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Outpatient Annual Report

Corry Counseling Services

Outpatient Mental Health Program 

2019/2020 Annual Program 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. All 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 and February.  This added service allows for the psychiatrist to maintain continuity of care from alternative locations to a rural population during the winter months. 


From March 23, 2020 until June 30, 2020, all service provision was done via telehealth/telephone. This was a direct result of the COVID 19 pandemic. During this time period, individuals who receive medication injections continued to be seen for in-person appointments. 95 psychiatric evaluations were completed by the psychiatrist and CRNP utilizing either videoconferencing or in-person appointments. There were 896 medication checks completed telephonically by the Psychiatrist and CRNP. The psychiatric nursing staff completed 321 nursing medication checks via telephone. Outpatient therapists completed 1059 individual therapy appointments and 10 family therapy appointments via telephone.  There were 3 intakes completed in person and 81 intakes completed telephonically. 


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


Staff

For the first three quarters of 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.  One full-time therapist retired on April 30, 2020, and the part-time therapist assumed that position. At the end of the fiscal year there were 3 full-time therapists. There were two resignations from nursing staff in July 2019.  Two full-time psychiatric nurses were hired to fill those positions in August 2019. There were no changes with the prescribing staff. 


Training

An annual training plan was developed for the Outpatient program.  All licensed staff continued to work on completing continuing education credits required for 2/28/21 PA Licensure. This includes 3 hours of Ethics, 1 hour in suicide prevention, and 2 hours in child abuse recognition and reporting.  Additional training goals for this year were for staff to complete the following Agency required trainings: Corporate Compliance, Bloodborne Pathogens, Agency Exposure Control Plan, and Child Abuse Recognition and Reporting. Required Relias Trainings specific to the Outpatient Program were the following: Behavioral Health Services and the LGBTQ Community, Best Practices for working with LGBTQ Children & Youth, and Implementation of Trauma-Informed Care Systems. Two additional Relias Trainings were added to the requirements in May 2020: Infection Control for Healthcare Professionals and Transmission-Based Precautions.  The two nursing staff that were hired completed all of the agency required orientation training during their 90-day probationary period. 


Outpatient staff met 100% of annual training goals for this fiscal year. The Director of Outpatient attended the 6th Annual Suicide Prevention Conference.  All staff completed Mental Health Procedures Act Training and PA Department of Human Services Adult Protective Services Mandatory Reporting Webinar or PowerPoint. 


The training goals for Outpatient staff for the upcoming fiscal year are for them to complete the following trainings: Corporate Compliance Emergency Response Plan, Abuse, Neglect and Exploitation of Older Adults, Ethics for Professional Counselors (therapists only), Ethical Decision Making (nurses only), Best Practices in Trauma Specific Treatment, and Best Practices for Delivering Telehealth. An additional goal is for all therapists to complete the CPT training program to become trauma certified clinicians. 


Licensed therapists and nursing staff 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 30 days for their start date.


Clients

The Outpatient Program served 1384 individuals this fiscal year.  There were 504 intakes completed, of which 321 were adult assessments and 183 were child/adolescent assessments.  There were 661 case closures.  There were no specific concerns regarding referrals.   Of those 1384 individuals, 1334 were White, 24 were Black, 8 were Hispanic, 5 were Native American, 3 was Asian, 3 were unknown and 7 were other.  742 were female clients and 642 were male clients. There were 5 clients ages 0-5, 265 clients ages 6-13, 168 clients ages 14-17, 192 clients ages 18-25, 404 clients ages 26-45, 268 clients 46-64 and 82 clients ages 65 and older. 




Productivity

The target goal for outpatient clients to attend their psychiatric evaluation was 95% for this year. 85% of psychiatric evaluations were kept this year. Productivity continues to not be measured on a regular basis for the outpatient clinicians, as they have consistently met and/or exceeded their productivity standard of 75% over the last several years. It is noted that from March 23, 2020 through June 30, 2020, average productivity for the therapists was 85%.  The psychiatric nurses also have an expectation of 75% productivity.  All of the nursing staff met or exceeded their expected number of medication appointments and Complex Case Coordination units. 


Licensure Visits and Quality Audit

The annual licensure visit was delayed due to COVID 19 restrictions and completed on 7/14/2020. This inspection produced commendations on resolving the treatment plan issues identified in the previous year’s inspection and the Plan of Correction was officially closed.  Recommendations were the following: develop a Quality Assurance Plan for Outpatient following the Quality Assurance piece of the updated Outpatient regulations (5200.44), and obtain verification of the psychiatrist’s Mandatory Child Abuse Reporter training. 


Client Satisfaction Survey Results

Client satisfaction surveys were conducted in January 2020.  A total of 339 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.  93% of the respondents agreed with statement 7, “The purpose and side effects of my medications were explained to me.”  95% 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 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 having a decrease of 25% or more.  There continue to be a number of variables that impacted the collection of data, such as clients dropping out of treatment, clients cancelling and rescheduling appointments, change in the prescriber’s schedules.  The COVID 19 restrictions created a new barrier, as clients were not coming into the building for their follow up medication appointments after March 23, 2020.  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 212 PHQ-9 and PHQ-A questionnaires completed at the initial psychiatric evaluation appointment from July 1, 2019 through February 28, 2020. Of those 212, only 98 individuals returned their scheduled follow-up medication appointment.  72% of those individuals had an improved PHQ score at their second medication appointment. Of those individuals who had an improved score, over 67% had an improved score of 5 or more.  20% had an increase of between 1 and 5 points in their score and 7% had a score that remained the same. . 




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.  Telehealth services will continue to be utilized during the 2020-2021 fiscal year. 


Clinical staff will enhance Outpatient Services by furthering their professional development, including completing the CPT trauma certification training.  


It is the expectation that Outpatient Staff will continue to be proficient in applying a trauma-informed approach in their daily practice. 





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