Checking In with Alaska Behavioral Health

Because the transition to a telehealth model had already been in the works, ABH’s rollout was smoother and more efficient than it otherwise would have been, Myers says; by April 2020, 80 percent of services were being delivered via Zoom.

“It’s really based on client choice,” Christine Alvarez, chief clinical officer of adult services, says of whether patients utilize services in-person or via Zoom. “Some people are just more comfortable [using Zoom] or it works better for their schedule or there are fewer barriers.”

Myers estimates that roughly 40 percent of patients currently utilize the telehealth option. “It’s a long-term strategy to be able to serve people through Zoom where appropriate, with appropriate being where it’s the right kind of service for them and it makes the service more convenient and effective for them,” he explains.

ABH is also meeting patients where they’re at with the October soft launch of a mobile crisis team in Fairbanks. A collaboration between ABH and the Alaska Mental Health Trust, the mobile crisis team will dispatch a clinician and peer support specialist—alone or in tandem with EMS or police, depending on the severity of the call—to help mitigate mental health crises in the field.

“Mobile crisis teams come in and provide de-escalation and very, very quick linkage [to services],” Alvarez explains. “We can get them an appointment at the clinic right away. We have medical providers that have same or next-day slots; we’ll be able to get them in and get them restarted potentially on their medications or coordinate with other care providers. We’re mitigating that crisis really quickly, so we’ll be able to prevent hospitalizations.”

Alvarez says the hope is to expand the unit’s reach to the entire Fairbanks North Star Borough, with the possibility of a telehealth option to reach rural communities. For now, the program will be limited to calls in Fairbanks.

“I think it’s always a matter of [being] mindful of ramping up and being able to provide the services that you provide well,” she says. “Right now, we just want to start small to see what the need is and then expand from there.”

EmPOWERing Youth

Social distancing requirements during the pandemic initially dropped the number of youths the Center could serve at one time down to six, but the easing of restrictions has allowed them to double capacity. Even without COVID-19 restrictions, the Center lacked sufficient space to fully meet the needs of the youth population. In 2020, ABH purchased an adjacent building that will triple the Center’s capacity and increase clinical space and group-based options. It will also allow them to provide shower and laundry facilities, something staff didn’t initially realize was a need.

“You would see kids in the bathroom trying to wash themselves in the sink,” Myers says. “The Seeds of Change program would let kids use the laundry machine to wash their clothes. And so, when the opportunity came to purchase the building next door, we thought, ‘Okay, we can build in these things, we can build in space for a shower facility, we can build in space for a laundry, we can build in space so we can accommodate more youth, more treatment space to provide more treatment.’ So, that’s what really drove that need.”

Though the opportunity to purchase the building arose quickly, the desire to expand the Center both in terms of size and offerings wasn’t a new one.

“It’s been a long time coming of wanting to be able to serve more people and have access to laundry, have access to more of our peer outreach workers on site,” Hanson says. “We’ll have more standalone programs, more structured and group services to work on independent living skills, which includes things like budgeting and cooking, as well as helping ensure good communication and study skills. And embedded in those is our mental health [services].”

The increased space means the Center can expand its clinical and outreach staff as well. An additional clinician will improve ABH’s ability to provide same-day, in-person crisis intervention services, while additional peer outreach workers will allow for more “outreach in the community to connect homeless youth to our center and to resources, as well as provide resources on-site,” Hanson says.

Closing ‘Significant’ Behavioral Health Gaps

In most states, the behavioral health system operates under a continuum of care that provides inpatient and residential mental health services, partial hospitalization programs, and intensive and traditional outpatient services, with the goal of placing patients in the least restrictive treatment setting, Myers explains. But as is typical in Alaska, there were significant gaps in the availability of these services on a regional and statewide level.

“Alaska only really had the traditional outpatient [services] and the inpatient through Alaska Psychiatric Institute, Fairbanks Memorial Hospital, and Bartlett Hospital in Juneau,” Myers explains. “There was really nothing in the middle, and really nothing for the long-term care.”

That meant, depending on the type of care needed, patients’ only options were to seek treatment in Anchorage or the Lower 48 or forego it and utilize a level of care that didn’t adequately meet their needs. Approval of the Section 1115 Medicaid waiver in 2020, however, is helping fill in those gaps by allowing ABH to accept coverage for pilot projects offering previously unavailable services.

“What we were really missing was a higher level of care for someone who maybe couldn’t access outpatient clinic-based services,” Alvarez says. “So, what we’ve been able to do is expand the community-based services, intensive case management, and that’s where 75 percent to 80 percent of the services are provided. So, it really increases client ability to participate in treatment; you kind of are able to meet them in the community where they are, their home or whatever.”

An adult mental health residential treatment program in Fairbanks, scheduled to open in November, will provides 24/7 residential care to patients who are not yet able to maintain their recovery safely in the community but are stable enough that they do not require inpatient services, Alvarez explains.

“That’s going to be a huge need for the community,” she says. “As of right now, if anybody needs that in Fairbanks, they’re coming to Anchorage, and before we opened our [residential] facility in Anchorage [in January 2021], the only option was to go out of state.”

The facility, which will serve adults eighteen and older diagnosed with a mental health or co-occurring disorder and a history of continuous, high-service needs, will provide medication and individual and group therapy under the supervision of an interdisciplinary team composed of advanced nurse practitioners, mental health clinicians, clinical associates, and peer support specialists.

The ability to remain in Fairbanks for treatment, rather than seek services in Anchorage or even out of state, is important for a patient’s long-term recovery.

“It’s always ideal when somebody needs treatment to have it in their own community, so when you link them to outpatient providers, you have their supports in place, so we’re very excited about that for Fairbanks,” Alvarez explains.

Even with the new programs ready to launch, ABH is already exploring new options to meet the continued demand for mental health services.

“We’ve been looking at various options for how we can make the next big expansion of space, shuffle things around so multiple things can grow,” Myers says. “We’re just trying to grow to meet demand; I don’t see an end point for that.”