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A Look at Longview - Part 2 · Healthier Together: Larimer County's Public Health Podcast

0:04
Welcome to Healthier Together, Larimer County's
0:06
public health podcast, where we come together
0:08
for healthier lives, connected communities, and
0:10
real conversations. From your local public health
0:12
team, I'm your host, Tom. And I'm Joanna. Today
0:15
we're talking about mental health crisis care
0:18
in Larimer County, the role the Longview Acute
0:21
Care Facility plays in the community, and how
0:23
their work is evolving. This is the second part
0:26
of our conversation with Dr. Leslie Brooks, Summit
0:29
Stone's Chief Medical Officer and Executive Director
0:31
at Longview, and Cassie D 'Amato, Summit Stone's
0:34
Director of Acute Services. If you didn't catch
0:37
last week's episode, go back in the feed to listen
0:40
and get some background on Summit Stone and Longview.
0:44
In December of last year, Longview opened a youth
0:48
acute care wing. Can you tell us the story of
0:52
how that came about? Oh, absolutely. I think
0:54
we were all very excited to see an expansion
0:57
of adolescent services in Larimer County. I think
1:01
this is a topic of conversation that sits within
1:03
many stakeholder settings. And having worked
1:06
in Larimer County for almost 20 years now, and
1:09
with youth many of those years, seeing the gap
1:12
in the acute level of care that existed, not
1:15
only in Larimer County, but within the state,
1:17
to see that addressed by the community in the
1:20
investment and wanting to bring. A crisis stabilization
1:23
unit to Larimer County, I think, was exciting
1:26
as a provider. And to be able to be part of something
1:29
that many people have recognized as a need for
1:32
so long is really a privilege. And in our work
1:35
with Larimer County Department of Human Services,
1:38
this came to fruition. And I think they were
1:40
a key partner in ensuring that we were closing
1:43
some gaps in this critical need for this emergent
1:48
level of intervention for some of the families
1:51
in greatest need. So I think that that partnership
1:53
has been really wonderful in linking families
1:57
in crisis to a service. When we opened Longview,
2:01
individuals and families were always able to
2:03
come and be assessed. But to add beds, to add
2:06
a place to stay for adolescents was really, really
2:10
significant in our community. And we continue
2:13
to partner with our partners at UCHealth for
2:16
the inpatient level of care stay as well. have
2:22
both expanded within the past year. So to see
2:24
that increase just within, you know, within some
2:28
recent timeframes has been extremely beneficial
2:31
for our community. And because we just launched
2:34
in December, we're certainly learning things
2:37
and we're building programming and we're evaluating
2:40
with our partners how we can continue to be a
2:43
resource for our school settings, for the Department
2:47
of Human Services and the families being served
2:49
there. and how we can continue to strengthen
2:51
the continuum because we know in serving youth,
2:54
this is a community effort. There's not going
2:57
to be one key element or piece of the continuum
3:00
that's going to resolve this, and we have to
3:02
do this together. So being able to really step
3:04
into providing yet another service that can hopefully
3:08
close some gaps. It doesn't close all of the
3:10
gaps. We know that. But to do so intentionally
3:13
with our partners, with the schools, and with
3:15
providers in our outpatient environments and
3:18
with DHS. It has been really, really wonderful.
3:22
And to continue to bring that level of integration
3:25
and investment into the community is certainly
3:29
something that we're looking for. Within this
3:31
level of care, as I said, we provide crisis stabilization
3:34
services. But within the unit, we have a child
3:38
psychiatrist. We have an adolescent psychologist.
3:41
We have occupational therapy. We have therapists.
3:44
We have care coordinators, nurses, providers.
3:48
So we have a very complex interdisciplinary team
3:51
to ensure that we're trying to close as many
3:54
gaps as possible with the time in which we have
3:56
individuals who do stay with us and families
3:59
that do stay with us. So we can hopefully provide
4:01
as much as we can in the, you know, in the short
4:04
amount of time that we have and then link them
4:05
appropriately. I would also nod to our Board
4:09
of County Commissioners and our Behavioral Health
4:11
Services partners. with whom we collaborated
4:14
on the addition of beds for our kiddos. Our Board
4:19
of County Commissioners were also very clear
4:21
and really, really committed to and enthusiastic
4:24
about offering bedded care for our kiddos. Inside
4:29
the partnership and our key stakeholders have
4:32
really understood that if we can get that kiddo
4:36
in when that crisis emerges. and stabilize the
4:40
kiddo and that family because the kiddo is going
4:42
back to that family. If we can stabilize that
4:45
and prevent that from becoming a larger crisis,
4:48
a more systemic family issue, we have done yeoman's
4:52
work to really offer a strong continuum of care
4:56
in our community that keeps kids at home, that
5:00
keeps families at home. Because once again, the
5:03
robustness of care that is delivered in people's
5:07
backyards cannot be underestimate it. What age
5:11
range does the youth wing serve? So true adolescence,
5:15
so 12 to 17. And how did this new wing change
5:20
the services that you're able to provide to people
5:23
in that age range? I think it's an important
5:26
element of providing comprehensive crisis care.
5:30
The facility was created as an acute care campus.
5:35
We provide urgent care services to individuals
5:38
across the lifespan. So as I said before, adolescents
5:41
could access care regardless. It would have been
5:46
through our behavioral health urgent care. So
5:47
we could assess an individual. What the crisis
5:50
stabilization unit does is offer an opportunity
5:52
for us to assess an adolescent and if they need
5:56
to stay with us a few days for some medication
5:58
evaluation for continued crisis stabilization.
6:02
We can place them within the facility. So that
6:05
existing within the facility alongside our adult
6:09
crisis stabilization unit really just helped
6:12
complete that continuum for the Longview acute
6:15
care facility, that we have some crisis beds
6:19
available to adolescents in addition to the adults
6:22
that we had. So from a SummitStone standpoint,
6:25
Longview is 24 -7. Having multiple 24 -7 units
6:30
that need to be staffed 24 -7, that need nursing,
6:33
that need prescribers, that need licensed therapists,
6:36
that is a tall order. And so doing that in one
6:39
place as opposed to standing up two or three
6:42
or four separate 24 -7 care facilities becomes
6:46
really challenging to do. And so the scope and
6:49
scale of Longview just made sense to have acute
6:52
care for adolescents incorporated into that.
6:56
And I do think having multiple levels of care
6:59
under one roof is what makes Longview so innovative.
7:03
So you can quickly access immediate care, that
7:07
immediate triage, maybe some labs and pharmacy,
7:10
like Dr. Brooks said, and walk down the hall
7:13
and be placed in a bedded unit versus needing
7:16
to drive across town or being placed in a different
7:18
facility. And the scale and scope of that, right,
7:22
allows for a really diverse workforce. occupational
7:26
therapy, lab, pharmacy, adolescent psychiatry,
7:30
adolescent psychology. Bringing all of those
7:33
different workforces together is really in part
7:37
driven by the scale and scope of what Longview
7:40
has to offer that makes those things possible.
7:42
So why is it important to have a space dedicated
7:45
specifically to serving youth? Are the needs
7:48
really that divergent from some of the other
7:50
populations that you guys serve? No, it's important
7:53
when we're vetting. clients that they have their
7:56
own space. And I think the county was really
8:00
intentional in making a very trauma -informed
8:03
environment. And we talked a little bit earlier
8:05
about the built environment and how it's built
8:08
for acute care and specifically for behavioral
8:11
health. And it's similar for kids and youth.
8:13
We want to make sure that the design of the milieu
8:16
itself offers a little bit more space than some
8:19
of our adult units that we have intentionally
8:22
built. sections of the wing itself. So we have
8:26
space for different therapeutic groups. We have
8:29
space for different psychoeducation groups. We
8:33
have a unique space for a quiet room or in a
8:36
sensory room. So the actual design of the wing
8:40
itself is really important to ensure that we're
8:44
building a therapeutic environment in which adolescents
8:46
feel like they're not. in a hospital or that
8:50
it's not an institution. Kind of a follow -up
8:53
question for this is, you know, for the youth
8:55
that do come to Longview, are they typically
8:57
brought by a parent or guardian or do they come
9:01
in by themselves? Yeah, really, there's a diverse
9:04
way that individuals and kids can come, whether
9:07
that's with a family member, we get referrals.
9:09
From the schools, as I said earlier, we dispatch
9:12
our mobile crisis response team. So we bring
9:14
an adolescent back and coordinate with their
9:17
families to meet back at the facility or meet
9:19
in the field. Law enforcement bring adolescents
9:23
through. We coordinate with our emergency departments
9:26
if families do access the emergency room and
9:30
they might refer families to Longview. So they
9:33
can come in a variety of ways. You have some
9:36
intrepid kids who come on their own. friends,
9:39
bring friends to the facility. All are welcome.
9:44
So what does follow -up care look like then for
9:46
youth who check out of Longview who are discharged?
9:48
Is it different from some of the adults that
9:50
you guys have supported? As I said before, discharge
9:53
is a critical component to our care and ensuring
9:55
that we're including collaterals and natural
9:58
supports in everyone's stay is important, but
10:01
even more so important for our youth. We know
10:04
that there's investment in the natural family
10:06
systems that that we want to ensure that we have
10:09
and including individuals that youth identify
10:13
as natural supports is important. Sometimes that's
10:15
family, sometimes that's friends, oftentimes
10:18
that's other pieces of the system, whether that's
10:20
school counselors or teachers or outpatient therapists
10:24
or maybe a primary care provider. So it is even
10:28
more important to include their natural systems
10:31
of support because Those are the folks that are
10:34
going to get them to their next appointment or
10:36
to get them involved in the pro -social activities,
10:40
whether it's with a school or a recreational
10:42
involvement. So ensuring that we're really looking
10:45
at the entire system is an important part of
10:48
the work that we do. So what would you say to
10:51
a youth who wants support with withdrawal management
10:53
or crisis stabilization, but they're hesitant
10:55
to visit Longview, maybe due to concerns about
10:58
the cost? maybe follow up with law enforcement
11:00
or just a general fear of admission? Is there
11:03
something that you would typically say to them
11:04
or what would you say? I think there's a variety
11:06
of ways that, you know, kids can get help, that
11:09
anyone can get help. As I said before, we're
11:11
connected to 988. So that's an easy phone call
11:15
away. And it's also can easily be texted as well.
11:20
So SAMHSA has set up that 988 has a text function.
11:23
And then, you know, questions can be asked there.
11:26
Kids can call us directly if they're hesitant
11:28
to walk in. And we also have our local Summitstone
11:33
crisis line that we coordinate with 988. And
11:36
oftentimes that can open the door for a potential
11:39
mobile so we can send our team out to meet adolescents,
11:43
whether it's at school or with their family or
11:45
with a friend in a park. So there's a variety
11:48
of ways that we would just encourage adolescents
11:50
or anyone really to call us and talk through
11:53
what might be happening. Because as I said before,
11:56
We really like to identify that we're here for
11:59
a self -defined crisis, and that can be anything.
12:02
You know, everyone's crisis looks a little bit
12:04
different, and there's no minimum criteria for
12:06
how you want to identify that. And we just want
12:09
to be a warm voice on the other end to encourage
12:12
someone to walk in if they need to, or have a
12:15
friend bring them in, or be on the other end
12:17
of receiving someone from EMS or law enforcement.
12:20
So, yeah, I would just encourage them to call
12:23
988, text 988. Call us, text us. We're there
12:27
for them. What's on the horizon for Longview?
12:31
Getting to 56 beds. When we launched the dashboard,
12:34
we were at 37 beds. We currently sit at roughly
12:38
48 beds with the opening of the adolescent unit
12:42
and then shortly thereafter opening our last
12:44
unit. Each of our units, with the exception of
12:47
the adolescent unit, has 16 beds. So Longview
12:50
is an urgent care with 10 exam rooms. a 23 -hour
12:55
observation unit that has about six beds, and
12:59
then four unique units. The first is the adolescent
13:04
unit, and it has a total of eight beds. We're
13:07
operating at six right now. And then three other
13:10
units that each have 16 beds. We opened the last
13:14
of those 16 bed units in April and opened that
13:19
unit with about eight beds. So we've got about
13:21
eight beds to go. I would say As we've talked
13:24
about the facility itself and the innovation
13:26
and the practices that we're committed to continuing
13:29
to lean into is building partnerships with the
13:34
university, with learners, with expanding our
13:36
intern practices, with practicums, really making
13:40
Longview a site that is recognized locally, regionally,
13:44
nationally as an innovative practice and somewhere
13:47
that people want to come work and want to come
13:50
learn and really learn how to provide. comprehensive,
13:54
complex, integrated, systemic crisis care. And
14:00
that requires investment from community partners
14:03
and then our continued learning. Longview's goal
14:06
has long been to be, Summit Stone's goal, to
14:08
be a center of excellence. We believe that the
14:11
way that we deliver this care is unique and really
14:16
important to ensure that we have physical health
14:19
providers, working alongside psychiatric providers,
14:22
that we have the addiction specialty that we
14:24
need to have, that we have therapists and peers
14:27
and case managers and care coordination alongside
14:30
the, you know, lab pharmacy doctors and things
14:33
like that that you need and really living into
14:36
this care requires all of those parts to come
14:40
together. And every time we send people away
14:43
to go get some other part of the care someplace
14:46
else. We do folks a disservice. We try really
14:49
hard. We need our emergency department partners.
14:52
So please don't hear any part of this as we don't
14:55
need them. But we really intended for us to do
14:58
our own sort of medical clearance. There is a
15:01
pattern in practice in behavioral health of sending
15:04
folks to emergency departments and hospitals
15:06
for medical clearance and then having them come
15:09
to behavioral health. We really wanted to eliminate
15:12
that slingshot so that we could. ensure that
15:17
we understood that folks were safe to be in our
15:19
care through the use of our own services, through
15:21
lab, pharmacy, again, having nurses and physical
15:26
health providers work alongside our behavioral
15:28
health providers. And that is a framework of
15:32
care that we want to expand and continue and
15:35
ultimately teach others how to provide that care.
15:40
I think Cassie and I are of the shared belief
15:43
that crisis care in a variety of disciplines,
15:47
both as a therapist, both as a physical health
15:51
provider, as a physician. That is not care that
15:54
is uniformly taught. And so delivering this care
15:58
and delivering it well, we believe are places
16:01
that we could, that is a space that we could
16:03
occupy in helping people understand how to do
16:07
this and how to do it well. So what would you
16:09
say is the most challenging part of your jobs?
16:13
We understand that, you know, that there is a
16:15
continuum of community -based care up through
16:18
crisis and hospital care. But it is not as tried
16:21
and true a system as our physical health partners.
16:24
There is a continuum of care when you have a
16:26
heart attack. We need to get you to an open vessel
16:30
in 90 minutes. And that is well known from the
16:34
EMS folks who respond to you out in the field
16:37
to the flight service that may need to come and
16:39
get you if you're in a rural area. to the hospital
16:42
that receives you. They know that they need to
16:44
get you to the cath lab as quickly as possible.
16:48
That is tried and true. That is not as tried
16:51
and true in the behavioral health space. And
16:54
we need to develop those systems and make sure
16:57
that they are in place, at play, and working
17:00
well in our community. The challenge of being
17:03
in behavioral health, the behavioral health system
17:05
is a complex system. You know, that's like the
17:07
passion that we lean into and why we... Why I
17:10
chose this work is the challenge of navigating
17:13
systems and breaking down barriers for anyone
17:16
trying to navigate the system. So the parity
17:20
does not exist for behavioral health care and
17:23
primary care is incredible. And having been in
17:28
the field for decades now, navigating the continual
17:33
challenges of the behavioral health system is
17:36
certainly a challenge. Also ensuring that we're
17:41
building a workforce that can withstand the complexities
17:44
of acute work in behavioral health. Because oftentimes
17:48
our staff are meeting everyone at the depths
17:52
of their days. And the psychological toll that
17:56
it takes in continuing to walk alongside someone
17:59
in a suicidal state, in a highly psychotic state,
18:03
in an agitated, aggressive, assaultive state
18:07
is real. And continuing to build strength and
18:11
support in a workforce that is rewarded for their
18:16
work, not only because of the dedication to service,
18:19
but in recognition of the complexities of behavioral
18:22
health that can be compared to the complexities
18:25
of physical health is something, you know, I
18:28
think that we really strive to continue to push
18:31
the system to make change and challenge that.
18:34
It is our number one job. Certainly. delivering
18:37
the services and delivering them competently
18:39
and well, but we can't do any of that without
18:43
our workforce. And the work that we do at Longview
18:47
and in our emergency departments and in other
18:49
acute care settings is intense. It is incredibly
18:53
intense to stay present with someone, even though
18:56
they may not be able to be present with you,
18:59
to walk alongside them in all the ways that Cassie
19:02
just described requires support. of a workforce
19:07
that is not robust. There aren't layers and layers
19:10
and layers of therapists and peers and case managers
19:14
and psychiatric providers waiting to take these
19:18
jobs. So how do we educate more of them and produce
19:23
more of them? And how do we retain them in this
19:26
field so that they have a career in this field
19:28
if that's what they want? You kind of touched
19:30
on this a little bit earlier just with, you know,
19:33
the challenges that you guys are experiencing.
19:36
But I'm wondering what the withdrawal services
19:39
that you provide actually look like on like a
19:41
day to day kind of thing. So somebody walks in,
19:44
they're having a hard time, they're going through
19:45
withdrawals. What does that look like to provide
19:48
that level of care? What do they typically experience?
19:51
Our typical process is, you know, for someone
19:53
to walk in and to be warmly greeted by our front
19:57
desk and then. triaged by a nurse and then met
20:01
by the therapist and the provider. So everyone
20:04
walks in and, like we have said, is assessed
20:07
in our behavioral health urgent care. So we'll
20:09
really be able to truly triage what might be
20:12
happening. We've said many times, you know, that
20:14
individuals come in a self -defined crisis. So
20:17
there could be an experience of withdrawal symptoms.
20:20
There could be some passive SI, some passive
20:23
HI. So really... Suicidal ideation. Yes. Homicidal
20:27
ideation. Acronyms. So we'll really triage what
20:31
might be happening from a therapeutic and clinical
20:34
and medical lens and then determine if someone
20:38
is safe to go home. That's ultimately what we
20:41
try to do. Like Dr. Brooks said, we discharge
20:43
and safety plan with about 60 % of individuals
20:46
who come through our door. If we do identify
20:48
that they might need to stay or might medically
20:53
meet. the criteria to be admitted to one of the
20:56
units or might need a few extra days to help
20:58
manage withdrawal symptoms. We can then move
21:02
forward with the process of admitting and moving
21:04
on to one of our bedded units. So what that looks
21:06
like is really creating, you know, a comfortable
21:09
space in one of our rooms with our behavioral
21:12
health techs who will walk through kind of any
21:15
belongings individuals have. We'll assign them
21:17
a space and then they'll stay in that space and
21:20
throughout the course of a day. They'll meet
21:22
with a therapist. They'll meet with our provider.
21:25
Our provider will either assess the current medications
21:27
or provide additional medications. We have multiple
21:31
groups that happen every day on our units. So
21:34
if they're feeling well enough and the withdrawal
21:36
symptoms aren't severe enough to where they can
21:38
engage in groups, someone will have goals groups
21:41
with our peer specialists. So individuals with
21:43
lived experience. We have an occupational therapist
21:46
if there's a screening that we complete and they
21:48
need some. some body movement or some other modification
21:52
tools that could help, we have the ability to
21:56
do that. We have, like I said, our individual
21:58
therapy and group therapists will provide sessions
22:02
daily. So they'll engage in multiple groups throughout
22:05
the day. And then obviously treatment planning
22:08
is a big part of that and discharge planning.
22:10
So if that includes some other family members,
22:13
we'll loop their family members in for a comprehensive
22:16
And a review of a safety plan or a recovery plan
22:19
to ensure that we're connecting to whatever services
22:22
that might need to be happening outside of our
22:24
care as well. The only thing I would add is that,
22:27
you know, for everyone, the question is, what
22:29
do you want recovery to look like? You know,
22:31
regardless of the type of crisis that you're
22:33
in, whether that's withdrawal or psychiatric,
22:37
what do you want this to look like? Because that
22:41
can involve a lot of things. It can involve medication.
22:43
It can not involve medication. It can involve
22:46
ongoing care. We hope that it will involve ongoing
22:49
care for folks, but that's not everyone's desire.
22:52
So our job is to sort of go and make sure everyone
22:55
understands what's available to folks. I will
22:58
say in the withdrawal management space, in the
23:00
substance use space, if someone wants what we
23:03
used to call medication -assisted treatment or
23:05
medications for substance use disorder, those
23:08
are available to them. They are available whether
23:11
they're in urgent care or on one of our units.
23:14
They can be available same day to folks. We can
23:17
get folks started on buprenorphine, suboxone.
23:19
We can get folks started on methadone and get
23:21
them transitioned over to an OTP. All forms of
23:25
FDA -approved medication for opioid use disorder
23:28
are available at Longview, and they can be available
23:31
in our urgent care. That is a challenge, I know,
23:33
for folks in our community, being able to access
23:36
those services in a timely fashion. And so those
23:39
are available at Longview. But yeah, asking the
23:42
question, your recovery is your decision. And
23:44
what do you want that to look like? And how can
23:46
we walk alongside you? I do have just one more
23:50
question. You know, with all the changes happening
23:52
at the federal level, I've always asked some
23:54
of the partners that come in who might be recipients
23:56
of grants or kind of pass -through dollars. Has
23:58
anything that's happened kind of at higher levels
24:01
or up in the federal government affected how
24:02
you guys provide services? Yeah, those are starting
24:06
to roll out. The impacts of H .R. 1 on our Medicaid
24:09
expansion population will be significant. We
24:13
are getting ready to manage some of the requirements
24:15
that come, work requirements and things like
24:18
that. So I would encourage folks in the community,
24:20
if they have questions about how that is going
24:23
to impact them, especially if they have Medicaid,
24:26
our health care policy and finance has a H .R.
24:29
1 portal that they can access. as well as they
24:32
can call us. They absolutely can reach out to
24:35
us and ask questions and we can help support
24:37
them through that process. But absolutely, there
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will be impacts and we as a system are getting
24:43
ready for the impacts. Cassie, Dr. Brooks, thank
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you both so much for joining us today. Thank
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you so much for having us. You can find links
24:51
to learn more about the topics we discussed today
24:53
in the show notes. If you have a question about
24:56
public health in Larimer County or a topic you'd
24:59
like us to discuss, let us know. Email us at
25:02
healthiertogetheratlarimer .org. Thanks for listening,
25:06
Larimer County. Until next week, stay well, stay
25:09
connected, and remember, we really are healthier
25:11
together.