Clients and case managers benefit from NIATx Change Project at IMPACT Alcohol and Drug Abuse

IMPACT is a service agency based in Milwaukee that helps people gain access to health and social services. The IMPACT 2-1-1 program, one of the busiest in the nation, serves 9 counties in southeastern Wisconsin. IMPACT Workplace Services offers employee assistance programs to companies and organizations that include manufacturing, education, and government and public service, and other areas. IMPACT Alcohol and Drug Abuse is the largest provider of alcohol and drug screening, assessment, and referral services in Wisconsin.

People who are convicted of Operating While Intoxicated lose their licenses and, in Milwaukee County, can only get them back after going through an assessment at IMPACT Alcohol and Drug Abuse. After appearing before a judge, drunken drivers have 48 hours to set up a meeting with a counselor at IMPACT, where their treatment strategy is determined.

In 2014, the Impact Alcohol and Drug Abuse had 7,000 open cases. One full-time case manager and two part-time case managers (who work less than 20 hours/week) were struggling to keep up with those open cases.

“An open case is one where a client has received an assessment and a recommendation for a driver safety plan, which is good for a year,” says Patricia Gutierrez, Alcohol and Drug Abuse Director at Impact. “The case manager has to follow all of those clients to make sure they’re attending treatment as ordered.”

Patricia is an experienced NIATx change leader, having participated in several Milwaukee County-based change projects over the past several years. When spring 2015 NIATx Change Leader Academy was announced, she thought it would be a great opportunity to for a change project focused on the IMPACT Alcohol and Drug Abuse open caseload. Specifically, the project sought to reduce non-compliance letters mailed to clients by 20%.

The NIATx Change Leader Academy was a refresher for Patricia. Michael Vocar, director of customer service for Impact, joined her at the Academy. Michael has participated on several NIATx change teams, but was a first-time attendee at the Change Leader Academy.

“The Academy really reinforced for me the importance of following the process,” says Michael. “A lot of times change teams want to rush through and make more changes, especially when they start to see positive results, but the Academy highlighted what I’ve heard Pat say over the years—to hold on and stick to the structure.”

Michael enjoyed the workshop’s interactive exercises and relaxed learning environment. “The instructors (NIATx Educational Services Director Amy McIlvaine and NIATx Coach Matt Roosa) created a very positive atmosphere. There were no wrong answers and I really liked that.”

Returning to the Impact office, the change team did a walk-through of the case manager’s phone message system. They discovered that that many clients were calling in response to having received a letter of non-compliance.

“Our process was to call the client directly if we didn’t get confirmation of treatment attendance from the provider,” explains Patricia. “If we couldn’t reach the client, we would send the non-compliance letter.”

Consequences on non-compliance include loss of an occupational license, which allows driving to and from work, and having to pay fees to get it reinstated.

Adds Michael, “We learned from the walk-through that providers were not contacting us because clients were not giving them the required information. The process was not working and it penalized the clients. ”

The result was a lot of back and forth between case manager and client—an overflowing voicemail box, and non-compliance letters. The change this team tested was to have a full-time staff member, Brian Cherry, monitor clients’ progress.

Brian makes calls to clients and treatment providers at 30-day intervals, starting at the tenth day. This process continues until clients complete their Driver Safety Plans. All the calls are tracked in a database.

This PDSA Cycle quickly showed positive results: the number of calls from people confirming their attendance in treatment dropped by 75%, from about 50 calls daily to 5 or 6.

And non-compliance letters? Comparing the first quarter of 2015 with the first quarter of 2014 showed a reduction in non-compliance letters of 57%.

As with many NIATx change projects, this change has yielded unexpected benefits. Patricia and Michael report that having fewer non-compliant clients has reduced the need for re-assessment. There’s less stress and better morale among the case managers. And the program overall has improved relationships with treatment providers and the Department of Transportation.

“Now that case manager is getting fewer calls, the front desk has fewer calls to transfer to her,” says Patricia. “This frees up phone lines for people who need to call us for an issue other than to confirm treatment compliance.”

The new system allows IMPACT to help clients address insurance or other barriers that keep them from completing treatment. “Clients now feel like someone is looking after them. We can keep more people in treatment through these phone conversations,” says Michael.  “We didn’t even think about that when we were planning this change project.”

Adds Michael, “This change project showed how for years we were actually creating more work for ourselves. Now, we’re nipping problems in the bud by being proactive.” 

IMPACT has added support for NIATx change projects—Executive Vice President John Hyatt is a NIATx coach who has been involved in the successful NIATx Wisconsin Mental Health Collaborative since 2010.

“We have a list of NIATx projects that we want to tackle, and John is there to reel us in if a change project gets out of hand,” says Patricia.

An upcoming NIATx change project will again look at IMPACT’s phone and messaging system, and staff are eager to be involved in it.  

“When staff see success with one change project, that opens the door for the next NIATx project,” says Michael.