Jefferson County reduces teen referrals, uses NIATx model to set annual goals

The Jefferson County Human Services Department in Jefferson, Wisconsin, has been using the NIATx model for its improvement projects almost continuously since 2009.

We wrote about some of their NIATx projects in 2013 in a NIATx E-news story, NIATx goes countywide.

“NIATx was just a good fit for our department,” says Director Kathi Cauley. “The appeal for us was that was easy for our staff to learn, it produced results, and we also started to save money pretty quickly.”

As an example, she cites a recent change project conducted as part of NIATx Wisconsin Mental Health Collaborative. The aim of the project was to reduce adolescent emergency detentions to the Winnebago Mental Health Institute, a psychiatric hospital located about 80 miles from Jefferson.  

“In 2013, the number of teens being referred to Winnebago was rising. We wanted to figure out why,” says Cauley. “Emergency detentions are costly and very traumatic for everyone involved, so we set up a change project to find better options.”

The first step was to assemble a change team, the Youth Crisis Stabilization Services Change Team. The team includes supervisors from the behavioral health divisions, family supervisors, and a fiscal person.

“Assembling a change team is one of my favorite parts of the NIATx model,” says Cauley. “We’ve found that staff feel empowered when they’re asked for their input, and you get the best ideas and information by including staff from every level of the organization.”

The team looked at factors that might be making some teens high-risk for emergency detention. They also examined the county’s crisis plan template and found many ways to improve it.

“Once we revised the crisis plan, we retrained staff,” says Cauley. “The new plan included working with the parents to identify what they could do differently to avoid the referral.”

By the end of 2013, 100 staff had been trained in the new procedure.

“By 2014, we had reduced our adolescent emergency detentions from 33 to 18 and saved the county enough money to invest in a new youth therapist position,” explains Cauley. “We’re hoping that we’ll see even better outcomes with that as well.”

Another part of the project involves the county’s foster care coordinator, who is working on developing a foster home that could be a community crisis stabilization facility and an alternative to hospital referral.

“This will be a place for doing crisis stabilization for less than 24 hours,” says Cauley. “Sometimes kids need a respite from the home environment and a neutral place to regroup, practice skills, and then go home.”

Cauley encourages anyone getting started with the NIATx model to start with something small, like the phone system.

“When we changed our phone systems, we found out that somehow we were missing voicemail messages,” says Cauley. “When we did a walk-through, we found out that pressing 0 to leave a message actually ended up in dropped calls.”

That problem was solved quickly with the help of the county IT team.

Cauley will be launching a large change project that will start with a walk-through of each of the department’s behavioral health divisions. Cauley will take on the role of Medicaid auditor, and a colleague will play the role of an administration services manager. They’ll be looking for process and system-related issues, and Cauley expects that each walk-through will take an entire day.

“We’ll be using the walk-through results to way to help set annual goals across the system,” says Cauley. “The beauty of NIATx is that you can use it to change any process of any size.”