Home visits work for behavioral health patients

Care coordinators offer psychotherapy

When behavioral health patients who have been hospitalized receive interventions in their home, their compliance with treatment recommendations increases and hospital readmission drops, a study by PsycHealth Ltd.'s Home Intervention Program has found.

An analysis of 52 Medicaid managed care patients in the home intervention pilot project showed 100% participation and compliance with the treatment recommendations and an 86% drop in overall hospital readmission rates within six months compared to their hospital admissions six months before the program was instituted.

Participants in the study had a history of two or more hospitalizations within the six months prior to enrollment and were noncompliant with the traditional outpatient aftercare.

The study was so successful that PsycHealth offers the program to appropriate patients including those who have had multiple hospitalizations without follow-up outpatient therapy, those who dropped in and out of therapy, and patients with barriers to compliance, such as lack of transportation or child care issues, says Madeleine Y. Gomez, PhD, president of the Evanston, IL, managed behavioral health care organization.

PsycHealth coordinates mental health care for group and private insurance companies, providing everything from 24-hour clinical services and crisis management to case management, utilization management, and quality improvement.

PsycHealth typically begins managing the care of its patients while they are still in the hospital.

"All of our patients leave the hospital with a therapy referral and/or a medical referral. We use our data system to create a comprehensive picture of the patient's status and incorporate that information to coordinate the appropriate follow-up care," she says.

The home intervention program received a Gold Award for Healthcare Management from URAC.

The Home Intervention Program provides services to patients who might not otherwise have received mental health treatment and follow-up, Gomez says.

The goal of the program is to increase compliance with post-hospital outpatient follow-up therapy and reduce rehospitalizations.

"Patients achieve better results and less recidivism if they have follow-up after leaving the hospital, but today it is reported that many people are basically being discharged with solely medication management referrals. Medication is one piece of the picture, but it doesn't change some of the habits or choices that have complicated the person's mental status. Psychotherapy can address those issues," she adds.

Faced with the challenge of overcoming patients' barriers to receiving follow-up therapy, Gomez decided to try an approach that was frequently used when she began her practice.

"It was once very common to do home visits. It was part of the arsenal of intervention. Some patients never go for their follow-up therapy visits. We have tried phone calls, letters, and all types of interventions. When that didn't work, we decided to pilot the home intervention program," she says.

People who have severe mental disorders often have problems dealing with day-to-day life and need a lot of support, Gomez points out.

"If they don't have a family or the family is unable to help, a therapist can help them comply with their treatment plan as well as reporting back to the psychiatrist if there are areas of concern or the patients are experiencing side effects," she says.

All patients whose care is being managed by PsycHealth receive a transition care visit from a care coordinator who is a social worker, a psychologist, or a licensed therapist.

When the firm's clinical care coordinator receives notification of a member's inpatient behavioral health admission, the case is referred to a therapist, who contacts the hospital case manager or patient before discharge whenever possible to set up the in-home appointment. The goal is for the therapist to see the patient for an in-home session within seven days of discharge from the inpatient level of care.

"The transitional care visit is the entry point into the home intervention program for many patients. If patients have a history of continuing their regular outpatient care or have a past relationship that has been effective, we would recommend that they continue, but there are other patients who would be appropriate for home interventions," Gomez says.

The therapist works to get informed consent releases signed in order to coordinate care with the patients' primary care physicians, she adds.

Ideally, the same therapist makes the assessment and conducts the home interventions.

In some cases, the transitional care therapist makes an assessment and recommends assignment of the case to a home intervention therapist.

The therapists are assigned by geographic area and by specialty. They come into their patient's home and work with the patient and whatever part of the family may need adjunctive treatment.

"During the home interventions, we focus on everything the patients need, including basic needs such as food, helping them fill out paperwork for assistance programs, or helping them get connected with a payment plan for utilities or gas, as well as individual and family therapy," Gomez says.