Episode 20: How 211 Care Coordination Improves Behavioral Health Outcomes in Maryland

On this episode of “What’s the 211?”, Quinton Askew speaks with Favour Akhidenor, Ph.D. and Esi Abercrombie with the 211 Care Coordination program. They discuss how Care Coordinators help improve behavioral health outcomes for patients in the Emergency Department of hospitals.

Show Notes

• 01:54 About the Care Coordination staff
• 2:32 What is 211 Care Coordination?
• 3:14 How it got started
• 4:06 Care coordination experience
• 5:07 Eligibility for the program
• 5:5 Key areas of growth – 211 Hospital Network, case consultations and the internship program
• 8:46 How referrals work
• 9:27 Challenges with coordinating care
• 11:33 Patient privacy
• 13:23 Impact of 211 Care Coordination
• 14:37 Outreach and training
• 18:10 Escalation of cases

Transcript

(01:26) Quinton Askew, President & CEO of the Maryland Information Network

Good morning and welcome to “What’s the 211?” podcast. My name is Quinton Askew, President and CEO with Maryland Information Network, 211 Maryland. And I am joined by our wonderful staff and guests this morning: Favour Akhidenor, Ph.D., who is a Program Director for 211 Care Coordination and Esi Abercrombie, who is our Program Assistant, as well as a Care Coordinator.

About the Care Coordination staff

We’re excited to hear about the Care Coordination program today. So, before we start, can you tell me a little about your role with the program and what you do? Esi, I’ll start with you.

(2:06) Esi Abercrombie, Program Assistant / 211 Care Coordinator

Hi, my name is Esi Abercrombie. I am the Care Coordination Program Assistant for 211 Maryland. I also double as a Care Coordinator. So, I get to work directly with the hospitals and the patients.

What is 211 Care Coordination?

Quinton Askew (2:32)

Thank you. So, what is 211 Care Coordination?

Favour Akhidenor, Ph.D., Program Director (2:41)

The 211 Care Coordination program is a program that is meant for emergency departments, only emergency departments in Maryland. It is a program that is mostly for patients that are in the ED. They overstayed in the ED Departments. And people that have substance use, mental health, as well as behavioral health needs. So, what that means is that when you are in the emergency department, let’s say they stay for two or three days. Most times, they stay for 48 hours. The hospital makes a referral to us, and what we do is we connect them to resources that will be helpful to the patient.

How it got started

Quinton Askew (03:14)

How did this program get started? What was the need for it? And why did we start doing it?

Favour Akhidenor, Ph.D. (03:21)

This program started in June (2022). The program was started by the Maryland Department of Health, Behavioral Health Administration. They reached out to 211 Maryland, Maryland Information Network and said, “We have a lot of patients in the ED that need help. Is it possible for your Maryland Information Network to coordinate care to assist this patient?”

It started in June (2022) with an outpatient program. From an outpatient program, we saw a need and we increased it to an inpatient program. Right now, we have the outpatient program and the inpatient program.

The outpatient program is run by 211, Maryland Information Network. We have Sheppard Pratt as a vendor that helps us with the inpatient part of the program.

Quinton Askew (04:06)

It’s a great relationship with the Maryland Department of Health, Behavioral Health Administration.

Care Coordinator experience

And, so Esi, for the Care Coordinators, what are some of the backgrounds of the Care Coordinators? And what’s the experience like when someone accesses or speaks to one of the Care Coordinators?

Esi Abercrombie, Program Assistant / 211 Care Coordinator (4:24)

Most of our Care Coordinators have a background in:

• behavioral health
• human services
• social work

Typically, the experience when someone is connecting with a Care Coordinator – if we are connecting with a patient, we like to follow up with them to make sure that they are still interested in the resources they need. We find resources that are convenient for the patient’s schedule and location. Then, after the appointment has been booked, we follow up with them to ensure they are getting the resources they need and that they attended the appointment. So, it’s a very hands-on personal relationship that we try to keep with the patients and the resources we connect them to.

Quinton Askew (5:07)

It helps to have empathetic and non-judgmental folks who are providing services.

Eligibility for the program

Dr. Akhidenor, you talk a little bit about the eligibility and folks that are in the emergency room for mental health. Are there any other kind of eligibility requirements? Or how do people get connected to the program? How does someone get referred?

Favour Akhidenor, Ph.D. (5:27)

They’re referred through the hospital. A patient cannot come in and say, “Hey, I want to get connected with Care Coordination.” You have to go to the emergency department.

The program works 24/7. We have 211, Press 4.

What I would like to clarify is that even though it’s meant for mental health, substance use, and behavioral health, we also don’t have any specific people that say, “Well, because you are this or that, you can’t come into the program. It is meant for all genders as well as all ages. It has no age range. Anyone can be referred to the program.

Key areas of growth

Quinton Askew (5:59)

You mentioned the collaboration with Sheppard Pratt, which also supports the inpatient component of the program. We know the program, as you mentioned, has been around for over a year. It has grown exponentially, not just inpatient and outpatient, but also your relationships with many health institutions. Can you talk briefly about those key programs or the growth that’s happened over the past year?

211 Hospital Network

Favour Akhidenor, Ph.D. (6:21)

Absolutely. One of the big ones for me is the 211 Hospital Network, where we meet once a month. That means that all hospitals in Maryland, the Emergency Departments meet with the 211 team, the state and local behavioral health authorities. All counties meet with us once a month. We discuss best practice as it relates to care coordination. Best practices, policy and connection.

We meet once a month. We talk about how we can improve the program and also how we can help assist hospital staff as well as the patients.

Case Consultation

Another very interesting one is the case consultation. We give hospitals an opportunity to meet with us at least once a month, whereby we review cases, complex cases, whereby the hospital cannot attend to those cases. They meet with us, we do a case consultation, talk about the cases, and help them place the case. Sometimes, the case can be challenging. And that’s what we involve the state. We escalate the case to the state, and the state comes in and assists.

So, case consultation is a big one that has expanded and has come into the program.

Internships

We also have an internship program. Our Care Coordination program has now extended to getting a social worker or anyone with a human services program to intern. As we speak, we have three interns who are interning with us, and we see it recruits more people coming into the program. So, we have relationships with the hospital, local behavioral health authorities and the state. We also have relationships with institutions, such as universities and students.

Quinton Askew (7:55)

That’s a great kind of collaborative effort, especially with the hospitals. I’m sure they’ve been excited about it. What are some of the success stories or great things you’ve heard from the hospitals with just how you have collaborated and brought everyone together?

Favour Akhidenor, Ph.D. (8:09)

One big one is that when we do case consultations. Some of their complex patients’ needs have been addressed in case consultations. We’re able to place patients with local behavioral health resources.

Another one is the Care Coordination Program has to do with more than mental health and people with substance use. We go as far as helping people and placing them with resources, as it relates to residential. Some of these patients who come to the hospital don’t have any place to stay. And that’s where 211, you know, apart from the Care Coordination program, we have other resources in 211 that we also connect patients with. They’re very pleased with that. We’ll be able to connect them to resources. That’s a big one for them.

How referrals work

Quinton Askew (8:46)

It is closing the gap. We talked a little bit about technology and how that supports the initiative. Can you just talk briefly about how you all use technology and how it works with the Care Coordinators?

Esi Abercrombie (8:59)

Absolutely. Our referral system is completely online. We use a database called iCarol; through that, we can:

• receive referrals
• escalate cases
• speak with the hospitals in the state to provide updates on cases

In addition, we’re completely virtual, meaning that most of the communication and connections we build with the state, the local behavioral health authorities, and other hospitals are completely online.

Quinton Askew (9:27)

I think one of the benefits of the program is that by folks partnering with us, we can get everybody on the same platform, speaking the same language and that collaborative process, which I think makes it a lot easier.

Challenges with coordinating care

Are there any challenges you all face when providing care coordination and identifying resources? What are some of the challenges when trying to connect folks to services?

Esi Abercrombie (9:50)

I mean, essentially, we are the middleman. So, we are working with the hospital, the state and the patient. Sometimes unfortunately, we’re not always able to find resources. There’s not enough bedding in the facilities that we are partnered with. So, we might have to escalate it to the state. And yes, finding resources can sometimes be challenging for things that are completely out of our control.

Quinton Askew (10:18)

This is a great segue to, as you said, just not enough resources. You talked a bit about the partnerships and programs, one of which is working with the state with escalation cases and our local Behavioral Health Administration. When the Care Coordinators find these gaps and cannot identify resources, how does your relationship with the state and escalation work? Can you talk a bit about that and the local Behavioral Health Administration? How does that help support some of those gaps?

Favour Akhidenor, Ph.D. (10:46)

Speaking about gaps – As Esi said, one of the big ones I think that most Care Coordinators also face is the fact that communication can be very overwhelming because you talk to this and talk to that. And before, you know, it’s becoming, you know, big. This is one of the reasons we developed the 211 Hospital Network, whereby we can talk and get resources within ourselves.

The biggest problem with resources is that if the state can’t get resources here, where do we go? Where do we get the resources from?

So having that connection with the 211 Hospital Network is a way of saying, “Oh, you don’t have the connection. Without the resources here. We have the resources.” And that’s what we discussed today – having to be able to close that loop. That gap, by having that connection, talking to each other, and looking for resources within ourselves, is difficult, but it’s a way to move the program to the next level.

Patient Privacy

Quinton Askew (11:33)

That’s great. Working with hospitals, the state, other programs and patients involves protecting people’s information. How do you play that role in sharing information, ensuring information is kept private and ensuring the patient’s privacy? So what kind of measures are taken to ensure that?

Favour Akhidenor, Ph.D. (11:54)

Most times, we use encrypted emails to send emails to each and every one of us. I encourage the Care Coordinators and hospitals to use the iCarol system. It is very protected and secure. We also do training with the hospital on how to ensure that patient information is not everywhere. We need to keep patient information very safe, and we do training. We conduct training for the Care Coordinators to understand how to keep patient information.

Quinton Askew (12:20)

Part of the program is also getting patient consent before we can provide services, which I think is a big part of that. As you said, Care Coordination serves everyone, whether seniors, children or individuals with disabilities.

Have there been any particular barriers, depending on what some of the needs are?

Favour Akhidenor, Ph.D. (12:49)

Sometimes, we have language barriers. We developed a way of talking to them through our language lines. Even with the language lines, sometimes it can be difficult because by the time we talk to a patient and use the language, now you want to give them resources, the other facility might not have the language line or be unable to connect to that. We try to make sure they have resources that has to do with language line.

A child can be three months and having to find resources for a child who is three months – they are not eligible for some programs because you can’t diagnosis this child that is three months.

Impact of 211 Care Coordination

Quinton Askew (13:23)

We would encourage any hospital to utilize it.

How do you know when there’s been success? What are some things you look at with your reporting to understand how effective it has been over the past year?

Favour Akhidenor, Ph.D. (13:42)

We use data, that is a big one. As you can see, the track record started with outpatient inpatient, and now we’re doing the two-hour case consultation, 211 Hosptial Network, and relationships we have built over the past few months. Having been able to have a relationship with local behavioral health authorities and the hospitals. The hospitals are on board. Many hospitals are coming on board, saying that success doesn’t tell you that the program is going well. And so you want to add something to that. For me, that’s what I see.

Esi Abercrombie (14:09)

We also track it not only on our external database, which is iCarol, but we also track it internally as well, making sure that our patients are getting the resources that they need once they’ve been placed or once we find outpatient resources for them, we mark that as successful.

We also track whether it’s been successful through the hospital or the state. We always ensure that we are on top of our patient’s progress and mental health journey.

Quinton Askew (14:37)

You also discussed the closed-loop process with follow-up, ensuring people got the needed services.

Outreach, training, and information about the program

How do people find out about the program? How do hospitals know? How do community members know? How do we let people know we have this wonderful 211 Care Coordination program available for hospitals?

Favour Akhidenor, Ph.D. (14:56)

We have an outreach coordinator that reaches out to hospitals. We give most hospitals some of our banners, flyers, make phone calls, and send emails. I visit hospitals to let them know what our program is about.

One big one is the follow-up that we do. It has helped us do some outreach. Let’s say we reach out to a patient and a patient said, “I want to go to this facility, and the facility doesn’t even know about the program.” So, by talking to the facility about the program, the facility helps spread the word with the hospital too.

Esi Abercrombie (15:33)

I did want to add that we also connect with different hospitals throughout the state to check bedding to see exactly how many beds are available for patients. So that also makes the hospital know of us and that we’re keeping track. We’re making sure that we can utilize you for resources. And if not, we have been reaching out to local behavioral health authorities as well as sending surveys.

Quinton Askew (15:59)

Because it’s for all of Maryland, just not specific jurisdictions, what would you want hospitals to know about the program?

Favour Akhidenor, Ph.D. (16:15)

I want hospitals to know that we are not here to replace their discharge planners or take their jobs. We are here to support them. We want them to know that they are not alone. We are working with them closely. And we want to ensure that they get what they want regarding resources and coordinating care with local behavioral health and the state. We also want them to ensure that they’re not alone.

I used to hear people say, “Oh, this is what our discharge planners do and that’s a duplicate of service; we have people on board that will be doing all this.” Yes, we know that. But we are not here to take oor do a discharge planner’s job. We are just here to support them. And that is a big one. I want them to know that we’re ready to support them.

Quinton Askew (16:55)

We’re here to collaborate.

Favour Akhidenor, Ph.D.

Yes.

Quinton Askew

So, with some healthcare providers, I know there’s a lot of outreach with you visiting hospitals and connecting. Are there other places where folks can get information?

Esi Abercrombie (17:12)

They can go to 211md.org/carecoordination to find out more about our program. We also have case consultations. We not only reach out to local behavioral health, but we hold meetings with them so that they can understand more about what we do, and we can understand more about what they do.

The 211 Hospital Network meeting that we have every month also allows them to understand more about what 211 Maryland is doing. And we can connect them to other care providers as well.

How to Refer Patients

Speaking of the website, we have a training video on how to make a referral. And what the program is all about.

Quinton Askew (17:51)

So, the website is a one-stop shop. You can go and refer someone, you can get training, you can find out everything about the program. So, anything you need to know, you can go to the webpage.

Esi Abercrombie (18:03)

They can go to 211md.org/carecoordination and find everything that they need.

Escalation of cases

Quinton Askew (18:10)

So, before we can close, just two more questions. You mentioned that working with the state, there was an opportunity to escalate a case if we aren’t able to help support it. So, what does that mean? And how does that partnership with the state work?

Favour Akhidenor, Ph.D. (18:24)

When hospitals send a referral to us, we work on the case and try to find resources. It means that we can’t find resources, or a case is escalated when a state agency is involved. In that case, the case automatically has to be escalated. When we escalate the case, the state picks up the case, looks at it, and gives us resources, as well as happiness to guide us on the way to go and say, “Hey, we don’t have this resource, but you can use this. You can use that.” They give us resources and communication to help us collaborate with the hospital.

And it’s done through iCarol. It’s not like we escalate cases by calling and all that. Everything is done through the system. We escalate and they do a follow-up after the case.

The state has helped us with the resources that we need. We now do a follow-up and reach out to the hospital and say, ‘Hey, we have escalated this case. This case has been escalated at this point. This patient is going to be placed in XYZ facility.”

When the patient is placed, we don’t just end there. We follow up with the patient and ensure that the patient likes the placement. You don’t just place patients where they don’t want to be. We want to place them where they want to be. So, we ask them, “Are you okay with this placement?” If they say yes, they give us a thumbs up and say, “Yes, we like this placement.” Then, we have to go back to the state until we are good to go. And that’s how we escalate cases. Cases are escalated depending on the case, its complexity, and if you can’t get referral resources.

Quinton Askew (19:48)

It is great to hear that the patient is a part of the process. So, as we’re wrapping up, is there anything else that the two of you would like to share or let folks know besides how wonderful the program is and how everyone should be using it?

Favour Akhidenor, Ph.D. (20:02)

I want to add that the program is unique. It is not like every other programming in the state. We have 211 in all American states. Guess what? Maryland has 211 and the Care Coordination program. It is very unique. You don’t have it in the other 211 programs. So, please use our program. It is very unique. We are here to collaborate and support and let you know that we are here to stay.

Quinton Askew (20:25)

That’s a great way to end. Thank you to our partners with the Maryland Department of Health, Behavioral Health Administration, some of our other partners with local Behavioral Health Administrations and other areas. Thank you for joining us today.

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