated High-Risk College Student Drinkers. Poster presented at the

Department of Education,

National Meeting on Alcohol and Other Drug Abuse and Violence Prevention in Higher Education.

Phelps, J. (2005). Award-Winning, Effective Approaches to Preventing Drinking and Driving on Campus. Presented at the Department of Education, National

Meeting on

Alcohol and Other Drug Abuse and Violence Prevention in Higher Education.

Phelps, J., Whisenhunt, N., Sintov, N., Day, M. & Singley, D. (2005). Web Assessment and Peer Educator Motivational Interviewing with Mandated Students. CSU

Alcohol

Conference: Creative Leadership in Alcohol Prevention on College Campuses.

Hsin Hsu, S., Williams, C., Brown, S, Wall, T. & Phelps, J. (2004). Motivational Correlates with Alcohol Sanctioned College Students. Poster presented at the

American Association

of Behavioral and Social Sciences Eighth Annual Meeting.

Williams, C., Phelps, J., Wall, T. (2003). Motivational Interviewing with College Students: A web-based Peer Assisted Feedback Approach. Tenth International

Conference on

Treatment of Addictive Behaviors. Heidelberg, Germany.

Awards

Honorary Recognition (2007) Organization of Counseling Center Directors of Higher

Education (OCCDHE) The SAFE Program.

Regional Award Collegiate Drinking and Driving Prevention (2005) Automobile

Association of America,

Substance Alcohol Feedback and Education Program. A program using motivational

interviewing with

college peer educators to intervene with sanctioned students.

UNIVERSITY OF CALIFORNIA OFFICE OF TECHNOLOGY TRANSFER

Technology Transfer License

The Substance Alcohol/Feedback and Education (SAFE) Survey

http://caps.ucsd.edu/safe/

Student Mental Health Initiative

• Led the implementation of a 3 year grant • Coordinated with UCOP • Supervised one Psychologist, student interns and post-doctoral fellows • To develop and enhance mental health and suicide prevention programs and services • Marketing for stigma reduction and outreach

• Faculty/staff/student gatekeeper training • Online mental health screening and intervention

Dissemination: One Publication

and Fifteen Presentations Publications:

Phelps, J., Crandal. M. M., & Juarez, R. (2013). Effective suicide prevention in higher education. The California Psychologist, 46 (3).

Presentations:

Crandal, M. M., Phelps, J. & Mortali, M. (2014, September). Interactive Screening Program: Utilizing a Web-Based Mental Health Screening Program.

Presented at the Student Mental Health Best Practices Conference, Los Angles, CA.

Nishi, K., Crandal, M. & Phelps, J. (2014, September). Effective Campus Awareness Spotlight: May is Mental Health Month. Poster presented

at the Student Mental Health Best Practices Conference, Los Angles, CA.

Phelps, J. & Ramotar, K. . (2014, September). High Tech Mental Health: UC San Diego’s Strategies for Integrating Mobile Applications. Poster presented

at the Student Mental Health Best Practices Conference, Los Angles, CA.

Crandal, M. M., Phelps, J. Burgoyne, M. & Liu, L. (2014, March). Strategies for Stigma Reduction and Community Engagement and Collaboration. Poster

presented at the Tools for Change Conference, San Francisco, CA.

Phelps, J., Survanshi, N. & Crandal, M. M. (2014, March). Meeting Youth Where They Are: Online and Mobile Outreach Methods and Implementing Web-Based

Strategies to Reduce Barriers to Mental Health Services for College Students. Workshop Presented at the Tools for Change Conference, San Francisco, CA.

Phelps, J., Crandal, M. M. & Juarez, R. (2014, March). Implementing web-based strategies to reduce barriers to mental health services for college students.

Presented at the Tools for Change Conference, San Francisco, CA.

Crandal, M. M. & Phelps, J. (2014, January). High Tech College Mental Health: UC San Diego’s Strategy for Connecting with Students. Presented at the

National Association of Student Affairs Professionals in Higher Education Mental Health Conference, San Diego, CA.

Crandal, M. M., Phelps, J., Caldwell, T., Chan, D., & Cate, E. (2013, July). Suicide prevention and barrier reduction outreach:

Utilizing a web-based screening program.

Poster presented at the annual convention of the American Psychological Association, Honolulu, HI.

Caldwell, T., Crandal, M. M., Phelps, J., Lyda, J. (2013, June). Online depression and suicide screenings: Exploring risks and navigating challenges.

Symposium presented at the annual University of California Office of the President Risk Summit, Oakland, CA.

Phelps, J. & Crandal, M. M. (2013, March). Implementing a campus suicide prevention program. Presented at the 1st Higher Education Strategizing

Forum, San Diego City College, San Diego, CA.

Trends in College Mental Health

Increased Utilization of CAPS Services

Increased Severity of Presenting Problems

Low number of high utilizers of services

Increase in use of Mental Health Technology

Mental Health Technology

800 + mental health apps Elemental health rapidly increasing & effective

(VA is a leader in this area) Technologies can augment in-person services (TAO) Students are digital natives and comfortable with Telecommunication

technologies include telephone, mobile devices, interactive videoconferencing, email, chat, text and Internet.

2015 Annual Report Penn State University

Chang Rates Between 2009-2010 And 2014-2015

For Counseling Centers And Institution (N=93)

Appointment

Attended

Students

Served

Institutional

Enrollment

5.6%

29.6%

38.4%

Institutional Enrollment

Descriptive statistics table (N=93)

students served

Appointments Attended

2014 Utilization

(% of student body served in the

counseling center)

change in intuitional Enrollment

Change in Students Served

Change in Appointments

Attended

Chang in Utilization

6,0821

4,525

30,656

26.3%

37.1%

210.1%

363.5%

212.2%

946

222

41

11.3%

-22.2%

-15.9%

-30.9%

-20.4%

19,506.4

1,529.9

7,716.5

9.5%

5.9%

31.8%

44.3%

24.9%

13,384.1

1,099.3

6,053.6

4.9%

103.4%

31.4%

46.3%

29.3%

Minimum maximum mean

Std.

deviation

0

500

1,000

1,500

2,000

2,500

3,000

2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15

Clinical Statistics

Initial Evaluation

Psychiatry

Conjoint

Crisis, Urgent, Triage

Group

Forums & Workshops

Mentees

5,590

6,202

7,136 7,339

6,659 7,001

7,991

5,000

6,000

7,000

8,000

9,000

2008-092009-102010-112011-122012-132013-142014-15

Individual Counseling CAPS Services Data CLINICAL SERVICE STATISTICS • 16,217 units of clinical service (+11% across 5 years) • 1,571 crisis/urgent appointments (+44%) • 2,454 initial appointments (+15%) • 7,991 individual counseling appointments (+12%) • 290 couples counseling appointments (+31%) • 3,017 group visits (+20%) • 733 psychiatric appointments (-46%) • 3,237 students served (+16%) • 3,687 initial appointment requests (+14%) • AVG NUMBER OF SESSIONS: 4

• MODE: 1 • MEDIAN: 3

Utilization

• One is modal number of appts per client/per year.

• Clients averaged 5.86 appointments.

• 20% clients accounted for over 50% of all appts!

• 1% of clients accounted for 6.5% of all appointments,

averaging 38.13 appointments.

• 10 clients utilized a total of 878 appointments.

CRITICAL INDICENTS AND RISK (% difference across 5 years)

24

37 45

72

55 57 54

22 17

35 22

50 55

72

46 54

80

94 105

112

126

5 15

21 20 28 27 28

0

20

40

60

80

100

120

140

2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15

Hospitalizations and Psychosis

Hospitalizations- Admissions

Hospitalizations- Evaluations (less than

24hr stay)

Hospitalizations- Total

Psychosis (requiring emergency care)

• 126 total hospitalizations, including admissions and evaluations (+58%) • 77 suicide attempts and hospitalizations (+60%) • 2 completed suicides (+0%) • 28 psychosis incidents requiring emergency care (+33%) • 2014-15: 28% had suicidal thoughts in the past year, 9% had current thoughts of suicide, • and 7% indicating at least one past attempt

CRITICAL INDICENTS AND RISK (% difference across 5 years)

• 126 total hospitalizations, including admissions and evaluations (+58%) • 77 suicide attempts and hospitalizations (+60%) • 2 completed suicides (+0%) • 28 psychosis incidents requiring emergency care (+33%) • 2014-15: 28% had suicidal thoughts in the past year, 9% had current thoughts of suicide,

and 7% indicating at least one past attempt

15 15 16

25

14 21 18 17

24 32

40 48 48

59

34 41

50

66 65 69

79

2 2 2 1 3 0 2

0

10

20

30

40

50

60

70

80

90

2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15

Suicide Incidents

Suicide- Attempts (serious, requiring

emergency care)

Suicide- Threats (serious, requiring

hospitalization)

Suicide- Total Incidents (registered

students)

Suicide-Completed

Problems

Increase volume of clients causes increase in wait times for Intakes

Intakes are so backlogged that Urgent Care is a de facto intake system.

Increased volume and severity of clients leads to urgent care staff to often

overutilized and feel overwhelmed.

Solutions

Add staff to Urgent Care

Integrate New Case Management Staff

Create an Urgent Care Committee

Phone Triage System

Use more same day groups and workshops

Possibly collaborating with Recreation for Yoga

Continue to improve management of high utilizing clients

Provide a customer service focus

Integrate Health Technology as needed

CAPS Changes

Services:

CAPS Case Managers

Added CP-II staff

Added CP-III staff

Approval to adopt changes recommended in the Urgent

Care brainstorming meeting

Pareto Principle 80/20 Rule

20% of the source causes 80% of the work.

Which 20% of client’s take 80% of effort? Focus efforts on how to most efficiently manage these

clients.

According to a 2015 Penn State Study of College mental Health,

20 percent of students seeking mental health treatment are taking up 50% of all campus

counseling center appointments.

Low frequency/High need students (identified in clinical oversight committee, nominated by

staff or via PnC data analysis)

New: Crisis, Suicidal Risk, Psychosis, Mania

Recurring: Recently hospitalized, low compliance, re-hospitalization, Students of Concern,

complicated clients

Low need clients

New: Direct off campus referrals, information about services, directly to group, documentation

Recurring: Renewals

Clinical: Use Case Mangers to create processes for and manage low need clinical issues.

Non-Clinical: Use Front Desk staff, website FAQ, telephone messaging, Proto Call training,

student

feedback, handouts, checklists, to assist students in being more informed consumers of CAPS

services.

Marketing CAPS Services

Improve expectations for urgent care and intakes

If clients have accurate expectations, they can ask for what they want and to self manage

needs, when appropriate

Also, marketing other options for mental health support such as Groups, TAO, Forums, Off

Campus

Referral, SARC/CAR and SHS., Marketing done trough website FAQ, Urgent Care

Description, Intake Description

Change the name of Urgent Care to ?

Vision

Continue Stephanie, Rob and others’ previous work.

Implement CAPS collective vision for Urgent Care.

Successfully integrate Case Managers (CM) into CAPS Clinical Services.

CM assists with hospitalization, UC and referral case management.

Focus on efficiency of services through phone triage and brief screening

Provide more upfront management of services to high risk/utilization issues and efficient service

delivery from low risk issues

With Judy, provide adequate training to all UC staff – telephone triage/crisis management.

Integrate with Sam and information technology such as Point and Click, laptop or mobile PC to UC office,

updating website and app, Telementalhealth, other technology for urgent care.

Continue to consult with outside colleagues, listservs and literature.

Provide excellent and responsive service to

Customers: Students

Partners: SHS, SA Case Managers, CARE/SARC, outside providers and referrals

Stakeholders: Staff, faculty, UCOP and the San Diego Community

Fellow CAPS Staff and CAPS Management.