Our Vision for Growth
The Wellness Connection’s coordinated, seamless service plan is the largest collaborative effort we’ve seen in Pinellas County. Launched and operational, The Wellness Connection continues to expand, partnering with more organizations and stakeholders to better meet the needs of the community.
The Future of the Wellness Connection
The Wellness Connection model was conceived as both a physical and virtual site. The physical site is a welcoming, engaging, and supportive environment for adults seeking behavioral health support at all levels and includes 24-hour behavioral health information, screening and assessment capability, an access center, integrated acute care secure detox and crisis stabilization unit, a recovery room (23-hour hold), mobile crisis unit, and on-site community providers. The virtual site is accessible by phone, video conferencing, electronic chat support, and includes community-based kiosk sites embedded in community locations.
This project allows for screening and assessment at a variety of access points that would use standardized care pathways and placement criteria that are common among community providers. Using care path protocols removes variability in screening and assessments and leads to increased positive outcomes for people seeking services. The concept allows for timely access and transition to community providers that are supported by warm handoffs through peer support, care coordination and intensive case management based upon the need of each individual and their situation. The Wellness Connection concept also supports follow-up processes to ensure that individuals receive the community-based services they are seeking.
Comprehensive behavioral health services including crisis response, stabilization, treatment and recovery support services are crucial elements of public behavioral health systems. There is a considerable body of evidence suggesting that a comprehensive continuum of services can improve outcomes for individuals, reduce inpatient hospital stays and costs, and facilitate access to other necessary behavioral health services and supports. In many communities, crisis response services also perform important public health, public safety, and community well-being functions. The universal mental health screening for children by the Primary Care provider’s initiative in Pinellas County, along with other stigma reducing prevention efforts, will add to the volume of people seeking interventions for lower intensity services. However, this positive additional need will stretch system capacity.
The goal of the Centralized Receiving Service is to improve access to the most appropriate treatment resources and to decrease the utilization of hospital emergency departments, jails, prisons and homeless programs for behavioral health emergencies. Through improved coordination and engagement, the community will realize a seamless integrated behavioral health system, where individuals will receive appropriate, timely, and quality care. The 2015-2016 General Appropriations Act authorized the Department of Children and Families to implement a Special Proviso Project described as “… a statewide initiative to fund centralized receiving facilities designed for individuals needing evaluation or stabilization under section 394.463 or section 397.675, Florida Statutes, or crisis services as defined in subsections 394.67(17)-(18), Florida Statutes”.
Although Pinellas County was not able to participate in that specific project the PBHSOC supported this concept and has developed a foundation for a Pinellas Centralized Behavioral Health Receiving System, a physical and virtual solution entitled The Wellness Connection.
The Wellness Connection concept visualizes a Behavioral Health Center that is the gateway to every level of care and defined by three (3) tiers of entry; regardless of location to include primary care practices.
- Tier I: Routine Care – Same Day Access (Main Hub and Virtual Access)
- Tier II: Urgent Care – Voluntary 24/7 (Main Hub)
- Tier III: Emergent Care – Involuntary 24/7 (Main Hub)
An Overview of Services
Assessment and Intake Protocols
Upon admission to all Tiers, a uniform and standardized intake screening and a bio-psychosocial assessment obtains information regarding presenting problems and immediate needs. Each Tier of entry will vary in the screening tools and protocols offered. A few of the specific tools and protocols include:
- Standardized Clinical Bio-Psychosocial Assessment
- Trauma Exposure Screening
- Psychiatric Evaluation
- Review of Currently Prescribed Psychiatric Medications
- Risk of Harm Assessment
- ASAM Placement Criteria
- Multidimensional Quality of Life Questionnaire
- Social Determinants of Health Screening Tool
- Recovery Capital Screening Tool
- Financial Screening
- Medical Assessment/Physical
Clinical Care Pathways
Levels of Care have been developed and standardized through the expertise and knowledge of our behavioral health subject matter experts and review of the most current treatment literature. Using care pathway protocols removes variability and leads to increased positive outcomes with the core feature being enhanced engagement at every step of the process to ensure effective treatment. The stratification of risk is determined based upon the totality of the screenings, assessments, diagnosis, and symptomology, health status, and social determinants of health. The care pathways will be uniform among partners/community providers and will include screening and direct referral, suicide prevention, crisis unit discharge, detox discharge, mobile crisis services, and substance use interventions.
BH Emergent Care 24/7 (Main Hub) – Tier III
Serves as one of the communities designated receiving facilities for emergent involuntary commitments. Staffing designed to manage the behavioral health, medical and safety needs of these individuals as a single point of entry. Designed as a convenient point of entry into the behavioral health system for immediate assessment as well as subsequent referral and linkage to the appropriate level of care. Initiates stabilization/detoxification or step-down bed placement. Includes 23-hour hold and inpatient care coordination. Services available 24/7, 365 days per year, physician consult and immediate Medication Management for stabilization. Individuals assessed for care based on a triage model. Nursing assessments conducted for co-occurring medical conditions. Ability to zoom and/or have mobile communication between law enforcement and nursing staff to determine medical clearance prior to transport.
BH Urgent Care (Main Hub) – Tier II
Designed for voluntary “urgent” access to care needs. Provides triage, crisis assessment, safety check, and may initiate crisis intervention or linkage to Mobile Crisis Team, physician services, medication management and care coordination. Generally operated with extended hours beyond normal business hours. Does not include involuntary commitments that receive an assessment at Tier III. Transition Clinic is part of Tier II service line.
Same Day Access (Main Hub Open Access and Virtual Access) – Tier I
Same-day access offered at both the Main Hub and at designated community locations. Tele-behavioral health access is for a routine type of access needs completed without the need to be face-to-face at the main hub. This process allows using HIPPA compliant video conferencing technology in convenient community locations such as community health centers, health departments, and emergency rooms. This will enable access to a uniform screening and assessment and complete the same process that takes place at the main hub. Warm transfers to mental health units, community-based services and other resources can happen virtually, and the person accessing services virtually can receive follow-up processes to ensure linkage. In some cases, using a virtual lobby, the person may be able to access the level of care in the same virtual session. Law Enforcement Officers could also use this virtual concept to access services for individuals that do not need acute placement.
Integrated Co-Occurring Crisis Stabilization Unit
Will serve all individuals who present with either an acute mental illness or substance use impairment, or a co-occurring mental illness and substance use disorder. This innovative approach integrates the services lines of crisis stabilization and detoxification services within the same facility but tailors the treatment to each person based on their needs. This model would co-locate the service lines of residential detoxification and crisis stabilization into one comprehensive, secure service line with a Baker/Marchman Act receiving facility as the point of entry.
Mobile Crisis Teams
Mobile crisis services assist in diversion from involuntary treatment and support the engagement and linkage to less restrictive services through the Transition Clinic. Mobile Crisis teams can also be deployed from the HUB location to potential clients in crisis and assist with the stabilization of the client, including setting forth a safety plan and linking to community services. The Mobile Crisis Response Team can divert from a Baker Act while ensuring the client has the support while they engage in ongoing community care. The Mobile Crisis Team may also assist Law Enforcement in determining if a Baker Act can be diverted.
This concept allows a process to divert individuals from involuntary commitment for resolvable or fleeting crises. The Recovery Room is a calming and inviting place that allows individuals and families to receive on-site counseling to develop robust plans to support safety and wrap needed services around the individuals in care. Includes physician consult, therapy and discharge/safety planning.
Intensive Care Coordination
Intensive Care Coordination using elements of the Wraparound Model and IMPACT Collaborative Care Model versus traditional case management/care coordination will provide intensive care coordination utilizing proven engagement processes such as motivational interviewing and feedback informed treatment. Lessons learned from the Pinellas Community Empowerment Team and the Pinellas Integrated Care Alliance will enhance the engagement protocols including linkage and engagement to recovery and social support services that positively contribute to social determinants of health. The focus of services will be to:
- Improve transitions from acute and restrictive to less restrictive community-based levels of care;
- Improve transitions of care between primary care and behavioral health care providers;
- Increase diversions from state mental health treatment facility admissions;
- Decrease avoidable hospitalizations, inpatient care, incarcerations, and homelessness;
- Focus on an individual’s wellness and community integration;
- Identify care gaps;
- Shift from an acute care model of care to a recovery model;
- Offer an array of services and supports to meet the consumer’s path to recovery.
Designed to seamlessly transition adults and children from acute care settings into outpatient care. The clinic provides rapid access and coordination for medical or behavioral health follow up. Patients are seen within 3-7 days of referral on-site as well as in the home or community by Care Navigators. The clinic provides short-term services such as focused intensive case management, crisis support, medication management, baseline assessment and brief psychotherapeutic treatment. Collaborates closely with local primary care clinics for coordinated care. The program is voluntary and individuals must be medically stable and non-violent. The clinic is a referral point for outpatient behavioral health continuum.
Community Based Partners
Offices will be co-located on-site at the main hub and will allow for an immediate welcoming transition from crisis and intervention to ongoing care and co-management at the most convenient outpatient location or virtual connection for the individual. This immediate face-to-face engagement allows the individuals to engage with the clinical provider who will hear their needs, concerns, and to help orient them to the healing process, instilling hope, promoting resilience, and confidence. Community providers will be co-located onsite at the main hub to include:
- Outpatient Counseling to include but not be limited to individual, family and group counseling, intervention and psychosocial rehabilitation.
- Co-Management integration of primary care.
- Case Management and Care Navigation.
- Psychiatric Services including medication management.
- Medication-Assisted Treatments such as a long-acting injectable clinic for mental health individuals and MAT for substance use disorders. Services would be offered 24/7 virtual access and the main hub would be certified as an Opioid Treatment Program (OTP).
- Intermediate Care includes specialized residential care for addictions, eating disorders, and short term residential.
- Recovery Support Services to include but not be limited to supportive employment, supportive housing, drop-in, SOAR, and incidental support funds.
- Wellness and Social Connectedness Support Services recognize the importance of social determinants for health and wellness. The campus envisions welcoming space that supports wellness groups, skill-building groups, and healthy activities that are supportive of individuals, families and social connectedness.
- Future state services proposed include an on-site Pharmacy, Patient Assistance Program, and Syringe Service Program.