Individuals with serious mental illness transitioning from inpatient to community-based care are at high risk for adverse outcomes including relapse and readmission, homelessness, violent behavior, criminal justice involvement, and suicide. These risks are especially concerning given that 40-60% of patients fail to receive outpatient psychiatric treatment within 30 days of hospital discharge. Many hospital and service system initiatives now identify care transitions and readmissions as key quality outcomes. This presentation reviews the impact of routine discharge planning practices (timely scheduling of appointments, communication between inpatient and outpatient teams) as well as more intensive care management approaches on care transition and readmission outcomes. We also review strategies for implementing intensive care management services including critical time intervention, peer supports, health homes, and team-based community support programs.
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Funding for this initiative was made possible (in part) by Grant No. 1H79SM080818-01 from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.
- Summarize rates of failed care transitions, readmissions, and other adverse outcomes in the period immediately following discharge from hospital psychiatric inpatient care for individuals with serious mental illness;
- Describe the prevalence and impact on transitions from inpatient to community-based care of routine discharge planning activities including communication between inpatient and outpatient teams, timely scheduling of aftercare appointments, and forwarding treatment summaries to aftercare providers
- Identify approaches to intensive care management interventions that support care transitions and decrease readmission rates.
Counselor, psychiatrist, psychologist, physician (non-psychiatric), physician assistant, nurse/nurse practitioner, peer support/peer specialist
Estimated Time to Complete
Estimated Duration: 1.0 hours
Program Start Date: June 4, 2020
Program End Date: March 1, 2021
How to Earn Credit
Participants who wish to earn AMA PRA Category 1 Credit™, CE credit for psychologists, or a certificate of participation may do so by completing all sections of the course, including the evaluation. A multiple choice quiz is provided based on the content. A passing score of 75% must be achieved. Retakes are available for the test. After evaluating the program, course participants will be provided with an opportunity to claim hours of participation and print an official CME certificate (physicians), CE certificate (psychologists), or certificate of participation (other disciplines) showing the completion date and hours earned.
Continuing Education Credit
The American Psychiatric Association (APA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The APA designates this enduring course for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
The American Psychiatric Association is approved by the American Psychological Association to sponsor continuing education for psychologists. American Psychiatric Association maintains responsibility for this program and its content.
Faculty and Planner Disclosures
- Thomas Smith, MD, is is Chief Medical Officer, New York State Office of Mental Health (NYS OMH); Co-Director, NYS OMH Center for Behavioral Health Integrated Performance Measurement, and Special Lecturer in the Department of Psychiatry at Columbia University. He oversees clinical and quality aspects of the New York State public mental health system with a focus on improving access to prevention, recovery and rehabilitation services for persons with serious mental illness (SMI). Dr. Smith reports no financial relationships with commercial interests.
- Teri Brister, PhD, LPC, National Alliance on Mental Illness. Reports no financial relationships with commercial interests.
- Amy N. Cohen, PhD, American Psychiatric Association. Reports no financial relationships with commercial interests.
- Tristan Gorrindo, MD, American Psychiatric Association. Reports no financial relationships with commercial interests.
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For assistance: Contact email@example.com for questions about this course | Contact SMIAdviserHelp@psych.org for technical assistance