Behavioral Health Assessment Officers
hello and thank you for joining this ur medicine recovery center of excellence webinar today we'll be discussing behavioral health assessment officers managing care for mental health and substance use disorders in rural emergency departments this webinar is a product of the HRSA rural communities opioid response program we are delighted to be one of the rural centers of excellence on substance use disorders and to have the opportunity to discuss this topic with you today next slide please my name is esther arnold and i'm the senior technical writer for ur medicine recovery center of excellence thank you for joining us before we get started we'd like to review some information about the zoom webinar platform if you have technical issues please let us know in the q a box and we will assist you if you cannot reconnect send us an email at ur medicine recovery at urmc.rochester.com
if dialing in you can view the slides via yesterday's reminder email we'll end with a discussion period please feel free to ask questions in the q a box throughout the course of the presentation we'll have an audience poll before the discussion please follow the on-screen directions when prompted closed captioning is available and can be activated by clicking the cc button at the bottom of your screen thank you to brianna and amanda for interpreting today next slide we often get the question what does your center of excellence do we've been working diligently since fall 2019 to reduce morbidity and mortality related to substance use disorder with a particular focus on synthetic opioids while our target service area includes 23 appalachian counties in kentucky ohio west virginia and new york that were hit hard by the opioid crisis anyone is welcome to benefit from our work to date all u.s
states and territories have participated in our events or used our products along with 48 other countries our approach is to disseminate evidence-based practices that we've identified through research and carefully adapted to rural communities today's practice is one of these many of our programs including this one are part of an ecosystem of recovery this ecosystem which will be discussed in a future article series addresses a wide range of needs across the community and the continuum of care please reach out to us at any time for support in planning and implementing programs such as this one our contact information will be shared at the end of the webinar next
slide our goals for today are to introduce the behavioral health assessment officer or bhao model that has been piloted in emergency departments in rural appalachian new york state discuss how the model can increase behavioral health resources in rural communities and support local access to care and provide an overview of planning and implementation highlighting teamwork in the ed in the community and via telehealth a recording of this webinar as well as slides will be available on our website we'll also be publishing a related toolkit some of the slides in this presentation include a green box that previews those tools next slide i'd like to introduce our speakers today starting with dr george nasra who oversees this bhao pilot program and dr emily clark the consulting psychiatrist who has been collaborating with bhaos through telehealth and telementoring george nasra is professor of clinical psychiatry at the university of rochester medical center where he serves as chief of the division of collaborative care and wellness he is board certified in general psychiatry forensic psychiatry and psychosomatic medicine dr nasra's career interests include collaborative and integrated care as well as increasing access to psychiatric services and reducing stigma for mental health he is dedicating time currently to developing new models of care integration between psychiatry and other areas of medicine we also have the pleasure of hearing from emily clark who is senior instructor at the university of rochester medical center dr clark attended medical school at kansas city university and completed her residency and fellowship at the university of rochester she holds board certifications in general psychiatry and geriatric psychiatry dr clark's areas of interest include alzheimer's disease and memory disorders geriatric mental health and telepsychiatry outreach she has recently been serving as the consulting and supervising psychiatrist for the bhao model we are presenting today next slide
Meet the presenters
dr nasra would you begin by talking about the needs and the evidence-based practices that led to the development of the bhao model thank you esther for the introduction i also would like to take this opportunity first to welcome everyone who made time to join our webinar this afternoon thank you now back to the question of need for developing the bhao model as most people on this call know there are significant barriers when it comes to addressing the mental health and substance use needs of rural communities the most obvious barrier is the issue of access to providers and services most rural areas have very limited if any access to psychiatrists or advanced practice providers and many do not have adequate numbers of therapists and social workers this in addition to other barriers such as stigma and confidentiality concerns as well as transportation barriers leads many to go to their local eds for their mental health and substance use disorder needs this is because the ed is a familiar setting for many less stigmatizing and closer to home over the past several years we have seen a trend of increased ed visits related to mental health and substance use disorders across the board and also a recent study in jama psychiatry found that ed visits for a number of mental health conditions such as suicide attempts drug and opioid overdoses intimate partner violence and child abuse were significantly higher during the peak of the covet 19 crisis next slide piece the type of behavioral health integration that is the subject of this webinar today introduces a behavioral health professional into the rural emergency departments to assist with screening and providing brief behavioral health interventions to patients as well as to assist with proper disposition of patients we call these embedded professionals behavioral health assessment officers or bhaos the bhao model then is based on two evidence-based practices care management and telemedicine we know for example that individuals with higher medical complexity who tend to be high utilizers of health resources tend to have significantly more mental health and substance use disorder comorbidity addressing the needs of those patients in a more effective way is likely to improve their overall health and decrease the cost of their care this is the argument for a care management model which is designed to improve care and decrease cost telemedicine is also an evidence-based practice with multiple studies showing its effectiveness for behavioral health care delivery in rural ed settings an interesting study published in 2014 by keith muller and colleagues showed that the perception among clinicians and administrators was that quality of care improved significantly with the adoption of telemedicine in rural eds a more recent study in 2020 by sarah ost and colleagues showed that psychiatry was the specialty where telemedicine had the greatest impact also a 2015 study from a group at the university of south carolina found that patients at hospitals that use telepsychiatry were more likely to receive outpatient follow-up and less likely to be admitted to the hospital therefore positively impacting the cost of care for patients next slide
Role of the BHAO
please the role of the behavioral health assessment officer or bhao for short is to serve as the independent behavioral health provider in the ed bhaos preferably have a background in mental health and hold a professional certificate in the field examples of backgrounds that serve this role well include licensed clinical social workers licensed mental health counselors or licensed marriage and family therapists keep in mind that these titles may be specific to new york state and may vary on your state's local licensing board other professionals such as licensed medical social workers and psychiatric registered nurses may be considered for the bhao role provided they have super they have appropriate supervision and training the bhao role is to perform mental health and substance use evaluations in the ev setting determine appropriate dispositions and link patients with appropriate resources for treatment some examples of the services the bhao can provide when it comes to substance use disorders include the distribution of naloxone kits and training patients and families on how to properly use these as well as serve as an intermediary between the ed and substance use treatment providers to reliably link patients for treatment the majority of the patients evaluated by a bhao do not require input from a psychiatrist and if they do a brief telephone conversation is typically what takes place if a complicated or a high risk patient case presents a bhao can seek out a formal telemedicine consultation from the psychiatrist to support rba jos in this model we have created an opportunity for them to network with other baos behavioral health providers and substance use providers in their community through our weekly to bi-weekly virtual huddles next slide please a needs assessment survey was conducted in 2014 in rochester and the finger lakes region of new york state this needs assessment identified significant opportunities for improvement in the areas of preventable hospitalizations and readmissions given that hospitals in the rural area of the finger lakes and southern tier region don't have the resources to adequately address the mental health and substance use needs of patients coming to their edes the department of psychiatry at the university of rochester medical center took the lead on designing and implementing a model of psychiatric consultation and management in rural hospitals by embedding masters level licensed professionals in the role of phaos the model also includes regular consultations and case discussions with a psychiatrist by phone or video conferencing we also hold weekly huddles with the with all the bhaos from different hospitals to share best practices provide education and create a sense of community among all the bhaos next slide piece it makes sense therefore that the first goal of the bhao model of behavioral health integration in rural eds would be to treat people in their own community rather than have them travel to another facility that may be hours away achieving this goal would increase access to behavioral health resources for patients in their local communities improve care and decrease cost next slide
one of the very early steps that we took when we implemented the bhao program was to identify a local champion at every hospital to serve as our contact and to push the initiative locally as well as identify obstacles and help resolve the problems as they come up we also created a community advisory board which with representatives from all the different stakeholders in the area these included hospital leadership at different levels leaders of local substance use and mental health disorder agencies and this was to engage them in a collaborative effort to examine and understand current workflows and processes of managing behavioral health concerns in the ed as well as provide workflows to linkage to care a lot of effort focused on communicating the benefits of the model itself but also trying to listen and learn from these different stakeholders about what might or might might not work for their local communities as you can imagine local cultures availability of resources and attitude about mental illness and substance use vary and it becomes very important to tailor the program to the community it is designed to serve next slide we designed the bhao program with a centralized hub with which includes a psychiatrist employed by the university of rochester as well as the program manager and other leadership and administrative staff the collaboration between the local hospitals and the hub is crucial for the success of this initiative it becomes important as mentioned previously that all stakeholders including hospital leadership cmos cnos ed directors providers and nurses at all levels have a good understanding and buy in to the model it also is important that phaos have a good knowledge of the communities they serve and that they say the psychiatrist consultant also gains such knowledge over time by paying attention to the local cultures and getting continuous feedback about the program we ensure that the model is tailored to the needs of the community it is designed to serve another important thing to remember is that the ed setting being a fast paced and high stress environment any new model of workflows being introduced into that setting we need to take into account the importance of minimizing the added stress on the providers next slide
you are probably already thinking about how much this program costs and how can it be sustainable of course this is going to depend on many factors and it will also be different in different communities as not all programs will look the same we included on this slide some information on what to consider but we encourage you to reach out to us via our website urmc recovery center of excellence and clicking on the technical assistance tab in the banner this will allow you to contact us by phone or email or send a request directly from the website we have also developed a toolkit that we can share with you which includes a practice pro forma that shows the expected financial implications of implementing the model it is important to understand that this program is not expected to be financially self-sustaining in the traditional sense like most behavioral health integration models the value of the program is measured by the impact it has on improving quality and decreasing total cost of care because a traditional fee for service model is unlikely to support this model of care we encourage you to explore with your local payers and or acos a value-based payment proposition look at how this program may reduce readmission penalties for your hospital factor in any reimbursement for expert assessments impact on retention and job satisfaction for your staff as well as other return on investments for your hospital and community at large if you combine these alternate payment models with grant funding which may be available to you sustainability of the model becomes then possible next slide
Access to local care
one indicator of the success of this model is the feedback we obtained from hospital leadership at a rural hospital piloting the bhao program who said that this has become key to behavioral health services and linkage to care for their community next slide in our model the bhao operates as the primary provider for bha or for behavioral health and substance use needs in their rural hospital setting because they are licensed behavioral health providers bhaos have the training to independently perform assessments and make disposition decisions in most situations the telemedicine consultation aspect of this model is a secondary approach and one that is used infrequently this surface is reserved for high risk and high complexity cases or other circumstances in which the bheo feels they need additional support we do offer an intermediary level of support between the psychiatrist and the bhaos through brief case presentations via telephone in these presentations a psychiatrist does not directly see or speak with a patient but the bago presents a case and disposition plan and confirms with the psychiatrist that their assessment and plan is thorough and appropriate while the ed is where the majority of the bhao's work is performed they may also provide consultation and support for input inpatient services as needed next slide please
Hiring a BHAO
when filling the bajo position we recommend finding individuals who are seasoned decision makers and good team players we have discussed bhao's holding some profession professional licensure in behavioral health but other considerations should be given to work environments they have experience in someone with experience in one or multiple of the environments listed below can bring highly valuable skills to the table especially when it comes to having confidence working with high risk emergency room patients next slide please recruitment should be highly individualized to the locale in which the organization is based some ideas for targeted recruitment efforts may include area medical clinics hospital system and community mental health centers there are some resources available for retention support including financial incentives like the loan repayment programs through her through herself professional support and assistance built in through our provider huddles and support through the local emergency department environment when it comes to organizational supervision and reporting each organization will determine the reporting structure that best suits their environment bhao supervision at the institutional level may come from the easy nurse management or the social work department we encourage you to check out the toolkit accompanying this webinar for more details on job descriptions and skills checklists to hire an ideal bajo candidate next slide please the bhao model is built on having a master's level licensed behavioral health professional in the role of psychiatric evaluator in the ed as you heard even though the bhao will not be expected to submit bills independently for the services they provide maybe with the exception of the screening and brief intervention and referral to treatment process called espirit they will still be expected to obtain a license in the state where they are practicing this is because most states require such licensure to provide care in a medical setting most states recognize licensed social workers licensed mental health counselors lmhcs and licensed marriage and family therapists lmfts as providers of mental health and substance use care many lmsws or licensed medical social workers and some rns registered nurses with psychiatric experience may be appropriate to provide this level of care and intervention and sometimes they are the only one the only option in some settings we encourage you to consult with your compliance department and review your state licensure and scope of practice requirements to make sure that such disciplines are in fact allowed to provide behavioral health interventions in the ed setting and what supervision requirements need to be in place for that to happen this is a scope of practice issue as well as a licensure issue and each state will have slightly different requirements next slide please
training should be flexible and individualized to fit the needs of the specific bhao and the region in which they serve key components of training should include general education on the bhao model and goals determination on the screening and risk assessment tools that a bhao will use in their patient evaluations formal training on substance use disorders and treatment and training related to the organization's specific ep workflow and how the bhao consultation and assessment will be incorporated into this a unique and crucial aspect of the bago training includes a focus on cultural competency ideally a bajo would be from the region in which they are going to serve and have a personal knowledge regarding the local culture perspectives and the resources available for behavioral health and substance use treatment if a bhao is not from the area or does not have knowledge of these resources a concerted effort should be made during training to provide education on these topics routine teleconference huddles built into our model also provide opportunity for other educational discussions based on the bhao's needs lastly it should not be overlooked that the other ed staff should have some sort of introduction to the bhao and education on the bhao roles and responsibilities this will help to support adequate utilization of the vao services next slide please again we emphasize that the bhao is a primary behavioral health provider within the ed team a valuable team player when it comes to addressing patients presenting to the ev with behavioral health or substance use needs next slide please
Teamwork in the ED
our presentation today we have referred to this model as a behavioral health integration into rural emergency settings we have used the word integration deliberately because the bhao needs to become part of the ed team the bhao will need to adopt the culture of the team and report through the same organizational structure as all the other ed staff as a member of the multi-disciplinary team and the ed the bhao's role will be to integrate into the triage workflow assess patients with behavioral health needs provide brief interventions and help with engagement and linkages to care with that in mind we have added three questions on depression anxiety and substance use during the nursing triage process patients who either answer positively to those questions or those who present to the ed with already identified mental health or substance use disorder needs will be referred to the bhao for further screening and evaluation the bhao may also connect with local mental health and substance use resources to make appointments and they will often engage peer advocates to assist patients when needed as you can imagine a level of trust between all team members in the ed is especially and especially with the bhao is crucial for smooth operation of this program ed leadership nursing staff and providers all need to understand the role of the bhao and buy into this model of care next slide
the telemedicine consultation between a patient and the consulting psychiatrist is a supportive resource that a bhao may utilize in appropriate circumstances in many cases the bajo can make an independent determination regarding a patient's care without consulting with the psychiatrist this helps to keep the workflow within the rural e.d
moving and further emphasizes the identity of a bhao as an independent provider on occasion there may be a case in which a bhao needs assistance making a diagnosis performing a thorough safety assessment or determining appropriate disposition planning when this occurs a bhao will reach out to the psychiatrist to discuss the case and together they will determine if a telemedicine consultation is indicated if so the bajo will then take the following steps first they will gather patient information and send this to the psychiatrist for review next they will schedule a video conference time and create a meeting link for the encounter then they will gather the appropriate resources needed for the encounter which usually consists of an ipad on wheels or other portable computer with video and microphone capabilities when the meeting time comes the bhao will then initiate the encounter introduce the patient to the psychiatrist and stand by throughout the assessment to assist with any technical or communication difficulties once the assessment is complete the bhao will take the ipad or computer out of the room and recap the recommendations with the psychiatrist they will then touch base with the patient and move forward with a treatment plan and disposition for support on how to make the telehealth encounter operate smoothly an example of workflow for the provider to patient encounter please see our toolkit next slide please we hope that we have highlighted for you how teamwork is key for all aspects of the behavioral health officer assessment officer model from the referrals to the telehealth consultations to the ed environment in which they are stationed next slide please and this teamwork extends beyond the
Building a professional network
ed through a professional network of colleagues to support the bajo ways in which our model fosters community networking and and professional development include one-on-one telementoring opportunities with a supervising psychiatrist which is usually through phone-based case presentations in real time weekly video conference huddles with other area bhaos the supervising psychiatrist and local behavioral health and substance use disorder professionals from their area and opportunities for formal teaching didactics from the psychiatrist or from community partners wanting to connect their services with the ez population next slide please
we use a cloud-based hipaa compliant database system to collect information on every patient referred to the bhao for evaluation when the bhao is not on site the triage nurse will still ask the same screening questions and communicate any positive results with the bhao to follow up when possible the bhao will enter basic patient information in the form of check boxes into a database this includes general demographic information presenting problems interventions provided referrals and recommendations as well as patient engagement and willingness to follow up all protected health information phis is handled in a compliance in compliance with hipaa rules and state confidentiality laws we have also set up a data exchange agreement with two substance use disorder treatment centers which allow those centers to report how many patients were successfully engaged and the length of their treatment episode the program itself does not require having such agreements but they do provide a significant benefit in that they allow us to better gauge how engaged our patients are following their ed visit the data exchange agreement and data collection is not does not directly impact the care of the patients but we found them to be valuable in helping us monitor program evaluation and quality improvement as well as identify gaps in care and inequities next slide
thank you dr nasra and dr clark quickly recap the topics we've covered the bhao model is a strategy to address urgent needs and rural eds collaboration is key to planning and implementation bhao is an experienced decision maker who does not need to consult with a psychiatrist in most situations teamwork within and beyond the ed is integral professional development is built into the model and a process is in place for data collection and analysis next slide we'd like to do a brief poll to prepare prepare for the q a and seek your guidance about future work for our center please take a moment to answer this question before we move on feel free to type other topics into the q a box during the q a we'll also be posting a link to a survey in the chat box there will be an opportunity to complete that when exiting the webinar and we'll have a moment to take the take a look at the results from our poll i see a number p number of people are interested in collaboration between bhaos and sud treatment programs training for bhaos and other members of the ed team financial considerations and sustainability use of telehealth and qualifications or responsibilities of bhaos as well as recruitment and hiring and bha's role in naloxone training and distribution thank you very much for participating next slide
if you have questions please feel free to enter them in the q a box we'll try to cover as many as possible and if we aren't able to get to your question today we'll follow up i see one question esther um that asked how would i would like to know how these bhaos will do their best to be person-centered if i understand the question correctly i'll try to answer it here and maybe dr clark can follow up person-centered uh is a recovery concept and our bhaos are trained in that recovery model in that we attempt to introduce [Music]
cultural humility into that model we attempt to introduce peer advocates as you heard me talk earlier and obviously understanding the local culture and the type of individuals presenting to the ed so that we are responsive to their individual needs in a culturally sensitive manner is also key to being person centered in that context i hope i was able to answer the question in some way dr clark do you have anything to add i would support exactly what dr nasra was just saying i would also emphasize that this would come down to the portion of the training modules and figuring out exactly where are those key areas where our vhaos need further education and support there's a question whether the bhao screened for previous history of head injuries if so is there a certain screening tool that's a good question um given the setting where this evaluation is happening i would answer by saying that we do not have a screening for head injury as part of the bhao model itself however patients who present to the ed have a medical screening that happens and if there is a head injury or a history of that that information would be communicated to the bhao but no there is no screening that happens systematically around head injuries that is a good point though and i will consider researching this and and whether we should add that into our screening model see we have a question about whether it's required to become a peer recovery coach to be a behavioral health assessment officer the answer to that question is no those are two separate roles the behavioral health assessment officer as you heard from dr clark and myself are licensed mental health providers they are professional clinical providers as opposed to the peer recovery support who are certified to be peer recovery coaches so if that's the question are we are we using certified peer recovery coaches the answer is yes um we are using uh recovery coaches that are certified by local agencies so they these are lay health workers typically individuals who have lived experience whether in terms of substance use or mental health concerns and they go through a training process and a certification process to become peer support coaches see we have a question about training for the bhaos what are the components of the training who provides the training how long does it take so the training for the behavioral health assessment officers again uh remember that those are licensed mental health and substance use disorder professionals and the additional training happened over two days uh provided by the um individuals or professionals from our recovery center at the university of rochester we held a um we we held like a retreat if you want and um there were multiple lectures there was a curriculum and i'm not sure esther can tell me if that curriculum is listed on the website or not but there was a curriculum that was provided to them as a formal training in addition to that there are the as part of the training is the weekly huddles that are that happen with us where questions and case discussions happen we are at this point because the training has occurred the the uh training uh through the um um retreat happened around about a year ago now we are now in conversation about holding a refresher course at this time and our skills checklist will include information about trainings that are recommended for bhaos [Music]
dr clark would you like to provide any examples of training that has sort of been ongoing in the course of huddles i know that they're often used for supplementing the initial training so based off of our bhao feedback we had a discussion about having formal didactics during those titles however they voiced that they preferred on the spot in the moment training in education through their case presentation with me over the phone so the bulk of our education takes place when they are calling me presenting a patient case and we discuss appropriate treatment options appropriate disposition plans pinpoint areas where they might ask questions about the safety the diagnostic disposition everything like that so i would highlight that we really emphasize that the education piece of this be flexible and really molding that based off of the feedback that you get from your bhaos in addition i can say that we also have had some presentations from our our local substance use treatment centers in the area and our bheos have also found that very useful having somebody coming in and just presenting exactly what they have to offer for their patients and educating them on the peer specialists that they have to offer as well we have a question about medications for opioid use disorder based on assessment and if appropriate are moud typically prescribed in the ed if the patient accepts referral for ongoing outpatient treatment currently part of our model is allowing access to suboxone so that is one treatment store that is open for our patients through this model currently i don't know if dr nazra has anything else to add to that that is correct uh dr clark so yes suboxone is initiated in the ed and that is uh part of the model that was uh different as we implemented the bhao model previously suboxone would not be initiated in the ed in this current model the ed providers have been trained and accepted the workflow where medication assisted treatment in the ed could be started with the understanding and with the collaboration with substance use disorder facilities that as we start this medication in the ed uh a linkage can be done with a substance use provider uh in the community and the ed would serve as that bridge so that there is no weight to starting the medication in addition to that and that's something that the clark mentioned in her presentation in addition to that naloxone kits are also provided to patients and families when when appropriate thank you both we have another question that asks what has the reaction to the bhao's been by the ed providers and the healthcare community at large i've only heard positive things from our emergency departments and in fact we actually hear from them pretty frequently if one of our bhaos are going to be out because they've learned how how big of a resource this has been and how heavily they rely on our vhos and their emergency rooms so i see nothing but positive feedback from them i would echo that as well this has been this has been a very valuable addition to the team um and uh the bhao's as dr clark is saying um if they happen to be off on a certain day um the the uh it is a no it is noticeable by the ed providers in fact as i mentioned uh one uh hospital leader was uh reminding us of how crucial this resource has been to their hospital and the community in their area um pastor is okay if i pull out one of the questions here oh of course so i see the question asking does the vhao work with individuals who are psychotic heavily intoxicated and or suicidal until the patient can be stabilized and or transferred to a quote unquote safe environment the answer is yes so because of their their training and their background in mental health and substance use that our bhaos are trained specifically to work in these types of environments and to help the ed staff manage patients who are psychotic heavily intoxicated suicidal any acute psychiatric need so they do help to provide initial assessments help to provide recommendations for the ed staff and help determine exactly what that patient needs whether it is additional time to let them stabilize and metabolize out whatever they they have in their system or transferring them immediately to a psychiatric center i see a question uh since the ed is a 24 hour 365 day service how is this position generally scheduled with the team to provide these services that's a good question and that's been a um something that we have been struggling with in implementing this model of care the ed is a 24 7 service the bhaos in our model currently work five days a week normal hours some hospitals have flexed those hours so they have decided because of the volume of patients coming to their eds they have decided to shift the bhao hours for example on certain days from 3 p.m
to 11 p.m for example and other days from nine to five for example beyond that we have not implemented implemented 24 7 coverage for the bhao however as you heard us say the triage process in the ed continues whether the bhao is there or not so what we're trying to do at this point is develop workflows that continue to be in place whether the bhao is there or not we are hoping that through um implementing those workflows we are able to change the culture and the ed enough where some staff whether they are the nurses or the providers in the ed can pick up some of the responsibilities of the bhaos when they are absent uh i cannot say that we are there at this point but this is the um idea moving forward is to develop a um a practice change in that environment enough to cover for the absent bhl other ideas also was to consider developing a pool of bhaos for multiple hospitals that can flex their times and be able in the future to provide additional hours for coverage okay see a question here about will there be future trainings for vulnerable groups such as aaa and the lgbtq community so again i would like to go back to that flexibility when it comes to training i think that we've been very fortunate where we've had some very strong vhaos who have pretty high confidence in the diversity of patients that they've worked with and their comfort working with a wide range of patients however this is something that is very important to consider for future trainings and the training that we had in the topics we covered is just meant to be a guideline for additional models that certainly depending on the population that you're serving the types of patients that are commonly coming into your ed that can help shape the training that you are providing for your bhaos as well as any areas that they feel they might be weak in you could help kind of bolster them question uh do you have any outcomes to share as far as reduction in readmissions or total cost of care from the rochester pilot this is information that we are still collecting we do have one published article on impact of the bhao model in terms of readmission and i'm going to turn again to esther and check and see if that article is published on the website if not then we can share that with you that will be available through the reference link on our on our slides another question asks what are the main challenges that you faced in implementing the model i think one of the challenges i'd like to highlight is education with the ed staff and the providers that it's important for them to understand what the bhao roles are what the limitations are exactly what to expect and how to best utilize them that that's certainly a trial and error thing on our end another uh another challenge has been staffing and recruitment as you can imagine finding bhaos to serve local communities in rural and remote areas is challenging so that was another uh thing to highlight here do you know what the presence of bhao's is nationwide and what kind of um you know or any feedback that you've received about the model thus far i'm not i'm not aware of uh i'm not familiar with the numbers of uh programs nationwide um it's a good question that um deserves a little bit more research before we can answer that so i don't give you the wrong numbers here i have not researched it on a nationwide level now okay and we'll certainly follow up i think we have time for one more question um how has covid19 impacted this model i mean since we're working in ev environments i mean our eds have not stopped working throughout this entire pandemic so it has certainly not affected our access to patients through that means and luckily since our education and supervision is being performed through remote consultation remote encounters it hasn't limited the bhao's access to myself or to any of our other providers in the area the other way uh covet has impacted this initiative is limiting our ability to meet face to face with the bhaos for for training or for huddles the other impact also has been as you heard us talk about the increase in ed visits um throughout the um the covet crisis patients have been holding back on accessing care which also means that certain conditions become more urgent and serious and ed visits have increased in the process as well whether it's because of uh increase in overdoses suicide thoughts intimate partner violence or other so our bhaos have been quite busy as dr clark was saying throughout this crisis uh otherwise we're still collecting the data to answer those questions at this point as well well i see we're approaching time um thank you dr clark and dr nazra and thank you for your questions uh we'll be be sure to follow up and please we we welcome your questions uh through our technical assistance center or um by email thank you for participating in today's webinar we hope you'll take a moment upon exiting to answer the survey which will also be in the chat a recording in slides including a reference list that will follow this slide and a toolkit will be available on our website recoverycenterofexcellence.org
and please do keep in mind that our technical assistance center is available to answer questions and to help with this and other practices we're so glad you could join us and wish you a great rest of your day thank you
Please take a moment to complete a brief survey about this webinar to help us improve our future resources.
The Behavioral Health Assessment Officer (BHAO) model is a strategy to increase mental health and substance use disorder (SUD) resources in rural emergency departments (EDs). A BHAO is a licensed behavioral health provider who practices in a rural ED. Typically, this provider is a licensed clinical social worker (LCSW), licensed mental health counselor (LMHC), or licensed marriage and family therapist (LMFT). The BHAO evaluates patients identified at screening to have behavioral health concerns and manages their care.
As appropriate, the BHAO provides naloxone kits and training and makes referrals to treatment programs for individuals with SUD who are ready, willing, and able to accept the referral. To connect patients with community resources effectively, the BHAO builds relationships with treatment organizations and other local service providers. Attentive to the needs of the unique rural community they serve, BHAOs listen to community voices, understand local strengths and barriers, and navigate resources with skill.
Through this role, a rural hospital can increase its mental health and SUD resources without having a psychiatrist onsite. BHAOs manage most of their caseload without needing to consult with a psychiatrist. In cases of higher complexity, BHAOs have a provider-to-provider telehealth consultation with a psychiatrist at a hub location outside the immediate area. If needed, the psychiatrist may then have a video visit with the patient and provide a second opinion.
In this model, telehealth is also used to build a community of behavioral health professionals in rural areas. BHAOs at different hospitals and the psychiatrist they consult with gather for regular huddles to learn from one another. These huddles, often held via videoconferencing, offer both educational opportunities and a professional network that doesn’t rely on travel.