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Community psychiatry makes positive IMPACT

IMPACT

Photo: Clinical Outreach Counselor John Grace prepares to hit the road on his way to visit a person at their home.

By ANDY GOODELL 

Associate Writer, Department of Psychiatry 

When treating severe mental illness, there’s an opportunity to go the extra mile – literally. 

IMPACT, or Integrated Multidisciplinary Program of Assertive Community Treatment, is an engaging model of community psychiatry at University of Iowa Hospitals and Clinics. This research- and evidence-based program has been helping those living with severe mental illnesses lead better lives since the mid-1990s. 

Nancy Williams, MD, Clinical Professor of Psychiatry, serves as Medical Director of the program. She says that for those living with serious psychiatric illnesses such as bi-polar disorder or schizophrenia, completing routine tasks such as doing laundry or going grocery shopping may prove incredibly challenging. These disorders can prevent people from holding down a job or having a consistent place to live, as well. Drug and alcohol abuse can compound the problems in these people’s lives, leading to frequent contact with the criminal justice system and/or hospitalization. 

“Serious mental illness is tough - one of the most difficult problems for modern medicine,” says Williams. “There are many challenges in treating and managing these conditions: treatments which may be only partially effective, shortage of providers, inadequate funding for research and care. Traditional treatment approaches have not been effective for many of our patients. 

For many years the norm was to institutionalize people with serious mental illness. In the era of deinstitutionalization, many people were removed from institutions and encouraged to live in the community. For both approaches, the results were unsatisfactory, with a low quality of life and a high level of readmissions to hospitals. That said, psychiatry offers no ‘cure.’” 

In the face of all of this, IMPACT’s approach to treatment starts to shine through. IMPACT team members work closely with people in their homes multiple times per week to ensure they can consistently lead lives of positivity and achievement of personal goals. It’s from these individualized interactions where IMPACT draws its unique strength. According to recent IMPACT program data at U of I Hospitals and Clinics, the average length of hospital stay for those in IMPACT before receiving treatment through the program was 16.3 days per year, whereas it dropped to just 1.2 days annually after they enrolled. This is proof positive that IMPACT works. 

“We work to provide care that enables people to have lives that are as fulfilling as possible while living with the disease,” Williams says. 

Betsy Hradek, an Advanced Registered Nurse Practitioner, is Team Leader for UI Hospitals and Clinics’ IMPACT program. Hradek’s strong interest in improving the delivery of health care is evidenced by the fact that she recently completed the Master of Health Care Delivery Science at Dartmouth alongside other U of I Psychiatry Department members. Having been with IMPACT since its inception at UI, Hradek has seen a great number of people with mental illness experience important success in their lives. She says people served by IMPACT are employed at better rates, have improved housing stability, reduced drug abuse, as well as a lower instance of contact with the criminal justice system.

Caring for the whole person

Chronic mental illness is often multi-faceted. Those living with these diagnoses deserve pragmatic, hands-on help on a day-to-day basis from experts in a diverse array of mental health professions. The inter-disciplinary IMPACT team includes physicians, nurses, substance abuse counselors, occupational therapists, social workers, and rehabilitation therapists. The strength of IMPACT is evident as these individuals use their varied skill sets together for the betterment of people in need of specialized care. 

Providing each person in IMPACT with focused, individualized care is priority number one. This approach enables people with serious mental illness to set and achieve their personal goals. Providers in IMPACT help in several very concrete ways that typically aren’t found in traditional clinical care. Team members can provide assistance with management of finances, negotiations with landlords, consistency with medications, and finding and keeping a job. 

In order to provide this kind of highly effective treatment, regular in-home contact is required. On average, IMPACT team members make home visits three to four times per week. They are able to see people as often as twice daily when needed and are available by pager 24/7/365. Through this interaction, staff are able to develop strong person-centered relationships that facilitate treatment and recovery. 

The relationship between physical and mental health is appreciated by the IMPACT team. Those living with serious mental illnesses typically live 25 years less than the general population due to a variety of factors, including higher rates of diabetes or cardio-vascular conditions. With this in mind, IMPACT team members help people keep track of things like blood pressure, blood-sugar, and other common factors associated with physical health, and set goals for health improvement. Integrating substance abuse treatment in IMPACT is also an essential aspect of the program. 

IMPACT also serves as a teaching tool for those who become part of the team. 

Erik Vanderlip, MD, MPH, worked as a member of the IMPACT care team during a large portion of the time he was enrolled in the Family Medicine-Psychiatry Residency at UI from 2007 to 2012. Vanderlip recently served as Resident-Fellow Trustee of the American Psychiatric Association. There, he represented all residents and fellows involved in psychiatry on the APA Board. Today, he’s an Assistant Professor with the departments of Psychiatry and Medical Informatics at the University of Oklahoma’s School of Community Medicine.

IMPACT provided Vanderlip with the opportunity to walk his patients through their recovery and the management of their illnesses in a unique way, outside of the clinical setting. 

While working alongside Williams, Vanderlip made home visits and discovered that the level of human contact involved in the program is what makes IMPACT so effective. He says the interdisciplinary nature of IMPACT and its team-based approach is novel in an ambulatory environment. Vanderlip was so impressed by the model of care that he went so far as to say it should be emulated in chronic disease management throughout the rest of medicine. Vanderlip pointed to the value of this approach, which leaves nothing in patients’ lives off the table. 

“I truly understand the effort and consistency it takes to work with people with SMI [serious mental illness] around health behavior change, exercise, diet and lifestyle,” says Vanderlip. “My life’s passion is improving the health and wellness of those with SMI, and IMPACT has shown me what is possible when a motivated and healthy team engages people with a focus on their health and wellness in partnership.” 

IMPACT at U of I Hospitals and Clinics is the flagship program of its kind in Iowa, with more teams having formed in the state since the mid-1990s thanks to Hradek, Williams, and others. But, it doesn’t stop there. The UI Department of Psychiatry is actively spreading the IMPACT approach to care by offering training opportunities for mental health care providers, as well. 

Learn more about the IMPACT program at U of I Hospitals and Clinics