Level II Pilot Program IICOP Sunsetted after Five Years

Intensive Integrated Community Outpatient Program (IICOP) Level II Pilot Sunsetted after Five Years

Hume Center’s Integrated Intensive Community Outpatient Program (IICOP) has ended after five years. IICOP was created in 2011 as a temporary pilot project funded by Alameda County Behavioral Health Care Services (ACBHCS) in response to the need to decrease emergency services by increasing integrated mental health services to Level II clients. Alameda County was one of the first counties in California to implement “California’s Bridge to Health Care Reform” by providing a health coverage plan called Health Program Alameda County (HealthPAC).

IICOP served Level II adults with co-occurring moderate to severe psychiatric disabilities and substance use disorders that were referred from a Level I Crisis Response Program (CRP) and ACCESS referral information center in Alameda County.  The program provided an array of services to help clients in the community further seek and maintain recovery and growth after experiencing life hardships from psychological crises. Such services also aimed to help lower the attendance rate of clients at psychiatric emergency services.

The program was an important one, as almost 9% of adults in Alameda County experienced psychological suffering in a one year period.  John George Psychiatric Pavilion, the major psychiatric emergency hospital in Alameda County, reported an average of 1,500 to 1,800 psychiatric emergencies every month. Many of these individuals need more than weekly psychotherapy, so Hume Center was called upon to create IICOP into a program that offered up 10 hours of community-based services a week as a pilot to test whether such a program could support these individuals better.

Program staff found that the individuals referred presented with the following barriers to wellness:

·         Severe ideations of harm to self or others.
·         Homelessness and difficulty maintaining housing.
·         Extreme financial hardships.
·         Transportation challenges.
·         Substance use history.
·         Involvement in the justice system.
·         Severe mental health symptoms needing consistent psychotropic medication evaluations.
·         Social isolation and stigma.
·         Low social support and struggles with maintaining positive social relationships.
·         Severe physical health conditions that exacerbate mental health symptoms.
·         Lack of knowledge of community supports.

The program worked with each consumer to reduce these barriers to wellness in order to reduce the need for psychiatric emergency services. The main goal of the program was to successfully discharge the client to primary care after up to 18 to 21 months of services. Using the Public Health Model, the IICOP staff supported clients with learning, practicing, and maintaining more adaptive coping behaviors to reduce and prevent mental health symptoms from continuing. IICOP staff endeavored to support clients with increasing independent functioning through linkage to community resources and providing consultation to community entities that prospectively impact clients (e.g., primary care, hospitals, social security offices, client referral agencies, social security disability agencies). The program offered psychiatry, psychotherapy, case management, linkage, consultation, and also several groups that covered an array of topics; including General Processing, Skills Building, Dialectical Behavioral Therapy, Relationships, and Life Transitions.

IICOP constantly looked to examine its successes and obstacles to success and generated reports regularly on its outcomes. Data on the psychiatric emergency services (PES) of each IICOP client was analyzed to evaluate the program’s goal of clients decreasing the need for psychiatric emergency services through intensive integrated mental health services. Data incorporated the comparison of each client’s use of PES before, during, and after the time of enrollment in the IICOP. Data from the 99 IICOP clients indicated the following:

·         87.9% of the clients (87/99) had a decrease of PES utilization during and after IICOP services compared to before entering the program.

·         75.6% of the clients (75/99) showed no use of PES while enrolled in the program.

·         89.9% of the clients (89/99) did not use PES services after discharging from the program.

When calculating the sum totals and averages of Before, During, and After data separately, results show a significant decrease in total and average of PES from Before (244, 2.46) to During (57, 0.58). Furthermore, results indicated a significant decrease in total and averages of PES from During (57, 0.58) to After (26, 0.26).

Other successes of the program were the team cohesion, generally high client engagement, strengthening consumers’ support system through family therapy and education, strengthening of community supports through consultation, and the provision of truly integrated services. Positive outcomes for consumers included decreased harmful behaviors; decreased psychotic symptoms; increased connection to medical care, disability income, housing, food, and other community supports; and employment and permanent housing.

The Hume Center is proud of all of the staff who provided services and administrative support in IICOP. We are proud to have implemented this pilot program that resulted in such a grand reductions in psychiatric emergency services and helped bridge the gap between mental health care and primary care.

July 1, 2016