After its first year providing crisis services, the GuideLink Center assesses its accomplishments and obstacles

The GuideLink Center (300 Southgate Ave, Iowa City) celebrates their first anniversary this February, photographed on Friday, Feb. 11, 2022. — Adria Carpenter/Little Village

During its first year, the GuideLink Center, a facility that provides care for mental health and substance use disorders, has helped over 1,000 people, said Executive Director Abbey Ferenzi. The center offers 24/7 services, including rapid assessment, triage and crisis stabilization, medically monitored withdrawal and a sobering unit.

“GuideLink Center was designed to fill the gap for people who didn’t need inpatient care, weren’t necessarily OK in the community, or were waiting two to six weeks for an appointment and needed more of that urgent care level,” Ferenzi said. “We are certainly filling the gap for that level of care in between outpatient and inpatient, that in-between urgent care level.”

The center was established by the Johnson County Board of Supervisors working in partnership with local healthcare providers and community organizations, including UnityPoint Health AbbeHealth Services, Prelude Behavioral Services, CommUnity Mobile Crisis and the Johnson County Ambulance Service.

GuideLink has 16 beds, half dedicated to medically monitored withdrawal and half dedicated to crisis stabilization. They also have room for 12 people in the crisis observation area, and for 10 people in their sobering unit.

“I think one of the major gaps we fill is being open and being accessible when people need us and getting them started. That’s where the name GuideLink comes from,” Ferenzi said. “We never want people to feel like they walked into the wrong place.”

From its opening day in February 2021 to December, GuideLink had 915 total encounters with individuals, 725 of the encounters leading to program admissions, according to the year-end comprehensive summary presented at the meeting of the GuideLink advisory board on Feb. 8. Crisis stabilization had 346 admissions, medically monitored withdrawal had 252 admissions and the sobering unit had 127 admissions.

The length of time an individual stays at GuideLink can vary from a few hours to five days. The average length of stay for the sobering unit is six hours, three days for crisis stabilization and three and a half days for medically monitored withdrawal.

Diverting people away from hospitals and jails

When a person first enters the center, they’re met by a triage counselor who conducts a needs assessment. Individual needs could include help for thoughts of suicide, emotional distress, depression, anxiety, intoxication, withdrawal and so on. Some people receive counseling and other resources, then return home. Others can be admitted into one of GuideLink’s programs for treatment.

The number of people coming to the center has steadily increased since it opened. Ferenzi attributes this to the need for mental health and substance use disorder services in the community, as well as the increased visibility of the center. From February 2021 to December, walk-ins constituted the most frequent type of encounter, 392 out of 915, or 43 percent. There were 227 referrals from healthcare providers such as emergency rooms, 150 law enforcement referrals, 110 referrals from mobile crisis services and 36 encounters from other sources.

Of the law enforcement referrals, GuideLink admitted 54 into the sobering unit, 44 into crisis stabilization and four into medically monitored withdrawal. The other referrals received crisis counseling, resources and safety planning.

“We’re diverting about 50 percent of people away from the ER, about 10 percent of people away from jail, and the rest of those individuals said they wouldn’t have gotten treatment at all,” Ferenzi said.

GuideLink helps anyone regardless of their residency, though most individuals live in Johnson County or within the Mental Health and Disability Services (MHDS) East Central Region, which covers nine counties including Johnson. But the center has helped individuals from as far as Sioux, Emmet and Woodbury counties, and had 10 out-of-state referrals during its first year.

“For med detox, like the people that we’ve seen out of state have been because there aren’t other available services in that area, so they’re traveling here,” said Brittany Mannix, the nurse manager of the sobering unit and medically monitored withdrawal. “A lot of them report that to get admitted to the hospital, they have to be, like, actively seizing, you know, like a really high threshold for admitting them. So they’re not able to get treatment elsewhere.”

Nearly 200 people were not admitted into a program during the last year. The majority were either not interested in being admitted or changed their mind during the process. They received crisis counseling and other resources. Seventy-six people were denied access to programs, either because they had more complex needs than the GuideLink Center handles or needed a higher level of care, refused to follow safety policies and program rules, or the center was at capacity.

Staffing shortages and lack of funding

The center is almost always full. GuideLink has a rotating staff of 55 people, with 28 of them in full-time positions. From February 2021 to December, the center denied admission to around 15 people due to capacity.

“There’s definitely demand for the services,” Mannix said. “So I’d say we may occasionally go a day or two when we’ve got an open bed or two. But more often than not, I would say we have people kind of waiting to get in.”

GuideLink currently has staffing for six out of eight beds in the medically monitored withdrawal program, and four out of eight beds in crisis stabilization, though they occasionally take five.

The GuideLink Center, 300 Southgate Ave. in Iowa City, has 16 individual rooms for crisis stabilization and detoxification treatment. Thursday, Feb. 11, 2021. — Izabela Zaluska/Little Village

“We don’t ever expect to be fully funded here,” Ferenzi said. “There’s always going to be operational losses because we do things that don’t fall into under any code. They don’t fall under any reimbursement rate necessarily. We’re bridging the gaps.”

GuideLink’s funding comes from the MHDS region and Johnson County, along with some grant money for certain programs, Ferenzi said. The center doesn’t refuse people if they are unable to pay, and some of their services, like the sobering unit, are free.

Most patients have some form of health insurance, usually Medicaid, according to Ferenzi. Staff will help those without insurance who qualify for Medicaid apply for those benefits. The center also has a sliding scale for fees, for those who need assistance paying.

Making sure funding is available for the center to function properly is always a concern.

“When you’re working, sometimes on a year-to-year budget, not sure you know what the funding is going to be or how much you’re going to get, it’s really hard sometimes to make some of those decisions about hiring, or the services we have, or the needs we have,” Ferenzi said.

Medicaid’s low reimbursement rate for treatments has contributed to funding shortages, which in turn is partially responsible for staffing shortages, she explained, especially since GuideLink doesn’t limit the number of Medicaid referrals it accepts, as many healthcare providers do.

“With some of our reimbursement rates for Medicaid, especially for direct care staff, you can make more working at McDonald’s, and that’s just not right,” Ferenzi said. “I hear this sometimes like, ‘Oh, that company just won’t pay those people more, and why don’t they?’ It’s about your reimbursement rates. So you can only pay your staff what you’re getting reimbursed.”

“It’s some of the reason for that shortage, ’cause people want to feel valued when they’re providing that supervision and doing this really hard work,” she continued. “And money isn’t everything, you know, that’s not every reason why someone feels valued. But you want a good living wage, understandably so.”

Ferenzi explained that finding the right person for the job can be difficult. The type of care GuideLink offers requires a certain personality, along with the right education and experience.

“We have to recruit and retain the right people to do that, because we’re not just about providing services here. We’re about providing high quality services,” she said.

Mannix said that while there is a high burnout rate for healthcare workers, the center hasn’t had much turnover.

“From what I’ve seen working here, it’s a really unique environment, and I feel like, for the most part, a lot of the staff feel excited about the work they’re doing,” Mannix said. “They feel like they’re starting to kind of chip away at the problem and contribute to the solution.”

They’re also concerned about staffing and capacity at other healthcare providers in the community. Sometimes GuideLink has to refer people to a hospital or other facility for continued treatment, and inadequate staffing at those providers can impact healthcare quality.

“Those systems are also just overburdened and understaffed, so I think that’s all across the board,” Mannix said.

Gov. Kim Reynolds spoke to Johnson County Supervisor Lisa Green-Douglass following the tour and discussion at the GuideLink Center on Thursday, Feb. 11. — Izabela Zaluska/Little Village

Expanding services and removing barriers to access

Going forward, GuideLink would like to continue expanding its services and increase access for the community. For example, the center designed the medically monitored withdrawal program for substances that can cause serious health issues if stopped abruptly, specifically alcohol, opiates and benzodiazepines (drugs commonly used to treat anxiety, insomnia and seizures), Manniz said. But the center could expand services for drugs that don’t require medical monitoring, like methamphetamine and marijuana.

Ferenzi said that there are some people in the community who suffer from a severe chronic mental illness or substance use disorder, but when law enforcement brings them to GuideLink, they refuse treatment.

“There really needs to be some additional services for people who really need help but don’t want it,” she said.

The center is also working to remove transportation-related barriers. On Feb. 15, the Iowa City Council unanimously approved awarding $939,082 in American Rescue Plan Act funds to CommUnity to expand its Mobile Crisis Outreach Program. The program’s eight new crisis response vehicles can help transport people to GuideLink.

GuideLink is also working with the University of Iowa to use its NITE RIDE program for students, Ferenzi said. And they’ve occasionally paid for cabs or used Medicaid transportation services to get people home, but “it’s still a work in progress.”

“Making the sobering unit accessible to the people that need it, that’s kind of what my focus is right now,” Mannix said. “There are people in town that do need a safe place to go to sober up, and so [we’re] just trying to figure out how to get them here, so that we can keep them safe.”

GuideLink is a starting place for filling systemic gaps, Mannix said. Navigating the healthcare system is difficult, even for professionals.

“We’re certainly not going to be able to help everyone, but we do hope that when people come here, even if there’s not something that can help them with, they at least have a positive experience, and feel like they were heard, and would be all more likely to come back again if they did need these services,” she said.

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