Care New England Health System always and continually strove to provide an efficient, full continuum of behavioral health services across its organization. However, the heightened, pandemic-driven rise in demand truly underscored the critical need for full-spectrum behavioral health access.
To meet this rising demand, the Providence, R.I.-based health system, which includes Women & Infants Hospital, Kent Hospital and Butler Hospital, a private, nonprofit psychiatric and substance abuse hospital, took a number of steps to expand access and reduce strain on emergency departments.
"For us, since the pandemic, quite frankly, our primary focus has been on access, and I think we've done some really interesting work here that we continue to refine and focus on," Mary Marran, chief administrative officer for Care New England and president of Butler Hospital, told Becker's. "And in that, a couple of fairly new initiatives that we continue to work on expanding relate to our front door."
As part of those efforts, Butler Hospital has implemented a triage center that assesses patients to determine the appropriate level of care for behavioral health needs. The hospital also opened an outpatient evaluation center to provide same- or next-day services, such as psychiatric evaluations, medication management and individualized counseling.
"Beyond our emergency room, where we evaluate patients, we stood up an outpatient evaluation center," Ms. Marran said. "If you walk into my hospital, it's not likely you need an inpatient stay, which most people, when they come to Butler, think they need.
"What we know is that 30% to 40% of the people who walk in don't need inpatient care. So, this triage point lets us send people over for an outpatient evaluation, and it allows us to safely divert you to an ambulatory or outpatient option and avoid hospitalization."
Butler Hospital has also opened a new 25-bed unit, the first fully publicly funded unit in the hospital's 175-year history. The unit, which opened in July, received $8 million from American Rescue Plan Act funds and an additional $4 million through congressionally designated funding. It is designed for short stays to reduce emergency room boarding across Rhode Island.
Ms. Marran noted that when work on the unit began, between 60 and 70 patients a day were visiting emergency rooms around Rhode Island for behavioral health needs.
"Many patients ended up boarding while they were waiting for access to inpatient beds," she said. "What we said to our state leaders and to our federal delegation is, 'We want to stand up a unit that allows us to … bring people more quickly into an inpatient stay and start their treatment sooner.'"
The initiative has been successful, according to Ms. Marran.
"What we've seen is the impact of that, and the boarding rates are definitely down here in the state, in our emergency room," she said.
She added that moving forward, Care New England is focused on improving access to behavioral health services and providing efficient care.
For example, Rhode Island has expanded its Certified Community Behavioral Health Clinics initiative to provide greater access to community-based services.
"All of our mental health centers here in Rhode Island are designated CCBHCs, so they're open seven days a week, and they're open expanded hours, which allows us here at the hospital to also leverage this increased capacity in the community, also helping access to services across the board," Ms. Marran said.
Additionally, Care New England is focused on placing behavioral health clinicians and providers into primary care practices and in some specialty care areas, such as weight management and oncology, as well as a family care clinic in the Pawtucket, R.I., area.
"We place behavioral health providers in those settings so that if you present to your primary care physician and express any kind of behavioral health concerns, we're able to get you in front of a clinician to evaluate and intervene early," Ms. Marran said. "The earlier we can address these conditions, the less likely it is that the person will need higher-level services."