University of Delaware
Nursing student Olivia Marshall and nurse practitioner Julia Jordan are joined by Lyn Hayes, UD professor of nursing, and Rick VanStory care coordinator Theresa Woolhar in the exam room at the center.

Seamless service

NMHC provides primary care for people experiencing mental illness, homelessness

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(Editor's note: For a video about the program, click here.)

2:13 p.m., Feb. 10, 2015--Until recently, 23-year-old Armendraiz had never had a comprehensive physical — not even when he played high school football in Texas.

But last month, the self-professed drifter made an appointment with nurse practitioner Julia Jordan at the Rick VanStory Resource Center (RVRC), a recovery-oriented peer center for people with psychiatric disabilities in Wilmington, Delaware. 

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The visit to the new medical office, which was converted from a conference room at RVRC in 2014, was the young man’s first step on a long road to dealing with his mental health and substance abuse problems.

“Julia really helped me,” Armendraiz says. “I have a lot of issues that need to be addressed, and seeing Julia got that process started. The longer I stay here and take care of the things I need to take care of, the better off I’ll be.”

Partnering to build a medical home

Jordan’s presence at the center every Wednesday is the result of a partnership that includes the resource center, the state of Delaware, and the University of Delaware through its Nurse Managed Health Center. The University pays Jordan’s salary whether she’s working at the NMHC on UD’s Science, Technology and Advanced Research (STAR) Campus or at RVRC.

For Allen Conover, chief executive officer of RVRC, two words describe the goal of the partnership: seamless service. 

“It’s part of the medical home model, which encourages care teams to meet patients where they are,” he says. “We’re used to our area, and it works much better if the providers come here.”

Conover says “we” because he’s talking about himself as much as he is about the people who come through the center’s doors every day from prison, from the hospital psychiatric ward, from the streets. Rick VanStory was Conover’s case manager when he was homeless several years ago, and Conover was instrumental in launching the center in memory of VanStory in 2009.

“Integrated health care enables us to follow a person through all the steps involved in dealing with complex problems,” Conover says. “Patient-centered care that addresses both physical and mental health is critical to well being and recovery.”

As a nurse practitioner, Jordan delivers primary care, including preventive care, health education and management of chronic conditions such as diabetes and hypertension. She also provides a much-needed bridge for RVRC clients who have been released from the hospital but not yet paired with mental health care providers in the community.

“Julia makes sure the patients are compliant with their medication and that their condition is stable,” says care coordinator Theresa Woolhar. “She can also write prescriptions for more meds if the patient doesn’t have enough to last until an appointment can be set up with a specialist. We have lots of people who would be in big trouble without Julia.”

That “big trouble” can include costly trips to the emergency room at taxpayers’ expense. 

“Just this week, we had two patients, one with a stomach illness and the other going through withdrawal,” Conover says. “Having them treated here rather than in the ER probably saved the state $10,000.”

But Jordan is doing more than saving the state money — she’s preserving people’s dignity.

“Patients love how caring and compassionate and warm she is,” Woolhar says. “The homeless are often treated as ‘less than,’ but Julia is very respectful to them.”

The RVRC clinic is also open to employees. “We don’t have to leave the site, and we don’t have to wait,” Woolhar says. “That’s really important when you’re working in a place where crises are a daily occurrence.”

Removing the stigma

For UD nursing students, the partnership offers an opportunity to gain practical experience in an environment that can seem foreign and even frightening at first.

“Most of our students come from suburban middle-class neighborhoods,” Jordan says. “Working here allows them to see firsthand what it’s like to practice nursing in an inner-city facility. They soon realize that the patients we treat here are people just like anyone else.”

Jillian Buck, a junior nursing student from Crofton, Maryland, worked with Jordan at the RVRC clinic during the fall 2014 semester.

“I’ve always been interested in substance abuse, and I really enjoyed the work because there was something new happening every day,” Buck says. “The patients are a diverse group of people who may have stumbled, but at Rick VanStory, they’re on their way back. It’s nice to be able to add to that by helping them with their health.”

For Conover, the benefit of having the nursing students at RVRC is two-fold: “We’re helping to train them while also breaking down the stigma of mental illness in the long run,” he says.

Building out the medical home

Jordan currently averages about eight patients a day at the clinic, more than half of whom are new and need full histories taken. As her caseload builds, a second day of her time will be added to the schedule at RVRC. 

A mobile testing unit will soon be added to the medical services offered there, as well, enabling clients to simply walk across the parking lot to be tested for HIV, TB and other diseases and conditions.

In addition, through a partnership with Kirkwood Pharmacy, a program called Wellness Stop allows the homeless to get their vital medications on a daily basis at the center so they don’t fall victim to the medication “roller-coaster ride.”

All of these developments are bringing Conover closer to his dream of having a whole range of services on site.

Allen Prettyman, director of the NMHC at UD, emphasizes that this is a replicable model. “We’re very happy to see how well our services have been received at Rick VanStory,” he says, “and we welcome the opportunity to set up similar satellite NMHCs in other communities.”

As for Armendraiz, he may have found a real home as well as a medical home. 

“I’ve always been a drifter,” he says. “That’s just who I am…. But I might just stay in Delaware. I like it here. It’s quiet.”

About the Rick VanStory Resource Center

The Rick VanStory Resource Center was founded in 2009 by former mental health consumers who recognized the urgent need for a recovery-oriented peer center for people with psychiatric disabilities. RVRC empowers individuals to access the resources and services they need to build independent, satisfying lives in the community through the support of their peers in an environment that is free of stigma.

Open to all mental health consumers in Delaware, RVRC receives support from the Delaware Department of Health and Social Services – Division of Substance Abuse and Mental Health as well as other grant-making agencies.

Services offered include recovery maintenance support, computer lab and library, hospital visitation program, clothing closet and pantry, housing and employment skills assistance, pre-hospital discharge planning, accompaniment to mental health court and other appointments, a 24/7 “warm line” and peer support.

RVRC was named in memory of case manager Rick VanStory, who died of bone cancer in 2007 at the age of 45.

Article by Diane Kukich

Photos by Doug Baker

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