La Crosse County Comprehensive Community Services Comprehensive Community Services (CCS) - community mental health program that seeks to support adults and children with their families in manage mental health or substance use in their natural community setting Diverse Team CCS Service Facilitators (youth and adult) CCS Mental Health Professional Community Agencies (contracted service providers) QA Staff 2017 NIATx Project Change Team Emily McGonigle – Sponsor Steve Burnette Rob van Nuland Ryan Ross – Change Leader Ingrid Herkin Carrie Rein Kristie Bechtel Kyra Lollis

Project Aim Increase CCS consumers’ successful outcomes on treatment plan objectives to 60% At the start of 2016, we were reviewing our program outcomes. Over the past 4 years our statistics showed that successful consumer outcomes on treatment objectives was averaging out to 44%. Surprising, we felt that our success rate was much higher 2016 project focused on improving measurability of service plans 2017 project continued that work by examining how service plans were being carried out

Change Process 2016 – project focused on improving measurability of service plans 2017 – project focused on how to best carry out service plans Promising practice of integrating Coordinated Service Teams (CST) Change team focused on developing CST with youth and adult consumers CST meetings held monthly Engaging all team members by having at meetings in person or via phone Sending copies of meeting notes to team members Assignment of specific tasks to each individual team member Revised our data tracking methods Continuation of 2016 project aim 2016 – focused more on refining service planning process (simpler and measurable plans) 2017 – utilized force-field analysis tool and nominal group technique to help identify the next step to support how the service plan objectives were being supported/focused on Wanted to examine if utilization of team meetings via CST model supported stronger outcomes Integrated CST/CANS into our CCS program SF focused on developing regular service team meetings at least 1x/month Challenge: having everyone present at team meetings Call-ins/phone calls Completed notes and sent to team members Challenge: attendance dropped (convenience of notes = no presence) Started assigning tasks to each team member at every meeting (including random assignment of note taker) Also revised how we collect data Improved outcome tracking form to not only track total program outcomes, but differentiated by youth/adult, by department cross-over Developed new tracking tool to measure changes in CANS scores for youth

Results Change Team We were using an existing outcome tracking tool Baseline graph from before – demonstrating trend of 44% of treatment objectives being met 2016 project – end of year at 61% 2017 project – overall program saw some regression 1st quarter with increase following ending at 61% (range of 48-61%) 2017 change team – utilizing CCS/CST model demonstrated much higher outcomes by comparison (ranging between 60-75%) Noteworthy: general trend from charting the data indicates a low 1st qtr, strong 2nd qtr, with reducing 3rd and 4th quarters. 2016-2017: continue to see trend of low 1st quarter with increasing following quarters

Additional Results An additional measure (not formally part of our NIATx project) was to start tracking CANS scores (Child and Adolescent Needs and Strengths assessments) in conjunction with CST. This summary graph demonstrates an overall decrease in youth needs from initial assessment, 6m/annual reviews, and discharge. One area of youth strengths has a reverse scoring mechanism, this graph demonstrates a growth of youth identified strengths from admission to discharge (maintained through review periods)

Next Steps Further explore differences between youth and adult programming Differences in range of outcomes, team structure, styles, tracking methods Piloting the Adult Needs and Strengths Assessment Building momentum for the CCS/CST combined model Increased training and technical support for facilitators Collecting data more frequently Reviewing objective data at each monthly team meeting compared to every quarter or 6-month review period Modifying progress notes to have objective data more easily discernable Overall this year we felt like we had fewer tangible change to steps, and more growth in our understanding by collecting and examining data. One area of question was distinguishing youth services from adult services Started tracking outcome data: Youth slightly above program average and tended to be more consistent by quarter (consistent b/w 50-60%) Adult programming slight below program average and more sporadic (60, 35, 70, 55) Teams: Youth tendency to larger teams with more complex issues, competing agendas but focused towards same objective often established by family/caregivers Adult tendency to smaller teams with differing levels of consumer motivation and fluctuating focus often established by consumer Building momentum into CST teaming Old habits of individualized practice, being the authority/leader, preserving resources, not seeing the priority/benefit of teaming Collecting Data more frequently than existing method of quarterly/6m review period Objective data tracking at each monthly team meeting Revising standard progress note to have clear spot for progress made (yes/no) (# of attempts)

Impact Consumers: Agency: Change Team: Higher outcomes for consumers engaged in CST process Higher outcomes for teams that intentionally review measurable progress Agency: Data able to show trends in services to make more informed decisions Change Team: Force Field Analysis and Nominal Group Technique Tools proved helpful Process brought out more questions of depth than solutions and outcomes This process has been more of a fact finding mission. We are coming to understand the bigger issues at hand and have a place to start making improvements. Something is working: not sure completely what that is (model, personality styles, client motivation) Questions drove further inquiry to examining data deeper (youth/adult) (ccs/cst/combined)(cans) Theme of noticing 1st quarter is routinely the lowest quarter of the year for outcomes Force Field analysis and Nominal Group Technique are helpful tools, especially to assist with variety of personality and communication styles Thank you – Questions?

La Crosse County Comprehensive Community Services Ryan Ross, MSW, CISW (608) 785-6048 rross@lacrossecounty.org Thank you - Questions