#OnTheMap – Behavioral Health Services

Sharon Pendlebury, Administrator of Behavioral Health Services (left), and Tamieka Johnson, BHS Outpatient Staff Therapist

Behavioral Health Team Provides Innovative, Award-Winning Care

Cheyenne Regional Medical Center’s Behavioral Health Service (CRMC-BHS) offers psychiatry services, mental health therapy and substance-abuse treatment in its second-floor wing at CRMC’s East Campus and also in nine medical clinics throughout the state through its expanding telehealth outreach. CRMC’s BHS program is one of the largest providers of mental healthcare in the state, and it continues to look for ways to serve an ever-growing need for behavioral health treatment in Laramie County and Wyoming.

B-Well Program Results in ‘Spectacular Outcomes’

B-Well is a good example of the innovative care and outreach that BHS has implemented over the past few years.

Currently providers from four Cheyenne primary care clinics refer 25 to 30 patients a month to B-Well (which stands for Behavioral Health Wellness). These are all new patients, an indication of the region’s ongoing need for this kind of treatment.

Heather Montross, BHS Outpatient Manager

“We received a grant from Wyoming Medicare to pilot the B-Well program at two primary care/patient-centered medical homes in Cheyenne three years ago,” explained Sharon Pendlebury, BHS Administrator.

Patients are referred to B-Well by their primary care provider—a physician, physician assistant or nurse practitioner.

“Many patients in B-Well are referred because they are experiencing symptoms of depression or anxiety that are impacting their ability to manage a comorbid medical illness such as chronic obstructive pulmonary disease, diabetes or congestive heart failure. They may be depressed and anxious to the point that they are not taking care of their medical needs in addition to their behavioral health needs,” Pendlebury explained.

Patients referred to B-Well receive treatment at their primary care clinic once a week for 12 weeks from Jennifer Thobro, a licensed clinical social worker and the BHS Outpatient Clinical Lead who has been with B-Well from the start.

“People are more likely to receive mental health therapy if it’s in a setting they are familiar and comfortable with and if someone they trust, like their primary care provider, recommends it,” said Heather Montross, BHS Outpatient Manager.

Jennifer Zimmerman, BHS Administrative Manager

The B-Well program treats adults of all ages, though most patients range in age from 30 to 50 years old.

Improvement is measured by a screening tool, called the PHQ-9, given to the patient at the outset and at each therapy session. The closer the score is to zero, the better.

“When they first start B-Well, most patients are at an 18 or a 19,” Pendlebury said. “Many are really struggling with the symptoms of depression and anxiety, including low energy, low motivation and some hopelessness.”

By the time they are through the program, most are scoring a 1 or 2, “demonstrating 80 percent or even better improvement,” Pendlebury said

Another reason for optimism is the impact B-Well has had on patients who are taking medications to manage a chronic illness.

“Medical compliance has gone up significantly, which is good for the patient’s well-being and therefore supports both the patient and their medical provider in their work to keep the patient’s illness well managed,” Pendlebury said. “We’ve had some truly spectacular outcomes.”

Dave Glennie, RN, board-certified by the American Psychiatric Nurses Association

Today, four primary care clinics in Cheyenne offer B-Well, and it will soon be offered via telehealth in Lander.

“Our therapist, Jennifer, is very protective of her patients and the partnership we have with the clinic providers. It’s a good relationship all around,” Montross said.

Pendlebury and Montross hope that B-Well’s outcomes will encourage other primary care clinics in the state to open their doors to the program.

“Our goal is to support patients, stabilize them and help them work with their primary care providers to better manage their health needs,” Pendlebury added.

While that is usually the case, about 10 percent of those referred to B-Well require additional help. These patients are referred to a BHS psychiatrist for more intensive care and support. Once the patient, psychiatrist and primary care provider agree the patient’s illness is well stabilized, the goal is to transfer the patient back to his or her primary care provider for ongoing behavioral health treatment.

Either way, getting patients the care and treatment they need is vitally important.

“It’s so much better to be able to offer patients access to behavioral healthcare to work things out at an early stage than it is to wait until they are on the brink of a crisis,” Pendlebury said.

BHS Provides Local and Statewide Access to Care

In Wyoming, long driving distances, lack of internet connectivity, the financial downturn and a long-prevalent sense of self-reliance and stoicism can delay people from getting early access to much-needed treatment and care. This gap has motivated BHS to offer an extensive range of services, which includes:

  • A 16-bed Inpatient Unit in Cheyenne for patients needing intensive psychiatric treatment in a safe, supportive and caring environment.
  • A Mental Health Intensive Outpatient Program (IOP) that offers a supportive, caring bridge for inpatients who have returned home or for outpatients who need more significant support and may be at risk of requiring a higher level of care. The treatment runs for 14 weeks (based on medical necessity) and is offered three times/week, with each session lasting two hours.
  • A Chemical Dependency Intensive Outpatient Program (CDIOP) for individuals struggling with addiction. The treatment runs for 14 weeks and includes nine hours of group therapy and one hour of individual therapy/week as well as an opportunity for family involvement.
  • Parent-Child Interactive Therapy (PCIT) to help with concerns about child rearing and interactions between a parent and child or a caregiver and child with the goal of promoting healthy family functioning.
  • Telehealth Psychiatry to nine clinic locations throughout the state.
  • Telehealth Psychiatry or Mental Health Therapy for Individuals, a self-pay option for adults who would like one-on-one mental healthcare and counseling via telehealth. Hours are flexible depending on the individual’s work schedule and needs. BHS is hopeful that payers will review this program and consider supporting it in the not-too-distant future.
  • The B-Well (Behavioral Health Wellness) adult therapy program for patients cared for at four primary care clinics in Cheyenne—and coming soon via telehealth to a primary care clinic in Lander.
  • Geriatric mental healthcare to participants in PACE (Program of All-Inclusive Care for the Elderly) and to residents of three Cheyenne nursing homes.
  • A free nurse visitation program for BHS patients who have questions or concerns and need support between scheduled visits with their psychiatrist.
  • Electroconvulsive Therapy for the treatment of depression and other approved mental health conditions.
  • The Zero Suicide in Healthcare Initiative, a national movement focused on eliminating suicide by:
    • Providing specialized suicide awareness training to all healthcare personnel
    • Encouraging community partners to work together to provide a safety net of services
    • Using electronic medical records to help identify individuals who are at high risk
    • Providing evidence-based treatment to stabilize at-risk individuals

“We offer some of the most extensive and comprehensive psychiatry and mental health services in Wyoming,” Pendlebury said. “And we continue to look into how we can reach more people in our state with much-needed psychiatry and therapy services. It can be a challenge, but we aren’t backing down, given the need and the great outcomes our team provides.”

BHS Inpatient Quality Outcomes: Among Top One Percent in the Nation

Marcie Mavreles, Psychiatric Assessment & Referral Team Clinician and BHS Inpatient Case Manager

The great outcomes referred to by Pendlebury are no exaggeration. In the fall of 2017, Cheyenne Regional’s Behavioral Health Inpatient Unit was recognized by the federal Centers for Medicare and Medicaid Services (CMS) as being one of the top 20 psychiatric units in the nation based on standard quality measures of psychiatric care. This places the unit among the top one percent of inpatient psychiatric facilities in the nation.

The 17 metrics measured by CMS focus on the following:

  • Providing an appropriate, accurate and comprehensive psychiatric assessment to patients prior to admission to an inpatient psychiatric unit
  • Providing the appropriate prescription of psychotropic medications to the inpatients
  • Treating each inpatient’s multiple needs
  • Providing a purposeful and sophisticated transition plan to inpatients and their outpatient providers upon each patient’s discharge from the unit

“We are delighted that Cheyenne Regional’s Behavioral Health Inpatient Unit has been recognized by the Centers for Medicare and Medicaid Services in this way,” Pendlebury said. “There is no more objective evaluation that that of the federal government’s CMS. This is validation that the care provided at our inpatient facility is really second to none. It’s also a validation of the people who provide the care—our psychiatrists, therapists, case managers, nurses, technicians and support staff. They truly are an amazing team, working together to provide a service that is vital not only to each patient and their families but also to overall community well-being.”

BHS Works Alongside ‘Great Partners’

This team approach is also exemplified in how BHS interacts with other agencies and organizations that help those with behavioral and mental health needs.

“We want to acknowledge and thank those agencies and organizations in the community and state that are equally committed to effectively and purposefully supporting community members facing a mental health or substance-use challenge,” Pendlebury said.

“The Wyoming Department of Health, Wyoming Behavioral Institute, Wyoming State Hospital, law enforcement, Community Action of Laramie County, the COMEA Shelter, individual therapy clinics, vocational rehabilitation organizations and many other agencies offer support to our patients in any way they can,” Pendlebury said. “They are truly great partners in this work we do, day-in and day-out.”

BHS has a particularly close partnership with Peak Wellness Center (Peak), a private mental health and addiction-recovery clinic based in Cheyenne and serving southeastern Wyoming.

“We have benefitted enormously from Peak’s specialist knowledge and support over the last five years,” Pendlebury said.

An example of the collaboration between BHS and Peak is the development of the Zero Suicide in Healthcare Initiative in Wyoming.

In May of 2015, the Wyoming Department of Health invited BHS and Peak to apply together to represent Wyoming at the second annual SAMSHA National Action Alliance for Suicide Preventions/ Zero Suicide Academy. (SAMSHA is the Substance Abuse and Mental Health Services Administration.)

BHS and Peak attended the academy in partnership, planned the programs within both agencies in partnership, precepted together for the SAMSHA Wyoming Zero Suicide Academy in 2017 and continue to work together to mentor other healthcare agencies who are rolling out the program across Wyoming.

“There is an increasing need for mental healthcare in our state,” Pendlebury noted. “It’s vital that those of us in this field continue working together to ensure as many people as possible receive the care, treatment and support they so urgently need.”

Dr. Jason Collison, BHS Medical Director

BHS Professionals: Here to Help

Outpatient Service

  • Five psychiatrists (with a sixth psychiatrist being recruited specifically for outpatient care)
  • Seven licensed therapists
  • Two psychiatric nurses
  • Two outpatient psychiatric technicians
  • Five-person administrative team, which supports the entire BHS service line, including Inpatient, Outpatient and the Psychiatric Assessment and Referral Team

Inpatient Unit

  • Two psychiatrists who specialize in the care of acutely psychiatrically ill adults
  • Nine full-time psychiatric nurses—with five being board-certified by the American Psychiatric Nurses Association
  • Four case managers—all licensed by the Wyoming Mental Health Professional Licensing Board
  • Nine full-time psychiatric technicians, with many having their specialty licensure
  • Two full-time program therapists who lead our DBT (Dialectical Behavior Therapy) bases in patient programming: eight groups/day, seven days a week.

 The unit is also served by an experienced Inpatient Leadership Team that includes:

  • A board-certified Director of Psychiatric Nursing
  • A master’s degree-qualified Clinical Manager
  • A licensed, experienced Clinical Access Manager who oversees throughput between the three BHS departments and the Cheyenne Regional health system and who also supervises both the inpatient Case Management Team and the Psychiatric Assessment and Referral Team (see below)

Psychiatric Assessment and Referral Team (based in the Emergency Department at CRMC)

This team is composed of four licensed mental health professionals who also have CRMC medical privileges and credentialing. The team provides mental health consultative services, usually focused on diagnostic and level-of-care recommendations to patients, their families and CRMC clinical teams.

All BHS departments and services are supported by a wonderful team of psychiatrists:

  • Dr. Jason Collison, BHS Medical Director
  • Dr. Jasper Chen
  • Dr. Jie Chen
  • Dr. Robin Eicher
  • Dr. Charles Peck
  • Dr. Stephen Poulos
  • Dr. Lenae White

Published December 2017