Creating a Value-Added Partnership:ElanaAlice

Trilogy, A Community Mental Health Organization, Collaborates With Rush University College of Nursing

Alice Geis, MS, APN
Trilogy Director of Integrated Healthcare 

Elana Habib, MPH
Trilogy Evaluation and Research Coordinator

Always do your best. What you plant now, you will harvest later. –Augustine “OG” Mandino ­

Half of the people with serious mental illness (SMI) who come to Trilogy do not have a primary care provider. This is a troubling statistic as national averages show that individuals with SMI die 11-32 years sooner than those without SMI, almost always due to preventable co-morbidities (National Institute of Mental Health, 2012). Chicago-based community mental health center (CMHC) Trilogy Behavioral Healthcare, a not-for-profit behavioral healthcare organization serving individuals with SMI, recognized the need for integrated mental health and primary care, and partnered with Rush University College of Nursing to address this need. In Trilogy’s Integrated Healthcare Program (IHP), clients receive coordinated client-centered behavioral health, primary care, and health promotion services, geared to enhance overall quality of life. The partnership has flourished since its inception in 2008.  The partners strive to “plant” the foundation for a nursing workforce that is prepared to embrace integrated healthcare provided in interprofessional teams, thus “harvesting” greater quality of care for individuals with SMI, now and in the future. The purpose of this paper is to use a description of the IHP at Trilogy and its partnership with Rush University to highlight benefits of such partnerships for both types of organizations, for students, and for clients receiving health services.

Individuals with SMI face ongoing stigma in many healthcare locations, reducing their confidence in obtaining primary care and other services. Even clients who are comfortable accessing CMHC services may have difficulty navigating a fragmented system in which behavioral health and general health services are provided in different locations (Geis & Delaney, 2010). These access barriers contribute to the higher incidence of co-morbidities such as Type 2 diabetes, cancer, and heart disease in people with SMI. Health behavior factors such as smoking, lack of exercise and poor nutrition exacerbate the poor health of individuals living with SMI. While just 19% of the 2.6 million adults in Chicago are current smokers, approximately 50% of Trilogy’s more than 600 clients are smokers (US Department of Health and Human Services, n.d.).  These factors underscore the necessity of collaboration between behavioral health and general health systems to improve the overall quality of life for clients.

Integrated care refers to the integration of behavioral or mental healthcare and primary care. The Chronic Care Model became the organizational foundation to integrated care in the past decade, which includes the clinical features of Self-Management Support, Delivery System Design, Decision Support, Clinical Information Systems, and Community Linkages (Center for Integrated Health Solutions, 2012). The model’s standards in each of these components serve to keep patients “informed and activated,” and the care team, “prepared, proactive, and practiced,” (The MacColl Institute, n.d.). The integrated environment ideally results in better client outcomes than a non-integrated health environment. Research suggests integrated settings and those incorporating the Chronic Care Model, result in reduced depression and anxiety, improved mental and physical quality of life, and social role functioning (Woltmann et al., 2012).

The Rush-Trilogy partnership addresses elements of the Chronic Care Model like Delivery Systems Design, by supplying health promotion and wellness program development and nursing care management for clients receiving mental health and primary care services. Further, the partnership supports involvement of nursing students in health promotion programs, which underlies the Self-Management Support feature of the CCM. Most of all, the partnership assists clients in accessing primary care resources, which substantiates the Community Linkages element.

The collaboration between Rush University College of Nursing and Trilogy Inc. began by hiring Alice Geis, an Advanced Practice Nurse from Rush University CON in 2008, who is now the Director of Integrated Healthcare. Geis oversees the nursing program and is the liaison with the university. Progressive colleges of nursing (CON) recognize that current funding trends for integrated community-based care necessitate a prepared workforce and seek to give students in-depth experiences in the community. Working relationships with community agencies that are able to reliably provide high quality  learning experiences for students benefits the university by providing settings for these experiences and is crucial to preparing the future healthcare workforce. More than 230 CON students have had various clinical experiences with Trilogy. Courses have included psychiatric nursing, public health nursing, comprehensive care management, and clinical immersion. Students from pre-licensure through nurse practitioner to the doctoral level have worked with Trilogy clients and staff in meeting their educational objectives. Geis’ understanding of both systems allows her to devise course plans and assign clinical activities which align the students’ learning objectives with Trilogy’s priorities.

Clinical experiences range in time from eight-week rotations to year-long residencies. Learning activities are varied, and include performing integrated health clinic assessments, co-facilitation of health promotion groups, observational community visits with outreach nurses, or direct care such as injections or vaccinations. Some courses have assignments which can guide the students to produce a sustainable health intervention. Through these comprehensive initiatives, students begin to see a holistic picture, rather than just a biological one, of individuals living with SMI. 

Exposing students to a population of clients who are stigmatized based on their illnesses can be of benefit to students by helping decrease misconceptions of SMI and building confidence for working with this population. Involving students in the interprofessional team-based care in the IHP helps them develop needed competencies in the areas of team communication, collaboration, and shared decision-making. Interprofessional care is associated with positive client outcomes (Zwarenstein, Goldman, & Reeves, 2009; Craven & Bland, 2006). While interprofessional education is increasingly seen in academic settings as vital to the development of the future workforce, not all clinical sites offer opportunities to learn and practice with members of other disciplines. At Trilogy, nursing students interact directly with licensed professionals of other disciplines on staff, and have opportunities for interprofessional learning activities with other students, residents, and interns in these disciplines.

An additional benefit to the academic partner with the faculty practice model used at Trilogy is the opportunity for participating faculty to stay current as clinicians in an innovative practice environment. The university also benefits by having access to experts in public psychiatry and community behavioral health, and can engage these individuals in various ways, for example as guest lecturers or adjunct faculty.

The Rush-Trilogy partnership facilitates an exchange of academic and real world perspectives offering enhanced learning opportunities for Trilogy staff. The organization has increased access to the resources of a major medical center, including research expertise. Integrating the mental and primary care health perspectives creates a process of “seeing outside of the box”. Students assist in Trilogy’s progressive vision, while Trilogy prepares students with a realistic experience they can take into their next workplace. The partnership allows continuity for projects that build upon each other, increasing in sophistication and value to the organization as these projects move forward. Clients receive a depth of services they might not otherwise receive, provided under the supervision of faculty and licensed professional staff. Finally, as exemplified by several former Rush University nursing students, their experience with Trilogy has continued into employment with the organization.

Evidence pointing to the effectiveness of integrated settings created a catalyst for policy and grant requirements that emphasize the development of integrated models of care in various healthcare settings. Moreover, the provisions of the Affordable Care Act served to accelerate system changes which promote tightly coordinated care. These factors encourage the development of a prepared integrated workforce to ensure better care for the client.  Geis is taking this commitment to a new level by collaborating with Trilogy in the development of a Center for Integrated Health Education (CIHE). The CIHE will offer a multitude of educational resources for not just nurses but case managers, peer staff, and licensed professionals working with people with medical co-morbidities and SMI. Building and sustaining the Trilogy-Rush partnership is a top priority poised to provide long-term benefits for clients.

© 2013 Trilogy Inc. All Rights Reserved.




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