Identifying and Addressing a Gap in Service: Integration of Clinical Psychology Students into the Saturday Neighborhood Health Clinic

James Broughton1, Preethi Kesavan2, Jimmy He, B.S.3, Will Ross, MD, MPH2, 1Washington University in St. Louis School of Medicine; 2Washington University in St. Louis School of Medicine, St. Louis, MO; 3Washington University School of Medicine in St. Louis, St. Louis, MO

Meeting: Hospital Medicine 2018; April 8-11; Orlando, Fla.

Abstract number: 90

Categories: Hospital Medicine 2018, Innovations, Other

Background: The Saturday Neighborhood Health Clinic (SNHC) is a volunteer physician and medical student-staffed clinic that provides episodic care for uninsured St. Louis residents and connects them with long term primary care providers. An estimated 20% of mentally ill adults remain uninsured. Furthermore, compared to the insured, depressed uninsured patients are only half as likely to successfully make appointments for urgent psychiatric referral care. Walk-in single session psychotherapy has been shown to lead to perceived and objective improvement of depression, anxiety, and distress, conditions often faced by patients within our target population.

Purpose: The SNHC started a monthly psychiatry specialty night staffed by volunteer psychiatrists and medical students in the winter of 2015. Since the initiation of this specialty clinic, we have noticed a significant demand for psychological counseling and identified two problems that could be addressed. First, there is limited recourse for uninsured patients, who must often tolerate lengthy wait times for an appointment at a Federally Qualified Health Center, or the monthly psychiatry night at SNHC. Furthermore, adherence to follow-up and medications are often difficult for our patients who face many barriers to care. The purpose of this program was to address both of these areas by implementing psychological counseling at our clinic.

Description: Starting in September 2017, we began integrating clinical psychology graduate students into the SNHC general clinic work flow to help address the psychological needs of our patients. The psychology students accompany medical students and attending physicians during patient visits, and are overseen by faculty from the psychology department. Due to the episodic nature of treatment at SNHC, psychology students focus on brief interventions and referral for appropriate follow up. We will analyze the distribution of psychological conditions assessed and interventions provided to better tailor future care. To determine impact on medication and follow-up adherence, we will perform longitudinal surveys with patients seen during the winter.

Conclusions: During the fall of 2017, psychology students evaluated and counselled 19 patients, (58% of all seen,) over 3 clinic sessions, as part of a pilot program. They provided counselling concerning diet and nutrition, adherence to birth control, cultural acclimation, grief and loss of a loved one, depression, and suicidal ideation. They provided referrals to sliding scale psychotherapy clinics, a grief support group, a trauma recovery center, the national suicide prevention lifeline, and other crisis hotlines. Because psychology students will be available at clinic each Saturday, they will alleviate long wait times for the monthly psychiatry clinic or connection to a primary care physician. As we continue to integrate psychology students into our clinic workflow through winter 2017-2018, we anticipate this program will provide our patients with more timely access to mental health services and an entry point to long term care.

To cite this abstract:

Broughton, JS; Kesavan, P; He, JZ; Ross, W. Identifying and Addressing a Gap in Service: Integration of Clinical Psychology Students into the Saturday Neighborhood Health Clinic. Abstract published at Hospital Medicine 2018; April 8-11; Orlando, Fla. Abstract 90. Accessed February 24, 2020.

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