Wood County Human Services

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

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

3. Step One • Q: What do we want to focus on? • Answer: Reduce hospital re-admissions at Norwood Health Center • 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 : Randall Ambrosius, Treatment Services Manager Charlotte Smith, BHS Division Manager Kathy Roetter, Director • Wood County Unified Services Norwood Health Center : Ray Dreager: Client Services                                                        Kristi Smith: Client Services Manager                 Pam Martinson: Health Information Manager  • Wood County Sheriffs Department: Robert Levendoske (Retired) • Consumer: Joe Arts   Doug Aughey •  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 ActionResults • Cycle One:Patient call 10% readmission crisis line • Cycle Two:Patient call 3.3% readmission crisis line • Cycle Three:Norwood Social 0 readmission Workers call Low number clients with script wanting to be involved

9. Change Cont. ActionResults • Cycle Four:Norwood Social 0 readmission Worker calls Low number clients with wanting to be script involved • Cycle Five:Norwood Staff 0 readmission (Nurse, psych tech, etc.) Staff making calls to whom 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 ServicesDepartment 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 • Little Aim: Increase the number of clients in support calls.

14. 2011 ActionResults Cycle One Improve script 2010 – 10 participated 10% 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?” Con’t to have all staff make support calls - good relationships. Have one hospital staff make calls and capture good data. Poor data, unable to capture everyone. Loss of relationship

17. ActionResults 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. • QUESTION - How many individuals are we reaching? 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!

22. Chapter 51 Detentions

23. Wood County Suicides

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