La Crosse County Comprehensive Community Services 2018 NIATx Project Summary MHP, SAP, 3 SF, 2 Community Providers, 1 Peer Support, QA Change Team: Emily McGonigle – Sponsor Brittany Ellingson Kyra Wolf Ryan Ross – Change Leader Darcie Marks Natalie Grimsled Anneliese Skoda Hannah Callahan Sadie Nelson

Project Aim Statewide Goal: Decrease 30-day re-hospitalization by 50% La Crosse County 2017 statistics 9% (n=6) Local Aim: Increase efficiency of CCS program by assisting consumers with achieving their treatment objectives 60% of the time Baseline: 2015 – 44%, 2017 - 57%

Change Process “A crisis occurs when adults do not know what to do” Carl Shick How do we ensure everyone on the support team knows what to do and how to do it? Pre-Test Survey: Involvement with Planning, Knowledge, Comfort Collaboratively Writing Service Plans and Crisis Plans Each individual provides 3 tangible supports they can offer individual Monthly Team Meetings to review plans and progress Utilizing the Nominal Group Technique, the team was able to identify multiple ideas Realized all ideas could be met by starting back at basic of collaboratively writing support plans (SP, Crisis) Test of at least 3 bullet points of specific interventions to be provided by each team member

Outcomes Original data: 9% re-admission rate (6 individuals) Survey of Partners/Providers Pre-Test Post-Test 1. Involvement in Planning 20% 100% 2. Knowledge – Intervention 50% 3. Comfort Level - Intervention 70% Original data: 9% re-admission rate (6 individuals) 4 individuals were open to CCS No hospital 30-day re-admissions since entering into CCS Pre/Post via Survey Monkey In general, do you feel like you were involved in helping create or draft the current Service Plan currently in place? When you read the Service Plan - do you feel like you have clear direction on what you are supposed to be doing W/ the consumer to help them work towards their current SP objective? What is your comfort level W/ carrying out the intervention listed on the Service Plan? Sent out prior to team meetings. Post send out 4-6 weeks after start of new plan 10 respondents Anecdotal: Community Partner called to share about CCS consumer with history of hospitalization. When consumer was experiencing a crisis, community partner was able to assist with coaching through the scenario and review crisis support plan. Individual was able to reflect they did not need to go to hospital, whereas previously that would have been their “safe place” but was able to find a “safe place” with this partner.

Data Outcome Trends & Looking Ahead Future Data Forecast Pilot Adult CCS Intensive CCS+CST Integration 1-2 SMART 3-year History

Impact Consumers Partners/Providers Program/System Report greater sense of achievement and possibility (hope) Fewer “Crisis of Week” episodes; know the team and the supports offered Partners/Providers Feel more empowered to assist rather than relying on County to do something Can actually see progress rather than fearing the next hospitalization Program/System More targeted service delivery = shorter length of stay, Shared responsibility between community and county Reduced fiscal cost of placements Change Team Reflections Challenging: more time to coordinate, forces “outside the box thinking”, no templates But Even More Helpful: shared responsibility, more supports provided, morale of team Consumers: View self as deserving/needing hospital – self-fulfilling prophecy Using more wraparound approach, less unstructured/unsure = fewer high level crises, can reach out when incidents are still ‘lower level’ Partners: Original View: County is the big system that takes care of everything and tells us what to do Referral with history of multiple hospitalizations was something to “fear” – waiting for it to happen again, almost perpetuating the self-fulfilling prophecy Program Target view: what specifically are we focusing on, who is doing it. Length of Stay has been reduced by 40% SF feeling burn-out from weight of having to prevent the next hospitalization, decompensation Estimated cost diversion of $1.2 million in placement costs (CANS data LON 6 qualifiers) Change Team SF report more work needed to coordinate team members up front (phone calls, emails) and negotiating plans. More helpful on back end: less coordinating when everyone knows what to do, higher morale of working together as a team, rather than us/them, county/paid provider, etc

Next Steps Supporting Other Service Facilitators/Support Teams with Implementation of CST/CCS Integration More Help with Supporting Family Members of CCS Consumers Ability of Consumers to Understand Engagement and Impacts of their Own Mental Health Expand Data Field to Examine Impact of CCS program on Lifelong Hospitalization Use 46 facilitators with differing levels of engagement to the teaming approach (different stages of change) Within Team, family members seemed to pose the greatest challenge – imbuing consumer as ‘problem’ and ‘never going to change’ H. Story – parents view youth as problem, youth rejecting and able to see future for self Teams reflecting various levels of insight consumer has into their own mental health – unsure what program/services receiving, reflection of: mental health services as a ‘hobby’

Looking Ahead 30-day readmission rates within the CCS program have been minimal Expanding Data Pool: Any hospital re-admission within the same year 2017: 5% of CCS consumers who utilized the hospital had a same year re-admission (n=4) 2018: 0% of CCS consumers had a same year re-admission *January-August 2018

Preliminary Comparison of Lifetime Hospital Use Pre/Post CCS from 2011-2018 (n=66) Based on individuals with prior hospitalization history before CCS enrollment and who have also have discharged from the CCS program for at least one year 66 individuals met this criteria Adult 69% decrease while in the program

La Crosse County Comprehensive Community Services 2018 NIATx Project Summary Change Team: Emily McGonigle, CCS Clinical Supervisor EMcGonigle@lacrossecounty.org (608) 785-5702 Emily Engling, CCS Administrative Supervisor EEngling@lacrossecounty.org (608) 785-6413 Ryan Ross, CCS Mental Health Professional RRoss@lacrossecounty.org (608) 785-6048 Anneliese Skoda Brittany Ellingson Darcie Marks Hannah Callahan Kyra Wolf Natalie Grimsled Sadie Nelson