Evaluation Findings: March 2016 through September 30, 2017
Who did we serve in Treat First?
Total: 3,910 clients were served during this 19 month period
- Gender: 54% were female and 46% were male
- Age: 37% were under 25 years ; 40% were 26-45 years and the remaining 23% were over 46 years of age.
- Race: Predominantly (61%) White, 4% African American, and 2% Native American
- Ethnicity: 49% Hispanic
What did clients say about their experience in the Treat First sessions?
- Adults: Rated the Treat First sessions very positively (i.e., 35 out of a maximum of 40 points) . They indicated that the sessions covered what they wanted, felt connected to the therapist and overall, thought their work together was good.
- Youth: Were even more pleased with their Treat First sessions (i.e., 18.5 out of a maximum of 20 points) They felt listened to, got to talk about what they wanted, felt good about the session work and felt positive about their next connection.
How many clients were able to resolve their issues within 4 visits? (And not need more care.)
Overall, 16% of the clients were able to have their needs met and not need more treatment after 4 visits. This was similar for both adult and youth clients.
Show/No Show rate:
- Two thirds (65.8%) of clients showed for their scheduled appointments.
There was a 21% “No Show” rate which varied across providers.*
*More recent trends indicate the No Show rate is at 16%.
Capacity: Number of visits per month:
The capacity of the providers to serve clients grew over the course of the project. In March of 2016, there were 378 visits. That grew to a high of 808 visits in August of 2017.
How are you better able to meet your client’s needs?
- It encouraged therapists to think more comprehensively about full engagement of client to meet all needs. Not to drag out referring to other supports, and to do them immediately. Increasing the urgent response to client stated needs.
Treat First helps client get needs met based on best interest of the client, rather than provider agency and regulations. Helping clients based on “what can I do vs. what’s wrong with you”
- Talked through EHR system limitations
- Flexibility for staff to be responsive to the need of clients
- Access services right away
- Emphasized that agencies should expect and embrace ongoing adjustments to work flow
- Several providers are using of check in tools on multiple levels
What do clients say or do to show that they are more engaged in their care?
- More success with 2nd appointment and connection to follow up services.
- Clients thinking more intently about need and fit for using CCSS
- Clients are more active about what services fit or don’t fit for them.
- Clients not complaining of the amount of paperwork: questions, assessment, and treatment planning that all happened on the first visit.
- Clients reporting that providers are more engaged and listening to them.
- Able to see clients quicker. Less wait list
- Talked about fit of Treat First and the population. (worried well is a better fit for Treat First at some agencies vs. chronic serious mentally ill).
- Treat First allows for cultural sensitivity.
Has Treat First supported/improved the quality of your care in any way?
- Treat First validated the utility of the Open Access format. Shorter wait times (from month+ to a week or so).
- Going well with staff, currently. Difficulties initially with change to Treat First. Adjusted work flow to be less information gathering-intensive in the first contact
- Able to respond more quickly and to client need. Person-centered
- Better connection and information at discharge
- Fluidity of discharge from inpatient to outpatient
- Psychiatrist refilling prescriptions immediately at this transition point out of hospitalization
- Managing doctors’. Schedules to allow Doctor. to refill immediately, rather than as a new and re-assessment. Prescribers will do this also with the discharge summary.
- Better engagement with hospitals about what is needed to smooth out transition. Hospitals responding. (Still some barriers based on location and capacity—getting creative with use of community resources)
- Opportunity to interact with MCO regarding hospital discharges.
- Quality is being highlighted: client input and feedback show this
- Able to observe bodily language of clients and affect change in clients
- Sets up client to interact with providers to be successful
- Perception of client experience—using this data to make adjustments to work flow
- Because clients are more engaged they also are more active in treatment planning
- Agencies noticing improved quality of assessments and other documentation
- Treat First is a culture change for agencies
- CSW are feeling empowered and appreciated
- Therapists seeing value of CSW’s.
- Evens out, and decreases, power differential between CSW and clinicians
- Valle Del Sol using Treat First model for all insurances, not just Medicaid
How does your staff feel Treat First is working for them and for their clients?
- Readiness, leadership and supervision sat at the front door to work through the work flow and identify Treat First clients.
- Staff peer pressured each other to get on board with Treat First process—this worked at La Casa
- Staff discerning urgent, important, both. Treat First fits better for both urgent and important.
Do you have more service capacity? Are you more responsive to referrals?
- Agency staff improved ability to meet the immediate needs of clients, including high needs clients
- Clinicians are thinking more about immediate linkage to other supports
- Some agencies able to see more clients (e.g., Lea County Guidance Center has seen 200 more clients than average)
- Because agencies are able to be discerning about matching services to meet needs of clients, agency have been able to see more clients and hire more staff
- Also improving collaboration with community service partners.
- Taking a burden off of behavioral health to “fix everything”
- Readiness also includes community resource availability, i.e., housing
- Agencies can get clients in for Treat First initial services but lack capacity to respond in the same way after the 4th visit. For one agency, the wait is up to 10 weeks on the 5th visit. La Casa takes this visit as a 1 hour to “clean up and tie up” the chart—assessment and treatment plan and then schedules future visits with client
- TF is a possible good use for interns and practicum students
What is your advice to other agencies considering joining Treat First?
- It pushes agencies to think about practice and processes that work for client first and with appropriate urgency
- It provides a good opportunity to make small adjustments along the way to learn and meet needs of agency also, in order to better focus on practice
- Stay open and communicate so you can to work through your workflow, EHR, and other processes .
- Empower staff at different points of practice
- It creates a rapid prototyping of process and strategies that have made for a learning cycle.
- Roll out slowly.
- Supervisors went through Treat First workflow with real clients. Training with live cases and at the supervisory level.
- Don’t overthink or be too rigid about the Treat First process
- Look at current practices to find the best easy overlay or alignment—early success and leverage programs. Cherry picking is encouraged for early success
- Leverage staff (networks) to build momentum and get buy-in at all levels of staff.
- Simulated role play worked well to prepared staff for Treat First changes
Suggestions to Leadership
- Take Treat First out of the pilot phase and make it the standard
- See all patients with a Treat First model and loosen up the timelines and rules. Eliminate the rules that no longer make sense
- Build flexibility to be considered a standard of practice
- How to we measure compliance and quality? Update compliance indicators
- Honor local implementation avoid overly prescriptive practice processes
- How do we help the practice model inform accountability?
- Assess every part of our system with: Is this in the best interest of the client?