Performance Improvement Report for 2019€¦ · improvement in functioning across all categories...

Performance Improvement Report for 2019

Washington County Health Department Division of Behavioral Health Services

Children and Mothers Experiencing Opportunities (CAMEO) House 750 Hospital Way

Hagerstown, MD 21742

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Demographics of Persons Served from January 1, 2019 – December 31, 2019

A. Gender CAMEO House is a residential program for pregnant women and women and children. The gender of all program participants is female.

B. Age Range

Analysis

CAMEO House residents typically have participated in multiple treatment episodes prior to admission to a level III.3 Program. Most residents (70%) are within 25-34 years old, which are typically age frames for childbearing. All women must be either pregnant or have children under the age of 10, which also coincides with the data that indicates that 70% of persons served are in the childbearing years. 13% of women admitted are younger than 24 years old, and the Program concludes that individuals under 24 years old have had fewer treatment admissions to higher levels of care (including III.3) due to a shorter span of addiction to a substance.

0

5

10

15

20

25

30

35

19 20-24 25-34 35-44 45-54

1 (2%)

5 (11%)

32 (70%)

7 (15%)

1 (2%)

Age Range of Adult Persons ServedN=46

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C. Race

Analysis The most recent statistics of race composition in the state of Maryland indicates that 58.8% of the population is

Caucasian, and 30.9% identify as African American or Black. Washington County Maryland data on race indicates that 82.6% of individuals are Caucasian, and 12.1% identify as African American. Racial composition at CAMEO House indicates that 63% of residents identify as Caucasian, 24% of residents identify as African America, and 13% of residents have an unknown race.

The statistics for persons served at the CAMEO House indicates that Caucasian residents (63%) are equally represented according to State of Maryland census reports. However, the Program has less Caucasian residents (63%) when compared to Washington County data (82.6%)

The CAMEO House receives referrals for admission through the Behavioral Health Administration. Referrals are received from women living all over the state of Maryland. A comparison of State of Maryland data with consideration of all counties indicates that 58.8% of the population identifies as Caucasian, and 30.9% of individuals identify as African American. The Program receives referrals from the entire State, which is reflective in the data of residents more closely matches data sets collected from the entire state, as opposed to Washington County data alone.

0

5

10

15

20

25

30

Black / African American White Unknown

11 (24%)

29 (63%)

6 (13%)

Race of Person ServedN=46

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The data set indicates that the race of 23% of residents was unknown. This data gap was caused by a failure to indicate race in the electronic medical record for data collection. The Program has an intervention of completing that screen consistently so that more accurate data can be measured in the future.

*Source: www.census.gov

Effectiveness

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Goal #1: Improve overall functioning of persons served from admission to discharge

Indicator Target Applied to Time of Measurement

Data Source Obtained by

Level of agreement change in functioning from admission to discharge on Q. 4, 5, 7 and 14 of the Adult OMS

Minimum of 30% improvement in functioning across all categories

Adult patients receiving treatment for at least 6 months that were admitted in 2018 but discharged in 2019 and/or patient admitted in 1/1/2019 and discharged by 12/31/2019

Upon patient admission, middle of treatment and discharge

Adult OMS questionnaire (adapted) PatTrac Report

Program Coordinator & Clinicians for data entry & analysis Operations & Compliance Coordinator for data collection

Result

Question #4 - I am confident that I can make positive changes in my life

Interview Period

Admission Concurrent Discharge

Average Score 3.84 3.63 3.68 *Higher scores indicate better / improved level in functioning; range is 0-4

Category Admission to Concurrent

N = 16

Concurrent to Discharge

N = 16

Admission to Discharge

N = 19

Count % Count % Count %

Same 12 75% 12 75% 14 74%

Better 1 6% 2 13% 1 5%

Worse 3 19% 2 13% 4 21%

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Analysis

Results indicate that most participants had the same level of confidence in making positive life changes from admission to concurrent to discharge. From admission to concurrent, 6% reported an improved level of confidence. From concurrent to discharge, 13% reported an improvement. From admission to discharge, 5% reported more confidence. Given the percentage of improvement, the Program did not meet the 30% target in the area of confidence level in making positive life changes. However, note that based on the average scores of patient response, it appears that residents have high level of confidence at admission (3.84) leaving little room for improvement in this area. This is the same result obtained from 2018’s data collection. Given the two consecutive year pattern, this particular question does not accurately measure program effectiveness and will therefore be excluded in next year’s performance measurement and management plan.

Question #5 - I am hopeful about the future

Interview Period

Initial Concurrent Discharge

Average

3.53 3.38 3.68

*Higher scores indicate better / improved level in functioning; range is 0-4


N = 16


N = 16


N = 19


Same 10 63% 10 63% 11 58%

Better 2 13% 5 31% 6 32%

Worse 4 25% 1 6% 2 11%

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Analysis Results indicate that most of the participants had the same level of hopefulness from admission to concurrent to

discharge. From admission to concurrent, the program did not meet the 30% target; however, the target was met from concurrent to discharge (31%) and from admission to discharge (32%). This result is also reflected in the average scores as indicated above. Note that this data set shows an improvement compared to 2018.

When the target was not achieved in 2018, one of the action plans was to increase counseling activities regarding

the importance of hope and how it impacts overall functioning and in maintaining sobriety. In 2019, the importance of hopefulness while living a life of recovery is a topic covered in clinical treatment groups, and is reinforced in individual counseling sessions. Program treatment curriculum will continue to include elements of improving hopelessness per the needs of the person served. Another interpretation of the data indicates that resident’s hopefulness increases congruent to length of stay because Program staff are effective in preparing residents for independent living following discharge. 2018 interventions implemented in 2019 were effective.

Question #7 - I am able to set my own goals in life

Interview Period


Average

2.89 3.06 3.37



N = 16


N = 16


N = 19


Same 9 56% 11 75% 10 53%

Better 5 31% 5 25% 8 42%

Worse 2 13% 0 0% 1 5%

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Analysis

Results indicate that most of the participants had the same level of ability to set personal goals from admission to concurrent to discharge. The Program met the target of 30% from admission to concurrent (31%) m and admission to discharge (42%). The implementation of case management plans for adults and children residing at the Program in 2019 was proven to demonstrate program effectiveness in teaching goal setting to residents through the course of treatment. The Program intends to continue with the implementation of case management plans and individual sessions focused on goal setting.

The target was not met from concurrent to discharge. This can possibly be attributed to difficulty in securing employment and housing in Washington County which are the primary goals for a successful transition to the community.

Question #14 – Overall, how satisfied are you with your recovery?

Interview Period


Average

2.68 2.94 3.26



N = 16


N = 16


N = 19


Same 7 44% 8 50% 8 42%

Better 6 38% 6 38% 10 53%

Worse 3 19% 2 13% 1 5%

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Analysis

The Program met the 30% target in increased level of patient’s satisfaction in personal recovery, which the Program views as an indicator of improvement in overall functioning. We may conclude that increased satisfaction with recovery demonstrates treatment services have been effective in providing skills and tools to person served to strengthen recovery efforts.

Efficiency Goal: Limit the number of residents transferred from level III.3 to level III.1 prior to Program discharge



# of residents discharged at level III.1

Maximum of 10%

CAMEO House residents

Discharges from 1/1/2019 to 12/31/2019

Program Treatment Slot Database

Program Coordinator and Operations & Compliance Coordinator

Result

2019 Program Discharge Count %

Annual count of patient discharge

34 100%

Annual count of patient discharge at III.3

32 94%

Annual count of patient discharge at III.1

2 6%

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Analysis

The Program met the goal of less than 10% of person served were transferred to Level III.1 at discharge. This goal has been set since the Program has changed Program time frames from 6-9 months of treatment to up to 6 months of treatment. Due to this change, the Program instituted case management plans which resulted in persons served identifying and reaching goals related to moving to independent living in the community in a shorter time period. This has decreased the need to transfer persons served to level III.I, as Medicaid reimbursement has paid for six months of treatment. Level III.I has reduced reimbursement rates compared to level III.3, so it is in the Program’s priority to keep persons served at level 111.3 for the entirety of the treatment episode.

Service Access Goal: Maximize occupancy of treatment slots.


Data Source

Obtained by

Average occupancy rate in 2019

92% average occupancy in 2019 with a minimum occupancy of 15 days per month

CAMEO House admissions and discharges

Admissions and Discharges from 1/1/19 to 12/31/19

Program Treatment Slot Database

CAMEO House Program Coordinator

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Result

Month in 2019

Percentage of treatment slots occupied for a minimum of 15 days

per month

January 92%

February 75%

March 83%

April 67%

May 83%

June 92%

July 83%

August 92%

September 58%

October 83%

November 100%

December 83%

Average 83%

Analysis

The CAMEO House did not meet the target goal of 92% of treatment slots were occupied for a minimum of 15 days. The data indicates the average percentage for the year was 83%. The Program had difficulty in 2019 with treatment slots going unfilled due to the Program’s dependency on the Behavioral Health Administration (BHA) for referrals. Due to BHA operating procedures, the Program is not able to seek out patients to potentially fill treatment slots, as all referrals are initiated by BHA. As individuals were discharged in 2019, it was challenging to automatically fill those treatment slots based on the number of referrals received from BHA.

Intervention

The Program will continue to work closely with BHA to fill treatment slots as soon as they are vacant. The Program will also provide education to the community about the Program, and the referral process, in order to increase referrals.

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Intervention for Retention of existing patients CAMEO will continue to work to improve in house issues in hopes of avoiding an unsuccessful discharge. We will

increase our use of behavioral contracts to address behaviors that put residents at risk of discharge.

Satisfaction

Goal: Increase satisfaction rating given by patients to an overall average score of 3.5 on the patient

satisfaction survey



Satisfaction rating given by program participants on the quarterly survey

Average rating is at least 3.5 on quarterly survey

Program participants

March, June, September & December, 2019

Completed Survey and Analysis Report

Program Coordinator and Operations & Compliance Coordinator

Result

Survey Item Average Response

March June September

December

Number of Survey Forms Received 9 9 6 7

Overall CAMEO House Services 3.06 1.94 1.98 2.84

Substance Use Counseling 3.44 2.56 2.60 2.86

Mental Health 3.29 1.17 - -

Vocational / School Services 3.38 1.00 1.60 1.83

Housing 3.14 - 1.80 1.40

Kidz Korner 2.63 - 2.75 4.50

Parenting - - 2.00 2.75

Overall Staff 3.41 3.89 2.68 2.56

Friendliness of Outreach Staff 3.56 4.44 2.50 2.14

Caring concern of counseling staff 3.22 - 2.33 2.43

Caring concern of counseling, mental health and nursing staff

- 4.11 - -

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Survey Item March June September

December

Caring concern of mental health staff 3.63 - - -

Caring concern of nursing staff 2.78 - 3.40 2.71

Courtesy of other support staff (secretary & maintenance)

3.88 4.11 3.00 3.29

Accepting of cultural needs 3.38 2.89 2.33 2.00

Overall Your Treatment 3.33 3.88 2.06 3.00

Explanation of clinical paperwork 2.67 3.33 2.17 3.14

Explanation of your person-centered plan 3.44 3.11 2.50 3.29

Treatment Groups 3.33 - 1.50 2.83

Overall Our Communication 2.78 2.72 1.17 1.57

Explanation of program / facility rules 2.56 2.67 1.17 1.57

Explanation of Level Progress 2.71 2.71 - -

Understanding Purpose of Program 3.78 3.78 - -

Overall Our Facility 2.89 3.26 2.83 2.67

Overall Comfort 3.33 3.78 2.83 2.57

Cleanliness 2.67 2.89 2.50 2.71

Playground, Activity Area and Equipment 2.25 2.44 3.20 2.71

Analysis

Overall the Program did not meet the goal of having an average of 3.5 rate of satisfaction among all categories. Overall CAMEO House Services

An analysis of ratings for Overall CAMEO House services indicates that the Highest Score was in the 1st quarter, it dipped in 2nd and 3rd quarter, but then increased again in December. The Program had turnover in five critical positions, which include the Director, Addiction Counselor, Parenting Coordinator, Vocational Coordinator and Logistics Coordinator. The impact of turnover lead to decreased Program efficiency related to the provision of services as new staff had to learn their job duties. Plan of action to improve satisfaction ratings next year are to continue to quickly fill open positions, and to listen to our clients when they make recommendations for improvements to the program. We have promoted our suggestions box recently, and current director has an open-door policy in regards to feedback and criticism.

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3rd and 4th quarter responses regarding housing were 1.8 and 1.4. The community has long waiting lists for housing, which impacts the persons served ability to find independent housing. The low scores may reflect delays to obtain housing due to community barriers, and not based on services at the Program related to housing. Our plan of action is to continue to making community connections to better assist our population in transitioning after our program. We have recently made two new connections to programs that assist women and children.

Overall Staff

An analysis of the patient satisfaction survey indicates that scores related to care and concern of counseling staff decreased by 1 point in September and December of 2019 in a comparison of overall average response from 3.22 in March of 2019. This can be attributed to the change in counseling staff which occurred in May 2019. The former Addictions Counselor, who had worked at CAMEO for three years was replaced in May of 2019 by a counselor new to the field of addictions treatment. The Program will provide education, feedback, and training to the new Addictions Counselor with the aim of improving persons served scoring related to caring concern of counseling staff.

An examination of results related to friendliness of outreach staff indicates that satisfaction in this area decreased in the 3rd and 4th quarters by almost 2 points. The Program had difficulty filling positions and retaining staff in 2019. As a result, the existing staff had to work overtime and double shifts to meet the Program needs which may have affected the friendliness of the outreach staff. As of February 2020, the program is fully staffed. The Program will reinforce customer service initiatives for outreach staff through training, role playing, and direct observation of staff. Overall Our Communication

There were significant decreases in overall communication among the four quarters. The rating decreased by 1 point in September and December, when comparing the satisfaction rates from March and June of 2019. In particular, the survey question related to explanation of program rules decreased in the 3rd and 4th quarter. The Program had a complete over haul of the clinical team (5 staff members) during the second half of 2019. As a result, Program policies and procedures were updated. There was a delay in the edit and distribution of the updated resident handbook, leading to inconsistencies among Program staff

regarding Program rules. Since hiring a Logistics Coordinator in January 2020, she has met with all active residents to review the handbook, and proper channels of communication. We believe we will see an increase in this area in coming months.

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Business Function

Goal: Increase amount of 2019 CY charges and collection compared to 2018 CY charges and collection



Actual amount charged and collected at the end of CY

At least 10% increase

CAMEO House Program

By January 31st of the following CY

PatTrac Charges and Collections Report

Operations & Compliance Coordinator

Result

996,640.16

968,850.67

106.11

979,206.97

870,374.65

113,442.08

- 200,000.00 400,000.00 600,000.00 800,000.00 1,000,000.00 1,200,000.00

Charges

Collection

Pending payments

CAMEO House CY 2018 and CY 2019 Charges, Collections & Pending

Payments

2018 2019

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Analysis

CAMEO House charged 2% less in 2019. This is most likely due to issues we have with our referral source in filling open beds. All referrals for CAMEO House come from BHA, which place women and children in one in four programs around the state. They often times are very busy, and have a slow response time in sending referrals, even with open beds in our program. We often times wait around 5-7 business days to receive a referral. We are addressing this issue with BHA with our new Logistics Coordinator. She is in communication with BHA via phone and email, and will contact them when a bed is open, or a referral declines a bed, immodestly instead of waiting until Monday.

Business Function

Goal: Decrease the adjustment amount between CY 2019 & CY 2018



Actual adjustment amount between CY 2019 & CY 2018

At least 50% CAMEO House Program

By January 31st of the following CY

PatTrac Charges and Collections Report

Operations & Compliance Coordinator

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Result

Analysis

CAMEO House’s adjusted charge amount was decreased by 67% in calendar year 2019 compared to that of 2018. The Program met the target due to efforts made in verifying due dates of authorizations. The Program intends to decrease the adjusted charge in calendar year 2020 by at least another 50%. In addition to continuing to implement the initiatives in place for 2019, the Program will continue to train our new Treatment Coordinator in 2020 in hopes to decrease the error rate in missing due dates for authorizations and concurrent reviews. The Treatment Coordinator will also be audited to ensure all clinical data in place for reimbursement.

27,683.38

9,142.92

18,540.46 (67%)

-

5,000.00

10,000.00

15,000.00

20,000.00

25,000.00

30,000.00

Ajustments

CAMEO HouseCY 2018 & CY 2019 Adjustment Amount

2018 2019 Difference

Performance Improvement Report for 2019€¦ · improvement in functioning across all categories...

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