Support: 866.543.6646
Sales: 855.489.1792


Why and How to Follow Up on Behavioral Health Discharges

Patients who have been hospitalized for a behavioral health incident, such as a substance overdose or a psychiatric episode, are highly vulnerable in the first few weeks or months after discharge. Behavioral health and addiction treatment can be frightening and isolating for many clients, especially after hospitalization or other inpatient stay.

During this period, your behavioral health client is at increased risk of relapse and even suicide. Therefore, it is critical for behavioral health practices to establish a follow-up plan for each client after discharge.

The Importance of Follow Up

Follow-up care is strongly recommended for addiction treatment and other behavioral health incidents. Research shows that 40 percent to 60 percent of individuals who are recovering from drug or alcohol addiction relapse. Long-term follow-up care is one method that has helped reduce relapse risk.

Appropriate follow up after discharge is also important for clients who are at risk of suicidal behavior. Research shows that 26 percent of all suicidal acts happened within the first month after discharge, and more than 40 percent within the first three months.

Research also indicates that when follow-up treatment is poorly integrated into a client’s psychiatric care, it could lead to lower-quality treatment, and thus worse outcomes.

Caring Letters in Follow Up

In the late 1960s and early 1970s, researchers working with psychiatrist Dr. Jerry Motto, of the University of California, San Francisco, sent “caring letters” to individuals who had been hospitalized for suicide and depression. These discharged patients had refused follow-up care.

The caring letters included simple notes expressing interest and concern. The letters did not demand a response, such as making a follow-up appointment, but did invite recipients to reply, if desired.

In the first two years after hospital discharge, the average suicide rate of the “caring letter” recipients was about half of those who did not receive a letter. These letters may have helped the recipients feel more connected to others just by letting them know that someone cared.

Creating a Follow Up Protocol

Behavioral health organizations and providers can integrate follow up in numerous ways, ranging from the simple to the complex. These include:

Notes and caring letters
Phone calls
Home visits
Text messages

The chosen methods should be integrated into an overall, structured, consistent follow-up protocol, according to the National Suicide Prevention Lifeline. Behavioral health providers should obtain client consent for follow-up early in their care and make sure that each client understands the follow-up service.

Discharge follow-up plans should include:

Thorough documentation, including all suicide risk assessments, management plans, consultations, and all actions that occurred as part of follow-up, including any caring letters, texts, phone calls, or home visits
Information from admitting facilities
Assessing for continued suicide or relapse risk
Focusing on medication adherence, if applicable
Culturally appropriate interventions to help reduce outcome disparities among racial minority groups

BestNotes EHR solutions allow users to save form letters for follow-ups, as well as send questionnaires for progress monitoring. This not only helps you reach out to individual clients, but can also help improve client outcomes, and better track data for reporting.

The right EHR system is vital for accurate documentation and thorough follow-up of behavioral health and addiction treatment discharges. Contact BestNotes today to learn more about our customizable options.

date:  Jan 28, 2020
Read More

What is Acceptance and Commitment Therapy and How Does it Work?

Acceptance and commitment therapy (ACT) is a type of counseling and psychological intervention that combines acceptance and mindfulness strategies with commitment and behavior-change strategies. Previously known as comprehensive distancing, it was developed in 1982 by Steven C. Hayes to combine cognitive and behavioral therapy.

How is ACT used?

ACT is intended to help clients increase their psychological flexibility. Psychological flexibility is usually defined as a person’s ability to stay in contact with the present moment and choose behaviors appropriate to their situation and values, even while experiencing unpleasant thoughts or feelings. This is an important part of developing resilience.

ACT clients can learn to accept their deeper feelings as appropriate responses to certain situations, without allowing them to prevent progress in life. Clients can learn to accept their difficulties and commit to making necessary behavioral changes, whatever may be happening in their lives or how they feel.

What does ACT involve?

With ACT, a client does not try to control, avoid, or feel guilty about painful emotions and past experiences. Instead, ACT encourages the client to embrace, learn from, and accept their thoughts and feelings while working to change behavior.

There are six core processes involved in ACT:

Cognitive Defusion: The client learns to recognize and accept their thoughts and feelings as “just thoughts,” without getting caught up in them or giving them control.
Acceptance: The client learns to embrace difficult experiences or feelings, such as anxiety or pain, and to let them pass by without avoiding or struggling with them.
Contact with the present moment: Through practices such as mindfulness, the client develops awareness, openness, interest, and receptiveness to the here and now.
The Observing Self: The client develops a transcendent sense of self, recognizing that their thoughts, feelings, memories, and physical body are constantly changing, and are not the essence of who they are.
Values: The client identifies and clarifies what is most important to them and who they want to be.
Committed action: The client sets goals based on their values and works toward them responsibly and meaningfully.

With ACT, the therapist works with the client on their self-talk and helps the client determine what issues require immediate action or change, and what can be accepted as-is. The therapist guides the client to stop fighting his or her emotions and past experiences, and instead practice more helpful behaviors to achieve personal goals.

Does ACT work?

ACT has been used to treat or manage a variety of behavioral health concerns, as well as manage physical conditions such as chronic pain and diabetes. Uses for ACT include:

Workplace stress
Test anxiety
Social anxiety disorder
Obsessive-compulsive disorder
Substance abuse

The research into ACT is still somewhat limited, but evidence suggests that ACT is superior to placebo for treating several concerns. Other research suggests that ACT may be equal to established interventions in treating anxiety disorders, depression, addiction, and somatic health problems.

Like most behavioral health treatment approaches, ACT is highly adaptable to different providers, clients, and settings. Shouldn’t your EHR solution be just as flexible? BestNotes offers EHR solutions that can be customized to your practice’s unique needs to help you save time, reduce frustration, improve profitability, and meet state reporting requirements. Contact us today to learn more or schedule a demo.

date:  Jan 24, 2020
Read More

Looking Forward to Value-Based Care in 2020

Value-based payment (VBP) models and value-based care have been difficult to implement, and behavioral health in particular has been slow to adopt VBP models. However, this year saw significant changes toward the implementation of VBP that providers should know about.

Key payers and providers, including the Centers for Medicare and Medicaid Services (CMS), announced in late 2018 that 48 percent of their business was finally tied to VBP models, according to Forbes. The Health Care Transformation Task Force is aiming for 75 percent of their respective businesses operating under VBP models by the end of 2020.

With that in mind, behavioral health and addiction treatment providers should be aware of significant developments in value-based care, and prepare for additional changes.

Value-Based Care Affects Healthcare Business and Financial Practices

The move to VBP has driven providers and healthcare organizations to rethink how they do business, operate efficiently, and control costs. As a result, the last few years have seen a rapid increase in healthcare mergers and acquisitions. Additionally, providers and health systems have been partnering with behavioral health organizations to expand their behavioral health or addiction treatment offerings in a cost-effective way.

In transitioning to VBP, providers are also rethinking how they work with payers. VBP models require payers and providers to agree on how much reimbursement is needed. Payers are encouraged to help providers choose the best care approach, while providers are encouraged to stay within their financial limits, while both sides work to reduce risk.

New Technology Will Influence Move to Value Based Care

As VBP encourages increased accuracy and healthcare savings, developers are demonstrating new technologies to help track health data. This includes digital therapeutics, a subset of digital health that leverages sophisticated software programs to help manage health conditions based on evidence-based interventions. Digital therapeutics could help patients with chronic conditions, including behavioral health concerns, follow treatment plans while supplying providers with more helpful data to guide those treatment plans.

Value Based Care Could Accelerate Under New Leadership

New leadership may also be key in encouraging the move to VBP models. This month, the Trump Administration chose Brad Smith to direct the Center for Medicare and Medicaid Innovation (CMMI). This agency was created by the Affordable Care Act and is tasked with testing and implementing healthcare payment and service models, especially those with a VBP focus.

Smith is former COO of insurance giant Anthem’s Diversified Business Group, and the co-founder and CEO of palliative care services company Aspire Health. In his new role, Smith will also be a senior advisor for value-based transformation to Department of Health and Human Services Secretary Alex Azar. Colleagues have noted that his experience in healthcare and entrepreneurship could help further the implementation of VBP models.

Prepare Your Practice for Value Based Care

The right EHR system is vital for behavioral health and addiction treatment providers looking to record and track patient data. Enter and track patient information accurately with BestNotes, a behavioral health EHR solution built specifically for your practice’s needs. Contact us today to learn more, or schedule a live demo.

date:  Jan 16, 2020
Read More

National Behavioral Health and Addiction Treatment News of 2019

This year has seen a lot of significant developments in behavioral health and addiction treatment. Let’s take a look at some of the biggest stories that made headlines across the nation in 2019.

Multiple Opioid Lawsuit Results

In August 2019, an Oklahoma judge ruled that consumer healthcare company Johnson & Johnson helped encourage the state’s opioid crisis. Although the company was originally ordered to pay $572 million, a state district judge reduced that to a one-time payment of $465 million. However, an appeal filed in December 2019 argues that this amount is not enough to cover the state’s opioid abatement plan.

In October, pharmaceutical firm Teva and drug distributors AmerisourceBergen, Cardinal Health, and McKesson all settled with Ohio’s Cuyahoga and Summit counties in a lawsuit that alleged the companies recklessly prescribed and distributed opioid medications. Before the $260 million settlement, the lawsuit was widely expected to influence the results of more than 2,000 other opioid-related suits.

Concerns About Vaping and Tobacco Increase

Vaping and tobacco use received a lot of news coverage this year. Part of that coverage involved lawsuits against e-cigarette company JUUL Labs Inc., accusing the firm of deliberately targeting minors. In the fall, several cases of lung injuries associated with the use of vaping products were reported to the CDC.

Finally, on December 20, President Donald Trump signed a $1.4 trillion spending package that raised the federal legal age for purchasing tobacco from 18 to 21. The law, which includes the purchase of e-cigarettes and vaping cartridge, will take effect summer 2020.

FDA Approved Controversial New Depression Treatment

The U.S. Food and Drug Administration in March 2019 approved Spravato (esketamine) nasal spray, in conjunction with oral antidepressant, for treating depression in adults for whom other antidepressant medicines have been ineffective. Critics of esketamine have argued that, due to its similarities to ketamine, the medication has a high potential for abuse. Currently the treatment is highly restricted under a Risk Evaluation and Mitigation Strategy.

Mental Health Coverage Remains Limited Nationally

Research shows that more Americans are having difficulty finding affordable behavioral health treatment, although under a 2008 law, insurers are required to provide equal access for mental and physical health care. The limited affordability of behavioral healthcare accompanies rising rates of addiction, suicide, depression, and anxiety. This year, consulting company Milliman reported that patients are more likely to use out-of-network providers for behavioral health or substance abuse treatment than for other conditions.

NAATP Releases New Guidebook for Addiction Treatment Providers

This year, the National Association of Addiction Treatment Providers (NAATP) released The Addiction Treatment Provider Quality Assurance Guidebook: A Guide to the Core Competencies for the Delivery of Addiction Treatment Services. This Guidebook is part of the association’s efforts to protect addiction treatment consumers and improve addiction treatment quality. In case you missed it, we covered the new guidebook in more detail earlier in the BestNotes blog.

Happy new year from BestNotes!

Is your behavioral health and addiction treatment practice prepared for 2020? Whether you’re looking to switch EHR systems or implement EHR software for the first time, BestNotes is prepared to help you every step of the way. Contact us today to learn more about how to make 2020 your practice’s best year yet!

date:  Jan 06, 2020
Read More

Functional Family Therapy: What it Is, and How to Use it

Children and teens have unique and often complex behavioral health needs. Functional family therapy (FFT) is often used to address behavioral concerns in juveniles aged 11-18 years. Here is an overview of FFT and how it works.

What does Functional Family Therapy involve?

Developed by Drs. James Alexander and Bruce Parsons, FTT is a short-term intervention that involves the whole family in addressing adolescent behavior problems.

FFT involves a series of five progressive phases:

Engagement: The therapist(s) work to demonstrate responsiveness and establish credibility with family members. Therapists are highly involved and available to the family, helping prevent youth and families from dropping out of the program.
Motivation: This phase encourages motivation and lasting change by working to reduce family hostility and blame, increase hope, and build healthier family relationships.
Assessment: The therapist helps identify patterns within a family through observation and questioning. This phase transitions from focusing on an individual problem to a more relational point of view. This helps prepare participants for the next phases of FTT.
Behavior Change: The therapist guides family members through communication training, parenting skills, and youth compliance and skill building. This helps improve family and individual functioning. This phase may include other therapeutic approaches, including cognitive-behavioral strategies.
Generalization: This final phase applies the improvements made in the Behavior Change phase to other areas. Therapists help participants plan for future challenges to prevent relapse. This phase often incorporates other community systems and members, such as probation officers or teachers, into the treatment process.

FTT usually lasts about 30 hours, in about 12-14 sessions over 3-5 months.

Proponents recommend that a team of master’s level therapists, under the oversight of a licensed clinical therapist, participate in this type of therapy.

All youths who participate in and complete FTT must also have at least one adult caregiver who is willing to be engaged in treatment and provide support during the process.

Who is Functional Family Therapy for?

Research indicates that FFT can help low- to high-risk youths with behavior problems and substance abuse. Individuals who participate in FFT also may have additional behavioral health concerns, including anxiety and depression.

FFT can benefit youth with multiple serious offenses, including felonies. FFT participants have been referred from multiple sources, such as juvenile justice, child welfare, mental health providers, and schools.

How effective is Functional Family Therapy?

Several studies have found that FTT is effective in reducing behavioral risk factors, substance use, and recidivism.

One Utah study found that families who participate in FFT significantly improved rates of reoffense and recidivism among serious delinquent youth. The same study found improvements in the juvenile court records of siblings of targeted youth, indicating that the family overall, beyond the targeted individuals, can benefit from FTT.

FFT has been endorsed by the Center for Disease Control and Prevention and the U.S. Department of Justice, according to Pennsylvania State University’s EPISCenter.

Does Your EHR Support Your Treatment Approach?

Behavioral health and addiction treatment providers usually offer different treatment approaches for different clients and conditions. Shouldn’t your EHR solution be just as flexible? BestNotes EHR solutions offer many customization options to help you work more effectively and improve profitability. Contact us today to learn more or schedule a demo.

date:  Dec 27, 2019
Read More