Recommendation 2, Strategy 3:
Increase Functional Bed Capacity – Partnerships

Strategy 3: Engage academic and service area experts to optimize efficient, evidence-based treatment in ASH that facilitates recovery in order to support smooth transitions to care in the least restrictive environment necessary, thereby returning people to their community. 

• Develop best evidence care models to optimize person-centered recovery plans that provide intentional and meaningful transitions through increasingly less restrictive settings;

• Implement these models within ASH and the service area to optimize health
  and well-being; and

• Train future clinicians within the state hospital system to attract more
  high-quality practitioners into public mental health.

The final strategy to increase functional bed capacity of the new ASH builds from previous recommendations to partner with academic entities. The initial ASH Redesign report recommended developing a plan to transfer management of some ASH operations to an academic partner. The ASH Redesign will continue to develop plans for ongoing meaningful academic and service area partnerships particularly focused on developing and implementing more efficient evidence-based practices using person-centered care models to facilitate recovery for individuals treated at the new ASH.

Academic Partnerships

Academic partnerships provide expertise to increase the workforce in the mental health system and provide the latest evidence-based practices for optimal person-centered care. In order to improve quality of care, the psychiatric workforce first must be expanded and the quality of the workforce improved through these key collaborations. There are several existing successful partnerships between academic psychiatry departments and state mental health systems around the nation including in New York (Columbia University), Georgia (Emory), Ohio (multiple institutions; e.g., Case Western Reserve University, The Ohio State and the University of Cincinnati), and Virginia (University of Virginia) (Ranz et al, 2008). In Texas, HHSC has established academic partnerships throughout the state. Examples of these current academic partnerships include:

• Operational management of the Harris County Psychiatric Center and the new UT Health Behavioral Sciences Center developed through partnership between local and/or state government and the University of Texas Health Science Center at Houston;

• Partnership at San Antonio State Hospital with the University of Texas Health Science Center at San Antonio to complete the SASH Redesign;

• Management of a long-term psychiatric unit in Tyler in partnership with UT Tyler;

• Clinical staffing from Texas Tech Health Science Center at the state hospital in El Paso;

• And multiple residency programs and faculty-led programs affiliated with academic partners located in and funded by state hospitals at Rusk, Terrell, and Big Spring as well as LMHAs in the ASH region. These residency programs are specifically designed to attract psychiatrists into the state hospital system to improve the quality and quantity of the medical workforce using university affiliations to recruit good trainees.

Public-academic partnerships are not a new concept between the University of Texas at Austin or the State of Texas; however, there is no coordinated effort to collaborate between ASH and the multiple related schools, colleges, and departments across the University of Texas at Austin. In addition to training psychiatrists, training other members of the care team would provide the best care and further expand the public mental health workforce. Educational programs developed in conjunction with affiliated universities provide opportunities to train nurses, social workers, psychologists, pharmacists and others to enhance the overall public mental health workforce. University affiliations also embrace innovation to study, develop and implement state-of-the-art mental health practices.

Academic psychiatry departments consistently report the benefits that a state hospital learning experience provides to their trainees; however, many note the distance between the university and the state hospital is a disincentive (Talbott, et al, 2010; Faulkner et al, 1983; Douglas et al, 1994). Located only 2 miles from the main UT campus and UT health district, the ASH provides a unique and optimal location for ongoing and additional interdisciplinary academic/public collaborations with Dell Med, UT Steve Hicks School of Social Work, College of Nursing, College of Pharmacy, and Departments of Psychology and Educational Psychology. Strengthening partnerships between ASH and UT could:

• Create a collaborative, multi-disciplinary, public-academic partnership to
  improve training, program innovation, and quality of mental healthcare within
  the ASH service area.

• Build from the collaboration between Dell Med’s Department of Psychiatry and Behavioral Sciences and the interprofessional practice training programs within UT to increase internship placements at ASH for students from the University of Texas’ Steve Hicks School of Social Work, College of Nursing, College of Pharmacy, and Departments of Psychology.

ASH and Dell Med’s Department of Psychiatry and Behavioral Sciences will continue to collaborate with the University of Texas’ Steve Hicks School of Social Work’s Texas Institute of Excellence in Mental Health (Texas’ center of excellence for evidence-based practice) to increase training, technical assistance, and evaluation of mental health evidence-based practice implementation throughout the region (Svendsen et al, 2005). A key to effective evidence-based practice implementation is on-going technical assistance, fidelity monitoring, and evaluation (Bond, et al, 2020; Aarons, et al, 2012; Bruns, et al, 2008).

Service Area Expert Partnerships

In addition to academic partnerships, collaborations with service area experts outside academia can help optimize the efficiency of the new ASH. An academic partner can support improving hospital operations, and by also working with external community partners can improve the care continuum. Academic partners can provide a critical bridge among the various components of public mental healthcare that often unfortunately work in silos.

Table 5 presents examples of service area experts with whom to collaborate in the care continuum. The previously mentioned CCBHC is specifically designed to integrate these various partners, serving as an example of one approach. Another example of service area partnerships is joining primary and mental health care providers to care for the whole person, which is accomplished through collaboration between Federally Qualified Health Centers (FQHC) with mental health providers and/or clinics. FQHCs are community-based primary care clinics that provide services to underserved communities, mental health services being a part of their care; however not all FQHCs are staffed for intensive or crisis mental health needs (Kaliebe, 2016). Therefore, some FQHCs have partnered with mental health clinics to provide this service. In a study of the rationale to increase mental health care within an FQHC, it was found that collaborative care can improve mental health care and increase access for specialty care for a community (Kaliebe, 2016). Establishing partnerships for a full continuum of care will remain a strategy to create an efficient system.

Partner Progress at ASH

In the 86th Legislative Session, Senate Bill (SB) 2111 required HHSC to establish a transition plan of some ASH operations to a contracted academic partner. HHSC worked with Dell Medical School to respond to the bill within the already established partnership for the ASH Redesign efforts. In response to SB2111, HHSC and Dell Med are working to create an academic unit at ASH. The academic unit will support training physicians, designing and testing new models of care and providing opportunity for clinical and health service quality improvement. New York and Ohio reported an infusion of qualified psychiatrists into their public system through similar initiatives (Ranz et al, 2008; Svendsen et al, 2005). We currently are planning to open the academic unit with the new hospital, but it may be established earlier within the current ASH if possible. Other developing partnerships between ASH and Dell Med’s Department of Psychiatry and Behavioral Sciences include increasing residency slots to expand recruitment of new medical professionals into public mental health and perhaps the forensic population. Additionally, Dell Med will lead an advisory board focused on developing metrics that specifically meet improved care and hospital efficiency goals and then provide the analytic support to evaluate those metrics and use them to drive improvement throughout the service area.

Person-Centered Care

Support from partnerships with universities and expert service providers will expand the professional workforce and create systems, structures and processes that promote person-centered recovery. Currently, structural and process barriers prevent individuals from moving through the proper levels of care as discussed throughout this document. Through better coordination across systems and organizations, leveraging information technology, and listening to patients and families, individuals will be served at an optimum level of care.

Strengths-based, mental health practice seeks to explore and emphasize the strengths and resources of individuals and their environments to help them to achieve their goals (Saleebey, 2002). While there are a number of functional and cognitive challenges, extensive research of mental health services has demonstrated that effective supports allow most individuals with mental illnesses to live independently even with these often life-long recurrent and chronic health conditions (Rog et al, 2014). In Texas, we over-emphasize state hospital care without building sufficient community supports. Through a multi-system collaboration in the continuum we will aim to improve our public psychiatry workforce and focus on a person-centered approach to providing care in the lease restrictive setting.