[NYAPRS Enews] MHW: Onondaga Collaborative Boosts Local Behavioral Health Care

[Harvey Rosenthal]

Group Of Providers In N.Y. County Benefit From Improvement Collaborative

Mental Health Weekly  May 3, 2010

 

Bottom Line...In a matter of months, a quartet of Onondaga County mental
health agencies have initiated modest changes that are improving client
access and increasing business revenue.

 

Four community mental health agencies in Onondaga County, N.Y., are
initiating rapid-cycle, low-cost changes to improve client access to
their clinic services, through a performance improvement collaborative.
While the formal coalition is expected to dissolve by the end of this
year, participants believe they have formed lasting relationships that
will continue to generate important information-sharing over the long
haul.

 

"There's a bonding that goes on in these collaborations as the group
discusses what's working for them and what's not," Thomas Zastowny,
Ph.D., a psychologist and health care consultant who has served as a
coach to the team of providers, told MHW. "They develop friendships that
last for many months and years after the project ends."

 

Patterned after a similar effort that was undertaken with substance use
treatment providers in the New York county that includes Syracuse, this
collaborative of mental health agencies has embraced clinic access as
the primary focus of its  members' efforts. In doing so it has drawn
heavily from the model of process improvement for behavioral health
agencies that has been advanced by NIATx, the initiative that started as
the addiction-focused Network for the Improvement of Addiction Treatment
but has since expanded its reach into the mental health provider
community. NIATx projects generally emphasize improving client access
and retention in treatment.

 

"Mental health services in this community are more collaborative than
substance abuse services are," Mathew Roosa, director of planning and
quality improvement at the Onondaga County Department of Mental Health,
told MHW. "With the state of a deficit in mental health services, there
has been a longstanding interaction among providers."

 

Rapid Improvements

In a manner similar to what is promoted through NIATx, members of the
provider collaborative in Onondaga County have been able  to initiate
the type of commonsense, rapid improvements that show immediate results
and therefore boost staff morale.

 

"This gives them some installation of hope - hope that they can change
and improve and have some control over their own destiny," said
Zastowny, referring to an autonomy factor that is critically important
in times when provider agencies face constant and sometimes crippling
financial pressures.

 

He added, "When something can be achieved over two, three or four weeks,
it brings a sense of empowerment." Being able to make a productive
change to the admissions protocol, for example, will inspire an
examination of what can be done to improve other processes.

 

Roosa, a former director of a behavioral health provider agency in the
county, has been involved with the formation and ongoing work of the
collaborative through his position with the county government; the
effort began in 2009.

 

While this is an initiative modeled after NIATx, it is funded by the
county, he said. Roosa shared with MHW various presentations that
outline the progress that has been made at participating agencies (an
original group of five is now down to four, as one agency ended its
participation in the effort).

 

For example, at the outpatient clinic for children and youth that is
operated by the county Department of Mental Health, the agency was able
to reduce unproductive time for physicians (which limited client access
to services) by reducing the number of phone-in prescription refill
calls from families of clients. The county-run clinic developed a letter
to consumers that continued to emphasize the safety net that the clinic
offered but that also urged families to engage in advance planning so
that the phone-ins would not be necessary.

 

The clinic staff found that they were able to reduce calls for
medication refills by 600 percent, which in turn allowed physicians to
increase their time available for client appointments by 8 percent. The
staff reported that previously stigmatizing beliefs that these were
families whose "chaotic lives" left them no ability to plan ahead were
false, and that maintaining a safety net agency could still be
compatible with instilling the notion of personal responsibility on the
part of families.

 

At the Brownell Center for Behavioral Health Services, staff established
a centralized intake process designed to improve client engagement and
retention and to enhance staff and client satisfaction. The intake
changes involved several elements, from re-evaluating the center's
telephone screening tool to establishing a multidisciplinary triage team
designed to screen for appropriate levels of care and to match clients
to the therapist who could best meet their stated needs.

 

The changes resulted in an impressive set of improvements to client
access. The no-show rate for appointments at the Brownell Center dropped
from an average of 26 percent to 18 percent. The total client population
was increased by 300 over a 90-day period. Staff members were pleased
that they were able to start building a therapeutic alliance with
clients more quickly.  In addition, these improvements were seen as
having a quantifiable business benefit for the agency, with an estimated
increase in potential revenue of $156,000 over six months.

 

Structure Of Collaborative

Roosa said that the composition of this collaborative, encompassing both
private agency and government- run clinic operations, illustrates a
difference between local  coalitions and many national groups. Local
collaboratives often reflect the wide diversity of services available at
the local level, so the participating agencies benefit from the
different perspectives that some dissimilar agencies can bring to the
group, he said.

 

Membership in the collaborative was not open to all mental health
providers in the county, as organizers wanted to keep the size
manageable

and conducive to productive discussions. Roosa said such a group
probably needs at least four members in order to gather enough
collective energy to make progress, but anything over eight members
probably would trigger a higher level of coaching and management
oversight.

 

With access issues expected to continue to pose challenges for mental
health agencies for some time to come, the collaborative is not expected
to solve all the problems. Roosa said it probably will cease formal
operations at the end of the year, although he and Zastowny believe the
relationships

that have been built will stay strong at the local level.

 

Roosa said that in the remaining months of the collaborative's
operation, one priority will be to sharpen the business case for this
type of effort, by getting a clearer handle on the revenue impacts for
participating organizations. He added that the county already is
considering using this collaborative's activity as a model for other
alliances it may organize, such as perhaps with providers of
developmental disabilities services. 

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