ANNUAL REPORT2016-2017

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UNIVERSITY HEALTH CENTER

ANNUAL REPORT

2017

Mission Statement

The University Health Center provides high quality, cost-effective health care and wellness programs topromote health and support academic success.

Vision Statement

Our vision is to be the provider of choice for health care and health information for UMD community, to berecognized as a leader in collegiate health care, to be an important source of information services for faculty

and staff, and to be an integral part of the University’s educational mission.

Values

Excellent customer service and non-judgmental patient care

Respect for all cultures and ethnicities

Open communication between providers and patients and among staff

Education and training for students and staff

Collaboration with and support of campus academic/service units

Positive relationships with state and local medical organizations

Fiscal responsibility and equitable use of resources

Continuous quality improvement throughout the organization

Integrative team approach to care

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2016-17 Goals and Accomplishments

The section below outlines progress on goals set in 2016.

Sustainability ACHIEVED-Silver Green Office status.

Assessment and Learning Outcomes ACHIEVED-Establish the Peer Education program as its own course through the Office of

Undergraduate Studies.o Our four previous year-long peer education courses (HLTH38X) in SPH have

transitioned to eight semester-long courses in UGST (PEER31X and PEER32X) andsuccessfully passed pilot and formal approval processes.

o 210 and 80 hours of academic credit were earned by Health Promotion and WellnessServices Peers/Interns and CARE Peers respectively.

ACHIEVED-Re-establish the Experiential Learning Program with University of Maryland Schoolof Pharmacy.

o Two pharmacy students completed their Introduction to Pharmacy Practice at the UHCpharmacy. In addition, one of our contract Pharmacy Technicians was accepted to thePharmacy Program at UMM!

Organizational Financial Health and Entrepreneurship ACHIEVED- Increase overall collections by 20% by allowing patients to pay at the time of

service as opposed to using Bursar billing.o Increased collection of copays and self-pay services (Behavioral Health and Physical

Therapy fees) at Registration by 191%. The amount billed to Bursar accountsdecreased by 28% during this time as well.

o The Business Units launched an effort to collect unpaid patients’ responsibilities.Billing staff sends secure email message, informs patients about their accountbalances, and accepts payment over the phone or at the Health Center (UHC) beforesending balance to the bursar account. Billing department has collected total of$19,124 over the phone since February 2017 alone and write-offs have decreased by12%.

IN PROGRESS-Implement a “cash only” billing model for the pre-travel services provided atthe UHC.

o Beginning August 1, 2017, the correct billing codes have been applied to pre-travelvisits and we hope that this will move us toward less complicated reimbursement forthese services.

Public Health ACHIEVED-Establish the framework for a Collegiate Recovery Community at the University of

Maryland.o Terps For Recovery is now a recognized student organization with 25 active members.o A recovery drop-in space was effectively piloted at the UHC with sign-ins to the space

doubling from Fall to Spring semester with at least 271 visits.o The AA meeting on campus at the Chapel has grown in student participation.

I love this course!

It's everything I

thought it would be

and more!

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o Significant progress has been made toward a supported-living option in College Park incollaboration with The Haven.

o A contract “Recovery Liaison” was hired during the 16-7 academic year to coordinatewith TFR, we hope to continue this in the Fall.

o The University has joined the Association for Recovery in Higher Education.

ACHIEVED-Undertake an antibiotic stewardship campaign that will lead to a 20% decrease inthe number of antibiotic prescriptions written from 15-16 to 16-17.

o Antibiotic prescribing for bronchitis decreased by 25% between January 1, 2016-June30, 2016 and July 1, 2016-December 31, 2016.

Space Utilization IN PROGRESS-Evaluate the functionality of the current UHC space and identify a plan for

potentially modifying the space to maximize efficiency.o An initial floorplan to build out unused space on the UHC ground floor as a new

location for The Campus Pantry has been created by Facilities Management. We arepreparing to begin fundraising for this project.

o A UHC committee is gathering, assessing and prioritizing space needs. Several minorprojects and relocations within the building have allowed more efficient use of space.

Occupational Health IN PROGRESS-In the next 1-3 years, an improved system for pre-employment screening and

immunization and better monitoring of lab activity and exposures is needed in order toadequately protect employees.

o A risk assessment was presented by the Director to the Research Council and aproposed budget has been submitted to the Vice President for Administration andFinance to create appropriate Occupational Medicine infrastructure. (Attachment 2)

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o Increased communication and collaboration with units on campus whose employeesare at risk for occupationally-acquired infections and other health affects has beenimplemented (Residential Facilities, Resident Life, Facilities Management, Research).The UHC is taking on additional responsibility in the process of insuring thatemployees at risk have access to indicated vaccines and risk-related surveillance.

o The UHC has improved identification of and communication about lab associatedinjuries and exposures by adding required not elements within our electronic medicalrecord.

This section outlines progress on goals that were set in previous years and that had not yet been achievedand additional accomplishments for 2016-17.

Work-Life Initiatives

A UHC Telework and Flex-time Policy was created for UHC Exempt employees.

Thriving Workplace Initiative

A variety of recommendations from staff to improve the workplace have been implementedand include, but are not limited to…

o The UHC Business Units (Billing, Registration, Business Office, Administration andFinance) have achieved 90% of their established goals related to cross training andmutual backup. This has allowed employees to feel comfortable that work will becompleted when they are out of the office.

o The Billing Staff have started a lunch-time indoor walking group in the Health Center.o Decision-making related to certain purchases has been streamlined and delegated

away from the Executive Committee and to employees.o We have provided a higher level of transparency about the finances of the UHC to

avoid the appearance that financial decisions appear arbitrary.

Many of our Supervisors attended Thriving Workplace overview sessions and the ExecutiveCommittee will collectively attend two TWI topical workshops.

Departmental Diversity Accomplishments

The UHC conducted the Mid-Atlantic Transgender Health Conference providing ContinuingEducation to over 150 participants from more than 30 institutions and organizations in theregion.

A Diversity Orientation has been added to the standard onboarding procedure for all UHCemployees, delivered by two UHC staff members. We evaluated the effectiveness of thissession via a participant questionnaire and have determined to continue.

I learned a lot more about the University and

Health Center's policies about diversity and

inclusion and the efforts being made to ensure

that it's a priority. I learned more about internal

Health Center efforts that I didn't know about

before. I also learned about different

offices/resources on campus that deal with

diversity & inclusion and some of the services

they offer.

I liked that it was more of a discussion than a

formal presentation & both Tom and Jenna are

great at having these kinds of conversations.

I would recommend this

Diversity Orientation to a

fellow employee.

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The CARE Lead Educator delivered two bystander intervention sessions focused on biasincidents at the request of the Office of Diversity and Inclusion (ODI).

Two International Student Coffee Hours were conducted by the Student Health AdvisoryCommittee and an initial tool was created to assist this student cohort with health insuranceliteracy from feedback from the sessions.

Assessment and Learning Outcomes

PARTIALLY ACHIEVED: Benchmarking patient satisfaction ratings with health center ofsimilar size and services and improvement of patient satisfaction scores (goal set in 2014).

o With the assistance of the Student Health Advisory Committee, a new patientsatisfaction tool was adopted (the ACHA Patient Satisfaction Survey). Using a series oftrials of survey invitation format, sender, email subject line and incentives, we wereable to achieve a peak response rate of 12% to the survey.

o The Faculty and Staff Assistance Program have excellent patient satisfaction scoreswith 92% of clients reporting that they would recommend the program to others.

The UHC Continuing Medical Education program was awarded Accreditation withCommendation for a 6 year period from the Maryland State Medical Society.

To increase supervisor and employee understanding of substance abuse, the Faculty and StaffAssistance Program has presented to all Facilities Management managers on this topic.

Instructional Technology/Technology

ACHIEVED: Full implementation of an immunization compliance database (goal set in2015).

o The Immunization Data Base has been fully implemented and is being utilized forrecording immunization records for incoming students.

PARTIALLY ACHIEVED: Install smart room technology in remaining meeting rooms (goal setprior to 2014).

o The Smart Cart that was purchased with a generous parent financial gift was used toprovide 57 Step Up! trainings at the UHC. The Smart Cart was also used to deliver highquality Continuing Medical Education to our staff.

o A technology donation request for equipment for the other meeting rooms at the UHChas been submitted.

IN PROGRESS: Website Upgrade (goal set prior to 2014).o The UHC Web Site redesign process is underway with anticipated completion of

January 2018.

Mental Health

A Laboratory position was re-allocated to Mental Health/CARE to provide counseling servicesto sexual misconduct survivors and other mental health clients.

In an effort to focus counseling services provided at the MHS to those students concurrentlyreceiving medication management and to focus on the purpose and strengths of the , callersnot perceived to need medication were immediately referred to the Counseling Center.

In an attempt to decrease the likelihood of employee turnover in our Mental Health Service,over $120,000 was reallocated to increase salaries that were below regional benchmarks.

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Grants and Fundraising

The UHC cooperated on a project with the Food and Drug Administration to evaluate theeffectiveness of several temperature measuring devices (non-contact thermometers). Theproject total budget is $134,998 covering around $20,000 in UHC expenses.

Two grants were awarded to CARE from the Governor’s Office of Crime Control andPrevention…$287,027 over 2 years for Outreach, Therapy and Advocacy.

Health Promotion and Wellness Services successfully used a $10,000 Moving MarylandForward grant to develop services to transgender students and improve provider proficiencyin providing Trans care.

Parent and Family Affairs and Pepsi gave over $6,000 to support efforts benefiting students inrecovery and Step Up! implementation.

An individual donor gave over $6,000 to support students in recovery.

Congratulations to you and your colleagues in the University Health

Center for the success of “Transforming Maryland: Training for

Excellence in Transgender Healthcare.” I am thrilled the alterations to

your grant that we discussed at the mid-cycle review proved to be

exceptionally successful.

-Luke Jensen, Office of Diversity and Inclusion

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2017-18 Goals

Thriving workplace initiative Improve interpersonal communication between employees based on challenges identified at our

Supervisor Strategic Planning Meeting. Success in this area will be demonstrated by positiveresponses on the Thriving Workplace survey that address communication.

Improve interdepartmental communication and referrals between Mental Health and Primary Careto expand the capacity of the UHC to manage students on psychiatric medications and improvepatient care.

Departmental Diversity Evaluate our vestibule space to improve accessibility to those who are visually impaired. In addition,

to insure the overall accessibility of the UHC. Further improve our service to international students as measured by feedback gathered by the

Student Health Advisory Committee.

Assessment and Learning Outcomes Increase our patient satisfaction survey responses to 2,400 to achieve interpretable data based on

our total visits and improve scores on overall satisfaction and the likelihood that patients wouldrecommend the UHC to a friend. (Attachment 1)

Public Health Fully implement additional immunization requirements for 2018 incoming students (meningitis and

tetanus/diphtheria and pertussis vaccines). Participate in the effective launch of a recovery supported living space in College Park and expand

recovery related programming in cooperation with The Haven at College. Work with campus partners to make progress toward full implementation of the recommendations

from the President’s Sexual Assault Prevention Task Force. Substantially improve the operation of the international student immunization onboarding process.

Patient Care Operations Increase the efficiency of care In Medical Units by assigning a Registered Nurse to work within each

Unit and by establishing Nurse Advice Phone and Electronic Communication Lines.

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Director

David McBride

Associate Director

Deirdre Younger

IT Staff

MR/Appts Supervisor

Denise Weiss

MR/AppointmentsStaff

Pharmacy Supervisor

Marie Powell-Daly

Pharmacy Staff

Radiology Tech

Physical Therapy

Arlene Hernandez

HousekeepingSupervisor

Linden Wilson

Housekeeping Staff

Assistant Director,Mental Health

Marta Hopkinson

SUIT Supervisor

Laura Place

SUIT Staff

FSAP Supervisor

Tom Ruggieri

FSAP Staff

Mental HealthPsychiatry Staff

Mental HealthCounseling Supervisor

Jeri Boliek

Mental HealthCounseling Staff

Mental Health FrontDesk Supervisor

Kit Johnson

Mental Health FrontDesk Staff

Assistant Director,CARE

Fatima Taylor

CARE Staff

Assistant Director,Health Promotion

Julia Matute

Health Promotion Staff

Marketing Staff

Massage/

Acupuncture Staff

Assistant Director forBusiness and Finance

John Randrian

Billing Manager

Jeff McDonald

Billing Staff Business Office Staff

Registration Manager

Nancy Heckman

Registration Staff

Laboratory Manager

Stephanie Webster-Sesay

Lab Staff

Clinical Director

HeatherTeitelbaum

Walk In Supervisor

Joy Howard

Walk In Medical Staff

Walk In NursingSupervisor

Rita Devens

Walk In/First FloorNursing/MA Staff

PC/WH NursingSupervisor

Linda Legrand

PC/WH MA Staff

Immunization/AllerySupervisor

Tina Thorburn

Immunization Staff

PC/WH Medical Staff

Occupational HealthCoordinator

Rebekah Giannakos

Occupational HealthNurse

AdministrativeAssistant

Marilyn McDonald

HR/BusinessCoordinator

Elizabeth Zapata

Executive Committee

Supervisors

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Key Statistics

Of note, we have intentionally increased promotion of appointment based visits which has allowed us to improve waiting times and increase

continuity for those students who care about that issue. Web booked appointments have shown to be increasingly popular with students, as the

chart reveals. Our missed appointment rate for scheduled visits remains very low, around 4%.

38,687

17,475 19,668

26,398

5,0455,229

7,728

1,024

24,941

8,268

14,071

997 1,313

37,658

17,296 16,702

23,003

7,8014,967

7,557

817

23,618

7,777

13,066

1,0711,240

37,995

15,85115,397

19,897

11,146

4,763

5,788

652

24,941

10,864 13,788

1,178 1,822

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

Medical Services Provided 16-17

6/1/2016-5/31/2017 6/1/2015-5/31/2016 6/1/2014-5/31/2015

10

952

9

160

9

315

6

4363

760 9

17

110 22

3

974

11,

419

1,8

08

4,09

9 4,7

18

814 1,0

45

87

656 95

6

11

,524

1,8

50

3,9

25 4,4

65

1,0

10

97

2

107

1,0

41

1,0

30

T O T A L M E N T A LH E A L T H V I S I T S

U N I Q U EM E N T A L H E A L T H

P A T I E N T S

I N D I V I D U A LV I S I T

M E DM A N A G E M E N T

I N I T I A LE V A L U A T I O N

T R I A G E V I S I T R E F E R R A L V I S I T G R O U P F S A P T O T A LV I S I T S

MENTAL HEALTH SERVICES PROVIDED

6/1/2016-5/31/2017 6/1/2015-5/31/2016 6/1/2014-5/31/2015

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Explanations for visit volume decrease in Mental Health:

There were no trainees in the Mental Health Service this past academic year leading to somedecrease in patient volume. Licensed therapists have been more reluctant to engage trainees as thehigh acuity of patients is perceived as transferring more risk to the staff therapists as supervisors ofcare.

There has been a downward trend in the number of group services. Reasons for this include thetransfer of a large eating disorder group to the Counseling Center, fewer/no trainees to co-facilitategroups and the perception that illness severity makes some students less appropriate for grouptreatment.

Staff departures and difficulty with recruiting have led to ups and downs in prescriber FTE. Collateral work for students with more severe illness is not captured by our visit tracking

mechanisms, but it can limit the time available for patient care.

MENTAL HEALTH SEVERITY INDICATORS

2016-2017 2015-2016 2014-2015

ER Referrals forPsychiatric Crisis

101 67 44

% reporting suicidalityon intake

35% 35% 31%

% reporting past suicideattempt on intake

10% 8% 10%

% reporting self-injury(ex. cutting) on intake

36%(19% cutting)

29% 25%

Our severity indicators continue to speak to a patient population with increasingly intense psychiatric illness

and a low level of positive coping skills (as demonstrated by the high cutting percentage).

A field indicating the need for extended care was added to our Mental Health notes in 2016-17 and it

indicates the 280 students were considered to be “unstable” and therefore could not safely be referred into

the community.

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SUIT (Substance Use Intervention and Treatment)

Substance use among SUIT clients

A proportionally higher number of students have used marijuana, tobacco, stimulants, benzodiazepines, cocaine, LSD, MDMA,

mushrooms and Salvia. There was an increase of about 35 students evaluated who met criteria for Cannabis Use Disorder. Of

note, students who regularly use marijuana are more likely to use cocaine, amphetamines and hallucinogens based on recent

publication.

Effectivness of SUIT Interventions

To assess the effectiveness of their interventions, SUIT has begun to measure a variety of behaviors that clients intend to employ

before and after their visits. Intention to engage in personal protective behaviors increased in all areas.

277

150

97

23 37 2441 29 27

11 3 5 4 6 3 2 1

0

50

100

150

200

250

300

Substance Use In SUIT Clients

# of Students AY 2016-17 # of Students AY 15-16

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

Drink or use less at a time

Drink or use less often

Eat before drinking

Skip the pregame

Know what you're drinking (how much alcohol, how many…

Alternate alcoholic and non-alcoholic drinks

Drink or use only when planned

Plan in advance how much to drink or use

Take a break from drinking or use (abstinence break)

Avoid drinking when you feel bad emotionally

Get support for other problems

Ask friends to help keep you safer and more accountable

Other type of change

Percentage of Each Change Strategy Identified Per Note/Visit atSAIP Intake and SAIP Exit

% at SAIP Exit % at SAIP Intake

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CARE SERVICES PROVIDED

Presenting concern new clients (a client may havemultiple concerns

16-17 15-16 14-15

Relationship violence 19 28 20

Sexual assault 69 73 82

Stalking 12 10 3

Child abuse 5 10 12

Sexual Harassment 6 7 6

Other CARE issue 24 16 4

Other non-CAREissue 3 4 9

Unique CAREclients/allservices

Unique newclients

Uniquecounseling

clients

Uniqueadvocacy

clients

Totalpsychotherap

y sessions

Total inperson

advocacysessions

Crisis calls

6/1/2016-5/31/2017 144 122 69 135 895 245 80

6/1/6015-5/31/2016 139 132 29 124 709 260 81

6/1/2014-5/31/2015 136 136 39 125 646 216 56

0

100

200

300

400

500

600

700

800

900

1000

Care Services Provided by Year

Step UP! Presentation Totals

6/1/16-5/31/17

6/1/15-5/31/16

6/1/14-5/31/15

Step Up!presentations

132 109 32

# incomingstudentsreached

3713 1706

Total studentsreached

4850 3161 1618

PURPOSEThe Health Promotion and Wellness Services unit at the University of Maryland Health Center aims to promote the holistic wellbeing of students through comprehensive and collaborative programming, peer education, sharing of accurate and relevant health information and resources, and providing empathic wellness consultations and coaching for the campus community. We recognize that how we think about wellness is affected by our culture and our life experiences. We strive to support inclusive, accessible, and diverse health and wellness opportunities. Our dynamic services are provided to empower students to develop a strong foundation to optimize their capacity to learn, reach their potential, enhance resiliency, and achieve their goals throughout their academic career and beyond.

Goals1. To facilitate the adoption and maintenance of positive health behaviors and wellness practices.2. To collaborate with Health Center staff in the delivery of client education services.3. To provide experiential opportunities for peer educators and interns.4. To increase awareness of Health Center programs and services.5. To increase knowledge of personal and community wellness.

ALCOHOL AND OTHER DRUGS COMPLEMENTARY ANDALTERNATIVE MEDICINE

Meditation Total Served1519

Massage and AcupunctureTotal Clients

755Total Visits

1,352

PEER EDUCATION ANDSTUDENT INVOLVEMENT

Peer Educators (3 programs)34 Peers

570 hours trained186 credits earned

Student Nutrition Advocates/Nutrition Coaches

6 Coaches90.5 hours trained

Interns/Independent Study2 interns

1020 hours worked24 credits earned

Student Health AdvisoryCommittee

40 members/volunteers40+ hours trained

NUTRITION

Nutrition Counseling345

Nutrition Coaching (NC)198

NC Client Hours495

PT+ (Recwell+NC)26

Outreach 3,319

UMD WEEKENDS Listserv5,271

Smoking Cessation Clients14

WELLNESS PROGRAMS

Total Outreach 6,120

Wags for WellnessParticipants

1,804

GENERAL OUTREACHAND MARKETING

Person to Person Outreach7,687

Social Media Outreach4,735

WebsiteUsers 199,940

Sessions 333,389Pageviews 584,34058.18% (new visits)

41.82 % (returning visits)

Media and PublicationsCoverageArticles 23

NOTES• HPWS Staff partnered with CARE to Stop Violence to deliver bystander intervention.• 2 New Alcohol and Other Drug Programs Piloted with posi-tive results!1. Sober Slam 36 Participants2. Higher Education Program 120 Participants

SEXUAL HEALTH

Outreach6,010

Outreach activities include tabling activities, large scale programming (FLF, Freefest, MD Day, Terportu-nity, Commuter Breakfast, campus-wide outreach, Condom Fashion, Wellness Expo, Dietetic Events, some specific audiences, etc.; generally facilitated by peer educators and professional staff.

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Attachment 1-Patient Satisfaction Results and Benchmarks-Spring 2017

% at top 2 tiers UMD 81.3 All Schools 82.5

Overall Satisfaction Avg UMD 4.29 All Schools 4.36

GOAL: Avg 4.5, 90% top 2 tiers Based on Big 10 Health Centers

% at top 2 tiers UMD 85.4 All Schools 85.4

Recommend Avg UMD 4.21 All Schools 4.30

GOAL: Avg 4.5, 90% top 2 tiers Based on Big 10 Health Center