Improving the Care Pathway for Major Depressive Disorder

Major depressive disorder (MDD) can be devastating for individual children, adolescents and their families. Due to the severity of the illness, they frequently require hospitalization. The Division of Psychiatry is focusing on enhancing the outpatient treatment of MDD, to decrease the need for hospitalization. Through utilizing improved scientific techniques and enhancing reliability of providing evidence based care, the division has been able to improve outpatient care outcomes and decrease admission rates in severe cases of MDD. The division has been able to decrease the admission rate by 50% in those patients with major depressive disorder enrolled in this program while maintaining enhanced patient safety. Accomplishing this happened by engaging in effectively training all therapy providers in multiple modalities of evidence based psychotherapy techniques, ensuring the reliable application of these therapies, enhancing referral mechanisms for medication management and using best evidence for drug selection and dosing. A subsequent benefit included improved utilization of high intensity services for more patients, as the major depression care pathway has opened inpatient beds for other patients in need and improved patient flow.

Improving the Management of Mental Health Crises

Each year, Cincinnati Children's Hospital Medical Center sees a significant increase in demand of the number of patients seeking emergency psychiatric assessment and treatment. This equates to a 75% increase in Emergency Department psychiatric assessments from FY 2012 to FY 2017, with over 8,000 visits and a 50% increase in inpatient psychiatric admissions. In emergency situations, obtaining timely outpatient management is often a great challenge. The division developed the Bridge Clinic as an additional level of care to provide access for patients in acute crisis but not requiring hospitalization. The design on the clinic is to provide crisis management interventions, support transition to ongoing mental health providers in the community, decrease acute psychiatric admissions to the hospital, and offer alternative pathways to emergency department visits. The clinic utilizes a time-limited, integrated care model to help patients and family members access mental health services. Independent clinicians, a psychiatrist, advanced practice nurses and care coordinators staff the clinic to provide crisis appointments and telephonic support. These interventions begin the process of helping the patient begin to develop healthy coping skills, to manage the crisis event and to assist the patient and family on navigating the mental health system to secure ongoing services. Success of this new level of care is significant. Since January of 2017 the Bridge received a total of 1,022 patient referrals. The vast majority of referrals see resolution in the clinic with the percent of patients returning to the Emergency Department, or in need of a psychiatric admission, of 2%. The number of patients successfully transitioned from the Bridge Clinic to on-going mental health services exceeds 90%.

Improving Community Care for Major Depressive Disorder

Major depressive disorder (MDD) is one of the most common causes of disability worldwide. This disorder is frequently found in children and is one of the most common diagnoses of patient’s coming to the hospital. The Division of Child and Adolescent Psychiatry utilizes multiple programs to enhance the care of patients with major depressive disorder. Due to nation-wide shortages in mental health providers, most children and adolescents with depression do not receive treatment. Improving access to care for this potentially severe illness is critical for improvement of the well-being of our community. Over the past several years, the division has engaged in training pediatricians to screen, diagnose and treat young people with MDD. The division has seen great advancement in these efforts over the past year with the utilization of the ECHO model for teaching of primary care providers to ensure effective case review. The ECHO model utilizes teleconferencing concepts, educational didactic, case review, and practice consultation to improve the education of pediatricians, family medicine, and nurse practitioners on the latest evidence based protocols to treat this disorder. After training, providers report feeling much more confident in their ability to provide care to this underserved population. All participating providers have reported increasing their management of this common disorder. The aim is the roll-out of this program region wide.