Handoffs Technologies as Continuing Care NIATx Webinar Series May 15, 2013 David Mathews, Ph.D. and Todd Molfenter, Ph.D. 1/21/08

Keys to Successful Hand Offs: Communication is Critical Dilemma: Positive outcomes when confronted by managed care, short episodes & limited resources.

Treatment & Recovery Only 17% of individuals who complete treatment in one level of care successfully access the next recommended level of care (OAS, 2005). Linking treatment to recovery supports improves outcomes 20-22% (Dennis, 2007) Only 20% of adults and 36% of adolescents receive any professionally-directed post-discharge continuing care. (Godley et al., 2001; McKay, 2001) 1/21/08

Handoff Defined The transfer of information (along with authority and responsibility) during transitions in care across the continuum for the purpose of ensuring the continuity and safety of the individual during healthcare.

Continuing Care Philosophy There are no discharges or terminations Status change from active to inactive means active with someone else All actions involve transferring care to someone else Warm Handoffs vs. Cold Handoffs

Hand-off as a Form of Communication In thinking of the way we communicate, it is important to think about the mode of communication. I use the red arrows to highlight two ends of this spectrum that we use to communicate every day in healthcare: paper and face to face communication. And clearly they are very different and it is important to know how they differ. Esp in the context of signout. This passage from Allistair Cockburn, who is actually a software engineer and prominent author on this topic describes it best: When you move from right to left, you lose richness, such as physical proximity and the conscious and subconscious clues that such proximity provides. You also lose the ability to communicate through techniques other than words such as gestures and facial expressions. The ability to change vocal inflection and timing to emphasize what you mean is also lost…Finally, the ability to answer questions in real time, are important because questions provide insight into how well the information is being understood by the listener.

Types of Handoffs One provider to another Critical reports (discharge, laboratory and pharmacy ) Facility transfers (home, IOP-OP) Other transitions in care (case management) One Level of Care to another One Agency to Another TYPES

JCAHO Requirement (2006) “Implement a standardized approach to ‘handoff’ communications, including an opportunity to ask and respond to questions.” New Requirement 2E states: Implement a standardized approach to “handoff” communications, including an opportunity to ask and respond to questions. This requirement is applicable to: [Ref 1] Ambulatory health care Assisted living facility Behavioral health care Critical access hospital Disease specific care Hospital Laboratory Long term care Office based surgery Home care The rationale is stated by the Joint Commission: The primary objective of a “handoff” is to provide accurate information about a patient’s/client’s/resident’s care, treatment and services, current condition, and any recent or anticipated changes. The information communicated during a handoff must be accurate in order to meet patient safety goals. In health care, there are numerous types of patient handoffs, including but not limited to the following examples: (see types above on the slide)

Sample Handoff Tools: Choose one and train staff of your agency!! SBAR I-SBAR I PASS THE BATON 5 P’s BSTAR

I - SBAR I – introduction S - ituation (the current issue) B - ackground (brief, related to the point) A - ssessment (what you found/think) R – equest (what you want next)

Recovery Management Handoff Form 1/21/08

More about Treatment The majority of those discharged from treatment do not receive the NIDA (1999) recommended 90 days of continuous care (White, in press). 80% of individuals who relapse after treatment do so in the first 90 days (Hubbard et al., 2001). The majority of substance dependent individuals only achieve stable recovery after 3-4 treatment episodes over multiple years (Anglin et al., 1997; Dennis et al., 2005). 1/21/08

NIATX: Five Principles Understand and involve the customer Fix key problems Pick a powerful Change Leader Get ideas from outside the organization Use rapid-cycle testing Standard slide – please do not modify. These five principles are based on research by Dave Gustafson et al. that investigated which factors where characteristic of organizations that have successfully improved their processes. These principles represent the top five from a collection of eighty characteristics. 1/21/08 13

Why a Walk-through? The walk-through… Helps understand the customer and organizational processes Provides a new perspective Allows you to feel what it’s like Lets you see the process for what it is Seeks out and identifies real problems Generates ideas for improvement Keeps you asking why?…and why? again Standard slide – please do not modify. Engage the audience: This is a good time to ask of anyone has done a walk-through before—and if so, what their experiences were. If not, provide an example of your own from a recent walk-through experience. 1/21/08 14

Making Changes PDSA Cycles Two-week-long cycles Plan the change Do the plan Study the results Act on the new knowledge Adapt Adopt Abandon Two-week-long cycles Standard slide – please do not modify. Pick a concrete example of a PDSA cycle and walk the audience through the story. Example: Plan: An agency decides to offer walk-in service on Wednesday afternoons Do: The agency offers the walk-in hours on Wednesday afternoon for two weeks. Study: No clients showed up for service during the walk-in hours—because the agency forget to notify their community that they were open for walk-ins. Act: Adapt by continuing to offer walk-ins and by advertising the walk-in hours to their community. Emphasis on short cycles—two or three weeks at the most. 1/21/08 15

Strategies to Support Long-Term Recovery Telephone-based continuing care (McKay et al., 2004) Recovery Management Checkups (Dennis et al., 2003; Scott et al., 2005) Assertive Continuing Care (Godley et al., 2004) 1/21/08

Handoff Technologies Video Introduction Video Meetings to Next Use Handoff Technologies Video Meetings between Levels of Care ACHESS Smartphones for continuing care 24/7/365 Interagency Change Teams Video Introduction to Next Level of Care 1/21/08

Video Introduction to Next Level of Care Video created to demystify first visit to outpatient offices Video given to Hospital for units Case Managers with portable DVD player 1/21/08

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Video Handoffs Clients at Next Step Recovery Center and Bailey Center Crisis Stabilization Units had video meetings with next level of care. Clients in the Hospital Have had video handoffs with community counselor.

Offender Re-entry Cook Co. Correctional Drug Treatment to post prison HIV Agency Five entities involved with service handoff HIV+ cases needing continuing care NIATx Change Team found barriers, created handoffs – 80% success 1/21/08

ACHESS Smartphones Using specially designed apps clients receive support from each other and Recovery Coaches and Recovery Managers 24/7/365 Pregnant clients in IOP/OP Technological Innovations helps communication during stressful transitions 1/21/08

Thanks for your attention! For more information contact: Todd Molfenter todd.molfenter@gmail.com David Mathews wdmathews@aol.com 1/21/08