1. On the Frontlines Karen Larsen LMFT, Director
Yolo County Health & Human Services Agency
January 31, 2018

2. A Little About Yolo County

3. 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

4. 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

5. 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.

6. 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

7. 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

8. Our Team

9. 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

10. 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

11. 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

12. 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

13. Questions
Karen Larsen LMFT, Director Yolo County Health & Human Services Agency