Council Bluffs Hospital, Schools Partner to Improve Mental Health

CHI Health Mercy Council Bluffs
Council Bluffs, IA

Recognizing a gap in mental health care of elementary students in their community, leaders from CHI Health Mercy Council Bluffs and Council Bluffs Community School District combined their resources to work toward a solution. The Transitions Program was launched for the 2014-15 school year. Now entering its fourth year, the collaboration between Mercy Behavioral Services and the school district has been a resounding success.

As its name suggests, the Transitions Program helps students — ranging from kindergarten through the fifth grade — ease back into the traditional classroom setting after being treated for mental health-related issues.

“The Transitions Program offers students a place to continue working on strategies and therapy before returning to the classroom,” said Michael Naughton, principal of Edison Elementary School in Council Bluffs. “The Transitions staff communicates with school staff to ensure students are working on the same standards as their peers. When students show they are ready to return to their school a plan is created to integrate the child slowly back into the classroom. I’m thankful for the work of the program as it helps our students work on coping strategies to ensure success when they return to the classroom.”

Staff members from both Mercy and the school district meet weekly to discuss the progress of students involved in the program.

“The Transitions Program provides a structure to gradually transition students from the hospital setting back to the regular education classroom,” said Becky Zorn, special education director for CBCSD. “Students are able to continue to learn grade-level content, while learning strategies to cope in the regular classroom. Communication from the program to the classroom and home has been great. The Transitions Program staffers all listen to the needs and concerns from families, the school and mental health professionals and implement support systems.”

The need for the Transitions Program arose as insurance companies developed stricter admission criteria for psychiatric inpatient level of care, which impacts how care is reimbursed (or not reimbursed). As a result, Mercy’s Partial Hospitalization Program saw an increase in the acuity of its patients.

At the same time, insurance companies were decreasing their willingness to authorize concurrent reviews for additional patient days in the Partial Hospitalization level of care. That led to patients being discharged to their outpatient provider with a higher acuity and heading back to school more quickly than before.

Children that were being discharged from the Partial Hospitalization Program and transitioning back to the community school had a high readmission rate to the inpatient unit and Partial Hospitalization Program as well as high Emergency Department utilization. Community schools found it very challenging to manage students with these increased acute mental health and behavioral health needs.

“They were seeing a lot of readmissions to the partial programs and the inpatient units and a lot of difficult transitions for the kids back into the school system from the partial program,” said Tina Sedersten, CHI Health Partial Hospitalization Programs manager. “With all of this occurring in the background, the hospital and the school district came together to see what could be improved and they came up with the Transitions Program. They wanted to use it as another level of care between partial hospitalization and being in school. It would also serve as another level of care between partial hospitalization and outpatient care.”

In 2014, the Transitions Program was developed following a year-long collaborative effort between CHI Health Mercy Council Bluffs, CHI Health Psychiatric Associates and the CBCSD Special Education Department. A partnership with CBCSD was sought because more than 75 percent of the patients served in the Partial Hospitalization Program were from the CBCSD and of those CBSCD students served, 64 percent were elementary students.

The Transitions Program is a 60-day (maximum) program for CBCSD elementary school children. Students are referred from the Partial Hospitalization Program if needing additional services to successfully return to the traditional school setting. This program allows students the opportunity to have gradual exposure to their school setting following their hospitalization while continuing to receive behavioral and academic support.

Students return to school for one to three hours at a time as directed by educators and therapists. The rest of the time is spent in the Transitions Program classroom. This program is not reimbursed by insurance companies, but CBCSD can provide this service under special education. CBCSD hires, manages and funds the special education teacher and special education paraprofessionals, who staff the Transitions classroom.

CBCSD also funds all supplies, furnishings, lunches and other regular needs of this program as if it were housed in a CBCSD building. Mercy provides the space utilized by the Transitions Program on the hospital campus. The hospital and health system manages the property, provides facilities and maintenance support and hospital security officers are deployed for crisis intervention.

Mercy’s Partial Hospitalization Program provides the referral to this program, consultation on psychiatric needs and crisis-intervention support. CHI Health Psychiatric Associates subsidizes Licensed Mental Health Therapist Mariah Wessel-Draper for this program as time spent in therapy sessions is reimbursable, but only accounts for approximately 33 percent of Wessel-Draper’s time. Wessel-Draper provides daily group therapy to all students attending the Transitions Program as well as individual and family therapy for those in need of services while attending the program.

As a part of the Transitions team, Wessel-Draper also assists with crisis management in the program, travels to the CBCSD schools with the student to facilitate a successful transition, assists in the referral process from the Partial Hospitalization Program to the Transitions program and is an integral contributor to the student Individual Education Plans, Behavioral Assistant Team and the Teacher Assistant Team.

The program has been highly successful and well-received by the school district, the hospital and the mental health providers. The Transitions Program has served 79 CBCSD students over the last three school years. During the 2016-2017 school year, 72.5 percent of students transitioned back to their home school and 27.5 percent of students transitioned to an appropriate specialized academic program.

Hospital readmission and emergency department utilization data was reviewed for each student two years prior to their enrollment in the Transitions Program and compared to data two years after completing the program. The analysis showed a significant reduction in hospitalization and emergency department visits.

Satisfaction surveys are also administered to gather additional input on the quality and value of the program as perceived by the CBCSD teachers, patients and families served. Over the last two years, overall satisfaction of the program was rated 74 percent “excellent” and 20.25 percent “good” by CBCSD teachers for an overall favorable response of 94.25 percent. Additionally, 100 percent of parents responding to the survey in the last two years state they would recommend the Transitions Program to a friend or family with a student in need.

“It gives you a good feeling about our health system and the school district in this community,” said Scott Halverson, Mercy Psychiatry Associates Outpatient Clinic manager, who was heavily involved in the development and implementation of the Transitions Program. “But it’s especially great to see the program be successful with these kids — that’s what we’re all about and that’s what we’re here for. We want to provide services that make a difference, regardless of the cost.”

Said Zorn: “A program like this isn’t successful without the cooperation of everyone. It has been a really good partnership and we hope to continue it.”

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