The Chesterfield Community Services Board, Daily Planet Health Clinic, Goochland Free Clinic and Family Services, Goochland-Powhatan Community Services Board, and the Richmond Behavioral Health Authority have joined forces to establish the Central Virginia Health Care Project, or CVHCP. CVHCP will provide comprehensive and integrated medical and behavioral health care to the uninsured in the region who experience mental health problems and do not currently have access to services. The CVHCP received an award totaling $267,071 from the Virginia Health Care Foundation, to support the project during the first three years.
The CVHCP sought competitive funding through A New Lease on Life, a $2 million special initiative of the Office of the Attorney General of Virginia, the Virginia Association of Community Services Boards, the Virginia Association of Free Clinics, the Virginia Community Healthcare Association, and VHCF. A New Lease on Life, administered by VHCF, was established to address unmet needs including primary medical care and access to prescription medications for uninsured public mental health clients and basic mental health services for uninsured patients seen by health safety net organizations.
Funding for the project is primarily being used to deploy a part-time psychiatric nurse practitioner to the two health clinic sites and a part-time family nurse practitioner to the three public mental health agencies. Beth Rafferty, LCSW, the Richmond Behavioral Health Authority’s hental health director, comments, “Thanks to the funding from the Virginia Health Care Foundation, the five organizations involved in our project have been able to provide integrated behavioral and medical health care to uninsured adults. These individuals have not in the past been able to access the essential care that they needed to continue to be productive and functional members of our community.”
Benefits of such an integrated system of care include enhanced identification and treatment of chronic conditions like diabetes, hypertension, and depression for the individuals being treated and, at a systems level, a reduced dependence on local hospital emergency rooms. Partnering with community resources, like the Kroger Pharmacy where patients are assisted with obtaining low-cost medications, is essential to the success of this project, as is working to help people get access to health insurance for their long-term benefit.
Robert Osborn, LCSW, Daily Planet Behavioral Health Program coordinator, said, "The Daily Planet has increased the availability of psychiatric services by one-third through CVHC Project funding. There is now greater access for people who otherwise may not have received psychiatric help, as well as a reduction in waiting times for those in need of services. It is inspirational to see what can be accomplished when community agencies come together for a common purpose.”
During the first project year, a total of 410 people in the region received services as a direct result of the A New Lease on Life initiative through more than 1,300 face-to-face patient contacts. At the two community health centers, 277 individuals received services during the grant year. Medical services were provided to 133 individuals at the three public mental health agencies. The demand for psychiatric services has been such that one site, a small rural clinic, was able to justify and secure funding for a part-time clinical social worker to provide additional supportive services and counseling to its patients.
The project is collecting outcomes data for both psychiatric and medical services. Utilizing the Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor, Suicidal Depression Screening tool, the psychiatric nurse practitioner can evaluate the level of success of the intervention and make appropriate adjustments. During the first project year, eligible participants demonstrated an average score reduction (i.e. improvement in symptoms related to depression) of 4.86 points (on a scale of 1-9, 9 indicating full-blown depression).
Medical services were suspended for the last quarter of the first project year due to a staffing shortage, resulting in difficulty capturing valid medical outcomes data. However, for the current project year, data on blood pressure readings and Body Mass Index will be captured for all hypertensive patients. For patients with diabetes, the nurse practitioner will report on changes in HBA1c levels.
The project also is tracking patients’ utilization of emergency departments for non-urgent care, kept appointment rates, the value of prescriptions filled for patients via pharmacy assistance programs and subsidies, and the overall value of medical and mental health services provided to uninsured patients. Quantitative and qualitative patient satisfaction data is being tracked and reported every six months for the life of the project.
Project staff have been challenged to overcome obstacles like transportation barriers, lingering stigma about mental illness, poor motivation on the part of persons with serious mental illness to seek medical treatment, and lack of education among primary case managers about the value of an integrated approach. Yet many project patients do see the value of these services in their own lives, like the individual who commented, “The staff knows our situation and is helping us greatly. Me and my family are so grateful for this clinic…these [staff] have literally saved my life.”
Submitted By Amy Andrews