Monday, November 22, 2010

How Do We Learn?

If you were to ask me to list the core values of our agency, I would identify training and staff development as  integrally important to the work that we do.   The training that we either bring into the agency or we participate in at the local, state and national level assures that we are fully informed and up-to date on the best practices in the field.  

Here at Sound staff development takes many forms-  we train at department meetings and management team meetings; we  provide eLearning access to all staff and require a minimum of 30 hours of training yearly; we require that all managers attend at least one  state or regional conference annually; we support staff obtaining advanced degrees through tuition reimbursement; and senior managers are encouraged to attend  at least one regional or national conference annually.  

Recently as part of ongoing staff development Jessica DeFlumer-Trapp and I attended the Open Minds Technology Conference  http://www.openminds.com/ in Baltimore.  This week she joins me as a guest blogger and discusses some of the “take-aways” from that conference.  She also informs us about the changes that  have been implemented in the case management programs through her participation as a  State of Connecticut Recovery Champion.

Gail

This month, I attended the Open Minds Technology Conference in Baltimore; this is a yearly national conference that addresses technology as it relates to and enhances behavioral healthcare.  One of the speakers made a comment about change that resonated with me.   The comment was to the effect of, “Mental health went unchanged for so many years [with regard to diagnosis, understanding, treatment] that people often selected to work in this field BECAUSE they didn’t expect things to change.”  This is an interesting commentary on both the field and the people who work in it; these days, however, it probably feels like change is ALL that happens.  Budget cuts, funding shortages, and uncertainty at the state and federal level has lead to feeling as though we are constantly on a treadmill- the belt keeps coming no matter how fast you run.  It may feel like you’re running BECAUSE of outside sources, but what should be recognized is that many of these changes and initiatives are being implemented with an eye on what is best for the staff, community, and people that we serve. 
“Case management” is a term that broadly encompasses the care that people receive in a community setting.  Over time, the idea that a person is a “case” to be “managed” has been phased out, and is being replaced with more recovery-oriented language- “community support”, “service coordination”, and “care coordination”.  The old model of the case manager’s role-  assuring that their clients were still alive, were taking their medications, were staying out of trouble- is going the way of the dinosaur.  Now, in order for states, the Federal government, and managed care organizations to acknowledge and fund the work being done in the community, skills-building work MUST be demonstrated.  The days of “forever” case management are over.  Now, persons served in these programs should expect to be admitted, develop necessary community living skills, and be discharged.  Re-admittance to the program is not considered a treatment failure; it is simply viewed as a need for additional support and education before we send the person back on their way to continue their recovery.
Connecticut launched the initiative in March 2010 to take Case Management and revamp it to a Community Support model.  All agencies that were impacted, throughout Connecticut, had to appoint a Recovery Champion to lead the charge.  This person is responsible for heading the team that will implement the change, creating some enthusiasm and energy for new work being done, and serve as a point person state-wide for discussing and bringing feedback to DHMAS and the Office of the Commissioner, about what really works in our organization.   At this time, I serve as the Recovery Champion for SCSI; I attend meetings by phone and in person twice a month, and provide feedback and data to DHMAS and OOC.  This affords me the opportunity to see how truly innovative SCSI is, with regard to our ECR, use of technology, and implementation of best practices in Community Support, including concurrent documentation, skills development, and productivity requirements.  The truth about a major systems change is that it is never as easy as it appears on paper- we deal with people, both those that we serve as well as those delivering the service.  People have needs and expectations that often fall outside of what can be anticipated.  All that in mind, it is SCSI’s commitment to innovation and best practices that have made this transition a natural next step in the movement toward fee-for-service Community Support and evidence-based practices. 

A word about the staff- we have asked them to change their daily work in a variety of ways.  This includes their documentation content, length of sessions, location of appointments, and number of visits per month.  We’ve added additional assessment tools, tracking forms, and training sessions.  These changes have been only secondary to asking them to enhance and modify HOW they deliver services to the people we serve.   Staff have handled these changes with grace and ongoing commitment to assure that whatever changes are made, are executed with the best interests of the people they serve, at the forefront.   Kudos to them- they are the ones that create and promote positive change every day.  The feedback from the persons served has been extremely positive- they continue to feel that they receive services that are helpful and effective, delivered by staff that truly care about their well-being.  As SCSI continues to change and grow, it’s that overall commitment to the persons served that will carry us where we need to go. 

Jessica


Be well!

Sunday, November 14, 2010

Where Are We Going?

Here at Sound Community Services we are always evaluating the work we do and looking for ways to improve the services we offer. The Annual Consumer Satisfaction Survey is an example of a tool we use to do just that.  You can review  our most recent survey at https://sites.google.com/a/soundcommunityservices.org/care-review/Home/satisfaction-survey-1  The Annual Consumer Satisfaction Survey focuses on how those we serve perceive our services, programs and staff.  While consumer input is very valuable it is not the only tool we can use to evaluate the quality of our work.   And today I want to discuss with you an initiative that you will start hearing more about in the next few weeks and months.

Sound Community Services is one of several behavioral health agencies in Connecticut that is participating in  a Connecticut Community Providers Association (http://www.ccpa-inc.org) (CCPA) sponsored statewide Benchmarking InitiativeCCPA is sponsoring this important initiative in collaboration with Behavioral Pathway Systems  (http://www.bpsys.org) (BPS). Through this initiative, we will receive benchmarking reports that will measure our performance in many areas of operation against that of other behavioral health agencies in Connecticut and around the country.

What is Benchmarking-   Benchmarking was a term first used by cobblers to measure people's feet for shoes. The cobbler would place someone's foot on a "bench" and mark it out to make the pattern for the shoes with the intent to provide the best possible product for the customer.  "Benchmarking" assured that the  shoe that was made fit the foot of the customer.  Today benchmarking refers to a series of “measurements” about various aspects of a business ( in our case our agency and the other agencies in the project) and the comparison of those measurements to  what are thought  to be the best practices in the field.  Benchmarking is a powerful performance management tool that can have significant value in behavioral health/human services settings as we strive to assure we provide the best possible services to our clients.   


This CCPA project is a best practice benchmarking project that will allow us to compare our agency to the other CCPA agencies  involved in the project and other similar agencies nationally.  We will learn where we do well by comparison and where there is  room for improvement.  We will then develop plans on how to make improvements or adapt specific best practices. As a result we should be able to improve the services we offer our clients.
Much work has already been done on this project .  Our work began last June when I, Emily Reynolds and Cindy Kirchhoff  participated on a statewide planning committee that worked to identify benchmarking metrics and operational definitions in several operational areas.  Once the metrics and definitions were agreed upon by the participating agencies, work began on the survey tool that would be used to collect the data.   That survey tool was completed in October.   Data collection will begin sometime in late November or December.   




The survey that many of you will be asked to complete will involve almost all aspects of the agency and most staff will complete only  the parts of the survey that relate to their jobs.  Data on the many of the following metrics have been included in the survey:

Financial Benchmarks
Current Ratio of Payer Mix
General/Administrative Expenses as a percent of Total Expenses
Days of Cash on Hand
Days in Accounts Receivable
Net Margin Percent
Cost per Person Served per Year
Cost per Unit of Service and per Person Served (By Service Area)
Bad Debt Percent
Accounts Receivable over 90 Days

Operational Benchmarks
No-Show/Cancellation, Rate (Initial, Ongoing, Medication Appointment)
Productivity (By Service Area)
Access (Days from Request to Initial Assessment)
Access (Days from Request to Psychiatric Medication Management Appointment)
Access (Days from Request to Psychiatric Evaluation)
Subsequent Access (Days from Intake to First Service Appointment)
Utilization (Residential or Inpatient Length of Stay/Outpatient Visits per Person)
Occupancy Percent

Clinical Benchmarks
Client Satisfaction
Psychiatric Hospitalization Rate
Discharge Status (By Service Area)
Manual Restraint Rate (By Service Area)
Medical Hospitalization Rate
Emergency Room Visit Rate
Suicide Rate
Involvement with Criminal Justice System
Employment Rate
Homelessness Rate

Organizational Climate Benchmarks
25 Item Organizational Climate Survey
Staffing Retention/Turnover by Role
Staffing Retention/Turnover by Tenure
Average Tenure of Staff
 
Be well!