Scattergood Foundation

Advancing Innovative Strategies for Change in Behavioral Health

Mental Health Resources, PLLC

Name of Innovative Program: 
Dual Diagnosis Intensive Outpatient Program in a Private Practice Setting
Sponsoring Organization
Mental Health Resources, PLLC
Name of Innovative Program Lead: 
Mental Health Resources, PLLC
E-mail Address of Innovative Program Lead: 
Wise@MHRMemphis.com
Project Description: 
Mental Health Resources is a multi-disciplinary private practice that provides a hospital diversion program serving individuals with dual diagnoses, primarily depressed people with substance abuse disorders.  We are the first, if not the only, private practice to implement and study hospital diversion intensive outpatient programs (IOP’s) in a private practice setting.  We serve adults who are commercially insured with managed behavioral health carveouts.  The majority of IOP’s are hospital based and serve as step downs from higher levels of care and are not utilized to prevent unnecessary hospitalizations.  These institutions are stakeholders in the hospitalization of these patients, not the prevention of hospitalization.  Providing non-institutionally based services with providers who have a stake in preventing unnecessary hospitalization is an innovative model to provide care, in the least restrictive setting, while lowering costs and meeting the needs of an under-served population.
Creativity and Innovation: 
Our IOP in a private practice setting is an innovative adaptation of a hospital based program.  IOP’s are traditionally used as step downs from inpatient or partial hospitalization and are part of the hospital continuum of care.  Instead of using IOP as a step down program following hospitalization, our IOP is used to prevent hospitalization. The program is staffed by our counselors, social workers and psychiatrists from our multi-disciplinary private practice.  There are very few IOP’s for dual diagnosis individuals and even fewer outcome studies.  Additionally, most dual diagnosis programs tend to treat people with substance abuse and serious mental illnesses (e.g., psychotic and bipolar disorders) and virtually no IOP’s exist in a private practice setting to treat depressed patients with comorbid substance abuse disorders.  While over half of our depressed patients present with suicidal ideation and would qualify for inpatient treatment, they would not be considered seriously mentally ill.
Leadership: 
There is a profound absence of evidence supporting IOPs for depressed substance abusing adults.  Our treatment model, proven effectiveness and high consumer satisfaction demonstrate that this level of care can be successfully implemented by other group practices.  We have developed strong collaborative relationships with managed care entities that have used our program as an innovative example for other practices to emulate.  We have consulted with managed care entities and private practice groups to facilitate their adoption of our hospital diversion concept in general and of our evidence based treatment program in particular. We have manualized the treatment groups to further facilitate adoption by others.  By publishing our treatment model and demonstrating our effectiveness we are increasing the awareness of the model and showing that it can be effectively implemented.  The program is a cost effective alternative to costly hospitalization that benefits the consumer, provider and insurer.
Sustainability: 
There is an oversupply of mental health providers, making manpower readily available.  The model serves as an opportunity for individual practitioners to join together and provide an additional level of care to their traditional practices.  The program is scalable, can start with existing staff, with only three patients, and expand.  Sustainability is achieved by virtue providing an alternative to hospital based services, a lack of similarly situated providers, alignment of goals with national MCO’s, local referral sources and employers, preventing costly hospitalization and thereby reducing employer costs. The IOP is readily accepted by most patients as it allows them to remain in home, while allowing providers to treat patients while they are in their natural environment.  Multi-disciplinary groups adopt the model to diversify and increase their practices and revenue streams. Depression and substance abuse are leading causes of disability, creating a demand for cost efficient, effective, treatment programs. 
Replicability: 
The treatment program does have the potential for duplication and adaptation by other similar organizations.  Our treatment forms, policies and procedures have been standardized to facilitate replication by other entities.  We have developed treatment manuals for every hour of clinical programming.  All of our process groups and psycho-educational groups have been manualized, thereby providing treatment guidelines for every hour of treatment, making transportability of our program, and duplication of our outcomes, readily available.  Consultation, observation and training can also be provided for interested organizations with similar competencies and populations.  Data collection procedures, outcome instruments and client satisfaction questionnaires can also be duplicated for the purpose of demonstrating treatment effectiveness.  Support is also available for establishing contractual arrangements with third party payers.  We have been approached by three national managed care organizations with requests to expand this program into other locations.
Results/Outcomes: 
The treatment effectiveness of our Dual Diagnosis IOP on our first 100 patients was published in a peer reviewed journal*.  Patients reported abusing substances an average of five days per week at the beginning of treatment and showed a significant and steady decline throughout treatment.   82% reported significantly reduced days used in the week prior to discharge and 69% used one or fewer days (53% achieved abstinence).  Patients started treatment with psychiatric symptoms comparable to those found in inpatient settings, and 56% presented with suicidal or homicidal ideation. All symptom scales, functional impairment ratings, and number of days of substance abuse were significantly improved at discharge.  Client satisfaction was consistently high, with an average of 3.7 on a scale of 1 – 4.   69% of patients significantly reduced days of substance abuse from five to one or none, while simultaneously significantly reducing psychiatric symptom severity and reporting extremely high consumer satisfaction.*article can be seen at: http://www.mhrmemphis.com/resources.php#2
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