REFERRAL, SCREENING, INTAKE: IMPROVING THE TREATMENT PROCESS Door County Department of Community Programs Mental Health Collaborative January through September 2011 Sponsor: DCDCP, Joe Krebsbach, Program Director Change Team: Tracy J. Faust (Change Leader), Tina Marie Baeten (follows data, oversees program), Kathleen Zak (enters data) Actually joined NIATx on 2/3/11 for the Kick-off. Data was taken from the beginning of the year, however, and compared to last year’s (2010) data for the months of January through September each year.

AIMS Reduce time between first contact/request for services and first treatment session. Client follow through for at least four sessions following intake. Reduce number of psychiatric inpatient admissions. Reduce number of psychiatric inpatient readmissions. AIMS 1 & 2: thought to be preemptive in terms of preventing future or further hospitalizations. AIMS 3 & 4: just make plain-old sense in the NIATx model.

PROCESS Initiation of a screening protocol following initial referral (February 2011). Implementation of a mental health program wait list to triage urgent and emergent cases from non-urgent requests (July 2011). Intake completed or at least scheduled with those hospitalized while still inpatient awaiting discharge (from prior to onset of project). Screening protocol was already in the works and implemented prior to actual NIATx involvement – training in February in Madison, data collected from January on. AODA program wait list had been in place for years; Tried to continue with an old idea of “accordion approach” to treatment, but with reductions in staff and expectation of doing more with less, a wait list could not be avoided any longer. Intakes were being completed this way prior to inclusion in the NIATx program.

RESULTS AIM 1: Number of days between first contact and intake reduced from 54 days at onset of change process to 4.6 days at the conclusion. AIM 2: 38.8% client follow through to at least four sessions following intake, 54% in 2010. AIM 3: Average six inpatient admissions per month compared to two per month in 2010. AIM 4: Three psychiatric readmissions for 2011 compared to three for 2010. AIM 1 – thought to be because of the screening process implemented in February 2011 AIM 2 – decease in follow-through likely due to initiation of wait list during 2011 rating period and changes in data collection. AIM 3 – spike in August of 13 admissions – 12 of whom we had never seen prior (either new clients or non-residents). AIM 4 – no change – not sure why – but all six were RFC – committed individuals versus those who were not placed on a commitment. However, with essentially 54 admissions in 2011 versus the 18 in 2010, 3 readmits for both years would show a significant percentage decrease in readmissions for 2011 – 16.6% readmissions for 2010 versus 5.6% for 2011 for an 11% decrease.

PROBLEMS Unknowns – the clients admitted to inpatient whom we’ve never seen before and/or are not County residents Budget Issues: Always having to do more with less Staffing within the Department Staff retention Communication amongst all the players Addition of a wait list; Triage criteria Comparative/Historical data seemingly unreachable and therefore immeasurable Unknowns accounted for all but one of our 13 admits in August alone – the main “outlier” in our data. One main/key player left the agency abruptly in June – directly in the middle of the change process and likely that position will not be filled. Communication between support staff entering the data as it comes through so that they understand what we want reported where and how. Traige criteria not the same as for the AODA wait list. Data collection/recording process changed from 2010 to 2011 - prior to joining NIATx

NEXT STEPS Continuation of the existing process to determine what affect those changes have had in regards to ongoing customer/client service. Continue with current AIMS and reassess throughout the 2011-12 period for further changes to the process in the future, in other words ADOPT – for now… Existing Process: Referral > Screening > Wait List or Intake. As this was the first year Door County was involved in the NIATx Process, continuation of the existing process to determine what affect those changes have had in regards to ongoing customer/client service.