New Horizons Counseling Center

Description

In 2010, Yoakum Community Hospital, a 25-bed Critical Access Hospital (CAH) located in Yoakum, Texas was determined to offer quality behavioral health services in the aftermath of five men's suicides that occurred over a period of 24 months. Understanding that depression and other behavioral health conditions are treatable for all age groups — including the geriatric population — the Yoakum team's goal of increasing behavioral healthcare access remains today.

The original program focusing on community members 50 years and older incorporated trauma-informed care, an approach which addresses both physical and emotional events that impact a patient's well-being. It also included care management and a referral process to assist the inpatient to outpatient care transition. With positive impact demonstrated by decreased acute hospitalizations and readmission rates, decreased suicide rates, and other improved community health and wellness indicators, care was continued.

In the past few years, the outpatient care model has separated from the acute care hospital model. Renamed the New Horizons Counseling Center from the its original name of "New Horizons Geriatric Counseling Program," its team now serves individuals across the lifespan, ranging from services that address school challenges of teenagers, to the life transitions experienced by older adults, to any behavioral health concerns that impact daily living and well-being.

Still following a key element of the original model, integration with the community's primary care providers, the offered services allow community members to remain in their home area with their families nearby — connections that are integral to providing comprehensive behavioral health care. Additionally, for some clients, assistance with transportation can be offered to prevent limitations to access care.

With the original model also focusing on growing the community's behavioral workforce, current center staffing now includes four licensed clinical social workers and several nurses. Financial sustainability continues to be linked to government and private insurance coverage.

The Yoakum team was invited to present their original inpatient/outpatient model at the 2018 annual meeting of the American Academy of Geriatric Psychiatry. The current Yoakum model also demonstrates that despite limited resources, building sustainable comprehensive behavioral health care can be accomplished in a rural community.

Services offered

In addition to LCSW comprehensive counseling services for both acute and chronic behavioral health conditions, professional assistance in a safe space is offered to teens and adults, with continued services for older community residents. Guidance for personal growth and improved well-being is another available service.

Results

The original model demonstrated decreased admission/readmission rates, improved blood pressure and glucose control, weight loss and other physical outcome measures in addition to improved quality of life measures. Additionally, informal qualitative assessments demonstrated behavioral health treatment stigma was considered low.

Patient perspectives of the original New Horizons program can be seen in this video:

Challenges

The program faces several challenges, including limited funding, a rise in managed Medicare plans, difficulty securing payment from some patients, and a younger working population that seeks assistance but struggles to commit to consistent session attendance.

Replication

Lessons learned during the original model's implementation and evaluation that might offer insights for current considerations for building a new rural behavioral healthcare models are:

• Recognition that although inpatient treatment is a necessary offering, outpatient care is the setting which brings most sustained improvement for behavioral health conditions.
  • The the original model's outpatient setting was also the implementation site of the LCSW "grow-your-own" workforce strategy where those professionals seeking Licensed Master Social Worker status could acquire the 3,000 supervised clinical hours required for their professional degree.
• Expect a low initial referral rate to improve after:
  • Hospital staff and outpatient providers begin to see the long-term impact of formal treatment for identified coexisting behavioral health conditions: for example, shorter acute admissions and fewer readmissions.
  • Treatment results prove the program's worth by outpatient outcomes seen linked to their most challenging patients: improved physical health due to behavioral health treatment and fewer outpatient visits.

Contact Information