Creighton Collaborates to Bring Psychiatric Services to OneWorld Community Health Center
Kristine McVea, MD, knew something had to be done.
With 350 patients on a waiting list for mental health treatment, and the list growing longer daily — with her nonprofit network of clinics seeing tens of thousands of patients every year for the usual range of human ailments — the mental health component was just out of control.
McVea is the chief medical officer for OneWorld Community Health Centers, Inc., a nonprofit network of clinics that serves the uninsured and the underinsured populations in Omaha and surrounding communities. More than 90% of OneWorld’s clients live below 200% of the federal poverty line and 75% are members of racial-ethnic minority groups, primarily Latinos.
Efforts to work with outside providers had largely foundered, and the network’s primary care physicians were becoming by default providers of psychiatric services.
As it happened, a solution that over a three-year period would eliminate that mental health waiting list, improve the quality of mental health care and involve the American Psychiatric Association (APA), was gestating at Creighton University.
That solution was the subject of a December 2019 report in Psychiatric Services, the online publication of the APA. Titled “How a Health Center Eliminated the Waiting List for Psychiatric Services,” the report chronicled the success of the Creighton and OneWorld collaboration.
Thomas Svolos, MD, who in 2014 was chair of Creighton University’s Department of Psychiatry, was looking for opportunities for psychiatric resident physicians to gain clinical experience in a primary care setting. In addition, Shannon Kinnan, MD, a member of the department’s core faculty who speaks Spanish, was interested in promoting mental health in the Hispanic community and was amenable to taking a part-time post with OneWorld.
It was an obvious deal to make.
Kinnan signed on with OneWorld as a part-time psychiatric consultant, and began what turned out to be a three-cycle integrated care process that reduced the waiting list from 350 to 252 for the first cycle and from 252 to 154 during the second cycle, each cycle lasting between 11 and 13 months. During the third cycle, when the Collaborative Care Model (CoCM) was fully introduced after a period of preparation, the waitlist dropped from 154 to just one, with the waiting period for new patients cut from six months to one or two weeks.
“When I first heard about the CoCM concept, it felt very foreign. But then I thought that teaching attendings (attending physicians) already do similar work.” Kinnan says. “A lot of times we hear from a resident doctor, who often does most of the assessment. They run a case by you, you ask a few more questions and you give an OK depending on their level of training. The Collaborative Care Model is very similar to that, just different professionals.”
CoCM is an integrated model. In this instance at OneWorld, the team consists of the primary care physician; a mental health therapist who does much of the interviewing and assessment of patients deemed in need of care; and a psychiatrist who receives the therapist’s report and makes recommendations to the attending physician.
Kinnan completed an APA training course in CoCM before introducing the program to OneWorld. Now fully operational, the program is providing great benefit not just to OneWorld but also to Creighton’s psychiatric residents.
“It exposes them to a new model of care that’s growing nationally and will put them ahead of the curve in adopting a new method that I hope will see wider and wider use,” she says.
The partnership with Creighton, and the consequent introduction of the CoCM program, proved effective quickly, McVea says.
“This is a model that’s innovative and is meeting needs that traditional therapy is not meeting, and it’s exciting to see, even in a short amount of time, the tremendous progress that patients make,” she says.
For Svolos, the experience has been testimony to the value of collaboration across institutions.
“This is what an academic institution like Creighton can bring to a clinical organization,” he says. “An organization may have a problem it’s not sure how to deal with, while Creighton has the expertise to know who’s doing what nationally, and what’s working well that might be copied.”
The spread of the COVID-19 virus has not halted the program, Kinnan said, though new procedures are in place. All of OneWorld’s psychiatric and behavioral health services became virtual as of March 23. Patients are connected via Zoom to their providers and telephone calls are used if internet access is unavailable.
Staffing for CoCM patients occurs weekly in a virtual meeting, also via Zoom. Patients receiving in-person medical care who request to see a therapist have access to them, again via Zoom.