Linking Healthcare & Problem Oriented Justice Systems: Strategies for Multi-Sector Alignment

Michael S. Shafer, PhD Nicole Janich, PhD, MSW

Adrienne Lindsey, MA, DBH

2018 AADCP Problem Solving Courts Conference: Heroes Unite for JusticeThursday, April 19, 2018Prescott, AZ

Learning Objectives

Multi-sector, multi-agency systems

Interplay of healthcare services and justice systems involvement

Strategies for maximizing multi-sector alignment

Resources & opportunities

part I: multi-sector, multi-agency systems

Culture of Health

Framework

CultureValuesLanguageResources

Areas of Multi-Sector Alignment

Tuckman’s stages of group development

Communication

Collaboration

Coordination

part 2: interplay of healthcare services and justice systems involvement

PresenterPresentation NotesW

Public Safety

Public Healthor

PresenterPresentation NotesPublic SafetyPublic Health ProtectPrevent, TreatRetributionRecoveryControlEmpowerOffenderPatient

sequential intercept model

Systems & Tools• Crisis Intervention Team

Training• Mental health courts• In-jail healthcare

services• Jail/prison release and

re-entry

Settings• Police Depts.• Courts• Jails/Prisons• Hospitals• Outpatient Clinics• ED/Urgent Care

Centers

Parties• County Prosecutors• Public Defenders• Peer Support Specialists• Case Managers• Psychiatrists/Psych. Nurses• Primary Care Physicians• Probation & Parole Officers• Emergency Room Physicians• Psychologists, Counselors

part 3: strategies for maximizing multi-sector alignment

change team defined

change teamA change team is (ideally) a group of individuals from several agencies, across multiple disciplines and various organizational levels, working together to complete one or more tasks toward a shared goal or objective.

(Allen, Foster-Fishman, & Salem, 2002; Hackman & Wageman, 2005; Rycroft & Malone, 2004)

PresenterPresentation NotesSimilar to a steering committee, action committee, etc. but actively engaging in and responsible for change

types of change teams

intra-agencyinternal single-agency change teams

inter-agencymulti-agency change teams

PresenterPresentation NotesBoth are feasible and useful; we will be focusing on inter-agency and multi-section change teams

inter-agency team benefits

interdependency of systems

consumers access multiple systems

improved linkages and relationships

improved access to services

PresenterPresentation Notes*Our systems are inextricably connected; must work together to reach our full potential*consumers must access multiple systems; ideally we’re working together for better continuum of care *linkages & relationships – can we take an existing relationship and make it better, stronger, more efficient

agency championschampions/opinion leadersChampions or opinion leaders are individuals within an agency who have the ability to influence others’ attitudes and behaviors towards the change objective due to their status or knowledgewithin their agency.

(Greenhalgh, Robert, Macfarlane, Bate & Kyriahkidou, 2004; Kitson, Harvey, & McCormack, 1998)

PresenterPresentation NotesDon’t want to fill an interagency change team with those who are ‘voluntold’ Who stands out as passionate? Informed? Willing to make the time? Who is well respected by their peers? If they don’t have the support/faith of the organization (particularly line staff) may not be effective

external facilitatorsexternal facilitatorThe person who enables a group to work more effectively in the process of undergoing organizational or inter-organizational change.

The external facilitator provides structure, focus, and direction for the group, while enabling group decision making and maintaining focus on tasks and the process of change.(Loftus-Hills & Harvey, 1999; Kitson et al., 1998)

PresenterPresentation NotesExternal facilitator provides the benefit of neutrality & objectivity Can also carry the load/lift when agency staff cannot (e.g. report writing, minutes documentation, etc.)

change team leaderchange team leaderThe Change Team Leader is an optional leadership positionwithin the change team who facilitates the change team alongside the external facilitator, and assists and supports the external facilitator with operations andlogistics.

PresenterPresentation NotesIdeally a change team is co-facilitated by an internal change team leader (co-chairing for multiple agencies also acceptable) and external facilitator

facilitator role

establishing trust

ensuring fairness

team motivation

identifying good goals

resolving conflict

focus

balancing agendas

gentle reminders

accountability

PresenterPresentation NotesBenefits of an external facilitator Balancing agendas: Assisting agencies with different goals and different lenses find common groundGentle reminders: ‘if you recall you said you would do x, is that still feasible?’

change team leader role

identifying organizational needs

prioritizing goals

generating goals to address needs

identifying problems

communicating change

assigning tasks

creating timelines

implementing goals

team member characteristics

interest

voluntary participation

tenure

subject matter experts

strong communication skills

organizational influence

availability

strong relational skills

partner agency considerations

trust

relationship quality

referral stream

existing contract

proximity

information sharing

PresenterPresentation NotesRelationship quality: some semblance of beginning trustAlready some referral stream between the agencies; contractual or willingness to move toward contractual is helpful

facilitator requirements

• group dynamics• challenging norms• organizational dynamics• implementation science• systems knowledge• leading group processes• strong communication skills

knowledge and skills

PresenterPresentation NotesWhether internal or external these are importantChallenging norms – to make change must challenge norms & the status quoShould be familiar with both or all systems involved (e.g. medical, BH, CJ), otherwise will lose credibility with one side Diplomatic communicator

implementation obstaclescommon obstacles• turnover• team conflict• team member

absences/non-participation

• leadership changes• lagging motivation• lag time/start-and-stop

progress• external forces

(state/local budgets, organizational-level changes)

PresenterPresentation NotesHaving a strong facilitator is important to avoid conflict or manage conflict appropriately

seeing the changehow will you know the change you are looking to see is taking place?• need for a baseline measurement• methods of measuring change• piloting the change• adjusting the change

PresenterPresentation NotesIs what you’re doing actually impacting the change you hoped to see?

MAT in community corrections environments (MATICCE) model

pharmacotherapy exchange

council (PEC)

community corrections

MAT providers

external facilitator (ASU)

PresenterPresentation NotesThis is the ‘change team’ Members: chief of probation, CEO of MAT agency, medical providers (nurses), line staff (POs), drug court sup

phases of the organizational linkage intervention

Phase Primary Outcome(s)Pre-Phase Local team is formed and project is introduced

1. Needs Assessment

Team completes a Needs Assessment that identifies the relative strengths & weaknesses in the inter-organizational practices

2. Strategic Planning

Team develops and adopts a Strategic Plan that identifies goals and objectives for improvements

3. Implementation Team works in a collaborative manner to implement the objectives and attain the goals identified in their Strategic Plan

4. Follow-Up Team assesses the relative sustainability of both the process improvement targets achieved and the method for facilitating process improvements

PresenterPresentation NotesNeeds assessment: what are we already doing well? What could we improve? (from a multi-sector perspective) Strategic plan: doesn’t have to be daunting, intimidating term; it is a roadmap to how you are going to get to what you want to achieve (some may be more ambitious than others; dependent on resources) Implementation: the going and doing it

MATICCE PEC needs assessment & strategic plan: POs don’t know enough about MAT (cross training), POs don’t know where to refer (provider brochure), tx agency didn’t always know if referral was for MAT or other services (changed referral process), some non-AHCCCS eligible probationers couldn’t afford MAT (patient assistance program)

strategic planning objectives

• staff training• cross-training• improve interagency communication &

collaboration• e.g. releases of information, streamlined referral

process• identify additional funding streams• develop shared standards

• e.g. monitoring medication compliance

PresenterPresentation Notes*staff training: POs did not know enough about MAT; brought in UA School of Pharmacy & MAT tx providers *cross training: MAT provider agency coming in to discuss their services (how to access, intake process, etc.) *communication: change referral process to make it more clear when an MAT referral was being sought vs. tx as usual*additional funding streams: tribal for their AI/AN, px assistance programs, etc.

MATICCE PEC needs assessment & strategic plan: POs don’t know enough about MAT (cross training), POs don’t know where to refer (provider brochure), tx agency didn’t always know if referral was for MAT or other services (changed referral process), some non-AHCCCS eligible probationers couldn’t afford MAT (patient assistance program)

MAT referrals

Chart1

baseline

post-intervention

6 month follow-up

Column1

percent of alcohol/opioid involved offenders referred for MAT

1%0

18%0

24%

1

18

24

Sheet1

Column1

baseline1

post-intervention18

6 month follow-up24

To resize chart data range, drag lower right corner of range.

organizational process improvement intervention (OPII)

local change team (LCT)

community corrections

substance abuse providers

external facilitator (ASU)

strategic planning objectives

• increase trust between probation and substance abuse treatment providers

• improve referral process and information sharing

key activities

• developed joint procedures for information sharing

• frequent meetings to collaborate• cross trainings and walkthroughs • regularly assessed progress towards goals -

made adjustments as needed

PresenterPresentation NotesCross trainings and walkthroughs - many commented were most helpful because they got to really understand what each agency went through with clients, and developed a shared understanding of the tools and processes

results• surveys showed improvements in

service coordination• probation officers more comfortable

reaching out to counselors• counselors able to utilize information

shared by probation (i.e. OST/FROST results)

**case example**

PresenterPresentation NotesRead this excerpt from report for case example: An interview was conducted with Probation Officer Jarek Wrobel about a specific case in which he utilized this new process. According to Officer Wrobel, the probationer he worked with had multiple drug-related convictions, numerous probation grants, violations, and reinstatements. One of his goals for this probationer was to intervene with her heroin use by providing addiction treatment and monitoring her behavior in the community. The probationer was an ALPHA Program graduate, and as such she was enrolled into the “after care” program at Sage Counseling. The Officer faxed over a referral along with the FROST and the case plan. In return he received a rapid response from the provider, with specific treatment recommendations to address the probationer’s addiction. Over the next few months of supervision, Officer Wrobel received information from the provider concerning the probationer’s attendance, participation, and progress on their treatment plan, and received immediate notification when the probationer failed to attend services. Because of this new process he was able to quickly address any behavioral concerns. In the Officer’s own words, “the client knew that we were in close communication with the provider and we were both there to help”. This was in contrast to the previous process, in which the officer provided a verbal direction to the defendant to report to a provider, without sending assessment or case planning information, and then requested information from the provider concerning treatment planning and progress at a later date.

part 4: reflective exercise

Thank you!

Adrienne Lindsey, MA, DBHPrincipal Manager, Interprofessional Training & Curricula

Adrienne.Lindsey@asu.edu

Michael Shafer, Ph.D.Director, Center for Applied Behavioral Health Policy

Professor, School of Social WorkMichael.Shafer@asu.edu

Nicole Janich, MSW, Ph.D.Research Specialist Senior

Nicole.Janich@asu.edu

mailto:Adrienne.Lindsey@asu.edumailto:Michael.Shafer@asu.edumailto:Adrienne.Lindsey@asu.edu

Linking Healthcare & Problem Oriented Justice Systems: Strategies for Multi-Sector Alignment�Learning Objectivespart I: multi-sector, multi-agency systemsCulture of Health FrameworkSlide Number 5Slide Number 6Culture�Values�Language�Resources�Tuckman’s stages of group developmentSlide Number 9Communicationpart 2: interplay of healthcare services and justice systems involvement���Public Safetysequential intercept modelSlide Number 14part 3: strategies for maximizing multi-sector alignment change team definedtypes of change teamsinter-�agency �team �benefitsagency championsexternal facilitatorschange team leaderfacilitator rolechange team leader roleteam member characteristicspartner �agency considerationsfacilitator requirementsimplementation obstaclesseeing the changeMAT in community corrections environments (MATICCE) modelSlide Number 30phases of the organizational �linkage interventionstrategic planning objectivesSlide Number 33organizational process improvement intervention (OPII)Slide Number 35strategic planning objectiveskey activitiesSlide Number 38part 4: reflective exerciseThank you!