WOW Specialty Home Care Service for Individuals With Serious Mental Illness

Abstract

Integrated Health Care (IHC) is a nurse-managed center of the College of Nursing, University of Illinois at Chicago through which faculty nurse practitioners and clinical nurse specialists provide primary and mental healthcare services for people with serious mental illness in partnership with Thresholds, the leading freestanding psychiatric rehabilitation agency in Illinois with locations throughout metropolitan Chicago.This article describes a new project to increase access to IHC services and improve health outcomes for the most vulnerable, hard-to-reach Thresholds clients (called members) through an innovative combination of strategies to outreach beyond IHC's three clinic locations, including: house calls, group visits, and telemonitoring, IHC Without Walls (IHC WOW).As an academic nursing practice, we view IHC WOW as an opportunity to integrate teaching and evidence-based practice; accordingly our objectives include expansion of novice and advanced practice experiential learning within this innovative practice domain.

Reducing barriers to accessing primary care for individuals with severe mental illness: examining characteristics of Canadian nurse practitioner practice

“…Storfjell et al (2008) proposed in an article describing a new project designed to improve access to NP primary care services for individuals with SMI, that NP-led shared medical appointments were one way to accomplish that goal. Patients who accepted the offer of a group appointment found the longer appointments encouraged casual conversation and sharing of personal coping strategies not easily provided in traditional one-on-one primary care visits.…”

“…A lack of standardized language across the literature makes it difficult to determine whether or not a barrier has been reduced (Groh, 2007;Storfjell et al, 2008). For example, the use and defmition of a term such as patient satisfaction (Doey et al, 2008) make it difficult to compare the efficacy of interventions meant to improve therapeutic relationships.…”

“…Collaborating with the patient improves coordination of physical and mental health care and helps formulate a response to address changing health care needs in an organized and comprehensive manner (Gardenier et al, 2007). NPs can collaborate to improve therapeutic relationships by moving away from a prescriptive approach and invites patients with SMI to take ownership and control of their health care (Storfjell et al, 2008). Developing strategies to overcome psychosocial obstacles that negatively affect health and access to primary care is another way NPs collaborate with individuals with SMI to improve therapeutic relationships (Johnson, 2001).…”

“…Receiving educational and emotional support in these centers helps reduce the internalized stigma that is a barrier to care and improves the acceptability of services. Interprofessional collaboration with other health providers assists NPs in establishing SMAs that provide an opportunity for individuals to share coping strategies to help deal with internal and externalized stigma (Storfjell et al, 2008). The SMA is a valuable tool that assists NPs in reducing stigma and improving access through improvements in the acceptability of services for patients requiring care.…”

“…Flexible practice can also provide time for advocacy and coordination of care while adapting practice to meet the unique primary care needs of this population. Introducing alternative models of practice, such as NP-led clinics and shared medical appointments, is another example of how flexible practice allows NPs to improve access to primary care by reducing stigma as a barrier (Storfjell et al, 2008).…”