Outcome Snapshots: Trio of Innovative Behavioral Health Models Brings Positive Results

Certain behavioral health disorders require variations from standard outpatient treatment models to best meet patients’ needs. Cleveland Clinic’s Center for Behavioral Health has long been an innovator in the development and refinement of such models, and this inventiveness typically yields benefits in patient outcomes.

This post provides cases in point from three distinctive Center for Behavioral Health program offerings. The outcomes featured are from 2015, the most recent year for which complete follow-up data are available.

Intensive Outpatient Program for mood disorders

For adults who suffer from a mood disorder or a dual diagnosis (e.g., depression with substance abuse), a weekly therapy session with a psychologist or psychiatrist may simply not be adequate. For such patients, the Center for Behavioral Health offers the Intensive Outpatient Program (IOP) at two sites in Northeast Ohio.

The IOP provides treatment services three to four days a week for 3.5 hours a day, generally over the course of four to six weeks. Group therapy is provided by a team of social workers, counselors and psychiatric nurses in consultation with the treating psychiatrists. Group size typically ranges from eight to 12 participants, and is limited to 15.

Goals of the IOP are to help patients reduce mood disorder symptoms, regain confidence and achieve greater levels of functioning, including returning to work, resuming daily activities and once again becoming contributing members of their families.

Program participants are evaluated initially and at follow-up (typically six to seven weeks after IOP completion) on the 7-point standardized Clinical Global Impression–Severity (CGI-S) scale, with higher scores indicating greater severity of illness. As shown in the figure below, among the 183 IOP participants in 2015, mean CGI-S scale score improved from 6.0 (severely ill) at program entry to 2.6 (mildly ill) at follow-up (P < .0001).

Alcohol and Drug Rehabilitation Center

Cleveland Clinic’s Alcohol and Drug Rehabilitation Center (ADRC) is a long-standing center of excellence offering an array of inpatient and outpatient services to help people overcome drug or alcohol dependency. Two of its programs — the Intensive Outpatient Program (IOP) and Partial Hospital Program (PHP) — provide comprehensive services while allowing participants to maintain active lives in the community.

The dual programs’ services are available four to five days per week, with treatment generally lasting 12 to 14 weeks. Contact hours are concentrated in the first four to six weeks before tapering to once-weekly group aftercare sessions for the last two months.

Completion rates for the ADRC’s outpatient programs compare favorably to the national average for outpatient programs (see figure below). During the first six months of 2015, 51 percent of 125 patients completed ADRC outpatient programs. Noncompleters were either transferred to another program, dropped out of treatment, were terminated by the program or left for an unspecified reason.

1National data are from the Substance Abuse and Mental Health Services Administration, Office of Applied Studies (oas.samhsa.gov/). ADRC = Alcohol and Drug Rehabilitation Center.

Shared medical appointments in women

Since 2003, the Center for Behavioral Health has offered shared medical appointments (SMAs) to women for managing anxiety and depression. SMAs are conducted as 90-minute sessions among a maximum of 12 patients with mood disorders, all of them female. Sessions consist of a series of one-on-one encounters with a psychiatrist that are focused on medication management (5 to 7 minutes per patient) supplemented by group education and discussion. A clinical nurse specialist helps the psychiatrist run the SMA and checks vital signs, scribes notes and places orders. The model offers advantages in terms of peer support and the ability to schedule appointments sooner.

In 2015, 128 SMA participants self-reported their improvement at their last follow-up visit, which occurred an average of 5.5 months after their first SMA visit. They used the Patient Global Impression of Improvement (PGI-I) scale, which allows responses ranging from “very much improved” to “very much worse.”

As shown in the figure below, most participants (61 percent) reported improvement, while 27 percent held stable.

A recent study conducted by Cleveland Clinic psychiatrist Lilian Gonsalves, MD (reported in this earlier post), found that the SMA model is at least as effective as individual appointments in the management of depression and anxiety symptoms in women.