Population Health

Responding to a Community Mental Health Crisis

Board’s pursuit of innovative partnerships increases services

By Jeffrey A. Wothers

Viewpoint

Carroll Hospital, located in Carroll County, Maryland, is the only hospital in a county of nearly 180,000 citizens. Everyone at the hospital — from doctors and nurses to senior leaders and support team members — takes pride in caring for their friends, family and neighbors.

Sixty years ago, a small group of Carroll County citizens gathered and began fundraising for the hospital. Today, that same level of community engagement is evident by how so many individuals in the county are willing to give freely and take leadership roles in the organization.

What every board member understands is that when it comes down to it, we are a community hospital and we answer to the community. Understanding the needs of the individuals we serve is paramount to fulfilling our mission of being the heart of health care in our communities.

Addressing a Behavioral Health Epidemic

That’s why when many board members began hearing about, or in many cases experiencing firsthand, the frustrations families were having in accessing care for substance use disorders for loved ones, they wanted to know more. How could we improve access? What resources do we already provide, and what additional services could we add?

As the opioid crisis worsened, board members were educated by Leslie Simmons, R.N., FACHE, then-president of Carroll Hospital and now chief operating officer and executive vice president of LifeBridge Health, of which Carroll Hospital is a subsidiary. Simmons emphasized that it is more than a substance use issue — it is actually part of a larger behavioral health epidemic.

“The staff, especially in our emergency department, see firsthand almost every day, the challenges that individuals and family members face when dealing with substance abuse or mental health conditions, and how they are often co-occurring diagnoses,” Simmons said. “We cannot treat one without addressing the other.”

Simmons and other hospital leaders are members of several communitywide committees to coordinate efforts in addressing the opioid crisis.

“We are extremely fortunate to have amazing community partners who stay in good communication and work well together,” Simmons noted. “Carroll County is often recognized as a model in coordinated community health initiatives due to the rapport between Carroll Hospital and the Carroll County Health Department, as well as our working relationships with other agencies,” she added.

Identifying the Need

The need for better coordinated behavioral health services was not new to the hospital or the community. To ensure patients have access to the most appropriate care, the hospital partners with local and state agencies that leverage available community resources in concert with the hospital’s behavioral health services. The collaboration provides numerous resources aimed at helping patients better manage their health. Social workers and case managers working together as a rapid response team are stationed in the emergency department (ED) and complete assessments to determine if patients are eligible for alternatives to inpatient care. Then the team steers those patients to more appropriate community-based agencies.

One of the hospital’s community partners, Access Carroll, provides integrated health care services for low-income residents in the county. Founded by Carroll Hospital and the Carroll County Health Department, Access Carroll opened its doors to patients in January 2005. Since then, what began as a primary care practice has expanded to offer dental care, care navigation and behavioral health services.

Access Carroll offers several behavioral health programs including a five-day ambulatory detox program. The hospital’s ED is in regular communication with Access Carroll staff and refers patients who are ready to enter an ambulatory detox program for assessment.

As the need for treatment for substance use disorders grew, the hospital identified several barriers to accessing treatment:

• Delay in patients starting a detox program. Access Carroll’s detox program required five consecutive days of treatment, beginning on a Monday. If individuals were referred on a Tuesday, they would not be able to begin the detox until the following Monday.
• Lack of insurance or inability to pay for outpatient treatment for substance use disorders.
• Gaps in connecting patients to an outpatient program. Such gaps could mean a patient would not follow through on treatment.

The community needed access to these vital services seven days a week, regardless of an individual’s ability to pay.

Opening the Door to Resources

The Carroll Hospital board of trustees decided to increase the hospital’s support of Access Carroll so it could expand services. The hospital, through a wholly owned philanthropic entity, the Carroll Hospital Foundation, pledged more than $3 million to help stabilize operations and to fund Access Carroll staff, 24/7 behavioral health services, medical and dental care, and hospital resources, as well as free diagnostic and lab services.

Access Carroll serves the most at-risk individuals in the community and treats the whole person. If patients are in a detox program, they also have access to an intensive outpatient behavioral health program, dental services and primary care. All of these services begin immediately, regardless of a patient’s ability to pay. Social workers and health navigators help patients enroll in insurance, help them with housing applications and provide assistance with anything else that falls under social determinants of health.

All of these programs happen under one roof, which allows for what Access Carroll’s executive director Tammy Black calls a “hot handoff.”

“One of the benefits of having truly integrated services is that if we are seeing a patient for detox services and they need dental care, we walk them down the hall to the dental suite,” Black said. “If you send someone across the street for a service, you could lose them.”

The financial support from the hospital allowed Access Carroll to expand the intake for the ambulatory detox program. Now if someone is referred, they can begin the consecutive treatment any day of the week. They no longer need to wait until a Monday.

“We offer seven-day-a-week assessments and intake, which is only possible when you have staff,” Black explained. “The hospital has a very pioneering spirit in that they understand the needs that we present and our ideas, and they are willing to let us try it.”

In fiscal year 2019, Access Carroll had 6,991 behavioral health services encounters, and the number increased the following year by 33% (so 9,317 in fiscal year 2020). Outcomes have been promising. Many patients go on to enter successful long-term treatment programs.

Partnering for a Shared Purpose

The governance structure at Carroll Hospital is designed so that the chair of the hospital board of directors also sits on the Carroll Hospital Foundation board of trustees and vice versa.

This cooperative structure allows for better communication toward the boards’ common goal of supporting the hospital’s strategic plan, according to Ellen Finnerty Myers, chief development officer at Carroll Hospital.

“The foundation is raising funds and focusing on the strategic needs of the hospital, and the hospital is partnering with the foundation early so the board and staff can plan and commit resources to fund needs through philanthropy,” Myers said. “It is a beautiful, symbiotic relationship that requires excellent and early communication.”

Carroll Hospital became a subsidiary of LifeBridge Health in 2015. Both of our organizations had a shared purpose of caring for our communities. The partnership ensured that Carroll County residents would continue to have access to high-quality health care close to home. LifeBridge Health also supports the mission-driven services and initiatives that are important to our community.

It’s incredible to be part of a team that is so focused and that functions at such a high level across a broad spectrum of boards and committees. At Carroll Hospital, there’s a culture of accountability that goes throughout the whole organization and to the community we serve. It’s been revealing, rewarding and reassuring to know our community is in such capable hands.

Jeffrey A. Wothers (jawothers@nilesbarton.com) is an attorney and the immediate past chair of the Carroll Hospital board of directors.

Please note that the views of the authors do not always reflect the views of the AHA.