Glenda Wrenn

Community Engaged Leadership to Advance Health Equity and Build Healthier Communities

Health is a human right. Equity in health implies that ideally everyone should have a fair opportunity to attain their full health potential and, more pragmatically, that no one should be disadvantaged from achieving this potential. Addressing the multi-faceted health needs of ethnically and culturally diverse individuals in the United States is a complex issue that requires inventive strategies to reduce risk factors and buttress protective factors to promote greater well-being among individuals, families, and communities. With growing diversity concerning various ethnicities and nationalities; and with significant changes in the constellation of multiple of risk factors that can influence health outcomes, it is imperative that we delineate strategic efforts that encourage better access to primary care, focused community-based programs, multi-disciplinary clinical and translational research methodologies, and health policy advocacy initiatives that may improve individuals’ longevity and quality of life.

Measurement-Based Care

Children with mental health and substance use disorders treated in routine care experience worse outcomes than patients enrolled in clinical trials that have demonstrated the effectiveness of evidence-based treatments. This wide gap between routine outcomes and optimal outcomes spans across a wide range of patient populations and clinical treatment settings. One of the contributors to poor outcomes in routine care is that providers do not regularly use symptom rating scales in behavioral health to determine quantitatively whether their patients are improving. Almost all randomized controlled trials with frequent and timely feedback of diagnostic-specific, patient-reported symptom severity to the provider during the clinical encounter found that outcomes were significantly improved compared to usual care across a wide variety of mental health and behavioral disorders. All pediatric and behavioral healthcare providers treating children with mental health and substance use disorders should implement a system whereby patients’ routinely complete measurement-based care (MBC) validated symptom rating scales that are reviewed by clinicians during encounters. MBC will help pediatric providers determine whether treatment is working or if there is a need to facilitate treatment augmentation, consultations, or referrals for higher-intensity services when patients are not improving.

Improving Quality of Emergency Care Through Integration of Mental Health

The goal of this study was to better integrate emergency medical and psychiatric care at a large urban public hospital, identify impact on quality improvement metrics, and reduce healthcare cost. A psychiatric fast track service was implemented as a quality improvement initiative. Data on disposition from the emergency department from January 2011 to May 2012 for patients impacted by the pilot were analyzed. 4329 patients from January 2011 to August 2011 (pre-intervention) were compared with 4867 patients from September 2011 to May 2012 (intervention). There was a trend of decline on overall quality metrics of time to triage and time from disposition to discharge. The trend analysis of the psychiatric length of stay and use of restraints showed significant reductions. Integrated emergency care models are evidence-based approach to ensuring that patients with mental health needs receive proper and efficient treatment. Results suggest that this may also improve overall emergency department’s throughput.

Using a self-service kiosk to identify behavioural health needs in a primary care clinic serving an urban, underserved population

Background Integration of behavioural health into primary care clinics is an established model of care and important approach to eliminating mental health disparities, but demands on provider time is a barrier to mental health screening. The purpose of this study was to determine the feasibility of using a kiosk placed in a primary care clinic to screen for multiple mental health disorders. Methods Quality improvement initiative with Plan-Do-Study-Act implementation and time series monitoring of utilisation outcomes. Results A total of 281 screens were completed identifying positive screens for depression (30%) and bipolar disorder (17%). Post-traumatic stress disorder and concerning substance use were less common. Conclusions Development of health information technology to facilitate behavioural health assessment in primary care is a promising approach to integrated care and provides additional benefits of population health monitoring.

Academic Psychiatry Elective: Mentored Academic Leadership Development for Medical Students

Developing future leaders in academic psychiatry requires early engagement in the process of career identity development process. Increasing diversity within psychiatry and recruiting top-tier students into careers in psychiatry are additional needs. Several studies have cited elective experiences as important to recruitment into psychiatry as a specialty [1]. For many medical students, the clerkship experience does not provide sufficient exposure to the diversity of academic career paths available within psychiatry. Educational research and clinical teaching excellence are the foundation of a successful clinician-educator career track, but with a few exceptions, development of academic electives is not represented adequately in the literature [2]. To address these recruitment and career development needs, we designed an elective to expose students to the career path of academic psychiatry via mentored research experience, didactic activities, career development, and exposure to innovative academic clinical services. In this report, we describe the educational components, present results from the first cohort of medical students, and discuss implications for medical student education innovation.