Making the Case for Parity Caring for the complex medical and mental - - PowerPoint PPT Presentation

Jessie Lombardi, LPCC Clinical Care Manager Health & Counseling Services

Caring for the complex medical and mental health needs

• f our students

Making the Case for Parity

• Does your institution have both a clinical and non clinical case/care

manager?

• Has your institution seen a recent increase in the following health

concerns:

• Head trauma/concussions
• Injuries
• Chronic medical problems
• Life threatening medical problems
• Increase in medical hospitalizations
• Does your institution offer medical case/care management?

Who Is In The Room?

Care Management Parity: Agenda

• Introduction to CWRU and our Clinical Care Management Model
• Care Management Parity
• Stake Holders and Buy‐In
• Case Study
• Questions & Discussion

Case Western Reserve University

• Cleveland, OH – rich with medical and mental health services
• University Hospitals – Case Medical Center
• Cleveland Clinic
• Case Western Reserve University: private, emphasis on STEM
• 5,121 Undergraduate students: mostly residential
• 6,219 Graduate and Professional Students
• 14% of the population – international students
• Cleveland Institute of Music: 400 students
• Cleveland Institute of Art: 550 students
• Urban campus

University Health & Counseling Services

Integrated and Holistic view of student health and wellness

• Mission Statement: To advance the well‐being, development, and

academic success of our diverse student body through integrated medical, mental health, and wellness services. We collaborate with the entire CWRU community through outreach, education, and services to promote a culture of safety, respect, and global citizenship that fosters lifelong resilience.

• Integration began July 2014

Not co‐located Major culture change!

• Consultants hired

CWRU Care Management: timeline

Summer 2015: Creation of Clinical Care Management position within Counseling Services

• Discharge planning – behavioral health hospitalizations
• Referral Coordination
• UH&CS Tracking of “high risk” students
• Other duties as assigned

November 2015: Creation of The Care Management Process

• Collaboration between UH&CS, Dean of Students Office, etc.
• Care Plan and tracking
• Only mental health concerns

CWRU Care Management: timeline

Summer, 2016

• Quickly outgrew our resources and services

September, 2016

• Parity entered our vocabulary: Lawyer, integration consultants
• Care Management Specialist: Counseling Services, LSW & LPN

Fall Semester 2016 & Spring Semester 2017

• Counseling Services = Supported by Care Management
• Health Services = Poor follow‐up, tracking, referral coordination, and little to no

campus collaboration

Spring, 2017

• UH&CS Associate Director for Care Management
• Nurse Care Manager: Health Services

Parity and the argument for Medical Case Management

March 15th, 2001: Senate Bill 543 the Mental Health Equitability Treatment Act of 2001 : Group health insurance must provide the same benefits for mental health services equal to those offered for medical and surgical services.

Inversely the same needs to be true!

Who are we missing by not offering collaborative, clinical case management services for medical health concerns?

• Increases in: concussions, cancer, diabetes, crohn’s and other

chronic medical conditions, transplant recipients, etc.

• Mind body connection

CWRU Care Management Roles

• Liaison for Counseling Services to Students of Concern meetings and document in EMR.
• Nurse Care Manager: attend Students of Concern meetings and document in EMR
• Referral coordination and follow up appointments/check‐ins
• Nurse Care Manager: Referral coordination and follow up appointments/check‐ins
• Advocate for the academic and student life needs of students with mental health concerns
• Provide medical documentation for academic and student life accommodations
• Collaborating with the Dean of Students Office and other University Offices to create a Care
• Plan. Monitor, track.
• Collaborate with University Office to create a Care Plan. Monitor, track.
• Discharge planning for mental health hospitalizations
• Discharge planning for medical health hospitalizations
• Continual evaluation of policies and procedures to
• Support Psychiatry by providing check‐in appointments
• “No Wrong Door”
• UH&CS Tracking of “high risk” students: Clinical Integration Leadership Team

Stake Holders and Buy-In

Within UH&CS

• 1. Executive Director
• 2. Director of Health
• 3. Director of Counseling
• 4. Clinical Staff
• 5. Community Providers

Campus

• 1. Students
• 2. VP for Student Affairs
• 3. Dean of Students Office
• 4. Undergraduate Studies

and Grad/Professional Studies

• 5. General Counsel

Case Study

• 19 y/o, male, first year, Chinese International student
• Came to Health Services for a “rash” that he couldn’t stop itching. Diagnosed with Eczema

at Health Services. Previously unknown to UH&CS.

• Did not follow up at Health Services, no‐showed his appointment
• Students of Concern Meeting – faculty indicated concerns about student’s behavior in
• class. Leaving class abruptly and not returning. Missed an exam (Undergraduate Studies).
• Dean of Students checked in with student – said he was doing ok, but was dealing

with a “medical problem”. Didn’t request additional help. Referred to Health Services.

• Students of Concern Meeting – Reports that he missed an entire week of classes

(Undergraduate Studies). Was not responding to Undergraduate Studies or Dean of Students Office.

• Students of Concern Meeting ‐ Res Life reports that father has been hanging around

student’s residence hall and this was worrisome to other students. Reports from Police that father indicated student had been hospitalized for “eczema” and “itching”.

• Behavioral Health hospitalization for anxiety and depression: student did not sign ROI
• Withdrew from CWRU and went home, with father, to China.

Case Study

Small Group Brainstorming Questions:

• 1. When could we have intervened for a potential different
• utcome?
• 2. How might your institution handle this situation/student?
• 3. Would Counseling Services help in this situation? Given the

information known?

• 4. What would your Dean of Students Office done differently?
• 5. At your institution, when would this student be brought up to

your “Students of Concern” meeting or “Care Team”?

• 6. What comes to mind when you read this case study?

Questions and Discussion

Jessie Lombardi, LPCC JVL16@case.edu 216-368-5872