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Regional Navigation and Resource Center

Providing immediate access to outpatient services and reducing ER visits. Offering a range of support from natural to traditional methods for holistic care. Resource hub for mental health services in Central Vermont.

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Regional Navigation and Resource Center

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  1. Regional Navigation and Resource Center Central Vermont medical center Washington County Mental health services

  2. What Problems Are We Solving • Immediate Access to Out Patient Services • Working to reduce emergency room visits and re-admissions • Following up with individual to see if they followed through with the referral and identifying necessary supports to assist • Transportation, phone supports, housing, natural supports, brief case management, community outreach • Present the broad spectrum of supports in a person-directed approach: natural community supports; peer support programs; wellness and alternative approaches, as well as traditional (yoga, Reiki, mindfulness, exercise, group and individual therapy, employment, education, medical care to include psychiatric treatment) • Maximizing Resources • May Be a Resource for Teams/Providers Who Need Assistance in Challenging Discharges from Psychiatric Units

  3. Develop Your Work Group Start small and build Designated agency directors from counseling services; intensive care services; community support services; psychiatry; executive director; IT Medical center staff Director of hospital medical services; community health team director; medical practice administrative and medical director; psychiatric practice and unit directors; psychiatric family practice Patient representation Private counselor representation

  4. Functions of a Centralized Referral System • Perform follow-up phone calls to all people leaving the ER and psychiatric units to check in, offer services • Network with primary care provider offices to accept referrals and subsequently refer to appropriate level of treatment/support • Establish Intake Clinician(s) and Brief Treatment Case Management within the Hub for immediate referral • Track all referrals from moment of intake to and through engagement with referral • Information and Education Regarding the Regional Services

  5. Do We Need a Centralized Referral System in Our Region? • Assess needs and gaps for mental health and substance abuse services in the region & map • Examine data to determine need • Number of individuals who go to the ER who are not hospitalized but need follow up MH treatment/support • Number of people whose needs cannot be met in primary care and need a screening and assessment for mental health supports • Number of people being referred to mental health follow up treatment/supports upon psychiatric unit discharge • Number of people who are self-referring for treatment/support to the designated agencies • Approximate number of individuals being served by private counselors in the area • Assessment of peer programming • Assessment of designated agency and private provider wait lists

  6. System Networking • As we examine what problems we are trying to solve on behalf of patients/clients, we recognize that we are striving to build a stronger network • Build a system among providers that meets the need, bringing together DA services, primary care provider services, peer services, private counselors, and others • Reduce redundancy in systems and fill necessary gaps • Consider workforce pressures; maximize access • Consider IT needs to develop navigation system • Perform cost benefit analysis

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