Intensive Outpatient Center with iPad Technology

Program Description

Grand Lake Mental Health Center (GLMHC) is a community mental health center in rural, NE Oklahoma covering over 5000 square miles in service area. A major challenge over the years has been providing effective and efficient services to consumers due to distances between our sites. Our most recent innovation started in January, 2016 and involves the use of mobile technology to provide services in new and innovative ways. GLMHC is using iPads to allow for better access to services. These iPads are set up to connect with qualified staff at our 24/7 Intensive Outpatient Center (IOC) which is centrally located in our 7 county area. The iPad program has three primary purposes: to give consumers instant access to GLMHC clinical staff for treatment and/or assistance during psychiatric crisis; to assist law enforcement officers and local ER staff that come into contact with individuals who have mental health and/or substance use issues; and to improve access for any consumers with financial, geographical, or transportation barriers. Currently GLMHC has deployed 496 iPads to consumers, local police and sheriff departments, and local ERs.

Creativity

The use of mobile technology allows the program an efficient and effective method of providing services to a wider group of individuals, all of them able to connect with qualified staff at the 24/7 IOC. The program also allows better access for consumers with transportation, financial and geographical barriers by placing mobile technology in the home. It allows instant access for consumers experiencing a mental health crisis situation through use of mobile technology instead of going to local ER. It allows Law Enforcement instant access to consultation when dealing with individuals with mental health issues. It allows increased ability to coordinate care for high risk individuals discharged from inpatient hospitalization as they may be provided an iPad upon release and have the ability to immediately connect with a licensed mental health professional in the event of exacerbated mental health or substance use issues.

Leadership

GLMHC met with local police departments, sheriff departments and Emergency Room staff in the counties we serve. We began with a tiered approach starting with individuals as they were discharging from inpatient hospitalization and consumers with barriers to receiving office based services. The second tier included consumers discharging from the 24/7 Intensive Outpatient Center and provision of iPads to Law Enforcement Agencies. The third tier included Emergency Room staff. After each tier we revisited issues to determine successes and areas for improvement. GLMHC management staff met with Oklahoma Department of Mental Health and Substance Abuse services, Oklahoma Health Care Authority, and licensing boards to explain policy, procedures, protocols and provisions of the program. The GLMHC Board of Directors are all updated frequently on the iPad program progress so they can be well informed when interacting with other community leaders.

Sustainability

The state mental health authority, Oklahoma Department of Mental Health and Substance Abuse Services is supportive of this program due to financial savings in the system. A psychiatric admission in our state costs payers about $495 a day with average length of stay around 5 days. The decreased admissions in our area due to the iPad usage and access to the IOC unit have saved hundreds of thousands of dollars. Law enforcement officers also are reporting decreased mileage costs since implementation of the iPad program. They report much less time is needed to handle psychiatric emergencies with the iPad and licensed staff availability and this keeps them in the community longer for other community police calls. These costs savings throughout the entire continuum of contact and care have promoted program growth and sustainability over the past year.

Replicability

Use of the iPad is an innovative addition in our arsenal of service provision and easily replicable. iPads are deployed with support for both mobile data and Wi-Fi. By utilizing a combination of Mobile Device Management, DEP (Apple Device Enrollment Program) , and Guided Access functionality, GLMHC is able to “lock down” iPads in such a manner that users can only utilize the iPads for their intended use: client initiated and or staff initiated telemedicine services. All telemedicine sessions are conducted over a peer-to-peer AES-256 bit encrypted connection that automatically adjusts video resolution based on the available connection speed at each end. This ensures the highest possible video and audio quality while also ensuring maximum mobility. By utilizing this technology, GLMHC is able to provide unparalleled access to qualified clinicians by making them literally two taps of a finger away — no matter where the client is located.

Results/Outcomes

In the first five months of operation, there have been a total of 721 potential psychiatric admissions and 448 avoided the trauma of that admission through diversion to the less intensive level of care at the IOC unit where the average length of stay has been around 34 hours. This is a 62% deflection rate which we evaluate monthly as we seek a goal of 85% which may be lofty but we believe attainable as community partners such as police, sheriffs, and local emergency rooms see the continuing value of a much lower level of care in psychiatric crises. We also see this goal as reachable with the opportunity to distribute more iPads for critical contact with providers and clients dealing with crisis. Over 4000 iPad sessions have been documented in our system since implementation.