Genoa Pharmacy: A&C’s Partner in Meds
Walking into the little pharmacy operating out of our 8320 Madison Avenue location, you immediately feel a shift in the workday tempo. This team is a hive mind, buzzing around the office in a way that seems chaotic at first, but settle in and there’s a rhythm, ticked off by the clatter of pills into plastic cups and the ring of telephones, the constant communication that flows from one person to the next to the next. When Genoa first partnered with A&C almost exactly ten years ago, they were a modest company, but today they’ve grown to 400 pharmacies in 44 different states with a thriving telepsychiatry business to top it off. Talking with Pharmacist Brad Goedeker about how Genoa’s growth alongside Adult and Child, you get the sense that this team leads with heart. That their clients are what matters most to them. He speaks passionately about their mission to innovate new ways to serve A&C’s unique client base. They pack months worth of meds into med tubs for people with limited mobility or transportation, they use A&C’s courier service and often ship meds to clients’ front doors, they synchronize meds: grouping pills by day in dated, small packs bound into long ribbons. They will sometimes help clients enroll for insurance and/or act as a client’s advocate in med-related insurance matters. “Anything extra we can do to make sure they don’t miss something. We’re constantly trying to think of new ways to achieve that,” said Brad. “It’s like, if you can come up with it, we’ll put it together if we can create better positive attitudes and have folks think highly of us.” “We’re always trying to avoid anybody having to change their regimen because whatever drug becomes unavailable. It happened this week with Invega brand name tablets, we identified that we had one client that has to take brand Invega, six milligrams, because his insurance prefers brand versus generic. Well, it’s not available now for three weeks, you can’t get it. Well, I was able to secure that from a Genoa pharmacy in Illinois that did not need it, and we had them ship it directly to us from their supply. So, this client is not going to miss a dose and he doesn’t have to change his meds. So, that’s a big win. We pride ourselves on that kind of stuff.” In this way, they seem like the perfect partner for A&C, always innovating & collaborating, asking what more they can do to serve the client in front of them.
Adult & Child Health Services Awarded Federal Qualified Health Center Look Alike Status
Adult and Child Health of central Indiana has announced an award from the United States Department of Health and Human Services. Adult and Child Health’s primary care clinics have received designation as a Federal Qualified Health Center (FQHC) Look A Like program. Under the Health Resources and Services Administration (HRSA), federally designated health centers ensure access to health care for underserved communities and vulnerable populations, regardless of a patient‘s ability to pay. A long-term provider of mental health, addictions, and child welfare services, Adult and Child is a newcomer to primary care services. Achieving federal designation for primary care allows Adult and Child to better serve the needs of communities by joining primary care, mental health, and addictions services into a single integrated healthcare model. With two designated primary care sites in Indianapolis and Franklin, and a primary care collaboration with Jane Pauley Community Health in Greenwood, Adult and Child Health has three federally qualified community health centers operating in the Indianapolis region. “Healthcare can no longer afford fragmented and separate physical and behavioral health treatment.” said Allen Brown, CEO. “Our patients’ physical and mental health certainly aren’t separated. Adding primary care and enhanced funding through federal designation means A&C will have a sustainable model for unified, comprehensive, whole health services.” Through existing Community Mental Health Center and Licensed Child Placement Agency services, Adult and Child’s mental health, addictions and child welfare programs serve 11,000 unique patients per year, but many of those persons face difficulties accessing primary care. After implementing primary care services in early 2017, Adult and Child provided over 4,500 medical visits to medically underserved individuals. At the Indianapolis community health clinic on Ohio Street, Director of Adult Psychiatry Dr. Christine Negendank sees firsthand the benefits of integrating primary and psychiatric care. “At the downtown clinic we often see patients impacted by mental illness, poverty, substance dependence, and homelessness” said Dr. Negendank. “Our patients typically also have significant physical health issues, but referring these high needs patients to outside clinics presents barriers to optimal care. Having psychiatry and primary care working side-by-side increases access to both systems and provides better outcomes for our patients.” For further information about Adult and Child services please contact Dan Arens, Chief Strategy Officer at [email protected] or 877.882.5122.
Spotlight on: Therapeutic Foster Care
In the wide scope of Adult and Child, at times it can seem that the Therapeutic Foster Care team exists its own bubble. The team has a separate brand and a separate website and answers to an outside entity (DCS). But in reality, foster care is deeply intertwined with several other service lines, from home-based services working with biological families to primary care looking after children’s medical needs. Housed on the seventh floor of 603 E Washington St, the TFC team is fortunate to have such easy access to various other A&C service lines. In Indianapolis, there are around eight foster care agencies, but Adult & Child is the most comprehensive. “Most agencies have to refer out for services, but A&C can literally take care of all that under the same roof,” said Alicia Harding, a TFC team leader. This type of open communication is often a resource for getting quick answers to questions or being able to streamline care for children with trauma and/or other health problems. The integrated care aspect and novelty of child therapy can be a draw for prospective foster parents looking for a support system when embracing such a challenging role. TFC is always working to keep its foster parents afloat in uncertain waters. “As an agency we really are striving to support and work with foster parents in an ongoing process, to work hand in hand for the benefit of the child,” said Amanda Vipperman, licensing specialist and team leader. Amanda also keeps track of much of the data on how many foster parents are coming into the agency. Currently, there is an average of 10 new inquiries a month from prospective foster parents and an average of two certifications per month. Alicia Harding commented on the disparity of these numbers: “It is a long process and it feels very invasive at times… You do feel vulnerable throughout the process and I don’t think a lot of people like to feel vulnerable.” In this process, foster parents must go through background checks and be prepared to discuss in great detail: their finances, their home life, their relationship, etc. It also takes a lot of effort and time to become a licensed foster parent. The entire paperwork and interviewing process alone takes roughly 20 hours. But at its heart, all these hurdles are in place to make absolutely sure that the home is a stable and safe environment for children. Through the process, the TFC team tries very hard to make sure prospective foster parents feel comfortable and supported in an attempt to keep them moving toward their goal. “There is a huge, huge need for foster parents right now for kids in our community,” said team leader Jodi Kelley, referencing the fact that there are currently more foster kids than there are homes to put them in. There has been a push from the agency to spread this message and to encourage people in the community to reach out for more information if they have ever considered fostering. Being a foster parent can be a wonderful and life-enriching experience for many, but there are darker realities that prospective parents should prepare for when looking into the process. Many people come to fostering with the desire to give back and help a child, “but what they don’t realize is that it takes a lot of working with what feels like a broken system,” said Alicia. “And it’s never going to be a perfect system when you take a child and traumatize them further by removing them from the only home they know.” She noted that to make the best of it and stay positive, foster parents must also practice self-care and to not take themselves too seriously. She notes that foster care looks different for everyone and it’s so important to be adaptable. “It’s hitting a moving target always, but it can definitely be done.” More info on A&C’s foster care program at indyfostercare.org.
Zero Suicide: A New Focus on Prevention
“[My client] is classified at A&C as a “high risk.” He’s expressed suicidal thoughts and suffers from traumatic brain injuries, debilitating spinal pain, and other serious conditions.” “A client was initially seen for an intake by the Neighborhood Team, endorsing [suicidal] ideation without intent. The team worked collaboratively to develop a safety plan, CALM, and provided relevant psycho-educational materials in the respective language. The client left the appointment, but later felt triggered, and decided to return to A&C downtown clinic.” These are quotes from employees of A&C. So many of us work with clients every day who have struggled with thoughts and plans of suicide. Unfortunately, this is common in the world of behavioral health. Mental illness is the driving force of almost every suicide, and any agency worth its salt is going to screen all clients for this risk. But is that enough? Indiana is far above the national average in suicide attempt and completion rates. It is the 2nd leading cause of death for people ages 15-34. The state has the nation’s highest rate of students who have contemplated suicide at 19% and the 2nd highest rate of attempts at 11%. With numbers like this, it feels crucial to take a look at our methods for detecting suicide risk and ask ourselves how we can do better. Enter Zero Suicide. Developed by the Suicide Prevention Resource Center, it’s a model of care meant to bolster the effectiveness of an agency’s suicide prevention plan. A&C was introduced to this model through a learning community where different organizations across the country share and discuss ways to improve practices. The Substance Abuse and Mental Health Services Administration (SAMHSA) chose to fund Zero Suicide implementation for a few learning community participants, and A&C was selected. “It was a natural fit,” said Matt Oliver, A&C’s Chief Clinical and Informatics Officer and chair of the Zero Suicide Committee. He and the nine other members of the ZS Committee have now worked for over a year on implementation. While a year sounds like a long time, this effort is organization-wide, meaning that every one of the 700+ Adult & Child employees must be trained. September has been the month of ZS training. Employees who work one-on-one with clients in the clinics, in therapy sessions, skills sessions, etc. have completed classroom trainings. Anyone working behind the scenes has taken an online training course. Staff members are trained to look for indicators of a potentially suicidal person and then taught what questions to ask to determine risk. “We don’t want people to slip through the cracks,” said Matt. If someone expresses suicidal intent, they are placed on the ZS Pathway, a process taught to direct care staff during classroom trainings. The Pathway is designed to fortify clients with several different levels of support including weekly check-ins from A&C’s Crisis Team, enrollment in therapy, and creation of a Safety Plan providing steps to take when experiencing suicidal thoughts. Even after clients improve and are removed from the Pathway, they are still working with primary care providers and receiving supplemental support from the Crisis team. Equally important to adopting the Pathway model is shifting A&C culture around the topic of suicide prevention. Part of adopting ZS into an organization is for employees to understand that every suicide is preventable and that prevention is part of everyone’s job. Teaching staff how to detect and offer help to those struggling with suicidal thoughts is important to build up confidence around the topic. A staff confident in their prevention knowledge and plan of action is what success in ZS looks like. With suicide being such a large problem in young people, A&C’s ZS push will involve more emphasis placed on detecting risk in youth. Some may think that talking to kids and teenagers about suicide will introduce them to the idea, but this is a myth. With the statistics that we have, it’s the reality of teenagers’ lives to experience thoughts of suicide. The majority already have passing thoughts about it from time to time. For many it’s not a serious issue, but for those who may be struggling, we never want to feel too squeamish to do a safety check-in. Matt Oliver says he hopes this effort will make a dent in the Indiana statistics. “We’d like suicide to be a never event,” he said. After all of the training wraps up at the end of September, the official date Zero Suicide goes into practice is October 1st. After that, it is to remain an ongoing standard within the A&C culture. The ZS model is the first formal Pathway the organization has adopted, and its success is likely to set the stage for other formal Pathways in the future.
