Lessons for Cross-Sector Improvement

1. Lessons for Cross-Sector Improvement APAC Forum September 27, 2013

2. The Triple Aim Better Health for the Population Better Care for Individuals Lower Cost Through Improvement

3. The Problem When we seek to bring different sectors together to solve shared problems, it’s very difficult and it very rarely happens. Why?

4. Barriers to Cross-Sector Collaboration • The fact of separate organizations • Different aims • Different philosophies/cultures (mistrust) • Different (sometimes competitive) funding streams • Different networks • The sheer complexity of meaningful collaboration

5. If This is the Rule, Are There Exceptions? • The Early Years Collaborative • Alcohol and Other Drug Treatment Courts • 100,000 Homes Campaign

6. Session Objectives • Share stories of cross-sector improvement • Identify “clues” (early insights on what seems to work) • See if we can apply them to one or two your current challenges

7. Brandon Bennett Faculty Improvement Advisor Lessons for Cross Sector Improvement Scotland’s Early Years Collaborative

8. The Glasgow Effect “The deprivation profiles of Glasgow, Liverpool an Manchester are almost identical. Despite this, premature deaths in Glasgow are more than 30% higher, with all deaths approximately 15% higher. This ‘excess’ mortality is seen across virtually the entire population” Dr Harry Burns (Chief Medical Officerof Scotland) suggests stress in early childhood can lead to long term chronic ill health Sir Harry Burns Walsh D, Bendel N, Jones R, Hanlon P. It’s not ‘just deprivation’: Why do equally deprived UK cities experience different health outcomes? Public Health

9. Vision To make Scotland the best place in the world to grow up in by improving outcomes, and reducing inequalities, for all babies, children, mothers, fathers and families across Scotland to ensure that all children have the best start in life and are ready to succeed

10. Work Stream Aims Stretch Aims: To ensure that women experience positive pregnancies which result in the birth of more healthy babies as evidenced by a reduction of 15% in the rates of stillbirths (from 4.9 per 1,000 births in 2010 to 4.3 per 1,000 births in 2015) and infant mortality (from 3.7 per 1,000 live births in 2010 to 3.1 per 1,000 live births in 2015). To ensure that 85% of all children within each Community Planning Partnership have reached all of the expected developmental milestones at the time of the child’s 27-30 month child health review, by end-2016. To ensure that 90% of all children within each Community Planning Partnership have reached all of the expected developmental milestones at the time the child starts primary school, by end-2017. Source: The Scottish Government

11. A cross sector approach An implicit recognition of the unique drivers that will exist and persist across localities and which are linked to geography True collaboration between Civil Service (Health, Education, Social Welfare, Judicial), Private Enterprise, and the Third Sector (non-profits and charitable organizations) Community Planning Partnerships as a key leverage point for local intervention

12. Lessons Learned (thus far) Build of Previous Success Choose Something Meaningful Leverage Existing Structures Focus on Asset Based Development Equip Communities with a Mechanism for Introducing Change (Model for Improvement)

13. Challenge Questions What local assets exist in your community to bring together dispirit leaders? What issue can be framed across sectors that most would be excited about?)

14. The Alcohol and Other Drug Treatment (AODT) CourtTe Whare WhakapikiWairua A Community Collaborative Judge Ema Aitken APAC Conference September 2013

15. The What, the How, the Why AIM: to stop the cycle of crime – imprisonment – release – crime – imprisonment for AOD dependent offenders. HOW: by using the coercive power of the Court to get offenders into treatment, and the collaborative effort of the community to change and maintain behaviours. OUTCOME: to reduce reoffending, save money and restore our people to their families and communities as healthy productive citizens.

16. Getting Started: The problem and the Realities • Clearly identified the problem: that current system is not effective in reducing reoffending for AOD dependent offender. • And the realities: that addiction is an illness that requires individual-specific treatment, and that offending thoughts and behaviours need also to be addressed. • To reduce reoffending we need to understand what long term recovery looks like and walk with our participants on that journey.

17. Four Stages of Recovery

18. The Journey: consultation and collaboration AODT Court

19. The Model Chosen • USA 10 Key Component model: proven to be more effective than any other intervention in their criminal justice history when dealing with ‘high risk/ high needs’ offender. • Proven to significantly reduce reoffending rates if 10 Key Components applied. • In NZ: a post-guilty plea pre-sentence intervention available for AOD dependent offenders who would otherwise be facing up to 3 yrs imprisonment .

20. The Underlying Principles • Judge-led team approach • Abstinence-based court • Customised treatment, habilitation and rehabilitation • Intensive monitoring through regular court appearances and regular and random AOD testing • Proximal and distal goals identified and set, incentivesand sanctions used to achieve those goals • Honesty is permanent proximal goal

21. The Three AODTC Phases Sentence

22. The Pilot • 5 year pilot – formative and substantive evalutions at 12 months and 4 years • 62 participants across both courts (max. 100) • 8 different ethnic groups • 8 women 54 men • 20 recidivist drink drivers; 42 recidivist criminal offenders

23. Getting Started • Know your problem and develop a well-informed sense of the possible solutions • Consult widely and throughout the set-up and implementation phase • Evaluate processes early and respond • Stay optimistic, focused and energetic – it will take longer than you think!

24. 100,000 Homes Campaign • Aim: House 100,000 of America’s most vulnerable homeless by mid-2014. • The math: • 2-3 megacities to house 40% of their unsheltered population; • 50 high-burden communities to house 300 per year; • 75 middle-burden communities to house 100 per year; • 125 lower-burden communities to house 100 each. • 10,000 families • Current status as of Sept 2013 (over three years in): 66,000 housed

25. Field Plan Big City & County: 25% of resource and effort assume house 25% of c&v or 12,000, total Other: Special populations & mid/small cities: 25% of resource and effort assume 75 mid-sized cities house 250 ea and 125 small cities house 100 ea or 31,000 individuals + 10,000 families + 5,000 Hospital to Home 5,000 pre-launch 25,000 by 18 months 50 core cities (>1,000 unsheltered): 50% of resource and effort assume 25 house all c&v and 25 house 50% of their c&v or 43,000, total (average of 300/city/yr) 100,000 by 3 years

26. 100,000 Homes Approach • Know the problem (vulnerability index) • Employ housing first (wraparound services) • Create easy-to-track, shared metrics • Continuously improve core housing process

27. Vulnerability Index

28. 100,000 Homes Approach • Know the problem (vulnerability index) • Employ housing first (wraparound services) • Create easy-to-track, shared metrics • Continuously improve core housing process

29. Simple, Shared Metric

30. 100,000 Homes Approach • Know the problem (vulnerability index) • Employ housing first (wraparound services) • Create easy-to-track, shared metrics • Continuously improve core housing process

32. The Real Secret? Tenacity (Rhythm) and Leadership (“Team 42”)

33. Kansas City, Kansas (A Possible Next Step?) http://www.kansashealthmatters.org/modules.php?op=modload&name=NS-Indicator

36. Take-Home Lessons • Shared aims matter • Leadership “maturity” matters • Common systems matter • Common data/visualization matters • Management system matters (rhythm and style of meeting) • Policy environment matters

37. Q/A Do you face similar challenges in your work? Where are you stuck?