Category:Behavioral Health: Difference between revisions

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==OVERVIEW==
==OVERVIEW==
We have an at-risk population in the Yukon-Kuskokwim Delta for depression, suicide and substance abuse. The suicide rate has consistently been higher than the national average. In order to capture patients who need help, we screen for depression at every visit in the outpatient clinics, village clinics and SRCs.  
We have a very at risk population for suicide and substance abuse. We have a very high suicide rate. We screen for depression on every visit, and contact the ACT clinician for a positive screen.  If the depression screen is positive during the screening for an outpatient visit in the SRCs, the Wellness Counselor or Behavioral Health clinician in the SRC should be called to see the patient. Below is a list of the different resources available in the different parts of the hospital for our patients.


If the depression screen is positive during the screening for an outpatient visit in the SRCs, the wellness counselor or BH clinician in the SRC should be called to see the patient. Here is a list of the different resources available in the different parts of the hospital for our patients.
The service delivery system at YKHC is comprised of various service components, including Crisis Services, Outpatient and Village Services, Residential Services, Developmental Disabilities, and Support Services.  
 
The Behavioral Health Services division for YKHC is located across the street from the hospital. They have several family and child counselors. They also supervise the behavioral health clinicians and the behavioral Health Aides that work in the SRC facilities. There is a position for a Psychiatric Nurse Practitioner.  


===Alcohol/Drug Use In The Delta===
===Alcohol/Drug Use In The Delta===
We seem to be having an influx of heroin in the Bethel area that is also spreading out to the villages. We have had several deaths due to heroin overdose in the last year. Use seems to be mainly smoking, but there is also some injection use as well. Prescription Med abuse is also present, which YKHC works hard to combat with our Pain Management Program and Committee.  
Alcohol and drug use, like the rest of the country, is problematic in the YK Delta. At this time, Bethel is a “damp” community, which means alcohol is not sold here, but it can be brought in.


Marijuana use is very common and per Alaska state law every person is allowed to grow four plants and have product for personal use, but they are not allowed to transport, smoke in public, and sell it to others. People can get marijuana cards from providers in Anchorage but YKHC is not allowed to give medical marijuana cards or prescribe marijuana as we are a federal facility—except for Marinol.  
Marijuana use is very common, and recreational use is legal in Alaska.  Per Alaska state law, every person is allowed to grow 4 plants and have product for personal use. They are not allowed to transport, smoke in public, or sell it to others. There are two marijuana retail shops in Bethel.  People can get marijuana cards from providers in Anchorage, '''''but YKHC is not allowed to give medical marijuana cards or prescribe marijuana as we are a federal facility. The exception is for Marinol.'''''


Alcohol is the drug of choice for the Delta with marijuana a close second.  
We also are having an influx of heroin in the Bethel area and the villages, which has resulted in deaths due to overdose. Use seems to be mainly smoking, but there is also some injection use.  Naloxone is available in the Village Clinics and can be prescribed for patients on chronic narcotic therapy.  


Treatment options for patients interested in quitting substance abuse include a Bethel alcohol treatment facility—PATC and multiple treatment facilities in Anchorage/ Juneau/ Sitka. Eddie Turner, Dena Coy, Ol Minto—Fairbanks, Raven’s Way. The best way to get our patients into treatment is to either refer them to our Behavioral Health through an EMR RAVEN refer to Behavioral Health or call 543-6161 to help get them set up for an assessment. Or if they have private insurance you can call Bethel Family Clinic and have them see Teri Davis to help facilitate setting up treatment plans.
Prescription medication abuse is also present and YKHC works hard to combat this with our '''Pain Management Program and Pain Committee'''. For patients seeking treatment for opioid dependence, contact the Opioid Treatment Case Manager.


Several AA groups and a Al-anon meet in town at the Catholic Church, PATC, Tundra Women’s Coalition, and the Hospital in the Main Conference Room.
Options for patients interested in getting treatment for substance abuse include a Bethel alcohol treatment facility (i.e., The Healing Center) and multiple treatment facilities in Anchorage, Juneau, and Sitka. The best way to get our patients into treatment is to either refer them to YKHC Behavioral Health through PowerChart/FirstNet or call 543-6161 to help get them set up for an assessment. For patients with private insurance, you can call Bethel Family Clinic to help facilitate setting up treatment plans.
==SRC Outpatient Behavioral Health Resources==
At each SRC there should be at least one Wellness Counselor—a Behavioral Health Aide who can counsel and listen to patients who have anxiety, depression, etc. 
==Psychiatric Resources==
YKHC has two rotating psychiatrists. '''David Ondich MD''', our psychiatrist for adults,  prescribes most of the psychiatric medication needed in the Delta. He works via VTC (teleconference) in Behavioral Health in Bethel. He is always available by phone if needed— 612-824-9812 or by email David_Ondich@ykhc.org.


'''Dr. Karen Jackman''' is the child psychiatrist and works directly out of Specialty Clinic in the hospital and does VTC and face-to-face visits only in Bethel. She works 50 percent for YKHC. She also supervises the children at the McCann Treatment Center who are under her care for drug/inhalants/alcohol use and other psychological diagnoses. Her contact information is Karen_Jackman@ykhc.org.
Several AA/NA groups and Al anon meet in town weekly at the Catholic Church, The Healing Center, Tundra Women’s Coalition, and the Hospital Main Conference Room.


''Nick White, PNP'' Our Psychiatric Nurse Practitioner is also working out of Specialty Clinic doing Video Teleconferencing from Montana. He is a full-time provider and is excellent with prescribing meds. He consults with all of us and Ondich and Jackman when necessary.  
==Behavioral Health Crisis Services ==
Crisis Services will respond to urgent behavioral health services needs that occur in the Bethel hospital and regional clinics. Urgent behavioral health services needs include responding to Title 47 requests for mental health status evaluations to determine what level of care a patient will need to alleviate an urgent behavioral health crisis. Urgent care walk-in times and primary care consultation services are also provided.


==Emergency Behavioral Resources==
===Emergency Services ===  
===Acutely Suicidal Patients in Village Clinic / ED/ Outpatient Clinic===
Emergency Services conducts behavioral health evaluations of individuals who present as being in crisis and to take appropriate steps to initiate the provision of services depending on the outcome of the evaluation. They will assist monitoring of patients in the hospital on Northwing who are involuntarily held for Title 47-related observation and evaluation for further treatment or referral.  
Contact VPOs or State Troopers. The patient will require a police escort to Bethel on a Title 47 due to risk of harm.  


Contact '''On-Call Behavioral Health Clinician''' in Bethel, who is available by calling the operator, and asking them to page the on call BH clinician. He/She can help make the arrangements for the Title 47 with the VPOs and make sure that the patient goes straight to the ER when they arrive in Bethel.  
Village Services directly administers the Emergency Services component. Emergency On-Call Responders-Emergency Services Clinicians and Complex Care Managers are available twenty-four hours per day to respond to behavioral health crisis for all individuals in the Yukon-Kuskokwim service area. The responders provide immediate mental status examinations and work with the primary care providers in the village or hospital to plan care for management of the crisis and follow-up of the individual. On-Call Attendants are available to stay with an individual admitted to the hospital for evaluation when ordered by an admitting physician to provide safety and security for a client. During the evaluation period comprehensive mental health and substance abuse assessments are completed by the Emergency Services Clinician to assess and manage the client within the behavioral health system of care. '''The Emergency On-Call Response Team is available twenty-four hours per day at 543-6100 or 1-800-478-2642'''


Keep the patient in an examination room until they are evaluated.  
If you have an actively suicidal patient in a village, the VPOs or state troopers will need to be involved and the patient will have to be escorted from the village on a Title 47 with a police escort. There is always an on-call Behavioral Health Clinician in Bethel who is available by Tiger Connect.  He/she can help make the arrangements for the Title 47 with the VPOs and make sure that the patient goes straight to the ER when they arrive in Bethel.
 
==Bethel Outpatient IMPACT Program==
In the Outpatient Clinics in Bethel, there is an Outpatient Behavioral Health Clinician, who works with the IMPACT program 9 AM – 5PM. All patients over 16 are offered a PHQ 9, a depression-screening questionnaire by the nursing staff.  


* '''Review it briefly when seeing the patient''':  If it is 15 or over, or they check the questionnaire at all saying they think about dying, or if the patient needs a real time intervention, call 6553. One of the IMPACT clinicians will respond. They are available during the day to counsel patients about depression, anxiety, relaxation exercises, grief, etc.
===Inpatient Psychiatric Services===
We have four observation rooms where psychiatric patients (suicidal/homicidal ideations, overdoses, acute psychosis) can be admitted.  


If the IMPACT clinician feels they need a few more sessions, the IMPACT clinician can set up appointments with the patient.  If he/she feels the patient needs more extensive counseling, he/she can facilitate an appointment with a counselor from the main Behavioral Heath Department across the street.
There is a psychiatric service for ED and inpatient which is staffed by Psychiatrists, Psychiatric NPs, and Psychiatric PAs.  They can be reached via Tiger Connect to ‘Psych On-Call’.  They may also be involved in following-up, typically via VTC or Telehealth with recently discharged patients.


IMPACT Outpatient Psychiatric Non Urgent Consultant Dr. Shane Coleman shane_coleman@ykhc.org can be contacted via email for questions regarding dosing changes or addition of complex medications. He will reply in a few days. Dr. Coleman is a provider at ANMC and is available on Monday afternoons for direct consults. In addition, you may email Raphael Martins, IMPACT BH Clinician rapahel_martins@ykhc.org
Patients may also be transported to the Alaska Psychiatric Institute (API) or North Star Behavioral Health in Anchorage.


==Inpatient Psychiatric Services==  
=== Crisis Incident Stress Debriefing ===  
The Inpatient unit has two observation rooms where we admit high risk suicidal or mentally ill patients who need one to one monitoring with a sitter. They are held under Title 47 for their safety. They have monitoring of blood levels as well as administration of antidote medications, such as in the case of Tylenol overdose.  
Coordinate Critical Incident Stress Debriefings (CISD) response teams with other providers throughout the YK –Delta and debrief with trauma first responders. Develops Crisis intervention teams with community partners throughout the YK-Delta. Coordinates the training and certification of the crisis team members. Coordinates all logistics of crisis village-based responses by contacting and deploying team members and ensuring adequate coverage and follow-up.


If the patient requires a prolonged inpatient stay will often be transferred to facilities in Anchorage such as API – Alaska Psychiatric Institute or to Charter North, Northstar – for adolescents.  
==Behavioral Health Outpatient Resources==
=== YKHC Psychiatric Resources===
David Ondich, MD is our adult psychiatrist who prescribes most of the psychiatric medication needed in the Delta. He sees patients via VTC in the Behavioral Health Department in Bethel. He is available by email at David_Ondich@ykhc.org.


===Non-YKHC BH Services In Town===
=== YKHC Psychological Resources===  
Not covered by YKHC health benefits—would have to be private pay or insurance payment.  
The Yukon-Kuskokwim Health Corporation employs one Licensed Clinical Psychologist who provides psychometrics and interpretive reports to assist in the provision of comprehensive diagnostics to specific clients in the region.


'''Dr. Sarah Angstman''' is a licensed psychologist in Bethel who does neuropsychiatric testing and counseling. Her offices are in the Bethel Community Service Foundation. Her services are covered under Medicaid.
=== Children’s Specialty Diagnostic Services ===
Children’s Specialty Diagnostic Services provide two mental health professional clinicians who work directly with children to ensure appropriate diagnosis particularly when multiple contributing factors (including abuse issues, FAS/FAE) must be considered.


'''Bethel Family Clinic''' has some behavioral health counselors, including Terri Davis, who works really well with narcotic addiction. They are the local HERSA clinic and run off a sliding scale.  
=== YKHC Outpatient Counseling Services ===
Outpatient Counseling Services are available in the regional clinic as well to supplement services especially to Bethel residents, when a close relative may be the village counselor, and for the villages who may not yet have a counselor. Services available in the villages include: substance abuse assessments; individual, couple and family counseling; substance abuse outpatient and aftercare counseling; anger management sessions; substance abuse treatment groups and other specialty groups are available. These same services are all available through outpatient counseling services in Bethel.  


==Mental Health, Substance Abuse and Developmental Disabilities==
Village Clinicians are Master’s level prepared in Human Services with both experience and specialized training in the fields of Mental Health and Substance Abuse Treatment. They receive culturally appropriate training in supervision of native counselors and work closely with the Village Behavioral Health Aides (BHAs), clients, family and other providers to complete a holistic intake and develop treatment plans for implementation by the village based service providers. This service employs five full time staff members. BHA’s are positioned at many villages to engage community services and make referrals for higher levels of care, as needed.
This service delivery system at YKHC is comprised of various service components. The components are Crisis Services, Outpatient and Village Services, Residential Services, Developmental Disabilities, and Support Services.  


===Crisis Services===
===YKHC Outpatient ACT Program===
Crisis Services will respond to urgent behavioral health services needs that occur in the YK regional and in the YKHC hospital. Urgent behavioral health services needs include responding to Title 47 requests for mental health status evaluations to determine what level of care a patient will need to alleviate an urgent behavioral health crisis. Urgent care walk-in times and primary care consultation services are also provided.  
At the Ambulatory Outpatient Clinics in Bethel, there are Outpatient Behavioral Health Clinicians, who work with the '''Access to Collaborative Treatment or ACT program'''. All patients over the age of 16 are offered the PHQ-9 depression screening questionnaire. Please review it briefly when seeing the patient. If they score =>15, or they check the questionnaire saying they think about dying, or they need a real time intervention, call ext. 6553 and one of the ACT clinicians will respond. A referral to ACT can also be made via PowerChart/FirstNet. They are available during the day to counsel patients about depression, anxiety, relaxation exercises, grief, etc. If the ACT clinician feels they need a few more sessions, the ACT clinician can set up appointments with the patient. If he/she feels the patient needs more extensive counseling, he/she can facilitate an appointment with a counselor from the main Behavioral Health Department.


===Emergency Services===
===YKHC Behavioral Health Department===
Conduct behavioral health evaluations of individuals who present as being in crisis and to take appropriate steps to initiate the provision of services depending on the outcome of the evaluation. Will assist monitoring of patients, in the hospital Northwing, who are involuntarily held for Title 47-related observation and evaluation for further treatment or referral.
The YKHC Behavioral Health Department is on the second floor of the hospital. There are several family and child counselors. They also supervise the Behavioral Health Clinicians and the Behavioral Health Aides that work in the SRC facilities.


===Village Services===
===Non-YKHC Behavioral Health in Bethel===
Directly administers the Emergency Services component. Emergency On-Call Responders, Emergency Services Clinicians and Complex Care Managers are available 24 hours a day to respond to behavioral health crises for all individuals in the Yukon-Kuskokwim service area. The responders provide immediate mental status examinations and work with the primary care providers in the village or hospital to plan care for management of the crisis and follow-up of the individual. On-Call Attendants are available to stay with an individual admitted to the hospital for evaluation when ordered by an admitting physician to provide safety and security for a client. During the evaluation period comprehensive mental health and substance abuse assessments are completed by the Emergency Services Clinician to assess and manage the client within the behavioral health system of care. The Emergency On-Call Response Team is available 24 hours a day at 543-6499 or 1-844-543-6499
Patients may choose behavioral health services outside of YKHC, which would be the financial responsibility of the patient. The Bethel Family Clinic has behavioral health services, including narcotic addiction. Bethel Family Clinic is the local Health Resources and Services Administration (HRSA) clinic and uses a sliding scale fee.


===Crisis Incident Stress Debriefing===
==SRC Outpatient Behavioral Health Resources==
Coordinate Critical Incident Stress Debriefings (CISD) response teams with other providers throughout the YK Delta and debrief with trauma first responders. Develops crisis intervention teams with community partners throughout the YK Delta. Coordinates the training and certification of the crisis team members. Coordinates all logistics of crisis village-based responses by contacting and deploying team members and ensuring adequate coverage and follow-up.
At each SRC there should be at least one Wellness Counselor, a Behavioral Health Aide, who can counsel and listen to patients who have anxiety or depression.
 
==Prevention Services==
Prevention services, established in January 2012, has established traditional healing and elder consultation as the forums with which to implement community and family support systems in the region’s villages.  


===Outpatient Counseling Services===
== Prevention Services ==  
Available in the regional clinic as well to supplement services especially to Bethel residents, when a close relative may be the village counselor, and for the villages who may not yet have a counselor. Services available in the villages include: substance abuse assessments; individual, couple and family counseling; substance abuse outpatient and aftercare counseling; anger management sessions; substance abuse treatment groups and other specialty groups are available. These same services are all available through outpatient counseling services in Bethel.  
Prevention services, established in January 2012, has established traditional healing and elder consultation as the forums with which to implement community and family support systems in the region’s villages.


===Family Spirit Program — Calricaraq===
===Family Spirit Program — Calricaraq===
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Was created to divert inebriates from the emergency room and jail to a more adequate and safe place to sober up. It utilizes three full time ER technicians and a manager who is responsible for Sobering Center program design, development, management, quality assurance, and evaluation and reporting  
Was created to divert inebriates from the emergency room and jail to a more adequate and safe place to sober up. It utilizes three full time ER technicians and a manager who is responsible for Sobering Center program design, development, management, quality assurance, and evaluation and reporting  


==Residential Services==
== Residential Services ==
 
=== Crisis Respite Center (CRC) ===
CRC is a five-bed program that provides emergency support services for individuals experiencing a life crisis so disruptive it cannot be managed in an outpatient setting. CRC provides evaluation, treatment, psychosocial rehabilitation, cultural activities, and referral in a voluntary setting for those individuals needing to be monitored and protected, or those just needing some temporary help. CRC works closely with the Alaska Psychiatric Institute (State Hospital), Emergency Services, Integrated Outpatient clinic and other residential programs. The alternative setting provided by the Crisis Respite Center, while ensuring the client's needs are met closer to their home community, can also ensure the client’s needs are met in a culturally sensitive manner.
 
=== Bautisa House ===
Bautisa House is a home for adults in the region with a severe and persistent mental illness. It is a 10-bed licensed assisted living home. The program serves older and/or more disabled individuals and offers long-term place. Some residents also have a developmental disability. The program teaches them daily living job-seeking and independent living skills as appropriate, and provides access to cultural and community activities.


===Crisis Respite Center (CRC)===
=== Malone Home ===  
This five-bed program provides emergency support services for individuals experiencing a life crisis so disruptive it cannot be managed in an outpatient setting. CRC provides evaluation, treatment, psychosocial rehabilitation, cultural activities, and referral in a voluntary setting for those individuals needing to be monitored and protected, or those just needing some temporary help. CRC works closely with the Alaska Psychiatric Institute (State Hospital), Emergency Services, Integrated Outpatient clinic and other residential programs. The alternative setting provided by the Crisis Respite Center, while ensuring the client's needs are met closer to their home community, can also ensure the client’s needs are met in a culturally sensitive manner.  
Malone Home is a 5-bed assisted living home for adults with moderate to severe mental retardation. The team members work closely with DD services to provide appropriate services and habilitation to the residents. The home provides a long term setting for those that live there.


===Bautista House===
=== Phillips Ayagnirvik Treatment Center (PATC) ===  
A home for adults in the region with a severe and persistent mental illness. It is a 10-bed licensed assisted living home. The program serves older and/or more disabled individuals and offers a long-term place. Some residents also have a developmental disability. The program teaches them daily living job-seeking and independent living skills as appropriate, and provides access to cultural and community activities.  
The PATC offers a ―new beginning to individuals suffering from the disease of substance abuse or addiction. PATC offers a full continuum of care, including Residential Treatment, Outpatient, Aftercare, and a Therapeutic Court Treatment Program. The PATC Recovery Program regional and statewide referrals with treatment modalities, which combine 12 Step Recovery with research-based treatment methods, and build upon cultural teachings by Elders, and medical or psychiatric services for patient who need them. Positive Native Family Values, Life Skills and Anger Management classes are an integral part of the Treatment Program. Traditional crafts and Subsistence activities are a valuable addition to our services.  


===Malone Home===
=== Residential Program ===  
A 5-bed assisted living home for adults with moderate to severe mental retardation. The team members work closely with DD services to provide appropriate services and habilitation to the residents. The home provides a long term setting for those that live there.  
PATC operates a ASAM Level III.5 treatment facility with 16 beds for both men and women. We have an ―open enrollment models, with an average 6-week length of stay. ‖ The Program is fully capable of treating co-occuring mental health issues along with all kinds of substance abuse and addiction.


===Phillips Ayagnirvik Treatment Center (PATC)===
=== McCann Treatment Center ===  
Offers a new beginning to individuals suffering from the disease of substance abuse or addiction. PATC offers a full continuum of care, including Residential Treatment, Outpatient, Aftercare, and a Therapeutic Court Treatment Program. The PATC Recovery Program regional and statewide referrals with treatment modalities, which combine 12 Step Recovery with research-based treatment methods, and build upon cultural teachings by Elders, and medical or psychiatric services for patients who need them. Positive Native Family Values, Life Skills and Anger Management classes are an integral part of the Treatment Program. Traditional crafts and subsistence activities are a valuable addition to services.  
McCann Treatment Center is a 14-bed facility that houses two programs for male youth ages 10 – 18. The youth from both programs work together with team members to develop their strengths, learn skills to live at home, and reduce symptoms of emotional disturbance and substance abuse. A key component of McCann is a strong culturally relevant subsistence program. Youth are involved in year round subsistence activities, including winter trapping, summer fishing, fall berry picking and spring ice fishing.  


'''Residential Program.''' PATC operates an ASAM Level III.5 treatment facility with 16 beds for both men and women. We have an open enrollment‖ model, with an average 6-week length of stay. The program is fully capable of treating co-occuring mental health issues along with all kinds of substance abuse and addiction.  
==== Residential Psychiatric Treatment Center ====
The McCann Treatment Center (MTC) is a culturally diverse, individualized, strengthens based program that focused on building self-value and meeting the clients’ needs using an eclectic and comprehensive approach to treatment. As a Residential Psychiatric Treatment (RPTC), with a focus on inhalant and substance abuse, treatment includes complete assessments; individual/group/family psychotherapy; psycho-educational groups on multiple topics; recreational and cultural activities; an accredited school with two certified teachers, comprehensive Subsistence Education Program; and life skills training to help each youth gain confidence and self-value. Our state of the art building has a gym for exercise and therapeutic games, a special Men’s House for activities with elders and families, and a steam to relax and process with elders and staff.


'''Outpatient Programs.''' Phillips Ayagnirvik offers two outpatient components. These are both ASAM Level I. Aftercare is offered for those who have completed residential treatment and can access services in Bethel. Outpatient services are provided for those consumers who do not require a residential level of care.
====Behavior Rehabilitation Services (BRS) program====
Eight beds are available for youth placed in the Behavior Rehabilitation Services (BRS) program. The BRS program services clients that are in the custodial care of the Office of Children’s Services (OCS) or the Department of Juvenile Justice (DJJ). Six beds are available for RPTC or Community Referrals. Clients referred to the PRTC beds, as well as the BRS beds, join together in the treatment process and form a therapeutic community. Length of stay is 12-18 months for both the RPTC and Boys Group Home program.


'''McCann Treatment Center''' is a 14-bed facility that houses two programs for male youth ages 10–18. The youth from both programs work together with team members to develop their strengths, learn skills to live at home, and reduce symptoms of emotional disturbance and substance abuse. A key component of McCann is a strong culturally relevant subsistence program. Youth are involved in year-round subsistence activities, including winter trapping, summer fishing, fall berry picking and spring ice fishing.
==Learning Resource Center==
The Learning Resource Center is a day habilitation program for open to all our residential and community consumers. Psychosocial rehabilitation, skills building, groups, and cultural activities are the focus of the program.


'''Residential Psychiatric Treatment Center.''' The McCann Treatment Center (MTC) is a culturally diverse, individualized, strengths-based program that focuses on building self-value and meeting the clients’ needs using an eclectic and comprehensive approach to treatment. As a Residential Psychiatric Treatment Center(RPTC), with a focus on inhalant and substance abuse, treatment includes complete assessments; individual/group/family psychotherapy; psycho-educational groups on multiple topics; recreational and cultural activities; an accredited school with two certified teachers; comprehensive Subsistence Education Program; and life skills training to help each youth gain confidence and self-value. Our state-of-the-art building has a gym for exercise and therapeutic games, a special Men’s House for activities with elders and families, and a steam to relax and process with elders and staff.  
== Outpatient Programs ==
Phillips Ayagnirvik (PATC) offers two outpatient components. These are both ASAM Level I. Aftercare is offered for those who have completed residential treatment and can access services in Bethel. Outpatient services are provided for those consumers who do not require a residential level of care.


Eight beds are available for youth placed in the '''Behavior Rehabilitation Services''' (BRS) program. The BRS program services clients that are in the custodial care of the Office of Children’s Services (OCS) or the Department of Juvenile Justice (DJJ). Six beds are available for RPTC or Community Referrals. Clients referred to the PRTC beds, as well as the BRS beds, join together in the treatment process and form a therapeutic community. Length of stay is 12-18 months for both the RPTC and Boys Group Home program.
==Resources/References==
===Learning Resource Center===
* [[Media:Posttraumatic Stress Disorder 12-11-2018.pdf| Posttraumatic Stress Disorder (PTSD) 2018)]] (PowerPoint Presentation)
This day rehabilitation program is open to all our residential and community consumers. Psychosocial rehabilitation, skills building, groups, and cultural activities are the focus of the program.
* [[media:Psychological Evaluation YK.pdf|Psychological Evaluation for YK Delta Residents 2018]] (PowerPoint Presentation)
* [[media:Psychiatric Vignettes.pdf|Vignettes Illustrating Special Psychiatric Populations 2017]] (PowerPoint Presentation)

Latest revision as of 02:43, 1 February 2023

OVERVIEW

We have a very at risk population for suicide and substance abuse. We have a very high suicide rate. We screen for depression on every visit, and contact the ACT clinician for a positive screen. If the depression screen is positive during the screening for an outpatient visit in the SRCs, the Wellness Counselor or Behavioral Health clinician in the SRC should be called to see the patient. Below is a list of the different resources available in the different parts of the hospital for our patients.

The service delivery system at YKHC is comprised of various service components, including Crisis Services, Outpatient and Village Services, Residential Services, Developmental Disabilities, and Support Services.

Alcohol/Drug Use In The Delta

Alcohol and drug use, like the rest of the country, is problematic in the YK Delta. At this time, Bethel is a “damp” community, which means alcohol is not sold here, but it can be brought in.

Marijuana use is very common, and recreational use is legal in Alaska. Per Alaska state law, every person is allowed to grow 4 plants and have product for personal use. They are not allowed to transport, smoke in public, or sell it to others. There are two marijuana retail shops in Bethel. People can get marijuana cards from providers in Anchorage, but YKHC is not allowed to give medical marijuana cards or prescribe marijuana as we are a federal facility. The exception is for Marinol.

We also are having an influx of heroin in the Bethel area and the villages, which has resulted in deaths due to overdose. Use seems to be mainly smoking, but there is also some injection use. Naloxone is available in the Village Clinics and can be prescribed for patients on chronic narcotic therapy.

Prescription medication abuse is also present and YKHC works hard to combat this with our Pain Management Program and Pain Committee. For patients seeking treatment for opioid dependence, contact the Opioid Treatment Case Manager.

Options for patients interested in getting treatment for substance abuse include a Bethel alcohol treatment facility (i.e., The Healing Center) and multiple treatment facilities in Anchorage, Juneau, and Sitka. The best way to get our patients into treatment is to either refer them to YKHC Behavioral Health through PowerChart/FirstNet or call 543-6161 to help get them set up for an assessment. For patients with private insurance, you can call Bethel Family Clinic to help facilitate setting up treatment plans.

Several AA/NA groups and Al anon meet in town weekly at the Catholic Church, The Healing Center, Tundra Women’s Coalition, and the Hospital Main Conference Room.

Behavioral Health Crisis Services

Crisis Services will respond to urgent behavioral health services needs that occur in the Bethel hospital and regional clinics. Urgent behavioral health services needs include responding to Title 47 requests for mental health status evaluations to determine what level of care a patient will need to alleviate an urgent behavioral health crisis. Urgent care walk-in times and primary care consultation services are also provided.

Emergency Services

Emergency Services conducts behavioral health evaluations of individuals who present as being in crisis and to take appropriate steps to initiate the provision of services depending on the outcome of the evaluation. They will assist monitoring of patients in the hospital on Northwing who are involuntarily held for Title 47-related observation and evaluation for further treatment or referral.

Village Services directly administers the Emergency Services component. Emergency On-Call Responders-Emergency Services Clinicians and Complex Care Managers are available twenty-four hours per day to respond to behavioral health crisis for all individuals in the Yukon-Kuskokwim service area. The responders provide immediate mental status examinations and work with the primary care providers in the village or hospital to plan care for management of the crisis and follow-up of the individual. On-Call Attendants are available to stay with an individual admitted to the hospital for evaluation when ordered by an admitting physician to provide safety and security for a client. During the evaluation period comprehensive mental health and substance abuse assessments are completed by the Emergency Services Clinician to assess and manage the client within the behavioral health system of care. The Emergency On-Call Response Team is available twenty-four hours per day at 543-6100 or 1-800-478-2642

If you have an actively suicidal patient in a village, the VPOs or state troopers will need to be involved and the patient will have to be escorted from the village on a Title 47 with a police escort. There is always an on-call Behavioral Health Clinician in Bethel who is available by Tiger Connect. He/she can help make the arrangements for the Title 47 with the VPOs and make sure that the patient goes straight to the ER when they arrive in Bethel.

Inpatient Psychiatric Services

We have four observation rooms where psychiatric patients (suicidal/homicidal ideations, overdoses, acute psychosis) can be admitted.

There is a psychiatric service for ED and inpatient which is staffed by Psychiatrists, Psychiatric NPs, and Psychiatric PAs. They can be reached via Tiger Connect to ‘Psych On-Call’. They may also be involved in following-up, typically via VTC or Telehealth with recently discharged patients.

Patients may also be transported to the Alaska Psychiatric Institute (API) or North Star Behavioral Health in Anchorage.

Crisis Incident Stress Debriefing

Coordinate Critical Incident Stress Debriefings (CISD) response teams with other providers throughout the YK –Delta and debrief with trauma first responders. Develops Crisis intervention teams with community partners throughout the YK-Delta. Coordinates the training and certification of the crisis team members. Coordinates all logistics of crisis village-based responses by contacting and deploying team members and ensuring adequate coverage and follow-up.

Behavioral Health Outpatient Resources

YKHC Psychiatric Resources

David Ondich, MD is our adult psychiatrist who prescribes most of the psychiatric medication needed in the Delta. He sees patients via VTC in the Behavioral Health Department in Bethel. He is available by email at David_Ondich@ykhc.org.

YKHC Psychological Resources

The Yukon-Kuskokwim Health Corporation employs one Licensed Clinical Psychologist who provides psychometrics and interpretive reports to assist in the provision of comprehensive diagnostics to specific clients in the region.

Children’s Specialty Diagnostic Services

Children’s Specialty Diagnostic Services provide two mental health professional clinicians who work directly with children to ensure appropriate diagnosis particularly when multiple contributing factors (including abuse issues, FAS/FAE) must be considered.

YKHC Outpatient Counseling Services

Outpatient Counseling Services are available in the regional clinic as well to supplement services especially to Bethel residents, when a close relative may be the village counselor, and for the villages who may not yet have a counselor. Services available in the villages include: substance abuse assessments; individual, couple and family counseling; substance abuse outpatient and aftercare counseling; anger management sessions; substance abuse treatment groups and other specialty groups are available. These same services are all available through outpatient counseling services in Bethel.

Village Clinicians are Master’s level prepared in Human Services with both experience and specialized training in the fields of Mental Health and Substance Abuse Treatment. They receive culturally appropriate training in supervision of native counselors and work closely with the Village Behavioral Health Aides (BHAs), clients, family and other providers to complete a holistic intake and develop treatment plans for implementation by the village based service providers. This service employs five full time staff members. BHA’s are positioned at many villages to engage community services and make referrals for higher levels of care, as needed.

YKHC Outpatient ACT Program

At the Ambulatory Outpatient Clinics in Bethel, there are Outpatient Behavioral Health Clinicians, who work with the Access to Collaborative Treatment or ACT program. All patients over the age of 16 are offered the PHQ-9 depression screening questionnaire. Please review it briefly when seeing the patient. If they score =>15, or they check the questionnaire saying they think about dying, or they need a real time intervention, call ext. 6553 and one of the ACT clinicians will respond. A referral to ACT can also be made via PowerChart/FirstNet. They are available during the day to counsel patients about depression, anxiety, relaxation exercises, grief, etc. If the ACT clinician feels they need a few more sessions, the ACT clinician can set up appointments with the patient. If he/she feels the patient needs more extensive counseling, he/she can facilitate an appointment with a counselor from the main Behavioral Health Department.

YKHC Behavioral Health Department

The YKHC Behavioral Health Department is on the second floor of the hospital. There are several family and child counselors. They also supervise the Behavioral Health Clinicians and the Behavioral Health Aides that work in the SRC facilities.

Non-YKHC Behavioral Health in Bethel

Patients may choose behavioral health services outside of YKHC, which would be the financial responsibility of the patient. The Bethel Family Clinic has behavioral health services, including narcotic addiction. Bethel Family Clinic is the local Health Resources and Services Administration (HRSA) clinic and uses a sliding scale fee.

SRC Outpatient Behavioral Health Resources

At each SRC there should be at least one Wellness Counselor, a Behavioral Health Aide, who can counsel and listen to patients who have anxiety or depression.

Prevention Services

Prevention services, established in January 2012, has established traditional healing and elder consultation as the forums with which to implement community and family support systems in the region’s villages.

Family Spirit Program — Calricaraq

Grew out of a collaborative effort of the communities of the Yukon-Kuskokwim region, the Department of Health and Social Services, Division of Alcohol and Drug Abuse, Office of Children Services, the YKHC, Association of Village Council Presidents (AVCP), Tundra Women’s Center (TWC), Orutsararmuit Native Council (ONC) and other community providers in the Yukon-Kuskokwim Delta area. The primary purpose of the project is to implement a community development model that strengthens families, using collaborative efforts of regional resources with local resources and traditional family life and values. The primary goal of the program is for children to be safer in their homes.

Meth and Suicide Prevention Initiative (MSPI)

This is a program that utilizes the Family Spirit model to provide community support, education and training on the issues related to suicide at villages. This program has two full time staff to coordinate MSPI activities.

SBIRT

(Screening Brief Intervention Referral to Treatment) program is an evidence-based program for planning, organizing, and coordinating alcohol abuse screening activities with all YKHC patient care areas to screen and refer primary care patients to substance abuse treatment, as needed. SBIRT tracks progress SBIRT screenings, referrals made, and referrals completed.

Sobering Center

Was created to divert inebriates from the emergency room and jail to a more adequate and safe place to sober up. It utilizes three full time ER technicians and a manager who is responsible for Sobering Center program design, development, management, quality assurance, and evaluation and reporting

Residential Services

Crisis Respite Center (CRC)

CRC is a five-bed program that provides emergency support services for individuals experiencing a life crisis so disruptive it cannot be managed in an outpatient setting. CRC provides evaluation, treatment, psychosocial rehabilitation, cultural activities, and referral in a voluntary setting for those individuals needing to be monitored and protected, or those just needing some temporary help. CRC works closely with the Alaska Psychiatric Institute (State Hospital), Emergency Services, Integrated Outpatient clinic and other residential programs. The alternative setting provided by the Crisis Respite Center, while ensuring the client's needs are met closer to their home community, can also ensure the client’s needs are met in a culturally sensitive manner.

Bautisa House

Bautisa House is a home for adults in the region with a severe and persistent mental illness. It is a 10-bed licensed assisted living home. The program serves older and/or more disabled individuals and offers long-term place. Some residents also have a developmental disability. The program teaches them daily living job-seeking and independent living skills as appropriate, and provides access to cultural and community activities.

Malone Home

Malone Home is a 5-bed assisted living home for adults with moderate to severe mental retardation. The team members work closely with DD services to provide appropriate services and habilitation to the residents. The home provides a long term setting for those that live there.

Phillips Ayagnirvik Treatment Center (PATC)

The PATC offers a ―new beginning to individuals suffering from the disease of substance abuse or addiction. PATC offers a full continuum of care, including Residential Treatment, Outpatient, Aftercare, and a Therapeutic Court Treatment Program. The PATC Recovery Program regional and statewide referrals with treatment modalities, which combine 12 Step Recovery with research-based treatment methods, and build upon cultural teachings by Elders, and medical or psychiatric services for patient who need them. Positive Native Family Values, Life Skills and Anger Management classes are an integral part of the Treatment Program. Traditional crafts and Subsistence activities are a valuable addition to our services.

Residential Program

PATC operates a ASAM Level III.5 treatment facility with 16 beds for both men and women. We have an ―open enrollment models, with an average 6-week length of stay. ‖ The Program is fully capable of treating co-occuring mental health issues along with all kinds of substance abuse and addiction.

McCann Treatment Center

McCann Treatment Center is a 14-bed facility that houses two programs for male youth ages 10 – 18. The youth from both programs work together with team members to develop their strengths, learn skills to live at home, and reduce symptoms of emotional disturbance and substance abuse. A key component of McCann is a strong culturally relevant subsistence program. Youth are involved in year round subsistence activities, including winter trapping, summer fishing, fall berry picking and spring ice fishing.

Residential Psychiatric Treatment Center

The McCann Treatment Center (MTC) is a culturally diverse, individualized, strengthens based program that focused on building self-value and meeting the clients’ needs using an eclectic and comprehensive approach to treatment. As a Residential Psychiatric Treatment (RPTC), with a focus on inhalant and substance abuse, treatment includes complete assessments; individual/group/family psychotherapy; psycho-educational groups on multiple topics; recreational and cultural activities; an accredited school with two certified teachers, comprehensive Subsistence Education Program; and life skills training to help each youth gain confidence and self-value. Our state of the art building has a gym for exercise and therapeutic games, a special Men’s House for activities with elders and families, and a steam to relax and process with elders and staff.

Behavior Rehabilitation Services (BRS) program

Eight beds are available for youth placed in the Behavior Rehabilitation Services (BRS) program. The BRS program services clients that are in the custodial care of the Office of Children’s Services (OCS) or the Department of Juvenile Justice (DJJ). Six beds are available for RPTC or Community Referrals. Clients referred to the PRTC beds, as well as the BRS beds, join together in the treatment process and form a therapeutic community. Length of stay is 12-18 months for both the RPTC and Boys Group Home program.

Learning Resource Center

The Learning Resource Center is a day habilitation program for open to all our residential and community consumers. Psychosocial rehabilitation, skills building, groups, and cultural activities are the focus of the program.

Outpatient Programs

Phillips Ayagnirvik (PATC) offers two outpatient components. These are both ASAM Level I. Aftercare is offered for those who have completed residential treatment and can access services in Bethel. Outpatient services are provided for those consumers who do not require a residential level of care.

Resources/References

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