1. Access Goals 1.Access to a mental health provider faster 2.Access to treatment from day 1 3.Access to follow up care 4.Reduced burnout for Access Staff

2. Access to a mental health provider faster Old Access: – Phone scheduling by a non-clinician – Walk-in Wednesday – Regional differences

3. Paradigm Shift ED Crisis = ED Access Access = ED Access + Outpatient Access

4. Time Frame for Change

5. Change Processes Education Optimization Pilot Implementation

6. Education Goal: rapid and accurate diagnostic assessment – Triage – Assessment – Safety

7. Triage Who needs to be seen? – https://dl.dropboxusercontent.com/u/94001596/ Access%203.19.15/Access%20Triage%203.29.15.d oc

8. Assessment Common Presentations Scripts Techniques

9. Common Presentations https://dl.dropboxusercontent.com/u/940015 96/Access%203.19.15/Common%20Presentati ons%203.19.15.doc

10. Scripts https://dl.dropboxusercontent.com/u/940015 96/Access%203.19.15/Scripts%20and%20scre ens%2003.29.15.doc

11. Techniques Some examples: – Symptom-amplification – Normalization

12. Safety Risk Factors: suicide and violence risk are increased overall given multiple dynamic factors (symptoms… and stressors...) and static factors (Axis I - III; other unmodifiable risk factors…). Protective Factors: the above risk factors are mitigated by protective factors, including strong future-orientation, hopefulness, engagement with treatment, close relationships. Assessment: there was no indication of currently increased or imminent danger to self or others based on today's exam; outpatient care with safety plan and close monitoring is appropriate. Or: Assessment: given…, there is a significant likelihood of imminent danger. A 5150 has been placed, and patient will be

13. Assessment Assessment 1: – Cross-sectional and longitudinal are most consistent with a diagnosis of... – Differential diagnoses include... – Possible precipitating factors include:

14. Assessment Assessment 2: – I am uncertain about the patient’s diagnosis for the following reasons... – Differential diagnoses include – Clarification of diagnosis will require longitudinal follow up and additional collateral data. – Possible precipitating factors include:

15. Optimization Universal Template Clinical Decision Making

16. Salinas Pilot Team care: – Phone triage by a clinician – Walk-in triage by a clinician; access available every day – Supervisor to review presentation – MD available

17. Salinas Pilot Problems: – Limited f/u for mild to moderate illness; Beacon unable to provide f/u – Insurance Solutions: – IMPACT – USC – Insurance Specialist Fragmentation of care within our system secondary to MOU

18. Structural Changes Monthly meeting, data collection on pilot Time frame TBD

19. Reducing Staff Burnout Technological innovation to increase time with and care for patients and decrease unnecessary documentation Standardization of caseloads Standardization of access services across region allowing for collaboration Increased specialization of services allowing clinicians to pursue their passions

20. Reducing Staff Burnout Increased education = Brown bag Tuesdays Wellness group