In 2013, Greater Cincinnati Behavioral Health Services (GCBHS) began implementation of a service model referred to as Open Access (OA). The goal was to make access to service easier for clients and to make the most efficient use of staff time.
In Open Access, anyone can come in for an assessment during the hours of operation and be seen by a diagnostician. This immediate access to care is important when working with people who are experiencing severe mental illness and/or substance use disorder. The OA model allows for staff time to be more productive and increases the number of people who can be helped. Patient intake and diagnostic evaluation happen on a walk-in basis. This means potential clients are seen the same day, so services can be implemented much faster and it also reduces the amount of time a client would typically have to wait. Open Access is also a business practice that provides behavioral healthcare organizations with the ability to streamline processes, making them more efficient and allowing more people to be served.
Also referred to as Same Day Access, Open Access (OA) was designed to increase capacity as well as deliver critical services to vulnerable populations. Prior to Open Access, clients or potential clients would make an appointment but many times, because they were struggling with serious mental illness and/or substance use disorder (SUD), the patients would not make the scheduled appointment time and be considered “no-shows.” Dana Santo, the Chief Clinical Officer for Mental Health Services at Riveon Mental Health and Recovery (formerly The Nord Center), located in Lorain, Ohio, says that prior to implementing Same Day Access, the rate of people missing appointments was high because they were scheduled so far in advance that the potential client would forget, find services elsewhere, or no longer want to address the issue.
Since moving to the model in February of 2022, Riveon is now completing up to 120 assessments per month and seeing a much higher rate of clients opting in for services. Their assessment time has also been streamlined from 90-120 minutes to typically 60.
Although the concept of Open or Same Day Access has been around since the 1980’s, the idea was
brought to Cincinnati in 2012 by MTM Services, a consulting firm that assists healthcare providers to increase capacity and deliver services in a more efficient way. It was originally presented to 24
organizations. According to Joy Fruth, MSW, the Lead Process Change Consultant who was part of the MTM team who came to Cincinnati, “From that original group of 24, thirteen agencies chose to pilot or implement the model. The process was primarily about access redesign and increasing client engagement by getting them into care quickly.” She continues, “It takes about a year to implement the strategies and since 1995 we (MTM) have assisted thousands of providers in 49 states in making the transition.”
The results MTM reported for Greater Cincinnati Behavioral Health Services (GCBHS) in June 2014 showed that total wait-time for clients was reduced by 78% and the organization was able to save over $20,000 annually by moving to the Open Access model.
“Open Access works because our clinicians are considering all the presenting needs and making recommendations on the spot,” says Julie Kubin, LPCC-S, the GCBHS Director of Addiction Services in Hamilton County. “Not just an assessment but working with the client to connect to resources and support. After their assessment they meet with someone who will do a treatment plan and help with immediate resources. Our peers help with that. It makes the client feel connected and supported.”
In 2023 Greater Cincinnati Behavioral Health Services (GCBHS) received a grant from the Anthem Blue Cross and Blue Shield Foundation whose goal is to advance health equity by focusing on improving the health of those in society who are considered vulnerable, by partnering with organizations and programs in communities who serve these populations. The grant helped GCBHS expand substance use disorder (SUD) services in the Open Access process. The need was evident. Numbers showed that almost 50% of people being diagnosed with a mental health disorder had a co-occurring SUD diagnosis. Open access allows for needs to be met faster, and clients to engage with staff face-to-face from the very beginning of their care.
Nikki Bisig is the GCBHS Senior Vice President for Behavioral Health in Hamilton County. She says this
funding was important because, “Mental health issues and substance use disorders often co-occur and their symptoms can overlap. That makes it hard to assess and treat those disorders separately. An integrated assessment process can help us expedite access to the care for the client, which can ultimately lead to better recovery and quality of life.”
Completing comprehensive behavioral health assessments through Open Access reduces delays in treatment and provides immediate resources to patients, reducing negative health outcomes. Nearly 3 out of every 4 clients at GCBHS have incomes below the federal poverty level, with 10% struggling with housing insecurity or chronic homelessness. The socioeconomic status of an individual is a strong social determinant of health, with individuals in poverty having less access to healthcare, education, and job opportunities. GCBHS works with partners to address the health equity gap, connecting clients to wrap-around services that enhance their lives and improve their chances of recovery. The implementation of Open Access has helped expedite this process, reducing wait-time for clients so they receive supportive services the same day. It also reduces fragmentation of care by addressing the whole person upon intake, centralizing their care plan across multiple services.
The two-year grant funding is scheduled to end in May 2025, and lessons are still being learned.
Recently, Open Access’ mental health diagnosticians were trained and are now completing integrated Mental Health and SUD assessments. Like the initial need for the Open Access Model, this will reduce another barrier to accessing services. Instead of having to complete two separate assessments, individuals with co-occurring disorders can now just receive one comprehensive assessment that identifies all their behavioral health needs. This approach also streamlines the process for staff allowing them to serve more people and ensuring they are connected to all needed services from the beginning of their treatment.
コメント