Wood County Human Wood County Human ServicesServices

Mental Health CollaborativeMental Health Collaborative2010-20112010-2011

Randall Ambrosius, MSW, LCSW, CSAC, ICSRandall Ambrosius, MSW, LCSW, CSAC, ICSWood County Human Services Department Wood County Human Services Department

Wood County Human Services Wood County Human Services DepartmentDepartment

Located in Central WisconsinLocated in Central Wisconsin AODA / Mental Health Clinic located in AODA / Mental Health Clinic located in

Wisconsin RapidsWisconsin Rapids Norwood Health Center located in Marshfield Norwood Health Center located in Marshfield 24 hour Crisis Line24 hour Crisis Line

Mobile Crisis LineMobile Crisis Line Legal ServicesLegal Services

Step OneStep One

Q: What do we want to focus on?Q: What do we want to focus on? Answer: Reduce hospital re-admissions at Answer: Reduce hospital re-admissions at

Norwood Health CenterNorwood Health Center

Q: What is the current hospital re-admission? Q: What is the current hospital re-admission?

BASELINEBASELINE

Current re-hospitalization rate is 4%Current re-hospitalization rate is 4%AIMAIM

Reduce re-hospitalizations 3% or lessReduce re-hospitalizations 3% or less

Committee MembershipCommittee Membership Wood County Unified Services :Wood County Unified Services :

Randall Ambrosius, Treatment Services ManagerRandall Ambrosius, Treatment Services Manager Charlotte Smith, BHS Division ManagerCharlotte Smith, BHS Division Manager Kathy Roetter, DirectorKathy 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)Robert Levendoske (Retired)   Consumer: Consumer:

Joe ArtsJoe Arts    Doug AugheyDoug Aughey

  Project CoachProject CoachTom Mosgaller: UW-Madison, NIATxTom Mosgaller: UW-Madison, NIATx

The Walk ThroughThe Walk Through

““What is it like to be a clientWhat is it like to be a client??””

NIATx ProcessNIATx Process

Plan: General change idea to be tested.Plan: General change idea to be tested.

Do: What specific change did we put in place?Do: What specific change did we put in place?

Study: What were the results of this change?Study: What were the results of this change?

Act: Adopt, modify, or abandon the change Act: Adopt, modify, or abandon the change idea.idea.

Rapid Cycle ChangesRapid Cycle Changes

ActionAction

ResultsResults Cycle One:Cycle One: Patient callPatient call 10% readmission 10% readmission

crisis linecrisis line Cycle Two:Cycle Two: Patient callPatient call 3.3% readmission 3.3% readmission

crisis linecrisis line

Cycle Three:Cycle Three: Norwood SocialNorwood Social 0 readmission 0 readmission

Workers callWorkers call Low number Low number clients with scriptclients with script wanting to wanting to

bebe involvedinvolved

Change Cont.Change Cont.

ActionAction ResultsResults Cycle Four:Cycle Four: Norwood SocialNorwood Social 0 readmission 0 readmission

Worker callsWorker calls Low number Low number clients withclients with wanting to be wanting to be scriptscript involved involved

Cycle Five:Cycle Five: Norwood StaffNorwood Staff 0 readmission 0 readmission

(Nurse, psych (Nurse, psych tech, etc.)tech, etc.) Staff making calls to whom Staff making calls to whom

they have a connection.they have a connection.

ResultsResults

4%

0.80%0%

10%

3.30%

0% 0% 0% 0%0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

10%

11%

12%

1 2 3 4 5 6 7 8

30-Day Cycles

Perc

ent

Before Intervention

After Intervention

Cycle 8 Ends 12/31/10

Summary of 2010Summary of 2010

1) The goal was 3% or less. During this process we averaged 1) The goal was 3% or less. During this process we averaged 1.76% re-admission of those who participated.1.76% re-admission of those who participated.

2) Individuals who did not participate had a 5% average re-2) Individuals who did not participate had a 5% average re-admission.admission.

3) Low numbers of individuals to participate in support calls.3) Low numbers of individuals to participate in support calls.

4) The relationship is the most important factor.4) The relationship is the most important factor.

Wood County Human ServicesWood County Human Services DepartmentDepartment

Mental Health CollaborativeMental Health Collaborative

2011 Part II2011 Part II

“The Big Aim and the Little Aim”

2011 AIMS2011 AIMS

Big AimBig Aim: Reduce hospital re-admissions at : Reduce hospital re-admissions at Norwood Health Center Norwood Health Center

Little AimLittle Aim: Increase the number of clients in : Increase the number of clients in support calls. support calls.

20112011

ActionAction ResultsResults

Cycle OneCycle One Improve scriptImprove script 2010 – 10 participated 10% re-admission 2010 – 10 participated 10% re-admission

2011 – 30 participated 2% re-admission2011 – 30 participated 2% re-admission

Cycle TwoCycle Two Con’t to useCon’t to use 2010 – 17 participated 3.3% re-admission 2010 – 17 participated 3.3% re-admission

scriptscript 2011 – 21 participated .05% re-admission 2011 – 21 participated .05% re-admission

32 clients could not participate with a 19% re-admission rate.32 clients could not participate with a 19% re-admission rate.

What happened?What happened?

Record number of hospital Record number of hospital admissions admissions occurringoccurring in in

cycle 2.cycle 2.

A Balancing ActA Balancing Act

““What to do?”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.

ActionAction ResultsResults

Cycle 3Cycle 3 One staff One staff 2010 – 7 participated 0% re- 2010 – 7 participated 0% re-admissionadmission

collects and collects and 2011 – 19 participated 1.6% re- 2011 – 19 participated 1.6% re-admissionadmission

makes support makes support

calls.calls.

QUESTIONQUESTION - Should we use E-mail? - 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.

QUESTIONQUESTION - How many individuals are we reaching? - How many individuals are we reaching?

ANSWER - 60% contact with individuals in support call ANSWER - 60% contact with individuals in support call program.program.

% Hospital Re-admissions% Hospital Re-admissions

0%

2%

4%

6%

8%

10%

12%

Cycle 1 Cycle 2 Cycle 3

Year 2010Year 2011

# of Participants in Support Calls# of Participants in Support Calls

34

70

0

10

20

30

40

50

60

70

2010

2011

Hospital ReadmissionsHospital Readmissions

329

259

0

50

100

150

200

250

300

350

2009

2010

Making a Business StatementMaking a Business Statement

Cost per day of hospitalization… $1,034Cost per day of hospitalization… $1,034

Average cost of every commitment… $4,000Average cost of every commitment… $4,000

Clients feeling good about not being Clients feeling good about not being

re-hospitalized… re-hospitalized… priceless!priceless!

Chapter 51 DetentionsChapter 51 Detentions

503

363

331

0

100

200

300

400

500

600

2009

2010

Year to DateSept 2011

Wood County SuicidesWood County Suicides

13

10

5

0

2

4

6

8

10

12

14

2009

2010

Year to DateSept, 2011

Next Steps Next Steps (ACT)(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