NO WRONG DOOR IN MCDHHS/MD

1. NO WRONG DOOR IN MCDHHS/MD NACCHO HIT WORKSESSION July 14, 2010 An integrated and interoperable health and human services care delivery system!

2. CONTEXT ABOUT MONTGOMERY COUNTY WHY THIS IS IMPORTANT OUR SERVICE INTEGRATION EFFORTS 3 AREAS NEEDING INPUT: ELIGIBILITY DATA SHARING FUNDING FLEXIBILITY HEALTH CARE REFORM AND THE OPPORTUNITY BEFORE US NEXT STEPS Today’s agenda

3. INFORMATION ABOUT OUR COUNTY: • 1 MILLION RESIDENTS • 29% FOREIGN BORN • 44% ETHNIC MINORITY • 40,000 OUT OF 140,000 CHILDREN IN THE PUBLIC SCHOOL SYSTEM ON FARMS • OVER 32,000 UNINSURED ADULTS, CHILDREN AND WOMEN SERVED THROUGH HEALTH CARE SERVICES • SERVED 70,000 HOUSEHOLDS IN FY09 AND 39,000 USED MORE THAN TWO SERVICES FROM THE DEPARTMENT • A STAFF OF 1500 WITH OVER 80 PROGRAMS • TANF/SNAP, MA AND EA CASELOAD GROWING – APPLICATION VOLUME GREW BY ALMOST 42% • 6 ZIPCODES OF EXTREME NEED – POVERTY ON THE RISE

4. InterOptimability Drivers: Consumer-centric, Family Focused, Technology Enabled TANF Food Stamps Health Child Welfare Juvenile Justice Mental Health Education Early Learning Substance Abuse

5. How is DHHS Organized? • In 1996, 4 County departments became one entity. • Objective: Integrated, coordinated and comprehensive service delivery.

6. How is DHHS Organized? • One Director • Centralized administrative functions • Moving towards single client record supported by an interoperable database • Uniform intake form to identify all service needs • Designated entire HHS entity as HIPAA covered – including social service and income support programs.

8. Outcomes to be achieved Earlier comprehensive identification of individual/family needs Quicker delivery of comprehensive and integrated services – would reflect a public and private partnership effort Individuals/families achieving outcomes identified in their respective case plans Improved cooperation and collaborationamong staff of the public and private partners Improved client functioning – place based approach to care delivery where possible Improved client satisfaction Reduction in length of stay in services/treatment/care Reduction in recidivism Increased efficiencies – an ROI/SROI metric

9. Montgomery County Department of Health and Human Services Services andMD State Department Connections by Service Type • Aging and Disability Services • DOA, DOD, DHR, DHMH, DVA • Behavioral Health and Crisis Services • DHMH, GOC, DHR, DPSC • Children, Youth and Family Services • DHR, GOC, GOCCP, DJS, MSDE • Public Health Services • DHMH, MSDE, DHR • Special Needs Housing • DHR, DHCD, DHMH • Community Outreach | All Departments PHS CYF BHCS SNH Department of Health and Human Services ADS

10. FEDERAL AGENCIES WHOSE REGULATIONS AND FUNDING STRATEGIES IMPACT COUNTY SERVICES • ACF • CMS • SAMHSA • HRSA • CDC • ONCHIT • HUD • NIH • VA • OFFICE ON AGING • HOMELAND SECURITY • TITLE XIX • TITLE IVE • CSBG • CDBG • MENTAL HEALTH BLOCK GRANT • FEDERAL and STATE GRANTS • 40% DHHS BUDGET IS FROM STATE AND FEDERAL SOURCES • 60% OF DHHS BUDGET IS FROM COUNTY SOURCES

11. DHHS CYF PHS ADS SNH BHCS ECO Map of DHHS, State & Federal Agencies Federal: ACF ONCHIT HRSA SAMHSA CMS HUD State: GOC MSDE DHR DHMH DOA County: Montgomery County DTS Enterprise infrastructure Policies Security CIO support and outreach

12. How is DHHS Organized? • One Director • Centralized Administrative Functions • Moving towards single client record supported by an interoperable database • Uniform intake form to identify all service needs • Designated entire HHS entity as HIPAA covered — including social service and income support programs

13. \ HHS Team Member INTEGRATED SERVICE TEAM Customer TeamMember Community Partner Team Member Team Member Labor Management Partnership CHIP-Community Health Improvement Process Information Technology QSR-Quality Service Review One HHS Lane Equity Trust Customer Service Accountability Children Youth and Family Services Community Outreach Aging and Disability Services Special Needs Housing Behavioral Health and Crisis Services Public HealthServices NO WRONG DOOR--ONE HHS

14. Timeline Opportunities emerge from Stewards of Change convening at Yale with federal partners; built our Beacon proposal with a clear vision for a unified Electronic Health and Human Services Record. Change Management and small test of change Successor to the Director with the integrated vision takes office. She hires APHSA to help with integration. More conversations, focus groups and activities occur. Work stops though at point that deepening integration runs into workforce resistance Integrated Department created by State Legislative action from Four local departments. Legislation also creates a single entity for purposes of HIPAA Co-location deepens partnership and coordinated and integrated business practices I take the job and believe that the County Executive has given a mandate to further integrate the department. Assess activities and accomplishments to date and begin to build on past work. Get grant from Casey Family Programs at the start of December 2007. Grant commences January 2008. Conduct assessment and vision map Work continues with many outreach opportunities with State and Federal entities

15. Scenario One Homeless diabetic woman with Schizophrenia Three episodes of hospitalization in last 12 months Hard for her to regularly take medications Hard for her to have nutritious meals Services offeded by DHHS to address these complex needs Homeless Program Mental Health Treatment Montgomery Cares Housing Stabilization Services

16. Scenario Two • 15 Year old Latino Male • Referred to Crisis Center after school suspension • Indicates to counselor his desire to commit suicide • Mother receiving mental health services • Father believes the family troubles are a private matter • Father is strict and bruises on client may indicate abuse Services Offered by DHHS for this family • High School Wellness Center • Mental health services for child, mother and family unit • Anger management • Culturally competent service delivery • Meaningful after school time activities

17. Scenario Three 42-year old non-English speaking recent immigrant Tests by DHHS indicate she has tuberculosis Appears to be some domestic violence at home Has two children ages 2 and 6 – and is pregnant again 2 year old needs child care, family can not afford it 6 year old has special needs and housing is unstable Services offered by DHHS to address these complex needs Public Health TB Clinic Child Care Services Maternity Services Income Support Services LEP Services Domestic Violence Service via Abused Persons Program Adult Mental Health Services Housing Stabilization Services Education through Public School System

18. Scenario Four • 90 year old woman identified as hoarder • 21 year old great-grand-daughter moved in • Great grand-daughter has two preschool aged children • Great grand-daughter a former drug user is abusing again • Department of Housing believes house not livable Services offered by DHHS to address these complex needs • Adult Protective Services • Child Welfare Services • Early Learning and Child Care • Special Needs Housing Services • In-home Aide Services • Income Supports • Substance Abuse Treatment • Medical and Primary Care

19. No matter which door she arrives through

20. She will be greeted and provided the face sheet Service Request Form Needs Questionnaire Check in screen

21. She will fill out service request form and needs questionnaire Client identified needs Basic demographic information

22. Triage worker interviews her Confirms needs and schedules appointments or provides referrals

23. She leaves session with appointments for follow-up assessments Appointment and referral letters in six languages

24. TCA Y System provided feedback regarding assessments outcomes HIV-Aids Y Housing N Child care Y Care coordinator gets feedback from program assessments If client meets criteria coordinator calls for a service team

25. Service Team established and coordination with client begins – Virtual or in person with client as core participant – self directed care as much as possible Better outcomes with coordinated care

26. TOOLS WE HAVE DEVELOPED • Universal Screening tool • Face Sheet • Confidentiality Policy • Practice Model • Scheduling tool • Customer service protocols • Qualitative Evaluation tools • Enterprise tools • Oracle ERP • Seibel CRM

27. Microsoft Architectural Vision

28. DHHS Change Vision 2015

30. Areas of Practice Intake and Eligibility — Opportunity with Health Reform Outreach and Navigation — Budget related opportunities Practice Model Re-Design with Stratified Case Types — Define levels of intervention and train to expectations and the role of a family advocate Accountability — What does this look like Change Management Fiscal Year 2012 Budget

31. Feedback from our work to date: • If we identify redundancies will they translate into efficiencies that will save money? And if so what happens? • Eligibility – even if you get it right without the right outcomes the eligibility intervention could be misplaced • Capacity of current staff and their willingness to learn – a huge challenge • Assumption as well that if you get clients to the right places then outcomes will be achieved – how would you evaluate this assumption and what is the basis for it and why do we believe that there is a high probability of success with this approach • Technology – the what, the why and the how and will it streamline and improve process and outcomes?

32. The Policy Conversation • Integrated Eligibility • Blending and Braiding Funds • Confidentiality • Evidenced Based Practice • Interoperability Place Based Initiatives in the Context of: • Health Reform • TANF Reauthorization • Medicaid Waivers • Home and Community-based Services • Universal Pre-K • Employment Strategies • Housing First and 10 year plans to end chronic Homelessness • New American Strategies • Equity in Service Delivery • Role of Technology in Supporting Integrated Practice

33. QuestionsandDiscussion