Access Goals

1. Access to a mental health provider faster2. Access to treatment from day 13. Access to follow up care4. Reduced burnout for Access Staff

Access to a mental health provider faster

• Old Access:– Phone scheduling by a non-clinician– Walk-in Wednesday– Regional differences

Paradigm Shift

• ED Crisis = ED Access• Access = ED Access + Outpatient Access

Time Frame for Change

Change Processes

• Education• Optimization• Pilot• Implementation

Education

• Goal: rapid and accurate diagnostic assessment– Triage– Assessment– Safety

Triage

• Who needs to be seen?–

https://dl.dropboxusercontent.com/u/94001596/Access%203.19.15/Access%20Triage%203.29.15.doc

Assessment

• Common Presentations• Scripts• Techniques

Common Presentations

• https://dl.dropboxusercontent.com/u/94001596/Access%203.19.15/Common%20Presentations%203.19.15.doc

Scripts

• https://dl.dropboxusercontent.com/u/94001596/Access%203.19.15/Scripts%20and%20screens%2003.29.15.doc

Techniques

• Some examples:– Symptom-amplification– Normalization

Safety• Risk Factors: suicide and violence risk are increased overall given multiple dynamic factors

(symptoms… and stressors...) and static factors (Axis I - III; other unmodifiable risk factors…).

• Protective Factors: the above risk factors are mitigated by protective factors, including strong future-orientation, hopefulness, engagement with treatment, close relationships.

• Assessment: there was no indication of currently increased or imminent danger to self or others based on today's exam; outpatient care with safety plan and close monitoring is appropriate.

• Or:

• Assessment: given…, there is a significant likelihood of imminent danger. A 5150 has been placed, and patient will be

Assessment

• Assessment 1:– Cross-sectional and longitudinal are most

consistent with a diagnosis of...– Differential diagnoses include...– Possible precipitating factors include:

Assessment

• Assessment 2:– I am uncertain about the patient’s diagnosis for

the following reasons...– Differential diagnoses include– Clarification of diagnosis will require longitudinal

follow up and additional collateral data.– Possible precipitating factors include:

Optimization

• Universal Template• Clinical Decision Making

Salinas Pilot

• Team care:– Phone triage by a clinician– Walk-in triage by a clinician; access available every

day– Supervisor to review presentation– MD available

Salinas Pilot

• Problems:– Limited f/u for mild to moderate illness; Beacon unable to provide

f/u– Insurance

• Solutions:– IMPACT– USC– Insurance Specialist

• Fragmentation of care within our system secondary to MOU

Structural Changes

• Monthly meeting, data collection on pilot• Time frame TBD

Reducing Staff Burnout

• Technological innovation to increase time with and care for patients and decrease unnecessary documentation

• Standardization of caseloads• Standardization of access services across

region allowing for collaboration• Increased specialization of services allowing

clinicians to pursue their passions

Reducing Staff Burnout

• Increased education = Brown bag Tuesdays• Wellness group