Eastern Aleutian Tribes (EAT), a Tribally-owned Health Organization in Southwestern Alaska, provides medical, dental, and behavioral health services at eight Federally Qualified Health Center locations across the Aleutian Island chain.
In the furthest corner of America’s most remote state, Alaska’s Aleutian Islands are known as some of the most beautiful, secluded and challenging locations in the world. After years of relying on EAT medical staff, mid-level behavioral health clinicians and outside referrals for psychiatric medication management, EAT partnered with Array Behavioral Care to establish a long-term telepsychiatry solution close to home.
The islands extend 1,400 miles off mainland Alaska and are characterized by towering mountains, broad valleys, fjords, tundra and glacial lakes. Located between two tectonic plates, residents of the islands live with the risk of seismic activity like volcanic eruptions, earthquakes and tsunamis. Due to extremely high winds and rugged sea navigation in the Pacific Ocean, the islands are accessed via plane, typically costing over $1200 round trip.
The islands are home to the indigenous Aleut tribal communities. Each of the eight island communities served by Eastern Aleutian Tribes is unique and ethnically diverse, populated by both Aleut natives and Euromericans. Local populations range from 40 residents in the smallest village of Cold Bay to 965 residents in the largest village of Sand Point. Facilities in these areas are extremely minimal with typically just 1-2 stores and restaurants in each town.
The majority of the islands’ residents live subsistence lifestyles – spending their days fishing, hunting or otherwise utilizing the resources of the land to make a living. Other work on the islands includes processing plant workers or jobs in the service and administrative sectors. These separate island populations are unified by their common history, cultural similarities and shared resilience as they collaborate to thrive in such extreme and isolated conditions.
Brenda Wilson, Behavioral Health Manager at Eastern Aleutian Tribes, and her very supportive Supervisor Dr. Shanda Lohse are prime examples of this resilience. Wilson spent the past two years persevering against these challenges to connect Eastern Aleutian communities with high-quality, culturally competent psychiatric care, a resource that is scarce in even the most populated cities of the lower 48 states.
Eastern Aleutian Tribes was founded in 1991 with a mission to provide and continually improve quality healthcare services for their communities. Wilson, who is also a trained and Certified Behavioral Health Aide Practitioner and holds a Bachelor of Social Work Degree, has been a staple of EAT’s behavioral health department for over 20 years. The department is made up of master’s level Clinicians and Behavioral Health Aides who offer residents 24/7 crisis intervention services, substance use programming and counseling for individuals, groups and families. In areas where staff is present, they offer in-person services. Otherwise, telehealth is utilized.
Without a psychiatrist on staff, the behavioral health team at Eastern Aleutian offered coordination for psychiatric services and medication management via medical staff collaboration or referrals to outside agencies. Neither was ideal. If the staff managed psychiatric medications, they struggled working beyond their scope of practice, but referring patients to mainland facilities often meant long, expensive flights and wait times up to 18 months for care. In 2020, the behavioral health needs of the community reached a boiling point.
“There were incidences where people were on the wrong medication, too much of the medication or too little, and some that really reacted with people terribly,” Wilson described. “They felt like they were going crazy, they didn’t know what was wrong, and their families were noticing.”
Stabilizing these patients in crisis was extremely difficult for the department to manage without a psychiatrist on staff. Seriously mentally ill patients in crisis that required medical stabilization needed to be medically evacuated from the islands to facilities on the mainland, costing about $100,000 per flight. In 2020 alone, Eastern Aleutian had to utilize these medevac services 13 times, costing the region over $1,300,000.
Eastern Aleutian Tribes needed additional behavioral health clinicians who would be sensitive to the residents’ challenges, from understanding the complexities of their location, ongoing substance use issues, to years of intergenerational trauma. Upon recommendations from their tribal network, EAT decided to partner with Array Behavioral Care to bring psychiatric expertise directly to their communities via telepsychiatry in July 2020.
From the start, the two organizations shared a commitment to delivering culturally competent services, personalized for the community’s acuity and unique circumstances. Array matched EAT with a skilled telepsychiatrist, Dr. Karen Jackman, and an experienced Licensed Clinical Social Worker, Wilma Harpole – both of whom were located and licensed in Alaska.
Both clinicians were carefully screened by Array’s partner success team with EAT’s clinical needs in mind. Wilma Harpole, for instance, was a natural fit given her certifications in Substance Use Counseling and her years of experience working with the Alaskan Native population in Kotzebue. EAT leadership met with the clinicians prior to onboarding to confirm they were a good match culturally and to ensure that they shared a similar philosophy of care.
Array staff worked with EAT leadership to understand behavioral health workflows and optimize any new processes that the clinicians would need to integrate with the clinics. Wilma and Dr. Jackman were trained to chart in the partner EMR, coordinate patient scheduling with onsite staff, and procedures were established for prescription delivery to the islands.
Once the clinicians were fully trained, they went live with patients in November 2020 with 16 hours of psychiatry services and 24 hours of therapy services per week. Wilson admits that the Behavioral Health department was nervous to see if the community would connect with off-site telehealth clinicians who are not immersed in the community.
Due to both organizations shared commitment to clinical integration and cultural fit, these doubts were quickly alleviated. The first year of the program has been so overwhelmingly successful that Eastern Aleutian Tribes have expanded services to 4 days a week and are adding another Array psychiatrist to meet the increasing demand for care in their community. The key benefits include:
Since beginning services with Array, the clinics have been able to increase access to behavioral health intervention at preventative stages, reducing the need for psychiatric stabilization services. They are happy to report zero medevac cases in 2021 vs. 13 in the year prior, saving the organization and the region over $1,300,000.
With Array clinicians in place, anyone at any of EAT’s eight communities seeking behavioral health services can be seen within 24 hours. Instead of waiting up to 18 months for care on the mainland, patients can be seen in their homes or at the local clinic – saving the patients so much time and travel expense.
Finally, patients who need coordinated behavioral health care are getting the support they need from EAT and Array clinicians. Plus, the mid-level clinicians at the clinics are growing their skills and confidence in treating BH conditions with consults and supervision from Array’s clinicians.
Brenda Wilson, Behavioral Health Manager at Eastern Aleutian Tribes
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