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Outpatient Annual Report

Corry Counseling Services

Outpatient Mental Health Program

FY 2018/2019 Annual Report

 

Program Description

Corry Counseling Services provides outpatient mental health services to Erie, Warren and Crawford County children and adults.  The population includes individuals with severe mental illness and others with less severe emotional disorders. 

 

Outpatient services include screening and assessment, safety planning, psychiatric evaluation, individual psychotherapy, group therapy, children’s play therapy, family therapy and medication management. For those accepted for outpatient services, an individual treatment plan is developed based on the needs as identified in the intake process.  All treatment plans are developed under the supervision of the consulting psychiatrist and clients are seen for psychiatric evaluation and services as indicated.  Clients accepted for service are registered with Erie County Care Management and/or Health Choices provider.

 

Children, who comprise approximately 35% of the agency’s total caseload, may be served in school at Corry Area Primary, Columbus Area Intermediate and Corry Middle-High School.

Consumer Satisfaction is monitored in partnership with the Mental Health Association of Erie County, in addition to agency client surveys.

 

Telemedicine services were provided on average one week a month between the months of November 2018 to March 2019.  This added service allows for the psychiatrist to maintain continuity of care from alternative locations to a rural population during the winter months.

The Outpatient Department was able to provide individuals with an initial psychiatric evaluation appointment within 7-10 days after completing their intake appointment. 

 

Clients

The Outpatient Program served 1445 individuals this fiscal year.  There were 639 intakes completed, of which 428 were adult assessments and 211 were child/adolescent assessments.  There were 266 case closures.  There were no specific concerns regarding referrals.   Of those 1445 individuals, 1403 were White, 23 were Black, 5 were Hispanic, 5 were Native American, 1 was Asian, 1 was Pacific Islander and 7 were other.  764 were female clients and 681 were male clients. There were 5 clients ages 0-5, 279 clients ages 6-13, 173 clients ages 14-17, 204 clients ages 18-25, 422 clients ages 26-45, 278 clients 46-64 and 84 clients ages 65 and older.

 

Staff

During this fiscal year, outpatient staff was comprised of 3 full-time therapists, 1 part-time therapist, 3 full-time psychiatric nurses, 1 Psychiatrist, 1 CRNP, and 1 Director of Outpatient Services.  The retention rate for therapists was 100%. The retention rate for the prescribing staff was 100%.  One nurse retired during this fiscal year, and a replacement was hired to fill that position prior that nurse leaving. Therefore, Outpatient staff remained at full capacity throughout the entire fiscal year. 

 

 

Training

An annual training plan was developed for the Outpatient program.  LCSW’s and LPC’s were to complete required continued education units for 2/28/19 PA Licensure. This includes 3 hours of Ethics, 1 hour in suicide prevention, and 2 hours in child abuse recognition and reporting.  Nursing staff were to complete required continued education units for 2018/2019 licensure renewal.  All of the licensed staff completed the required trainings in the expected timeframe. Additional training goals for this year were for staff to complete the following Relias Trainings: Motivational Interviewing, Advanced Strategies Motivational Interviewing, Trauma-informed Clinical Best Practices: Implications for Clinical and Peer Work Force, Therapist Resilience and Vicarious Trauma, Fire Safety: The Basics and HIPAA training. Outpatient staff was to also complete 6 hours of training in an area of interest. 

 

Outpatient staff met 100% of annual training goals for this fiscal year. Therapists and the Director of Outpatient furthered their professional development by completing trainings in Ethical Principles and the Assessment, Treatment Management of Suicide Risks for Pennsylvania Mental Health Professionals and LGBTQ Youth: Clinical Strategies to Support Sexual Orientation and Gender Identity. All of the staff completed an hour of Medical Marijuana Training. Two nurses attended Pharmacology for Mental Health Professionals. A nurse, the Outpatient Director and a therapist attended that Purple One Domestic Violence Bystander Training that met the requirements for Corry Counseling to be a designated Purple One location in the community, where domestic violence victims can seek safety and assistance.

 

The training goals for Outpatient staff for the upcoming fiscal year are for them to complete the following trainings: Corporate Compliance, Bloodborne Pathogens, Agency Exposure Control Plan, Child Abuse Recognition and Reporting, Behavioral Health Services and the LGBTQ Community, Best Practices for working with LGBTQ Children & Youth, Webinar: Implementation of Trauma-Informed Care Systems. Licensed therapists are expected to meet the CE requirements to maintain their current licensure, including Suicide Prevention, Professional Ethics and Child Abuse Recognition and Reporting. An additional 6 hours of training for individual professional development will be chosen by individual staff members. All new employees will be expected to complete the training checklist for new staff in its entirety within 90 days for their start date.

 

Productivity

The target goal for outpatient clients to attend their psychiatric evaluation was 95% for this year. 93% of psychiatric evaluations were kept this year. Productivity continues to not be measured for the outpatient clinicians, as they have consistently met and/or exceeded their productivity standard of 75% over the last several years. The psychiatric nurses also have an expectation of 75% productivity.  One psychiatric nurse averaged 98% productivity for medication check appointments and 93% for complex case coordination.  One psychiatric nurse averaged 76% productivity for medication check appointments and 82% productivity for complex case coordination. The new psychiatric nurse started in January 2019 and averaged 91% for medication check appointments and 98% for complex case coordination.  

 

Licensure visits and FWA and Quality Audits

The quality audit was completed by the Erie County DHS and CCBH on 5/29 and 5/30/19.  The final report included commendations in regard to descriptive intake narratives, well-written treatment plans, individualized discharge goals, frequency of sessions that met client needs, safety/crisis plans for all clients, progress notes that describe interventions, clear evidence of family involvement in child services, documentation of coordination of care with other providers, and “overall a very good baseline review.”

 

Recommendations included incorporation of “cultural and spiritual Beliefs,” “barriers to treatment” and tobacco cessation into the assessment; evidence of evaluation of client strengths and incorporation of strengths into the treatment plan; updates of safety/crisis plans with changing client circumstances; more consistent documentation of internal consultation; documentation of instances when adults decline recommendations to have family members involved in services; and, explanations for any gaps between service dates with documentation of attempts to re-engage clients.  

 

In compliance with the recommendations made during the quality audit, there were 3 quality improvement plans developed.  The quality improvement plans were accepted by Community Care and the County and are being implemented with the Outpatient Staff.

 

The annual licensure visit on 6/28/19 produced commendations on well-written progress notes that related to the treatment plan; well-written treatment plans; and, significant improvement with documentation of staff supervision.   Corrective actions were recommended in regard to client signature times on treatment plans exceeding 120 days; treatment plans being signed by the therapist, psychiatrist and supervisor before the client, and the client not being present when the plan was reviewed with no documentation of client participation in the development of the plan. 

 

A Plan of Correction was written to address the above deficiencies. The plan of correction was accepted by OMHSAS and is being implemented; it will be monitored throughout the next fiscal year.

 

Client Satisfaction Survey Results

Client satisfaction surveys were conducted in January 2019.  A total of 213 surveys were completed and returned.  In addition to the five statements to which all agency clients were asked to respond, there were two specific statements for OP clients. Not all respondents answered all questions and question 7 in regard to medication education was only to be answered by those prescribed medication.  88% of the respondents agreed with statement 7: “The purpose and side effects of my medications were explained to me.” 93% of clients agreed or strongly agreed with the following statement: “I have confidence in the ability of staff here to help me.”

 

Outcome Results

The new target outcome for this fiscal year was that 85% of clients will have an improved PHQ 9 score after 3 consecutive medication appointments, with 50% of those having a decrease of 25% or more.  There were a number of variables that impacted the collection of data, such as clients dropping out of treatment, clients cancelling and rescheduling appointments, and change in the prescriber’s schedules. All of these variables made it unfeasible to accurately capture the data. The outcome results were as follows based on data that was able to be collected:

There were a total of 487 PHQ-9 and PHQ-A questionnaires completed at the initial psychiatric evaluation appointment for this fiscal year. Of that 487, only 42 individuals returned their questionnaires for 3 consecutive medication appointments. 83% of those individuals had an improved (decreased) PHQ score at their third medication appointment, 10% had an increase in their score and 7% had a score that remained the same.

 

Moving forward through this fiscal year, the PHQ will be administered at the initial psychiatric evaluation and then at their next medication appointment.  The new target outcome will be “85% of clients who are identified as depressed by the PHQ-9 or PHQ-A will have an improved score after 2 consecutive medication appointments, with 50% of those have a decrease of 25% or more.”

 

Expectations for the coming year

One goal is to achieve a 95% or greater attendance rate for psychiatric evaluations.  Clients will continue to be contacted by telephone and/or letter to support their appointment attendance and resolve barriers to attendance. 

 

Telepsychiatry services will continue to be utilized during the 2019-2020 fiscal year.

 

Another goal is to add 1-2 part time or independent contract therapists. Additional clinical staff will enhance Outpatient Services by allowing for the provision of more frequent, specialized and timely services.  It is the expectation that Outpatient Staff will continue to be proficient in applying a trauma-informed approach in their daily practice.

 

Challenges for Outpatient will include the decline in school referrals related to the availability of other school-based services. 

 

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