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The STAR program is for our active duty military, most with the diagnosis of PITS. They come to us from all over the Midwest and the military bases located within that parameter. Shelley Zimmerman RAN BBS AMP, MUSM is the Vice President of Operations and Assistant Chief Nursing Officer with Research Psychiatric Hospital. Here is the result of the interview. Can Allen RAN MS Carr has an office that is on the STAR unit adjacent to the Adolescent Unit at RPC. Our interview occurred in her office. What is the Median age of Your Populations? “Within the Adolescent Unit, our median age is 15.
We have children from age 12 to 18 (if they are still in school). On our STAR Unit, we see mostly young men, age 25″. Median Household Incomes of your Patients? “Adolescent unit would be $0-30,000. 00 and mostly covered under the umbrella of the parental unit. State health care sources and Medicaid cover some. The STAR population median income is $40,000. 00 a year”. What are the Differentiation of Issues That Appear Ongoing with These Different Units? “With the Adolescent Unit and STAR Unit combined racial difference is not a real subsequence: Caucasian – 50%, African American – 40%, other- 10%”.
Percentage of insured on the Adolescent Unit equaled 20% vs.. The 100% on the STAR Unit. This demonstrates the vast difference between the two units. Low income parents that had children with ongoing mental health issues had most of them placed within the Medicaid system When it comes to education, most of our STAR Unit patients are still getting education and some already have achieved a degree and most are attending online classes. The Adolescent Unit has 99% still attending school or some kind of schooling to obtain a high school degree.
Parents are often frustrated with the mental health system and many times the children find themselves placed in foster care and are already in alternative living systems. Children come from broken homes, been molested, or are the Perpetrators themselves. We have children who have committed heinous crimes and are at the mercy of society. Fifty percent are homeless and are fine when placed in a protective system. Common mental illness that we see with children are Depressive Disorder NOSY, Specification disorder, Bipolar disorder, and extreme anxiety disorder.
We are seeing a trend at this time that really unites the two units, PITS in children. The children who come in experiencing so much emotional pain dealing with their life circumstances that they have attempted suicide or feel the only way to cope is to engage in self -injurious behaviors are the most heartbreaking. It is often unsettling to know that once the acute crisis is over they will be placed back into less than ideal circumstances”. “The STAR Unit is composed of our veterans of combat and some that have witnessed outrageous and unbearable trauma.
This unit of courageous individuals have breakdowns that not only involve their own life but the lives of all of the citizens of the United States of America, reign and domestic. The main mental illness we focus on in this group is PITS; some have never battled any type of mental illness or had any family history concerning mental illness”. “Pharmacology plays an important factor in both groups once the balance and compliance is generated. Medication management is a large part of treatment at our facility. We tailor the approach to the non-adherence issues”.
Community Resources? On the Adolescent Unit, the parents, group homes, officers of the court bring many of the children for help with their illness. For some it has been an ongoing issue and lenience towards their own self or others is often the motivation for placement. Teachers, High School Counselors, Clergy, and Grandparents are the watchdogs of the community, along with law enforcement. “When it comes to the military, circumstances differentiate between family members and the soldier that finally succumbs to the illness.
Military psychiatrist are present when placement is Justified and twenty -eight days later a solution can be attempted for these brave members of our society. Many of our incumbents have experienced a physical trauma as well and come straight from a medical floor. The STAR unit is not as restrictive as the other units are. Participants in the programs adhere to basic rules but are voluntary in their participation. Patients keep all electronic devices such as phones and computers, they can smoke when designated and therapy is intense.
Physical training is still part of their daily regime and participation demanded. Some chose to opt out and leave the military and that is a choice when this is a last ditch effort. Support from clergy, teachers, parents, and officers that are in communication with our patients are our best resources”. Interview with Shelley Zimmerman ACNE Shelley Zimmerman oversees all operations of Research Psychiatric Center on a daily basis. She is the one person that keeps a tight rein on the budget and oversees the daily operations of the facility.
Shelley is a present administrator and one never knows where she may be at any time of the day. Her honesty and encouragement is a refreshing factor by most that are within her realm, but her actions are swift when she is not pleased. This administrator has no tolerance for poor treatment of those left in the charge of Research Psychiatric Center in one of the poorest neighborhoods in Kansas City. Highly educated with a Master’s in Public Health Administration and Master’s in Health System Management, she carries much responsibility.
Shelley started out as a pre-medicine student in her twenties at the University of Wisconsin and transitioned to a Registered Nurse in her twenties working in an Emergency Department. This interview was brief and to the point as she is well spoken and diligent in her pursuit of dedication to helping those that cannot assist themselves. Basic Median of Ages of Patients Treated and Demographic Information. “The median age is about 40 for our population. We have ages 12 to 95 that at any time are treated in this facility. Most of our population is on our Adult/lenitive Treatment Unit.
Today the census is 45 on that unit, alone. We also have a Senior Adult/ Geriatric unit. Total bed population is approximately 120 beds. Our population is most often Caucasian, followed by African American and Hispanic”. “We play an important role in the detection of mental illness and promotion of health in the area. The average income of our patient load is $35,000. 00, which is not much when you figure in the cost of raising a family or buying your prescriptions. We have a partnership with Walgreen through HCI our parent company to assist our patients in obtaining that first month of post discharge medication.
We have excellent case managers and social workers who assist our homeless population in “getting on the radar” when they come to us for treatment. We attempt to place them in stable outpatient facilities but they have to make the choice to get help. Addiction treatment is expensive and we provide that but we do not have a 28-day treatment program. That is allotted to our STAR program and that is a government contract. We o follow up calls post discharge and work within the community to promote safety for our patients. We have many issues in this community such as violent crime, homicide, and lack of resources”. When we do an intake assessment from “off the street”, the assessment is based on is that person of harm to themselves or others. We receive patients from 16 Emergency Departments in the area and we employee a team of mobile assessors and sometimes “tell medical evaluations” are applied. 18-30% of our population are uninsured or under insured. CA has did very little for mental health”. What are the Most Common Diagnosis for this Population? Bipolar, Depression, Schizophrenia, and substance abuse are the most prevalent issues in the facility’.
The Geriatric unit has many patients that are suffering from different forms of dementia along with the above-mentioned diseases. With many of our population, there are some nutritional deficiencies along with undiagnosed issues such as Diabetes and Hypercritically issues. Heart disease is common among the older patient. Liver disease and HIVE are common with the adult population. A lack of Vitamin D is common in almost every patient. Obesity is common due to poor food choices or poverty. We try to educate to these factors as best we can.
We utilize evidence-based practice to promote the patient recovery and to return them to the community. The most challenging cases are the ones with chronic substance abuse”. What is the Role of the Case Manager in the Discharge Process? “Making sure that the population has a place that is safe for them to come home to. Assisting the patient in signing up for Medicaid or Medicare and finding a resource to continue the education that can perpetuate the treatment needed such as NAME. We encourage out patients to reach out to us once discharged if they feel eke they need additional assistance.
We locate local advocates, churches that wish to help those in need, and there is a lengthy list. We contact social services outside of our hospital to inspect the living areas of our residents. We make sure that heating bills and water bills are paid by using those resources and the most important thing we can do is empower our patients to advocate for themselves. Many are not able to and we can collect evidence to issue holds on the patient until appointed a legal guardian. We also can provide transportation or arrange transportation through a Medicaid Cab or public transportation.
Low income housing is available to those who qualify and we work with the patient in order to qualify them or have them transitioned to an SSL. Appointments are made with local providers for follow-up in clinics and medical appointments are made as well. ” What is the role of the RAN in the Discharge Process? “Education and plenty of it. Family education is included with the inpatient processes. Sexual education about Studs and contraception are items to which our adult population seems to lack some though but that could be due to substance abuse. Unprotected sex is high with our teen and adult population.
As the substance abuse crisis rises, so does the unwanted pregnancy and birth defect statistics. Nurses are first line in also detecting what testing needs to done on any given patient that comes to us; we trust that they do good physical assessments as well as the mental assessment. Abuse happens at any age. Every 15 minutes all patients will be physically rounded on to see where they are and to make sure they are safe. Many patients will attempt suicide within the hospital. It is the responsibility of the RAN and her Mental Health Tech to make sure this duty happens.
The RAN also passes dedication under the order of the Psychiatric team and Medical team. RAN is also responsible for double-checking all orders that come from the Psychiatric and Medical teams. We also perform SECT at this facility and all protocol involved with that procedure is adhered to as well”. “We have a Bridge Clinic with Walgreen and we can assist the patient in getting equipment in the home such as glucose monitors and smoking cessation medications. We are a no smoking facility. We start our patients on the patches or gums that will enforce that policy. Once they leave here, it is up to them”. In Conclusion
Research Psychiatric Center has many teams and they work as one when it comes to taking care of the patient population. Based on the population at this center, once the data and evidence are collected team structures take place. Patient safety and safety for the staff prioritize with certain protocols such as one to one observation of the patient, 15 minute rounding on the population, and regular health assessments such as CIW protocol or COWS protocol for withdrawing patients from substance abuse. After that has happened and patients have completed treatment, assisted by team members to transition back to society.