1. Wood County Human Services Mental Health Collaborative 2010-2011 Randall Ambrosius, MSW, LCSW, CSAC, ICS Wood County Human Services Department

2. Located in Central Wisconsin Located in Central Wisconsin AODA / Mental Health Clinic located in Wisconsin Rapids AODA / Mental Health Clinic located in Wisconsin Rapids Norwood Health Center located in Marshfield Norwood Health Center located in Marshfield 24 hour Crisis Line 24 hour Crisis Line Mobile Crisis Line Mobile Crisis Line Legal Services Legal Services

3. Step One Q: What do we want to focus on? Q: What do we want to focus on? Answer: Reduce hospital re-admissions at Norwood Health Center Answer: Reduce hospital re-admissions at Norwood Health Center Q: What is the current hospital re-admission? Q: What is the current hospital re-admission?

4. BASELINE Current re-hospitalization rate is 4% AIM Reduce re-hospitalizations 3% or less

5. Committee Membership Wood County Unified Services : Wood County Unified Services : Randall Ambrosius, Treatment Services Manager Randall Ambrosius, Treatment Services Manager Charlotte Smith, BHS Division Manager Charlotte Smith, BHS Division Manager Kathy Roetter, Director Kathy Roetter, Director Wood County Unified Services Norwood Health Center : Wood County Unified Services Norwood Health Center : Ray Dreager: Client Services Ray Dreager: Client Services Kristi Smith: Client Services Manager Kristi Smith: Client Services Manager Pam Martinson: Health Information Manager Pam Martinson: Health Information Manager Wood County Sheriffs Department: Wood County Sheriffs Department: Robert Levendoske (Retired) Consumer: Consumer: Joe Arts Doug Aughey Doug Aughey Project Coach Project Coach Tom Mosgaller: UW-Madison, NIATx

6. The Walk Through “ What is it like to be a client ? ”

7. NIATx Process  Plan: General change idea to be tested.  Do: What specific change did we put in place?  Study: What were the results of this change?  Act: Adopt, modify, or abandon the change idea.

8. Rapid Cycle Changes Rapid Cycle Changes Action Results Action Results Cycle One: Patient call 10% readmission Cycle One: Patient call 10% readmission crisis line crisis line Cycle Two: Patient call 3.3% readmission Cycle Two: Patient call 3.3% readmission crisis line crisis line Cycle Three: Norwood Social 0 readmission Cycle Three: Norwood Social 0 readmission Workers call Low number Workers call Low number clients with script wanting to be clients with script wanting to be involved involved

9. Change Cont. Action Results Action Results Cycle Four: Norwood Social 0 readmission Cycle Four: Norwood Social 0 readmission Worker calls Low number Worker calls Low number clients with wanting to be clients with wanting to be script involved script involved Cycle Five: Norwood Staff 0 readmission Cycle Five: Norwood Staff 0 readmission (Nurse, psych (Nurse, psych tech, etc.) Staff making calls to whom Staff making calls to whom they have a connection. they have a connection.

10. Results

11. Summary of 2010  1) The goal was 3% or less. During this process we averaged 1.76% re-admission of those who participated.  2) Individuals who did not participate had a 5% average re- admission.  3) Low numbers of individuals to participate in support calls.  4) The relationship is the most important factor.

12. Wood County Human Services Department Mental Health Collaborative 2011 Part II “The Big Aim and the Little Aim”

13. 2011 AIMS Big Aim: Reduce hospital re-admissions at Norwood Health Center Big Aim: Reduce hospital re-admissions at Norwood Health Center Little Aim: Increase the number of clients in support calls. Little Aim: Increase the number of clients in support calls.

14. 2011 Action Results Action Results Cycle One Improve script 2010 – 10 participated 10% re-admission 2011 – 30 participated 2% re-admission 2011 – 30 participated 2% re-admission Cycle Two Con’t to use 2010 – 17 participated 3.3% re-admission script 2011 – 21 participated.05% re-admission 32 clients could not participate with a 19% re-admission rate. What happened?

15. Record number of hospital admissions occurring in cycle 2.

16. A Balancing Act “What to do?” Have one hospital staff make calls and capture good data. Con’t to have all staff make support calls - good relationships. Loss of relationship Poor data, unable to capture everyone.

17. Action Results Action Results Cycle 3 One staff 2010 – 7 participated 0% re-admission collects and 2011 – 19 participated 1.6% re-admission makes support calls.  QUESTION - Should we use E-mail? ANSWER – No. Only 2% report having access to a computer. ANSWER – No. Only 2% report having access to a computer.  QUESTION - How many individuals are we reaching? ANSWER - 60% contact with individuals in support call program. ANSWER - 60% contact with individuals in support call program.

18. % Hospital Re-admissions

19. # of Participants in Support Calls

20. Hospital Readmissions

21. Making a Business Statement Cost per day of hospitalization… $1,034 Average cost of every commitment… $4,000 Clients feeling good about not being re-hospitalized… priceless! re-hospitalized… priceless!

22. Chapter 51 Detentions

23. Wood County Suicides

24. Next Steps (ACT) Continue to have hospital staff make support calls Use a video to introduce support calls and resources Utilize Peer Specialists/Clubhouses Review each client’s case