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Outpatient Annual Report

CORRY COUNSELING SERVICES

Mental Health Outpatient Program Summary

FY 2017/2018

 

Program Description

Counselling Services Center 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 implemented in February 2018.  The first telepsychiatry services were provided by Dr. Prabhu on 2/5 and 2/6/18. Telepsychiatry has not been utilized since although further use is anticipated in the coming year.  In May, surveys were sent to the 21 clients who received this service.  Of the 7 responses, 4 strongly agreed or strongly agreed with all statements endorsing telepsychiatry.  The other 3 responses were mixed. None of the concerns were technology related.  Survey results were shared with Outpatient staff. 

 

Outreach efforts were made to Corry Medical Group to inform physicians that Corry Counseling Services offers the unique service of Genesight testing. Genesight testing is a quick and effective way to assist our Psychiatric staff in selecting medications and dosages best suited for an individual’s condition and genetic makeup, especially for the treatment of refractory individuals. There has been a significant increase in referrals requesting genetic testing. This service is now offered by Outpatient staff to every individual who is seeking a psychiatric evaluation.

 

Staff

At the beginning of this fiscal year, outpatient staff was comprised of 3 full-time therapists, 2 contract therapists, 3 full-time psychiatric nurses, 1 Psychiatrist, 1 CRNP, 1 Physician Assistant and 1 Director of Outpatient Services. One full-time therapist position was added to the Outpatient Program this fiscal year. This position was terminated at the end of the 90-day probationary period. The plan is for this position to be subsequently replaced with a part-time therapist for the upcoming fiscal year. The retention rate for nursing staff was 100%. The retention rate for full-time therapists was 75%, with a 25% turnover rate. The hiring and subsequent firing of a fourth therapist within a 90 day timeframe was unique situation that impacted the retention rate for therapists.  The therapist retention rate would have been 100%, short of that occurrence.  The Outpatient Program did experience the loss of 2 contract therapists and a Physician Assistant during this fiscal year. The available time provided by the Psychiatrist increased from 16.5 hours per week to 21 hours per week.

 

Training

An annual training plan was developed for the Outpatient program. LSW, LCSW and LPC’s were to begin 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 2017/2018 licensure renewal. OP Director and licensed therapists were to complete TF-CBT training with the goal of certification to be scheduled by the Director. 

 

All Outpatient staff completed the child abuse recognition and reporting training, fire safety, bloodborne pathogens, HIPAA and Behavioral Health, Corporate Compliance policy and practices, and Trauma Informed Care. The nursing staff completed the required continued education units for their licensure renewal. Outpatient Director and three therapists completed a 6-hour training on personality disorders. Two therapists and Director attended the Fourth Annual Challenges and Innovations in Rural Psychiatry Conference. The school-based therapist completed an online training on mental health issues in the classroom.  One therapist attended training on Addiction, Trauma and Community Resilience. The Outpatient Director became a member of the Erie Coalition for a Trauma Informed Community and of the Erie County Suicide Prevention Taskforce.

 

The TF-CBT training and certification goal was not accomplished due to the requirements of the certification being incongruous with the current makeup of Outpatient clinical staff. This goal will be revisited in the future, as it remains a goal that Corry Counseling Services become a designated preferred provider for treatment of trauma.  

 

The training goals for outpatient staff for the upcoming fiscal year are for them 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 and HIPAA training. 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.

 

Clients

The Outpatient Program served 1411 individuals this fiscal year.  There were 604 intakes completed, of which 393 were adult assessments and 211 were child/adolescent assessments.  There were 631 case closures.  There were no specific concerns regarding referrals.   Of those 1411 individuals, 1373 were White, 28 were Black, 5 were Hispanic, 3 were Native American, and 1 was Pacific Islander.  751 were female clients and 660 were male clients. There were 13 clients ages 0-5, 298 clients ages 6-13, 152 clients ages 14-17, 181 clients ages 18-25, 410 clients ages 26-45, 278 clients 46-64 and 79 clients ages 65 and older.

 

Productivity

Productivity was not 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 88% productivity for medication check appointments and 74% productivity for complex case coordination. One psychiatric nurse averaged 75% productivity for medication check appointments and 67% for complex case coordination.  One psychiatric nurse averaged 70% for medication check appointments and 77% for complex case coordination.  

 

Client Satisfaction Survey Results

Client satisfaction surveys were conducted in March 2018.  At that time, the Outpatient program had 1078 active clients. Surveys were hand delivered to 452 clients, which represents 42 % of active outpatient clients.  All 452 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; nevertheless, there was only 84% agreement with this statement.  However, 94% of clients agreed or strongly agreed with the following statement: “ I have confidence in the ability of (OP) staff here to help me.”  The number of survey responses from OP clients more than doubled from last year, with 205 being completed last year to 452 being completed this year. 

 

Outcome Results

The target outcome for this fiscal year was for 85% of clients who are identified as depressed by the PHQ-9 or PHQ-A will show a 25% reduction in score after 6 and 12 months. There were 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. 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:

 

The PHQ-9 and PHQ-A began to be administered as a depression screening tool on 2/1/2017. Each individual age 11 and up was asked to complete the screening at the time of their initial psychiatric evaluation, at their 6 month medication appointment and again at their 12 month medication appointment. 391 clients have completed the screening as of June 29, 2018. Of those completed, 381 individuals had scores that were indicative of them experiencing symptoms of depression. 89 individuals were measured at their 6 month and/or 12 month medication appointment. 86% of those individuals reported a decrease in depressive symptoms since their initial screening. 59% out of 89 measured had a reduction of 25% or more in their score.

The target goal for outpatient clients to attend their psychiatric evaluation was to exceed 90% for this year. This goal was exceeded, in that 92% of psychiatric evaluations were kept this year

Moving forward through this fiscal year, the PHQ will be administered at the initial psychiatric evaluation and then at every medication appointment with a prescriber up to the fourth medication appointment or when client reaches a year of treatment. 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 3 consecutive medication appointments, with 50% of those have a decrease of 25% or more”.

 

Expectations for the coming year

One goal is to increase the attendance standard for kept psychiatric evaluations from 90% to 95%.  Clients will continue to be contacted by telephone and/or letter to support their appointment attendance and resolve barriers to attendance.  It is anticipated that Telepsychiatry services will continue to be utilized during this fiscal year.

 

Another goal is to add 1-2 part time or independent contract therapists. Additional clinical staff will enhance Outpatient Services being provided in both the clinical and school setting. 

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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