Excellence on a Shoestring: The “Home for Good” Program

March 17, 2010 By scottdm Leave a Comment

Today I’m teaching in Christchurch, New Zealand. For the last two days, I’ve been in Nelson, a picturesque coastal town opposite Abel Tasman, working with the local DHB (District Health Board). If you’ve never visited, make a point of adding the country to your list of top travel destinations. The landscape and the people are second to none. (In Nelson, be sure and visit The Swedish Bakery. My 8-year old son, Michael, unequivocally states it has the best hot chocolate in the world—and, believe me, he’s an expert).

I’ve been traveling to New Zealand at least once a year for the last several years to provide training on using outcomes to inform behavioral healthcare. Interest is keen and providers and managers are working hard to deliver top-notch services. However, like many other places around the globe, economic factors are taking a toll. On the day I arrived, one of the lead stories in the local paper (The Nelson Mail) focused on the economic crisis in healthcare. “Complaints about money, shortages, overwork, stress and unsympathetic management…in the always-stretched hospital service,” the story began, “[indicate] a rapidly worsening situation” (p. 5, News Extra). Today, the headline of an article in section A5 of The Press Christchurch warns, “Health Ministry staff brace for job losses.”

A little over two weeks ago, I was in Richmond, Virginia working with managers and providers of public behavioral health agencies. There too, economic problems loom large. Over the last two years, for example, agencies have had to absorb across-the-board, double-digit cuts in funding. The result, in many instances, has been layoffs and the elimination of services and programs—with a few prominent exceptions.

On March 5th, I blogged about the crew at Chesterfield CSB in Virginia that were serving 70% more people than they did in 2007 despite there being no increase in available staff resources in the intervening period and, at the same time, decreasing clinician caseloads by nearly 30%. In January, I posted text and video about agencies in Ohio that had managed to improve outcome, retention, and productivity at the same time that cutbacks had forced the furlough of staff! The common denominator in both instances is outcomes; that is, measuring the “fit and effect” of treatment on an ongoing basis and then using the data in consultation with consumers to improve service delivery.

If you’re not yet convinced, I have one more example to add to the mix: the “Home for Good” program. Vision, commitment, and drive are words that best capture the management and staff who work at this Richmond, Virginia-based in-home behavioral health services program. Some might question the wisdom of starting a private, primarily Medicaid-funded treatment program in the worst economic climate since the Great Depression. A commitment to helping families keep their children at home—preventing placement in residential treatment centers, foster care, and detention—is what drove founder and director Kathy Levenston to take up the challenge. The key to their success says Kathy is that “we take responsibility for the results.” As in Ohio and Chesterfield, Kathy and her crew routinely monitor the alliance and results of the work they do and then use the data to enhance retention and outcome. Listen to Kathy as she describes the “Home for Good” program. I’m sure her story will inspire you to push for excellence whatever the “shoestring” budget you may be surviving on at the moment.

Leading for a Change: The Training of Trainer’s (TOT) Chicago

March 9, 2010 By scottdm Leave a Comment

I’m writing tonight from my hotel room at the River Rock Inn in Rockland, Ontario, Canada. For those of you who are not familiar with the area, it is a bilingual (French & English) community of around 9,000 located about 25 km west of Ottawa.

Today through Thursday, I’m working with the staff, supervisors, and agency administrators of Prescott-Russell Services to Children and Adults. The goal? Introduce the latest “cutting-edge” research on “what works” in behavioral health and initiate a system transformation project for this group that provides child protection, mental health, family violence, and development services in the area. The time spent with the first cohort of 125 direct services providers and supervisors went by, as they say, in “the blink of an eye.” Tomorrow, I’ll be repeating the same training for the rest of the crew. On Wednesday and Thursday I’ll meet with supervisors and administrators. Suffice it to say, it’s an incredible opportunity for me to take part in such a large and well executed service improvement project. In these lean economic times, I’m inspired by both the time and resources being directed at improving services offered to this area’s most needy. By the end of the week, I hope to have interviews posted with some of the providers and leaders working in the project.

While on the subject of training, let me share the brochure for this year’s “Training of Trainers” event in Chicago, Illinois during the second week of August. As in prior years, professionals from all over the world will be joining me and the state-of-the-art faculty for four intensive days of training on feedback-informed treatment (FIT). Please note: this is not an “advanced training” in FIT where time is spent reviewing the basics or covering content. Rather, the TOT curriculum has been designed to prepare participants to train others. Every day of the training, you will learn specific skills for training others, have an opportunity to practice those skills, and then receive detailed feedback from ICCE Senior Associates and Trainers Rob Axsen, Cynthia Maeschalck, and Jason Seidel. Anyway, read for yourself. Agencies both public and private, in the U.S. and abroad, are sending staff to the event to learn the skills necessary to lead transformation projects. Space is already limited so register soon.

Click here to download the brochure to review or forward to colleagues

Addressing the Financial Crisis in Public Behavioral Healthcare Head On in Chesterfield, Virginia

March 5, 2010 By scottdm Leave a Comment

If you are following me on Twitter (and I hope you are), you know the last month has been extremely busy. This week I worked with clinicians in Peterborough, Ontario Canada. Last week, I was in Nashville, Tennessee and Richmond Virginia. Prior to that, I spent nearly two weeks in Europe, providing training and consultations in the Netherlands and Belgium.

It was, as always, a pleasure meeting and working with clinicians representing a wide range of disciplines (social workers, case managers, psychologists, psychiatrists, professional counselors, alcohol and drug treatment professionals, etc.) and determined to provide the best service possible. As tiring as “road work” can sometimes be, my spirits are always buoyed by the energy of the individuals, groups, and agencies I meet and work with around the world.

At the same time, I’d be remiss if I didn’t acknowledge the fear and hardship I’m witnessing among providers and treatment agencies each week as I’m out and about. Frankly, I’ve never seen anything like it in my seventeen years “on the road.” Being able to say that we predicted the current situation nearly 6 years ago provides little comfort (see The Heroic Client, 2004).

While nearly all are suffering, the economic crisis in the United States is hitting public behavioral health particularly hard. In late January I blogged about the impact of budget cuts in Ohio. Sadly, the situations in Virginia and Tennessee are no different. Simply put, public behavioral health agencies are expected to do more with less, and most often with fewer providers. What can be done?

Enter Chesterfield Community Service Board. Several years ago, I met and began working with Larry Barnett, Lyn Hill, and the rest of the talented clinical staff at this forward thinking public behavioral health agency. Their goal? According to the agency mission statement, “to promote improved quality of life…through exceptional and comprehensive mental health, mental retardation, substance abuse, and early intervention services.” Their approach? Measure and monitor the process and outcome of service delivery and use the resulting information to improve productivity and performance.

As Larry and Lynn report in the video below, the process was not easy. Indeed, it was damn difficult–full of long hours, seemingly endless discussions, and tough, tough choices. But that was then. Some three years later, the providers at Chesterfield CSB are serving 70% more people than they did in 2007 despite there being no increase in available staff resources in the intervening period. That’s right, 70%! And that’s not all. While productivity rates soared, clinician caseloads were reduced by nearly 30%. As might be expected, the time consumers in need of services had to wait was also significantly reduced.

In short, everybody won: providers, agency managers, funders, and consumers. And thanks to the two days of intensive training in Richmond, Virginia organized by Arnold Woodruff, many additional public behavioral health agencies have the information needed to get started. It won’t be easy. However, as the experience in Chesterfield demonstrates, it is possible to survive and thrive during these tumultuous times. But don’t take my word for it, listen to how Larry and Lynn describe the process–warts and all–and the results: