Service Coordination in the Department of Social and Health Services A Presentation of the Briefing...

Service Coordination in the Department of Social and Health Services

A Presentation of the Briefing Report

Joint Legislative Audit and Review Committee

June 26, 2006Presented by John Woolley, JLARC Staff

JLARC's Analysis of DSHS Service Coordination

JLARC directed analysis Look for answers to four questions:

1. Current efforts at coordination?

2. Initiatives to improve information systems?

3. Feedback from clients?

4. Other states’ experiences? A “lessons learned” approach

Background/Context

Report pages 1-3

Analysis of Service Coordination in DSHS

2


A Number of Lessons Learned

1. Current efforts at coordination?

2. Improve computer systems?

4. Experiences of other states?

3. Feedback from clients?

Initiatives take many different forms—involve just parts of DSHS or involve many participants outside of DSHS; and important to understand what is expected of an initiative.

Recent changes in information technology—an emphasis on enterprise-wide information and “hub” strategies—can facilitate information exchange and reduce information redundancy.

Client satisfaction surveys in place, but improvements needed to be more accurate. Look at service coordination not as a single event fixed in time, but rather as an ongoing, continuous evolution.

Background/Context

3


Single largest agency budget: $8.5 billion per year, with 18,000 employees

2.1 million clients equals 1/3 of state’s population—many get packages of services

DSHS Provides Services to 2.1 Million Clients

Background/Context

Report pages 1-3

Data Source: DSHS Research and Data Analysis, Client Service Database for state fiscal year 2004

Three Services: 171,808 clients, 8%

Four or More Services: 48,905 clients, 2%

Two Services: 674,556

clients, 32%

One Service: 1,201,872

clients, 58%

5


Information Also Available on Clients’ Use of Multiple Services1/3 of Aging and Adult Service Clients get some Economic Services

Background/Context

Report pages 1-3 Data Source: DSHS Research and Data Analysis: Fiscal Year 2003

6


Answering Question 1 learned: No Wrong Door has “morphed”: no

longer stand alone project

DSHS: coordination now part of ongoing strategic planning

Looked at strategic plan and individual initiatives

Question One

Report pages 5-9

Variety of Current Initiatives Considered Service Coordination

7


With 10 separate goals, no specific goal calls out “Improve Service Coordination”

But detailed strategies specifically address boundary crossing issues

Question One

Strategic Plan—Strategies Cross Organizational Boundaries

Goal F: Use Effective Treatment to Enhance Outcomes

Objective 2: Standardize practice of early screening, assessment, and referral to services

Strategy: Collaborate with other programs serving children, youth and adults to screen for co-occurring mental and substance abuse disorders and link with integrated treatment—includes: Health and Recovery Services, Aging and Disabilities, Children’s, Juvenile Rehabilitation

Performance Measure: Increase of consumers receiving an integrated mental health and substance abuse screen—Health and Recovery Services

Report pages 5-9 8


Initiatives Seek Solutions to a Variety of Coordination Problems

A-Teams Collaborative case management for clients to maintain community placement. MH, DD, SA, DOC, AAA, RSN, local law enforcement

Children’s Mental Health Initiative

Coordinate provision of MH services to children, with possible future goal of consolidation. Children’s and Health and Recovery.

Functional Family Therapy

Family-based service engaging entire family, with a focus on reducing repeated criminal behavior. Juvenile Rehabilitation and County Juvenile Courts.

(evidence-based practice)Report pages 5-9

9

Question One


Many Initiatives With Diverse Expectations

BasicBasic

Highly Developed

Highly Developed

COMMUNICATION - exchange information

COOPERATION - work together

COORDINATION - systematically align efforts

COLLABORATION - joint work effort and product

CONSOLIDATION - one system

INTEGRATION - bring all parts together

Question One

Service coordination takes many different forms—it can involve just parts of DSHS or involve many participants outside of DSHS.

Importance of understanding what is expected by an initiative: some are geared towards increased communication; some are geared towards the coordination of services; some are geared towards service consolidation, and many are a combination.

Report pages 5-9

10


Coordination of Client Information Historically a Problem

Looked at efforts at improving information coordination.From simple information (name, address,

etc.) to more complex information (assessments, services needed, services provided)

Efforts at eliminating “silos”

Question Two

Report pages 11-14

11


New Technologies May Help Coordinate Information


Question Two

Report pages 11-14

12


Current Efforts Adopt Mixed Approach Client Registry currently allows access

to “legacy” information Information changes include:

Implementing enterprise planning Requested funds for Client ($8M) and

Provider ($9M) hubs (2005-2007 biennial budget)

“Pragmatic” approach: major system replacement includes provider “hub”

Question Two

Report pages 11-14

13


DSHS Formal Client Survey in Place Formal survey of client opinions begun in

2001, conducted four times. 19 questions in total, two questions

specific to service coordination.

Question Three

Clients asked if they—strongly agree, agree, are neutral, disagree, strongly disagree to statements:

Someone from DSHS helps us with services from all programs

DSHS makes sure our services work well together

Report pages 15-17

14


Majority of Clients Agree With Both Questions

Question Three

First Service Coordination Question of Clients Respondents Involved With Three or More Programs Who Agree That DSHS Helps with Services From All Programs

Report pages 15-17

15

2005

Sur

vey

Tre

nd

Combined “Strongly Agree” and “Agree”


Majority of Clients Agree With Both Questions

Question Three

Second Service Coordination Question of ClientsRespondents Involved With Three or More Programs Who Agree That DSHS Makes Sure Services Work Well Together

Report pages 15-17

16

2005

Sur

vey

Tre

nd

Combined “Strongly Agree” and “Agree”


JLARC’s Consultant Experts: Survey Can Be Improved

Question Three

Overall design strong:But positive bias likely—seven changes

suggested to make results more meaningful, such as:

Rephrase from “I am satisfied with service X” to “How satisfied are you with service X?”

When determining client attitudes towards service coordination, surveys must be very carefully designed and administered to avoid bias. Improvements should be made to DSHS’s current methods.

Report pages 15-17

Report’s Recommendation:DSHS should develop a plan to strengthen its client survey process so that it produces more meaningful results. The plan should address design features, survey procedures, and the analysis and presentation of data so that any potential positive bias is minimized.

17


Considerable Body of Service Coordination Literature Available

Question Four

Experiences of other states and jurisdictions studied

Common themes include:Attentive to what initiative is attempting to

accomplishUsually takes place at local levelTakes time and a lot of effort: not one eventImpacts for clients not well documented or

assessed

There are a number of consistent themes learned from the literature. One is to look at service coordination not as a single event fixed in time, but rather as an ongoing, continuous evolution.

Report pages 19-20

18


Continuous Efforts Likely Most Important

Report pages 21-22

19

1. Current efforts at coordination? A number of current initiatives

2. Improve computer systems? Attempts to improve information in place

4. Experiences of other states? There are lessons from other states/jurisdictions

3. Feedback from clients? Survey establishes process for feedback

Initiatives take many different forms—involve just parts of DSHS or involve many participants outside of DSHS; and important to understand what is expected of an initiative.


Client satisfaction surveys in place, but improvements needed to be more accurate. Recommendation included. Look at service coordination not as a single event fixed in time, but rather as an ongoing, continuous evolution.


Concurrence With Report’s Recommendation

Both DSHS and OFM concur with the report’s recommendation.

JLARC Staff to contact for questions:

John Woolley

Phone: 360-786-5184

E-Mail: [email protected]

Service Coordination in the Department of Social and Health Services A Presentation of the Briefing...

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