WRNMMC, Bethesda, Md.  –   “Efficiency leads to recapture,” state Defense Health Agency (DHA) officials, recognizing the Adult Outpatient Behavioral Health (AOBH) Clinic at Walter Reed National Military Medical Center (Walter Reed).

The clinic successfully launched an Initial Entry Clinic (IEC) designed to assist Military Health System (MHS) beneficiaries obtain their first therapy appointment in under two weeks. “This initiative [allowed] Walter Reed to consistently meet access to care standards from January to July 2024,” added DHA officials.

“The AOBH IEC is a process allowing us to efficiently evaluate new patients to determine their behavioral health needs and enroll them in care appropriate to their presenting concerns and level of acuity,” shared Dr. Carla York, a psychologist and AOBH service chief.

“There were several factors that led us to change our previous processes for new patients,” York added. “Prior to establishing the IEC [in March 2016], patients seeking behavioral health services would simply be scheduled with the next available provider, regardless of the level of their need or the provider’s specialty. In addition, patients would often be scheduled for initial visits for both psychotherapy services and psychiatry, which was an inefficient use of valuable new patient appointments and contributed to prolonged wait times for a new appointment,” she explained.

“Established patients were often referred and/or transferred to other providers within the clinic once their needs were deemed a better fit for a different type of service or specialty than the provider who completed the initial appointment, which also led to an inefficient use of available appointments,” York added.

“AOBH has a highly skilled staff of behavioral health professionals with a wide range of areas of expertise. The ability to match a patient’s needs with provider’s expertise has led to greater patient satisfaction, reduction in transfer requests based upon specialty needs, and reduced caseload burden overall for therapists,” York said.

Patients calling the AOBH to request new appointments are routed to the IEC unless they are specifically referred for medication management or are transferring established behavioral health care from another military medical treatment facility (MTF), York explained.

“IEC appointments are typically conducted by trained behavioral health technicians under the supervision of licensed clinical psychologist,” York continued. “A discussion with the patient at the conclusion of the appointment includes recommendations for level of care and, if the patient is deemed appropriate for a lower level of care than AOBH provides, case management assists the patient in establishing care with another entity, such as Military and Family Life consultants, Fleet and Family services, etc.,” she added.

“For patients who will continue on to care in AOBH, an overview of the clinic and recommended level/type of care is discussed, including what to expect at the next appointment with a care provider, preliminary treatment planning, and general expected course of treatment. The IEC also supports training goals for the U.S. Navy predoctoral psychology interns, as they are active participants in the process and are able to fulfill supervisory competency via work with the behavioral health technicians,” York continued.

York piloted the AOBH IEC with U.S. Navy psychologist Lt. Jared Bollinger and psychiatry residents participating in the capstone leadership rotation in the AOBH. “The residents helped me develop training modules for the behavioral health technicians, and Lt. Bollinger assisted with supervision,” said York.

“Over the course of the pilot project and as we were able to expand the scope of the IEC, several clinical psychologists assisted with supervision, allowing us to develop into an established process for new appointments. We now have an IEC coordinator, Dr. Kalim Alcover-Pabon, who oversees the clinic, coordinates ongoing training for the techs, and provides supervision to all techs, both military and civilian.”

York said the supervisory staff also includes Dr. Sandra Jimenez, the primary supervisor for psychology interns, and clinical psychologist U.S. Navy Lt. Zaver Moore, who assists with tech training and supervision. In addition, clinical psychologists Dr. Lourdes Morales Vazquez and U.S. Navy Lt. John Mallory support the IEC, as well as several enlisted behavioral health technicians and three civilian psych technicians who work in the IEC.

“Perhaps the greatest benefit has come from optimizing available appointment use,” said York. “By evaluating new patients as they enter the clinic and matching them to appropriate care levels, we are able to book patients more efficiently into care. We also assist patients with matching to other care if it is deemed more appropriate, either outside the clinic or with a referral to another type of care, such as OT-BH,” she continued.

“Often, other services may be more appropriate for a patient’s needs, and we assist the patient with accessing those other care providers, which in turn improves the efficiency of treatment appointment use within our clinic,” York added.

“The improvement in care for patients has been the most rewarding,” York said. “Behavioral health care is increasingly difficult to access nationwide due to continuously increasing demand. When a patient needs behavioral health treatment, it is ideal to get them in quickly to assess needs and initiate treatment. We are seeing the benefits of the IEC’s impact on access. Patients are sharing that with us, both informally and formally through channels such as the Joint Outpatient Experience Survey (JOES).”

She added the IEC has also improved provider satisfaction across the board.

“Our process via the IEC introduces patients to treatment in AOBH and addresses some expectations up front, which allows providers to focus on providing high quality care once a patient is assigned to them,” said York. “It also allows providers the opportunity to receive patients that are a good match for their expertise/areas of interest.”

“As a service chief, it has been rewarding for me to see so many invested staff members work together to change a process for the better,” York added. “There are certainly a lot of challenges that come with taking on a task like this. In the early stages of the pilot project, I likened it to launching a blimp – slowly moving and bumpy at the start. It is very rewarding to see where we are now with a process that has truly improved many aspects of care delivery within the AOBH.”