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On the Frontlines Karen Larsen LMFT, Director
Yolo County Health & Human Services Agency January 31, 2018
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A Little About Yolo County
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Our Challenges Small county County mental health
Population of 215,802 (in 2016) 4 incorporated cities and a large rural area County mental health After Great Recession (2008/2009) laid off 40% of staff Nationwide Psychiatric shortage
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Strategies we tried Range of recruitment strategies for internal staff
Offering full-time schedules Offering part-time schedules Increasing the salary range Student loan repayment opportunities Contracting services to external providers Hiring Locum tenums Using Telepsychiatry to reach rural areas Using Midlevels-PAs/NPs Utilizing Student Interns
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Yet alas… We still had no full time providers.
We had little to no staff continuity for our clients. We had disjointed care teams. We had high no show rates. We had poor access. We had no back door.
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Alignment with our County & HHSA Strategic Plans
County – Thriving Residents Implement Community Health Improvement Plan HHSA-Create a culture of quality and make data driven decisions MHSA plan IGT funding Agency wide training on quality improvement (PDSA) Agency wide training on results based accountability
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Our New Innovations Working with Coleman & Associates
Rapid Dramatic Performance Improvement Clinic transformation Patient experience Revenue maximization Modernized healthcare Team based care and clinician support Leadership and staff development
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Our Team
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Adult and Aging Branch Organizational Chart
Yolo County Health and Human Services Agency Adult and Aging Branch Organizational Chart Sandra Sigrist Branch Director II Vacant Administrative Assistant Anisa Vallejo Senior Administrative Analyst Julie Freitas Clinical Manager Aurora William Homeless Services Manager Samantha Fusselman Deputy Mental Health Director Leigh Harrington, MD Medical Director, Behavioral Health Services Kim Britt Manager I Laurie Haas Deputy Public Guardian Salvador Torres Veteran Services Officer INTENSIVE TEAMS HOMELESS SERVICES PSYCHIATRY SERVICES IN HOME SUPPORT SERVICES PUBLIC GUARDIAN VETERAN SERVICES Mario Gallegati Supervising Clinician FULL SERVICE PARTNERSHIP Don Meek, MH Specialist I Kerri De Wein, MH Spec II Carmel Stewart, MH Spec I COMMUNITY READINESS TEAM Erica Brown, Clinician I Evonne Chaney, MH Spec II Kristen Cline Supervising Clinician Deanna Lynn-Steele, SWP Vacant HHSA Coordinator Theresa Smith Manager I Ian Evans Alcohol and Drug Administrator Katherine Barrett Supervising Clinician Harjit Singh Gill Manager II Ailene Isleta-Florento, MD Clare Maxwell, MD Jonathan Greenberg, MD Elizabeth Bowler, MD Ivan Putziger, MD Zev Wiener, MD (Telepsych) Ming Looi, RNP Carla Levin, NP Isabel Sanchez, CHA II Lorie Martinez, Admin Asst. Natalia Semeryuk, OSS Amalia Alvarez-Rodriguez, OSS Anna Shilina, OSS Sandra Jack, OSS Elida Serratos, Social Worker Sup. I Vacant Lyubov Melnichuk, ASW II Vacant Tiffany Retzlaff, ASW II Yousef Reggad, Social Worker Sup. I Jacqueline Alcala, ASW II Kathleen Stewart, ASW III Marisela Cortez, ASW II Munveer Cheema, ASW II Shirley Hernandez, ASW II Louanne Lohman, ASW II Javier Rosas, ASW II Renee. Sosa-Galindo, Sup. Sr. Analyst Joy Ramos, ASW III Liliya Merva, ASW III Becky Thompson, Analyst Kelly Lee, PHN Barbara Madsen, Con Officer Jeanine Weeks, Con Officer Jessica Gojkovich, Con Officer Michiko Pate, Sr. Acc. Tech Katey Galloway, VS Rep II Emily Meza, Associate Analyst Nadia Waggener, HHSA Coordinator MHSA WET & CCC FORENSICS & SUBSTANCE USE DISORDERS QUALITY MANAGEMENT ACCESS SERVICES CRISIS SUPPORT SERVICES Alicia Ruiz, Outreach Spec II Lana Shramenko, Outreach Spec I Donna Bousquet, Outreach Spec II Tessa Smith, Outreach Spec I Jennifer Hernandez Program Coordinator WELLNESS CENTERS Angela Angel, Outreach Spec II Brad Finlayson, Alcohol & Drug Spec II Sean Geary, Clinician II Rachel Tisher, Clinician II Ashley Atta-Mensah, RN Helen Ng, Analyst Linda Hernandez-Fogle Supervising Clinician Hannah MacDula, Clinician I Cheri Hendrickson, Clinician I Lynn Ly, Clinician II Sammy Hawk, MH Spec II Amanda Navarez, MH Spec II Linda Hernandez-Fogle Supervising Clinician Rob Villareal, Lead Clinician Brandi Cowan, Clinician I Marina Ceja, Clinician I David Walker, Clinician I Gina Espinosa, Clinician I Rosanna Fajardo, MH Spec II Vacant Kristi Abbott, Supervising Clinician Alison Steffensen, PsD Terri Lipet, MH Spec II Laura Christensen Supervising Clinician TRANSITION AGE YOUTH LaTisha Robinson, MH Spec I Spring Ackerman, MH Spec II Vacant Kellymarie Chen Admin. Services Analyst QUALITY IMPROVEMENT Peer Support Workers Liana Coffland Dennis Cortopassi Christine Gerner Sally Hays Asia Huff Angela Martinez Elias Mbvukuta David Moe Winona Robinson Christina Wilson Amy Leino, Clinician II MEDICATION CLINIC SERVICES COMPLIANCE Harpreet Gill Supervising Nurse Katherine Rodriguez, RN Breanna Herrera, RN Nahema Hicks, LVN Nicole Jamison Sr. Admin. Services Analyst Fabian Valle, Analyst Rebecca Lansbourgh, Admin. Clerk II Jean McSorley Supervising Clinician OLDER ADULT MH TEAM Ramiro Romo, Clinician I Sandra Holguin, MH Spec II Carolina Hernandez, MH Spec I Glenn Johnson, MH Spec II SUPPORT SERVICES INFORMATION SYSTEMS Kati Moore Supervisor Sue Anderson, Admin Clerk II Sagrario Landin, Admin Clerk II Maglin Danielson, Admin Clerk II Rachael Bazan, Admin Clerk II Nicole Jamison Sr. Admin. Services Analyst Pam Sidhu, IS Analyst PUBLIC AUTHORITY Rossana Vigil Social Worker Supervisor I Evan Wyatt, Admin Support Spec Paula Gonzalez, RS Olesya Prokopchuk, RS Olga Provorub, RS Melinda Meeken Social Worker Supervisor ADULT PROTECTIVE SERVICES Phonecia Stone, SWP Hannah Simmons, SWP David Lara, SWP Josefina Elliott, Clinician I INPATIENT DISCHARGE PLANNING Vacant Jocelyn Bueno, Admin. Clerk II Rev. 1/2/2018 Total Positions: 138
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Recommendations Client Access Preparation Teamwork Jockey the schedule
Robust reminder calls RN visit prep Care team huddles Teamwork Walkie talkies Track data in real time Jockey the schedule – actively move clients up and down to account for no shows, cancellations, late & early clients, make calls in real team(5 minutes before apt) if they are not here-especially for likely no shows Robust reminder calls – investigate client record to ensure we meet all needs, call client day before to follow up about what has happened and gather missing information, care more about the client than they care about themselves. RN tee up – RN works at top of license and everything below, increase client support, client sees they are being cared for by a team, Integrate RN as team member for psychiatry visits, increase face to face time between RN and client, leverage RN relationship with client to improve care. Huddle- front desk, RN, Case manager, clinician and psychiatrist huddle for 15 minutes at start of each clinic session. Identify what client needs, ensure all members on same page, anticipate sticking points and minimize. Put client at center of everything. Make them feel welcomed and prepared for. Walkie talkies- connect members of team in real time. Front desk with medical staff wherever they are, direct contact between front desk and crisis team, reduce sneaker time looking for people
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Recommendations Eliminate unnecessary work Communication & coaching
Reduced paperwork Cycle time, handoffs, duplication Re-vamp assessment, workflow Eliminate paper charts Communication & coaching Traveling roadshow Inspire and motivate Performance dashboard Posted daily, other items monthly or quarterly Revamp assessment paperwork process – eliminate as much paperwork as possible, reduce the number of handoffs, reduce duplications and improve turnaround time, make it easier for your clients Eliminate paper charts, scan in real time, utilize EMR, decrease time spent filing, decrease frustration searching for paperwork, allows all documents to be readily available to everyone Build client care teams – create multidisciplinary teams, client consistently sees the same team for every visit. Break down silos and collaborate when providing care, the sum is greater than the parts Communicate with the traveling road show – leadership rounding to where staff are located to share changes and new elements of the model, ask questions and get feedback Create a dashboard - # of clients served, # of crisis contacts, no shows, # missed opportunities, # assessments/re-assessments completed
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Don’t just monitor results
Respond to results with action If something’s not working, make an improvement and measure the impact Connect the dots- because you called those three clients, two came in who would have otherwise no showed and you were able to see one urgent client in the spot where the client you called rescheduled
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Questions Karen Larsen LMFT, Director Yolo County Health & Human Services Agency
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