The Citizen's Advisory Board held their quarterly meeting April 27 at the MHI, and heard updates from Dr. Daniel Gillette, superintendent of MHI, and Dr. Jason Smith, superintendent of the CCUSO program.
Dr. Gillette spoke about the "Mid-level" training program, which MHI has had, on-and-off, since receiving a Federal Grant through the Department of Public Health in October 2001. The grant was for two years, and Cherokee discontinued the program until State Fiscal Year 2005.
The program was established to expand and improve the workforce engaged in mental health treatment and services in Iowa, as very few graduates of the University of Iowa Psychiatry Program were choosing to practice anywhere in the state other than the Iowa City area. Also, many practicing psychiatrists are at an age where they may elect to retire soon.
Cherokee's program was the first such program in the United States, according to Dr. Gillette. They have programs for training both Physician's Assistants and Advanced Registered Nurse Practitioners, through both didactic lectures and supervised rotations, in adult and child/adolescent psychiatry.
The program receives P.A. students from P.A. programs in Iowa City, Des Moines, Omaha, and Sioux Falls, to do the Psychiatry portion of their training.
The Cherokee program has trained approximately 10-12 Physician's Assistants and two ARNPS, both of whom are now employed at CCUSO. Dr. Gillette says this has been a very fortunate situation for CCUSO, because the ARNPs can provide both the psychiatric and medical services that are needed there, so they don't have to contract with both a doctor and psychiatrist.
The Cherokee program is expanding its outpatient training for the current class of residents (there are currently three students), and are also in talks with the four regional mental health centers and one RCF-PMI provider regarding the Cherokee students engaging in outpatient work at those facilities. In addition to providing a bit of revenue to support the program, it is also hoped that these facilities may have an interest in eventually hiring the PAS and ARNPs after they are finished with their training. The three students are expected to begin working in outpatient settings sometime in May.
Dr. Gillette also spoke about the Measurement Performance Measures which the Department of Human Services have begun doing this fiscal year for the four MHIs, the two schools at Woodward and Glenwood, and CCUSO.
While Gillette has some concerns about the validity of some of the measurement tools they are using, he also said that the Cherokee MHI came out pretty good. He said there are three reasons he would cite in opposition to anyone who feels the Cherokee MHI should be closed, though there is no serious talk about closing the MHI. As one CAB member said, "They have been talking about that for 50 years."
Gillette's first reason is the good care that patients receive; number two is the good care that the buildings receive - much better than the other MHIs - and number three would be the cost effectiveness of the Cherokee MHI.
Smith talked about different "risk factors" which are considered in determining whether CCUSO patients are ready for discharge. He provided a "static" risk management form that is sometimes used, but Smith feels that the things measured on this form are things that don't change. He feels that "dynamic factors" need to be considered as well. These factors are behaviors that can be changed by the resident, such as compliance with supervision.
Smith said there have been cases when CCUSO staff did not agree with the recommendations of the "outside experts," sometimes feeling that a patient the experts approve for discharge aren't ready, and at other times, feeling that some patients who aren't approved, are. He hopes that the Dynamic Risk Factors he can provide will carry weight with those making the decision.