A Stabilizing Partnership
LSSI’s Project IMPACT Helps People in Crisis
Eye on LSSI, Fall 2011 ( Download PDF of entire publication)
At Swedish Covenant Hospital’s emergency room (ER) in Chicago, a mother comforts her sobbing teenage daughter. A concerned young woman approaches a hospital staff member, insisting that she be by the side of a non-English speaking relative undergoing a medical test. An elderly gentleman sits in a wheelchair, patiently waiting for care. Ambulances come and go. Phones ring, as the ER desk clerk juggles requests from visitors, patients and medical personnel — all at the same time.
Welcome to the hustle and bustle of a typical urban American ER. And that’s just what goes on the waiting room. Behind the ER doors, a number of acute patient crises await the hospital’s emergency medicine professionals. They urgently attend to the medical ones, while they rely on their colleagues with Project IMPACT — a unique crisis intervention program of Lutheran Social Services of Illinois (LSSI) — to assess and stabilize individuals incapacitated by mental illness, substance abuse and/or domestic violence. With its headquarters tucked in a corner of the hospital’s emergency department, Project IMPACT can instantly dispatch one of its trained crisis counselors to the ER.
“Psychiatric patients, who may have mental illness coexisting with medical illness and/or substance abuse intertwined, are every bit as important as a cardiac [or other] patient—and every bit as time consuming,” says Bruce McNulty, MD, chairman of emergency medicine at Swedish Covenant. “If left to the devices of the physicians and nurses, who are dealing with the enormity of everything else going on in the emergency department, we would struggle to service these patients well without Project IMPACT.”
On a 24/7 basis, the staff of this successful LSSI program brings to life the meaning of the acronym IMPACT: Immediate Multidisciplinary Pre-Screening Assessment Crisis Team. Project IMPACT serves all adult-age patients who come to the emergency room needing mental health or substance abuse care. These individuals in crisis receive help regardless of their ability to pay and the path — walk-in, police drop off or other referral sources — that brought them to the hospital’s ER. Following a client screening and evaluation, members of Project IMPACT consult with ER staff to either hospitalize patients on psychiatric units or refer them to the appropriate follow-up services in the community. Then, program staff members stand ready to provide compassionate and respectful assistance to the next client in crisis.
“I am always prepared for anything,” says crisis interventional specialist Melissa Prusko, who after a year working for Project IMPACT, has quickly learned to expect the unexpected. “It’s fulfilling to talk down an escalating situation with clients, who often are so upset and sometimes resistant to our help in the beginning, and bring them to a point where they feel safe in the end.”
In addition to counseling, Project IMPACT provides clients with food supplies, medication, clothing, psychiatric respite care and transportation.
Trust drives successful partnership
The partnership between LSSI and Swedish Covenant Hospital, a 323-bed hospital serving Chicago’s north and northwestern communities, began in 1993 when LSSI introduced this first-of-its-kind hospital-based service in the city. As it got off the ground, the innovative program assisted an average of 100 patients a month — a census that soon went up and up. In 1996, for example, Project IMPACT ended the year with 1,434 total clients served. Now, patient volume has more than doubled. The program serves some 250 clients a month, with the year 2010 seeing a total client tally of 3,012. Several factors have fueled this growth, according to Manoj Patel, program director for Project IMPACT.
“More cases of mental illness, especially during tough socioeconomic times; overcrowding at state hospitals; and cutting of outpatient resources have all contributed to the increase,” says Patel. “For example, other providers of mental health services in the Chicago area have experienced funding cuts. Clients can’t get appointments for two to three months. So, patients are coming back sooner to the ER.
“Also, as the ER patient volume has gone up at Swedish, so has ours. We are automatically consulted on every ER patient who may need crisis intervention.”
LSSI’s long-standing association with the hospital serves as a testament to the teamwork, trust and respect that exist between the staff members of Swedish’s emergency department and Project IMPACT. In addition to specific training provided by the program, many of the crisis workers possess clinical psychology and/or social services experience. Prusko, who holds a bachelor’s degree in psychology, intends to go back to school for advanced education in psychology. A medical doctor by training, Patel has expertise in cardiology and emergency medicine.
“We view the Project IMPACT staff members as psychiatric/mental health consultants and interact closely with them to discuss patient findings,” explains McNulty. “They have an incredible relationship with our psychiatrists and inpatient unit, as well as can connect patients in crisis with contacts in the community — which they do beautifully.”
Shifting with changing healthcare landscape
Despite state and federal mental health funding cuts seriously affecting and eliminating mental health services in recent years, Project IMPACT has survived — if not, thrived — due to effective and efficient management. Doing more with less and tapping into funding from non-public sources, such as private foundations, has helped. However, that’s not to say there haven’t been challenges.
In the past three years, behavioral health programs in Illinois have lost 49 percent of their funding,” says Tim Sheehan, executive director of LSSI’s Behavioral Health Services. “The infrastructure has taken a big hit, with people without Medicaid suffering the most.”
Yet the strong and consistently high performance of Project IMPACT and its stellar reputation for serving the community has given LSSI a solid platform to plan ahead, hopefully, for better times for mental health services. The program is poised to offer potential new and different services to meet changing patient needs in anticipation of future health care reform.
“With the promise of reform, there are evolving opportunities to expand good care and offer more services, not less,” predicts Sheehan. “The expectations of doing so, though, may depend in part on providers achieving better outcomes and more effectively containing healthcare costs.” Ideally, reaching these goals will require a serious effort, for example, to reduce the number of patients using expensive hospital ER, services for mental health care, provide early intervention programs and maintain viable, long-lasting linkages to community resources.
While Project IMPACT’s core mission continues to focus on helping people in crisis in the emergency room setting, the program is working on expanding its case management capabilities. Currently, crisis workers spend up to 45 minutes of face time with each client in the ER but their work doesn’t end there. They may then devote as much as 12 hours following up with appropriate placements in mental health facilities or dealing with insurers to provide coverage — usually by phone or e-mail. By hiring additional staff members, who can physically travel outside the walls of the emergency room and into the community, Project IMPACT expects to improve the connections of clients to services, and, ultimately, reduce recidivism.
“Project IMPACT’s clients go beyond the ER to the streets, to the ambulances, to the police station,” says Frank Jeffers, a veteran staffer of Project IMPACT, who helped start the program. “It’s a pleasure to work with so many people from different disciplines to stabilize out-of-control situations and find the most appropriate treatment for patients. It’s a great accomplishment to work together and serve the client.”
Eighteen years later, the services of Project IMPACT still make a significant impact for people grappling with an acute crisis to see that there’s hope ahead — whether it’s for the moment or for a lifetime.