Open Access Can’t Be the Only Door

Same day access shouldn’t limit access

Photo by Alex Holyoake on Unsplash

Same Day Access, or “open access,” is a model of intake in behavioral health that came about in response to the influx of new clients who were able to seek services thanks to the Affordable Care Act and the expansion of Medicaid services. According to Scott Lloyd at MTM Consultants, same-day access models reduce the average wait time for a client to be seen by 40%. In my practice, there was a time when the agency process was to schedule an intake appointment for a client between six to eight weeks away from their initial phone call. By that point, the client had either a) gone somewhere else b) gotten better or c) given up.

So, when the idea of “open access” was introduced to me, I embraced it. When we had a “walk-in,” my team and I scurried around seeing new clients in between current ones finding time to briefly assess those looking for help. Yes, it was a lot more work in many ways, and therefore our productivity numbers went up.

But more importantly, more people were being helped and helped sooner.

Initially, this process was limited to outpatient therapy clients. Case management clients, who were usually far less functional and often less motivated for treatment, were still being referred directly by hospitals and other agencies through previously established processes. Eventually, procedures were developed to allow for walk-in appointments for case management services, too. Open Access had created a new door for folks to walk through for help.

In some same-day access models, referrals for scheduled intakes are no longer being accepted. This means that clients who are being discharged from hospitals, residential treatment, or other similar higher levels of care are expected to connect with services by navigating a front-desk process that requires not only a level of initiative but also the ability to handle the requirements for intake on their own. Clients have to come to the office, sometimes traverse through a chaotic waiting room, and be sure to have all the required documents (photo ID, social security card, insurance card, proof of residence, proof of income, etc.)

Many of the clients who are coming from hospitals have psychiatric disorders that make this a challenge. The more traditional process allowed case managers — some of the most unappreciated, hardest working helpers in behavioral health — to assist clients in accessing services by making personal contact with the client, building trust and rapport early, and even finding ways to help them with transportation and other basic needs to provide comprehensive mental health care. Often, case managers would be tasked with going out to locate a client who’d been referred because the client was in need and sometimes living in unsafe conditions, like in tent cities. I have a colleague and friend who one time received a referral for a client whose address was listed as GPS coordinates because he lived under a bridge. Without going to see him, promising him a turkey sandwich and a Mountain Dew, and driving him to the office for the intake, this client would likely be still on the street (if he was still alive.)

So, in an Open Access model, why would we eliminate any door that allows a client to enter into treatment?

Same Day Access is a great idea. Allowing clients to walk in and be seen and assessed by a clinician when they are ready for help makes sense.

But they have to walk in.

What if they can’t or won’t because of the nature of their illness? Providing “open access” models without mechanisms for other types of appointments is limiting and will do more harm than good. Not for the bottom line, I guess — there sure won’t be any “no shows.”

But what about those people we’re supposed to be helping? The ones who need us the most? I fear they’ll be lost and underserved by a system that doesn’t fully understand their needs.

Originally published at http://helpingwithhope.wordpress.com on April 13, 2018.