Abstract: A Case Study Evaluation of Accord Services for High-Utilizers of Alternative Mental Health Crisis Services (Society for Social Work and Research 28th Annual Conference - Recentering & Democratizing Knowledge: The Next 30 Years of Social Work Science)

Schedule:

Friday, January 12, 2024

Independence BR B, ML 4 (Marriott Marquis Washington DC)

* noted as presenting author

Timothy Campbell, LCSW, Doctoral Student, State University of New York at Albany

Tomoko Udo, Professor, State University of New York at Albany

Jordan Dyett, LSW, Student, State University of New York at Albany, Albany

Preston Roberts, MA, Doctoral Student, State University of New York at Albany

Denard Cummings, Student, State University of New York at Albany

Carmen Morano, PhD, Professor, State University of New York at Albany

Background and Purpose: In June 2021, the Albany County Crisis Officials Responding and Diverting (ACCORD) program was piloted in rural areas of Albany County, NY. While evaluation of the first-year implementation suggests that the program may help address the needs of individuals with serious mental illnesses, the data also suggests that there are clients who received ACCORD crisis intervention services multiple times. Through a case study of a ‘high program utilizer’ (30+ crisis intervention services), this paper aims to highlight programmatic (i.e., ACCORD program specific) and system (i.e., services and systems in the community) gaps that may help enhance the effectiveness of a program such as ACCORD.

Methods: One client was selected for this study for receiving crisis intervention services 30+ times over the span of July 2021 to June 2022. Services include phone support, crisis intervention, and follow-up contact with the client or hospital for status updates. The client was a middle-aged white woman diagnosed with major depression disorder (MDD) and borderline personality disorder (BPD) and was a known client of the Albany County Department of Mental Health for utilizing outpatient mental health services. A timeline of the events was constructed based on an in-depth analysis of the ACCORD service fieldnotes of this particular client that an ACCORD social worker completed.

Findings: Three major themes emerged. First, client-initiated ACCORD services on several occasions after experiencing stressors related to outpatient therapy services (e.g., missed appointments, perceived confrontation from a therapist, and lack of social support). This coincided with the client subsequently contacting ACCORD services. Second, ACCORD mental health professionals provide competent and appropriate judgment in disposition determination for the client’s need for further assessment at a local hospital or safety planning to remain in the community. Third, the client has several clustered ACCORD services resulting in transportation to the emergency room with suicidal ideation despite prior utilization of phone support to manage a crisis.

Conclusions and Implications: The ACCORD program provides vital mental health services to rural Albany County, with phone support and access for clients who previously utilized police. Findings highlight the importance of ACCORD members continuing to use strengths-based and motivational interviewing skills (i.e. active listening, validating, and engagement in coping skills) to effectively mitigate combativeness and further threats to harm themselves or others. Additionally, the COVID-19 pandemic has exacerbated hospital staff shortages and access to inpatient psychiatric beds. Therefore, we recommend expanding community-based mental health, such as ACCORD and crisis case management services. This will promote accessibility, reduce the risk of repeated crisis contact, and decrease strain on other emergency services. Future research ideas include outlining specific intervention differences between high-utilizers compared to previously unknown clients.