A nurse practitioner, an occupational therapist, a psychologist and a social worker walk into an exam room, and it's no joke. It is the future of better health care. Interprofessional collaboration has been shown to improve the quality of patient care and improve outcomes.
With the help of a grant from the federal Health Resources and Services Administration (HRSA), the School of Nursing at the University of Mississippi Medical Center is designing an Integrated Behavioral Health Program with the goal of improving both the diversity of the state's health professions workforce and the health outcomes for Mississippi's vulnerable populations in rural and urban areas.
Over the next three years, the School of Nursing will receive $2.1 million from HRSA's Advanced Nursing Education grant program. Dr. Janet Harris, professor and associate dean for practice and community engagement and director of the doctor of nursing practice program, is the project director.
"This program is going to help us bring a pipeline of qualified individuals forward to help deal, in an interprofessional way, with patients who have chronic medical conditions."
Harris said that addressing psychological needs is critical to treating patients with multiple chronic conditions such as diabetes, heart disease and obesity. "We have identified a huge gap in the state of Mississippi in meeting the needs of our patients in the community who have psychological problems," she said.
The program will start at UNACARE Health Clinic, the School of Nursing's community clinic in midtown Jackson, and rotate through other community clinics, including two of the program's school-based clinics in Jackson and the Delta.
Dr. Robin Christian, left, and Dr. Janet Harris in the School of Nursing's simulation labDr. Robin Christian, associate professor in the School of Nursing, is the project manager.
"We found that 43 percent of Mississippi students over the age of 14 who have special needs and mental health problems never graduate from high school," said Christian.
"We were overwhelmed when we conducted a depression screening at the schools and saw how many of those children are actually depressed. There is no way they can actively participate in a classroom when they are dealing with mental health issues. Unhealthy students can't learn as well as healthy students," said Harris.
Harris analyzed emergency department admissions from the zip codes serviced by UNACARE. More than 1,500 patients 17 and older were identified with psychological or psychiatric issues in a 12-month period.
"If we could address these issues in the community before they become problematic, we could potentially impact our non-emergent emergency room admissions," said Harris.
Christian hopes that providing psychiatric and psychological care alongside primary care will make patients more likely to ask for help.
"There is a stigma involved with going to a psychiatric clinic, but if you are at a primary care clinic, no one will know you are there for psychological problems."
As part of the training, telehealth carts, equipped with all the components needed to connect remotely, will be placed at the School of Nursing's locations in both Jackson and Oxford. Students will be able to communicate with program directors at the school-based clinics and at UNACARE. Telehealth training will be provided by web-based modules.
Kayla Logan (right), RN, charts while second-year medical student Kristen Dent (left) helps nurse practitioner Kathy Rhodes examine a South Delta Middle School student inside the school’s clinic. The new grant-funded program will start in two schools in January with plans to expand to additional school-based clinics, including South Delta, within three years.During the first semester of the new training, psychiatric mental health nurse practitioner students and occupational health students will practice by working together in a collaborative group at the university's assessment lab with standardized patients. The following semester, students will begin rotations in interprofessional groups of five: two psychiatric nurse practitioners, an occupational therapist, a social worker and a psychologist.
"I think it's going to orient the group to each other's roles. Even though we as an organization support interprofessional education, it still seems to happen in silos," said Harris. "Getting a psychologist, a nurse practitioner, an occupational therapist and a social worker working side-by-side to understand each other's roles will be helpful from an educational perspective."
The grant will also play a part in building up Mississippi's base of mental health providers, another deficit in the state, by developing more faculty, students and preceptors in the program. A statewide consortium of graduate nursing schools, the Mississippi Educational Consortium for the Doctorate of Nursing Practice, is building a database of all the advanced practice nurses in the state.
The consortium also hosts conferences to help train and educate those in advanced nursing practice. Each of the collaborating schools participating in the grant will receive $20,000 from the grant, with the goal of increasing the number of psychiatric mental health nurse practitioners in the state. Member schools include the University of Mississippi, Delta State University, Mississippi University for Women and Alcorn State University.
"We have more than 40,000 nurses in the state, and less than 10 percent of those have a master's degree," said Christian. "Fewer than 300 of those have a doctorate degree. We are trying to educate our nurses and get them to practice at their highest level of education possible."
Harris said that a nurse educator has been hired to help in the coordination and tracking of all the different grant components. The program will employ a method of rapid cycle change favored by HRSA, PDSA: Plan, Do, Study, Act.
"It is a quick way of assessing and changing what you do," said Harris. "If we identify something that needs to change, we plan, do, study, act. We are counting on the interprofessional student group to give us feedback and help us make positive change as we go throughout the process."
Christian believes the program fits into the overall mission of the medical center, improving the health of Mississippians.
"To have a clinic where the psychologist and the family practice provider or the nurse practitioner work collaboratively with one patient to incorporate the mental health needs of that patient while they are there for their blood pressure or sinusitis visit."