NIATx goes county-wide: Jefferson County, Wisconsin

Kathi Cauley, Director of the Jefferson County Human Services Department in Jefferson, Wisconsin, has seen quality improvement programs come and go in her two decades with the department.

“What makes the NIATx process different is that it’s very easy and it helps you focus on your data,” comments Kathi. That simplicity and data focus have contributed to the Department’s adoption of the NIATx model across all of its divisions. All supervisors and managers have attended a NIATx Change Leader Academy, with multiple change projects in progress.

“Using NIATx principles has helped us transform our thinking and our culture, to become more responsive, more accountable, and make better decisions,” adds Kathi. 

The department consists of five divisions: Aging and Disability Resources, Administrative Services, Behavioral Health, Child and Family, and Income Maintenance.

NIATx efforts in 2012 included projects to improve:

• The intake process for clients admitted for inpatient substance abuse treatment
• The collection rate and documentation requirements for third-party billing
• Compliance with deadlines
• Access to interpreters for non-native English speakers
• Awareness of services offered through the Aging and Disability Resource Center
• Billing for targeted case management, to build in sustainability for an employment transitions program

The department’s participation in several NIATx initiatives has also contributed to its adoption of the quality improvement model. As part of the 2012 Wisconsin Strengthening Treatment Access and Retention-State Implementation project, the department used NIATx principles to explore selection and implementation of electronic health records and identify possible EHR options to implement. It was also active in the state’s Aging and Disability Resource Center’s (ADRC) Aiming for Excellent project, which introduced the NIATx model to all active ADRCs in the state. And as a participant in the NIATx Wisconsin Mental Health Learning Collaborative since 2011, the department has focused on reducing costly readmissions to psychiatric hospitals for people in the county’s mental health system.

Jefferson County serves approximately 500 patients in the public mental health system each year. The county does not have its own psychiatric hospital, but refers patients requiring hospitalization to other facilities in neighboring counties.

Within Jefferson County, Lueder House is a community-based residential facility that provides psychiatric care either pre- or post-hospitalization, or in some cases, in lieu of hospitalization. As part of the county’s Community Support Program, Lueder House provides psychiatric services, symptom management, vocational placement and job coaching, counseling, social support, coaching in activities of daily living, and other services.

The department’s change project for the Mental Health Learning Collaborative looked at how quickly county residents were being seen at Lueder House after discharge from a psychiatric hospital.

“The change team wanted to improve the admissions procedures at Lueder House and also wanted to improve the way treatment goals are set,” explains Kathi. “Examining that process showed that it wasn’t entirely clear who was supposed to be doing what to ensure smooth transition to Lueder House.”

Walk-throughs of the Lueder House admission process resulted in two change projects: one to streamline the paperwork, and a second to establish specific person-centered treatment goals.

As a result, admissions for short-term admissions of less than 10 days dropped from 62% to 42%; repeat stays dropped from 31.7% to 30.30%, and bed days increased by 33%.

“Consumers also reported much more positive outcomes from their stay at Lueder House,” reports Kathi.

In a current NIATx change project (2013) for the mental health collaborative, the county is

Working to improve crisis response times with law enforcement.

Participation in NIATx collaboratives has included support from an expert coach. John Hyatt,

Is Senior Vice President of IMPACT, a behavioral health assessment and referral organization based in Milwaukee, and also a NIATx coach. He’s been the coach for the department’s projects with the Wisconsin Mental Health Learning Collaborative. Says Hyatt,

“Kathi and her team have done a great job of “running” with NIATX concepts in their project to reduce hospitalizations as well as in all the other applications throughout their system.”

Kathi encourages other county human services departments to consider using the NIATx model to improve their systems. “Using the NIATx approach built a real can-do attitude among our staff. With all the changes we’re faced with now, NIATx makes it easy to address system level problems.”