Psychiatry

Spotlight: Barbara Harrison

Barbara Harrison has worked in the UNMC Department of Psychiatry for the last 23 years. Along with her role as a medical scheduler, she also helps organize the annual July picnic and the fall event at Vala’s Pumpkin Patch.

What is your role in the Department of Psychiatry?
My title/job is Medical scheduler. When I started I was phone and front desk. As we grew, I went to scheduling on the phone. I also do the Board of Mental Health paperwork.

Why do you love working in the Department of Psychiatry?
I love that I can help people. Not just our patients, but others in our department. Since I started here in August 1996, I have seen a lot of changes and a LOT of growth.

Why do you continue to help organize the staff event at Vala’s?
The Department has been going to Valas since 2010 and each year we grow! 187 people signed up this year! That is exciting!

What are some of your hobbies?
I have been square dancing for 45 years and received my 45-year pin dancing at Iowa State Square and Round Dance conventions. I have been married to my husband Terry for 42 years. Terry teaches square dancing and I teach line dances. We have been the chairpersons for two of Iowa Square Dance Conventions. The last convention that Terry and I chaired was at the Mid America Center, From April 15 to October 15 you will find us on the weekends at “Our Happy Place”. We own lots and have a 5th wheel with a porch attached at Woodland Campground in Little Sioux Iowa. We love it and hate to close it up for the winter. On nice weekends in the winter, we do go up and have a fire and hang out. I started a Bunco group in 1996 and we are still going strong! I am very active in our church, on committees and chair for the Faith, Family, fellowship, and fun. Terry and I have three Rescue dogs: Lillie, a Yorkie, Chloe is a beagle/Dachshund mix and Princess is a 3-year-old Yorkie.

Emerson co-authors article on eliminating waiting lists

Maggie Emerson, Advanced Practice Practitioners (APPs) Lead for the Department of Psychiatry, co-authored a journal entry on “How a Health Center Eliminated the Waiting List for Psychiatric Services.”

Emerson wrote the article with Shannon Kinnan, M.D., John Kern, M.D., and Anna Ratzliff, M.D. The article appears on Psychiatryonline.com.

“Improving access to psychiatric care is a huge challenge regardless of where you practice,” Emerson said. “Exploring innovative strategies to enhance psychiatric access to care for those in need is essential.”

The research project was based in a Midwestern federally qualified health center (FQHC) comprised of a large main campus medical home and seven satellite clinics. Health center staff included 19 M.D.s, 32 midlevel practitioners, and 12 behavioral health therapists. In August 2014, the waitlist to see a psychiatric provider at the FQHC consisted of 350 patients. At this time, the clinic began focusing on QI for access to psychiatric services and contracted with a local academic facility to provide 8 hours of psychiatric care per week. A team consisting of the chair of psychiatry, the chief medical officer of the FQHC, the behavioral health director of the FQHC, the contracted faculty psychiatrist working at the site, and, later, the residency program director met two to four times a year to address improving access.

Key strategies used in an effort to reduce the waitlist included the psychiatric collaborative care model (CoCM), a transition from traditional care to a one-time consultation clinic, e-consults, quarterly PCP education in psychiatry, availability of a mental health patient navigator, a psychiatric consultant available by cell phone, and regular review of the waitlist. After three-years, a 350-person waitlist was eliminated.

Emerson, APRN, PMHNP-BC, said she was surprised at how open the clinicians were to this new delivery model of care as it is a clear departure from traditional outpatient delivery methods.

“Also, not surprisingly but more so reaffirming, was the importance of using continued quality improvement efforts to explore the effectiveness or lack thereof, of implementation strategies,” Emerson said. “If you don’t take the time to examine what is working and what is not, you may never reach your full potential.”

Emerson added that many of the lessons learned from the collaborative care concepts and the model itself informed the efforts that Nebraska Medicine is utilizing to improve access to mental health care within the organization.

Along with her recent publication, Emerson was also recently selected to be a member of the American Psychiatric Association’s App Advisor Expert Panel.

Read the article here

 

Psychiatry Department receives high marks from Joint Commission

On Oct. 11, Nebraska Medicine, including the Department of Psychiatry, earned Behavioral Health Care Accreditation from the Joint Commission.

Dr. David Cates, Vice Chair of Clinical Services

On Aug. 14, members of the Joint Commission visited the Department of Psychiatry, and a site visitor conducted a detailed review of five cases encompassing the Intensive Outpatient Program and Poynter Hall.  In addition, the visitor interviewed two patients, walked through clinical spaces, met staff members, asked hundreds of questions, looked at our outcomes (SDS) data, and reviewed our plans for suicide screening and risk assessment.

“The reviewer was impressed with our care, teamwork, documentation, and focus on quality improvement,” said Dr. David Cates, Vice-Chair for Clinical Operations with the Department of Psychiatry.

For psychiatry, there were three findings: nutrition screen needs to include a dental assessment; when providers transfer care, they must create a formal transfer summary; and every new patient evaluation must include a cultural assessment. Action plans for addressing these findings were submitted to the Joint Commission.

“My thanks for everyone’s contributions to this team effort,” said Dr. Cates. “This accreditation is, in part, a result of the work everyone did in the past year screening for pain, documenting short and long term goals, and screening for exploitation. Current efforts by our staff to screen for nutritional status and cultural preferences, as well as completing discharge/transfer summaries as needed, position us for success in our next survey.”

In all, seven surveyors from The Joint Commission visited the Nebraska Medical Center and Nebraska Medicine ambulatory clinics as part of a routine accreditation site survey that occurs every three years. The unannounced survey took place from Aug. 12 to 16 and ensures compliance with the Center for Medicare and Medicaid (CMS) Conditions of Participation, a requirement to participate in Medicare and Medicaid programs.

“Overall, the survey went well,” said Dr. Harris Frankel, Nebraska Medicine’s Chief Medical Officer. “We should not lose sight of the fact that we partner with The Joint Commission to identify opportunities for improvement in patient quality and safety. The surveyors informed us that the number of findings, in part, tends to be proportional to the number of surveyor days, the size of an organization, and the complexity and footprint of the organization. We have some work to do going forward, and our teams are already engaged in planning that work.”

The joint commission will return for another visit in 2022.

Fighting stigma and building a career treating substance use disorders

Alëna A. Balasanova, M.D., Assistant Professor

When Alëna A. Balasanova, M.D., began her psychiatry residency at Boston University, she encountered patients with SUD the way all too many people do—with judgment: “I wanted to treat patients with depression and anxiety—I didn’t sign up to treat people with a drug addiction, I held some very stigmatizing beliefs.”

Over the course of her residency, however, she started working with patients who are on medication assisted treatment (MAT) and saw firsthand the transformation that occurs when a patient comes in the door very ill, is provided evidence-based care and begins to heal. Her perspective shifted drastically.

“My patients receiving MAT were repairing relationships, finding jobs, and becoming healthier,” Dr. Balasanova said. “I began to understand how remarkable it was that I could participate in helping a patient turn his or her life around.”

After completing her residency, Dr. Balasanova moved to Nebraska, where she was raised, because she saw an opportunity to improve the lives for patients with SUDs.

“There are so few MAT treatment providers in Nebraska,” she said. “I wanted to fill that gap.”

Filling the gap meant working to develop an outpatient addiction psychiatric clinic at the University of Nebraska Medical Center in 2017, where patients with SUD could get medication while also having their other psychiatric conditions treated. After the clinic was up and running, Dr. Balasanova then set her sights on something even bigger: an inpatient addiction psychiatry service where patients with SUDs could be seen in the hospital and medical intervention could begin immediately while clinic follow-ups are scheduled.

Dr. Balasanova did not stop there.

These new programs needed knowledgeable medical staff to run them, so she worked to develop a new rotation for psychiatry residents—Longitudinal Integrated MH/SUD Outpatient Clinic (LIMSOC). During the rotation, which lasts a year with a half a day per week in the clinic, residents learn how to use different treatment modalities and are encouraged to get their buprenorphine waivers. This means that no matter where residents choose to go after their residency, they are equipped to treat patients with SUDs.

“The journey I’ve taken has opened my eyes,” said Dr. Balasanova. “But there is so much more work to do.”

One of the biggest impediments to care for patients with SUDs Dr. Balasanova has faced is prior authorization for MAT. “Prior authorization for MAT has been a big problem for me and my residents. It’s something we deal with on a regular basis,” Dr. Balasanova said, “but it shouldn’t be—MAT is evidence-based but the insurance companies don’t seem to get that.”

Looking ahead, Dr. Balasanova is encouraged that she is helping train another generation of physicians to treat SUDs. “I am very lucky to be back in my home state to literally help my neighbors, and I hope all my residents go on to help end the epidemic where they can as well.”

The Article originally appeared on the American Medical Association’s End the Epidemic website