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“A true role model”

Gov. Reynolds tours and praises Johnson County’s GuideLink Center
Johnson County’s GuideLink Center, a one-stop clinic for people in an acute behavioral, mental or substance abuse crisis, began receiving patients on Monday, Feb. 15, with a “soft opening.” Gov. Kim Reynolds toured the facility on Southgate Avenue in Iowa City on Thursday, Feb. 11.

IOWA CITY– The GuideLink Center, also known as the Access Center of Johnson County, started accepting patients with an acute mental health or substance abuse crisis on Monday, Feb. 15, as part of a gradual “soft opening.”
The facility, located at 300 Southgate Ave. in Iowa City, has been a goal through roughly a decade of discussion in Johnson County. Momentum was gained in 2015 when then Jail Alternatives Coordinator Jessica Peckover started a crusade for a Crisis Intervention Team (CIT) made up of law enforcement officers, starting with the Johnson County Sheriff’s Office (JCSO).
Peckover envisioned an eventual mental health care system where people in crisis could go, or be taken to by law enforcement or Emergency Medical Services (EMS) personnel rather than going to local hospital emergency departments or the county jail. Often, neither the emergency room (ER) nor the jail are the appropriate facility for such a crisis for a host of reasons including needlessly occupying an ER bed, taking officers off the street sitting with these subjects in the ER, and adding to the number of inmates in custody in the jail without suitable accommodations for such crisis.
In 2015 Johnson County Sheriff’s Deputies began taking CIT training in San Antonio, Texas. San Antonio had developed a comprehensive program, which includes a stand-alone access center for such crises to avoid overloading area hospital emergency departments as well as to provide a diversion from incarceration in local jails. San Antonio’s program inspired Peckover who found support in the Sheriff’s Office, Board of Supervisors, as well as area mental health and substance abuse providers. In 2017 Peckover said the purpose of the then-proposed access center would be to connect people in crisis with the appropriate services while cutting down on utilizing less effective, and more expensive services which were not in a position to solve their problem. The county purchased the GuideLink site, originally named the Behavioral Health Urgent Care Center, in 2018 for $1,350,000 with construction beginning in late 2019 on the $6.4 million building.
On Thursday, Feb. 11, Gov. Kim Reynolds, along with Lt. Gov. Adam Greg and Iowa Department of Human Services (DHS) Director Dr. Kelly Garcia, toured the facility and met with key personnel in an informal conversation about regulatory and budgetary challenges GuideLink is facing while ramping up its operations. Attendees included representatives from partner agencies and local media.
“Our guiding principals were: different, innovative, think of the whole person,” Lance Clemsen, the chairperson of the Executive and Steering Planning Committee, told the gathering.
“It is this really lovely collaboration of very solid state leadership and really great local partners,” said Michael Flaum, a member of the steering committee. The process of developing this one-stop shop began with an Acute Care Task Force set up in 2007 or 2008, he said, which looked at mental health issues and led to a discussion on how many psychiatric care beds were needed in Iowa. “The answer I always gave is, I can’t answer that question independently. It depends on the array of services that we have. What we all knew was we were all totally reliant on the most expensive services,” he said. Flaum said it wasn’t by design, but rather out of necessity. In order to figure out how to provide better services, a committee formed, led by Peckover, and including a wide variety of stakeholders both public and private. “This project, from the start, was a meaningful collaboration between mental health services, substance abuse services, law enforcement and human services,” said Flaum.
Dr. Monika Jindal, the Medical Director for the GuideLink Center outlined three main concerns for the governor: financial viability, workforce sustainability and recruitment, and access to services through innovation of care.
Financial viability, with the potential of accessing state funding, is important, Jindal said, “because we’re this innovative model, our revenue (billing patient insurance) is not going to support all of our costs.” Part of the problem, she explained, is some of the facility’s services are difficult to bill for. “We’re not inpatient, we’re not outpatient, we’re in the middle,” she observed.
Workforce sustainability and recruitment will be a challenge, Jindal said, as the nature of the work can easily lead to burnout on the part of the providers. “It’s a challenging patient population,” she observed. “It is. We’ve all been called to do this work and the people we hire are motivated to do this work, but it’s often challenging to retain a high-quality work force because we can’t compensate in a way that’s comparable to the way that other healthcare institutions in the area are able to do.”
Under current regulations, registered nurses are required for direct patient care. However, Jindal asked if Licensed Practical Nurses could be hired instead. “That might give us some flexibility with hiring.” Jindal pointed out the staff is being asked to be “very nimble. We’re asking them to exist in a space that’s doing mental healthcare in addition to substance abuse care. That’s a really specialized skill set that we’re asking them to have, and we’re asking them to transition back and forth. That’s a lot.”
Barriers to access for care and integration of services, Jindal said, come down to regulations and/or protocols, which need to be changed or updated. For example, current protocols prohibit the Johnson County Ambulance Service (JCAS) from transporting a patient in need of treatment to a facility other than a hospital emergency room. Jindal said with the goal being to divert cases from the emergency rooms, the protocol needs to be expanded to include this new treatment model.
“This is incredible, the collaboration and the partnerships,” said Reynolds, who praised the innovative care model. “I know Kelly (Dr. Garcia) will be back here and we’ll be coordinating because we want to do it, too. I want to streamline services; every time we’re not doing that it’s a duplication of cost, and we’re not as effective or efficient as we can be, and that impacts the number of people we can serve.” The governor noted the concept of a holistic approach to patient care is, “what we need to do. It’s the right thing to do for so many, many, many reasons.”
The GuideLink Center, Reynolds said, “is a true role model for other areas of the state.”