NO WRONG DOOR IN MCDHHS/MD

NACCHO HIT WORKSESSIONJuly 14, 2010

An integrated and interoperable health and human services care

delivery system!

04/24/20231

Today’s agenda

CONTEXT ABOUT MONTGOMERY COUNTY WHY THIS IS IMPORTANT OUR SERVICE INTEGRATION EFFORTS 3 AREAS NEEDING INPUT:

› ELIGIBILITY› DATA SHARING› FUNDING FLEXIBILITY

HEALTH CARE REFORM AND THE OPPORTUNITY BEFORE US

NEXT STEPS

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INFORMATION ABOUT OUR COUNTY: 1 MILLION RESIDENTS 29% FOREIGN BORN 44% ETHNIC MINORITY 40,000 OUT OF 140,000

CHILDREN IN THE PUBLIC SCHOOL SYSTEM ON FARMS

OVER 32,000 UNINSURED ADULTS, CHILDREN AND WOMEN SERVED THROUGH HEALTH CARE SERVICES

SERVED 70,000 HOUSEHOLDS IN FY09 AND 39,000 USED MORE THAN TWO SERVICES FROM THE DEPARTMENT

A STAFF OF 1500 WITH OVER 80 PROGRAMS

TANF/SNAP, MA AND EA CASELOAD GROWING – APPLICATION VOLUME GREW BY ALMOST 42%

6 ZIPCODES OF EXTREME NEED – POVERTY ON THE RISE

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InterOptimability Drivers: Consumer-centric, Family Focused, Technology Enabled

WORKFORCE

GOVERNANCE

BRIDGING SILOS

CONFIDENTIALITY

PUBLIC AND POLITICAL WILL

CONSUMER CENTRIC

FUNDING

PERFORMANCE MANAGEMENT

INTEROPERABLE INFORMATION TECHNOLOGY

OPEN & INCLUSIVE

PROCESSES

TANF

Juvenile Justice

Education

Hea

lth

Food Stamps

Substance Abuse

Early

Learning

Child Welfare

Men

tal H

ealth

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How is DHHS Organized?

In 1996, 4 County departments became one entity.

Objective: Integrated, coordinated and comprehensive service delivery.

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How is DHHS Organized? One Director Centralized administrative functions Moving towards single client record

supported by an interoperable database Uniform intake form to identify all service

needs Designated entire HHS entity as HIPAA

covered – including social service and income support programs.

Department of Health and Human Services Organizational Overview

Office of the Director Uma S. Ahluwalia Director

Policy Oversight & Integration Public Information Labor Relations Special Initiatives Advisory Boards, Commissions and Committees

Aging and Disabilities Services John J. Kenney, Chief

Information and Assessment Services

Home and Community Support Services

o Community Support Network/Disability Services

o Home Care o Adult Protective Services/Case

Management Services o Nutrition Program

Assisted Living and Skilled Nursing Facilities

o Assisted Living Services o Ombudsman Program

Boards and Commissions o Commission on Aging o Commission on People

w/Disabilities Disabilities o Adult Public Guardianship

Review Board

Behavioral Health and Crisis Services

Raymond L. Crowel, Chief Mental Health Services o Adults and Seniors o Children and Adolescents o Multicultural Mental Health

Services Core Service Agency Substance Abuse/Addiction

Services Crisis Stabilization Partner Abuse Victim Abuse Boards and Commissions o Alcohol and Other Drug

Abuse Advisory Committee o Mental Health Advisory

Committee

Children, Youth and Family Services

Kate Garvey, Chief and Social Service Officer

Linkages to Learning Child Welfare Child and Adolescent Services Juvenile Justice Early Childhood Services Gang Prevention Initiative Income Supports and Child Care

Subsidy Liaison work with MCPS Boards and Commissions o Commission on Children and

Youth o Commission on Child Care o Commission on Juvenile

Justice o Citizen Review Panel

Public Health Services Ulder Tillman,

Chief and Health Officer Community Health Services Communicable Disease/

Bio-Terrorism Cancer and Tobacco Initiatives Licensure and Regulatory

Services o Assisted Living Facilities

Certification School Health Montgomery Cares Health Promotion Health Partnerships and Planning Long Term Care Medical

Assistance & Outreach Special Projects Boards and Commissions o Commission on Health o Montgomery Cares Advisory

Board

Special Needs Housing Nadim A. Khan, Chief

Housing Stabilization / Emergency Services To Prevent Homelessness

o Economic Supports Emergency Assistance Grants Welfare Avoidance Grants 60-Month Intervention

o Resource Supports Preventive Crisis Intervention with

case management Rental and Home Energy Assistance

Programs o RAP-Shallow Rental Subsidy Program o SHRAP-Deep Rental Subsidy Program

w/Service Coordination o Handicapped Rental Assistance

Program o Home Energy Assistance Programs

Homeless Continuum of Care Coordination (Supported through non profit partners) o Single Adult Shelters w/case

management o Family Shelters w/case management o Motels Placement and Overflow Shelters o Transitional Programs o Permanent Supportive Housing

Programs Interagency Housing Workgroup

Community Affairs Betty Lam, Chief

Community Action Agency and Board

Community Outreach Disparity Reduction Diversity Initiatives LEP Compliance

Chief Operating Officer Sherry White, COO

Budget and Finance Contracts Logistics and Facilities Information Technology Human Resources Operations and

Administration Compliance (ADA, HIPAA,

Olmstead)

Planning, Accountability and Customer Service JoAnne Calderone,

Manager Customer Service Grants Information and Referral Performance Management Strategic Planning

Legislative Coordination Intergovernmental Relations Patricia Brennan, Manager

Federal Congressional Delegation State General Assembly County Council Liaison

Special Assistant to the Director

Traci Anderson Labor Relations

Special Assistant to the Director

Robert Debernardis Facilities Management

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Outcomes to be achieved Earlier comprehensive identification of

individual/family needs Quicker delivery of comprehensive and

integrated services – would reflect a public and private partnership effort

Individuals/families achieving outcomes identified in their respective case plans

Improved cooperation and collaboration among staff of the public and private partners

Improved client functioning – place based approach to care delivery where possible

Improved client satisfaction Reduction in length of stay in

services/treatment/care Reduction in recidivism Increased efficiencies – an ROI/SROI metric

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Montgomery County Department of Health and Human Services

Services and MD State Department Connections by Service Type

• Aging and Disability Services DOA, DOD, DHR, DHMH, DVA

• Behavioral Health and Crisis Services DHMH, GOC, DHR, DPSC

• Children, Youth and Family Services DHR, GOC, GOCCP, DJS, MSDE

• Public Health Services DHMH, MSDE, DHR

• Special Needs Housing DHR, DHCD, DHMH

• Community Outreach | All Departments

ADS

BHCS

CYF

PHS

SNHDepartment of

Health and Human

Services

FEDERAL AGENCIES WHOSE REGULATIONS AND FUNDING STRATEGIES IMPACT COUNTY SERVICES

ACF CMS SAMHSA HRSA CDC ONCHIT HUD NIH VA OFFICE ON AGING HOMELAND SECURITY

TITLE XIX TITLE IVE CSBG CDBG MENTAL HEALTH BLOCK

GRANT FEDERAL and STATE

GRANTS

40% DHHS BUDGET IS FROM STATE AND FEDERAL SOURCES

60% OF DHHS BUDGET IS FROM COUNTY SOURCES

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ECO Map of DHHS, State & Federal Agencies

State:

DHHSPHS

CYF

ADS

SNHBHCS

MSDE DHR DHMH

County:

ACF

Montgomery CountyDTS

Enterprise infrastructurePoliciesSecurityCIO support and outreach

ONCHIT HRSA SAMHSA CMS HUD

Federal:

DOAGOC

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One Director

Centralized Administrative Functions

Moving towards single client record supported by an interoperable database

Uniform intake form to identify all service needs

Designated entire HHS entity as HIPAA covered — including social service and income support programs

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How is DHHS Organized?

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Community

Outreach

Children Youth and

Family Services

Publ

ic H

ealt

hSe

rvic

es

Special Needs

Housing

Aging and Disability

Services

Beha

viora

l Hea

lth

and

Crisi

s Ser

vices

CHIP

-Com

mun

ity H

ealth

Im

prov

emen

t Pro

cess

QSR-

Qual

ity S

ervi

ce R

evie

w

Info

rmat

ion

Tech

nolo

gy

Labo

r Man

agem

ent P

artn

ersh

ip

HHS Team Member

Team Member

Community Partner

Team Member

Customer Team

Member

INTEGRATED SERVICE TEAM

\

Accountability

Customer ServiceTrustEquity

One HHS Lane

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1995

1995 -

2003

2003 – 2007

2007

2009

2010

Integrated Department created by State

Legislative action from Four local departments. Legislation also creates a single entity for purposes

of HIPAA

Co-location deepens partnership and coordinated and

integrated business practices

Successor to the Director with the integrated vision takes office. She hires APHSA to help with integration. More

conversations, focus groups and activities occur. Work stops though at point that

deepening integration runs into workforce resistance

I take the job and believe that the County Executive has given a mandate to further integrate the department. Assess activities and accomplishments to date and begin to build on past work. Get grant from Casey Family Programs at the start of December 2007. Grant commences January 2008. Conduct assessment and vision map

Opportunities emerge from Stewards of Change convening

at Yale with federal partners; built our Beacon proposal with a

clear vision for a unified Electronic Health and Human

Services Record. Change Management and small test of

change

Work continues with many outreach

opportunities with State and Federal entities

Timeline

Homeless diabetic woman with Schizophrenia Three episodes of hospitalization in last 12

months Hard for her to regularly take medications Hard for her to have nutritious meals

Services offeded by DHHS to address these complex needs

a. Homeless Programb. Mental Health Treatmentc. Montgomery Caresd. Housing Stabilization Services 15

Scenario One

15 Year old Latino Male Referred to Crisis Center after school suspension Indicates to counselor his desire to commit suicide Mother receiving mental health services Father believes the family troubles are a private matter Father is strict and bruises on client may indicate abuse

Services Offered by DHHS for this familya. High School Wellness Centerb. Mental health services for child, mother and family unitc. Anger managementd. Culturally competent service deliverye. Meaningful after school time activities

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Scenario Two

42-year old non-English speaking recent immigrant Tests by DHHS indicate she has tuberculosis Appears to be some domestic violence at home Has two children ages 2 and 6 – and is pregnant again 2 year old needs child care, family can not afford it 6 year old has special needs and housing is unstable

Services offered by DHHS to address these complex needsa. Public Health TB Clinicb. Child Care Servicesc. Maternity Servicesd. Income Support Servicese. LEP Servicesf. Domestic Violence Service via Abused Persons Programg. Adult Mental Health Servicesh. Housing Stabilization Servicesi. Education through Public School System

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Scenario Three

90 year old woman identified as hoarder 21 year old great-grand-daughter moved in Great grand-daughter has two preschool aged children Great grand-daughter a former drug user is abusing again Department of Housing believes house not livable

Services offered by DHHS to address these complex needsa. Adult Protective Servicesb. Child Welfare Servicesc. Early Learning and Child Cared. Special Needs Housing Servicese. In-home Aide Servicesf. Income Supportsg. Substance Abuse Treatmenth. Medical and Primary Care

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Scenario Four

No matter which door she arrives through

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She will be greeted and provided the face sheet

Check in screen04/24/2023

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Service RequestForm

NeedsQuestionnaire

She will fill out service request form and needs questionnaire

Basic demographicinformation

Client identifiedneeds

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Triage worker interviews her

Confirms needs and schedules appointments

or provides referrals04/24/2023

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She leaves session with appointments for follow-up assessments

Appointment and referral letters in six languages04/24/2023

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Care coordinator gets feedback from program assessments

If client meets criteria coordinator calls for a service team

HIV-AidsY

TCAY

Child careY

System provided feedback regarding

assessments outcomesHousing

N

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Service Team established and coordination with client begins – Virtual or in person with client as core participant – self directed care as much as possible

Better outcomes with coordinated care04/24/2023

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TOOLS WE HAVE DEVELOPED› Universal Screening tool

› Face Sheet

› Confidentiality Policy

› Practice Model

› Scheduling tool

› Customer service protocols

› Qualitative Evaluation tools

› Enterprise tools Oracle ERP Seibel CRM

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ABC Residential

& Group Care

Health & Disability

Caseworker Team

Planning & Resource Allocation

Financial Management

Program Management

Information Technology

Child Welfare

Aging Voc. Rehab

Mental Retardation

Seniors Centers

Medicaid Contractor

No Child Left

Behind

GoodwillServices

DevelopmentalDisabilities

Community Health

CommunityMental Health

Workforce Develop

Medicaid

Income(TANF, Emerg.

AidMedicaid

Jewish Community

CenterCatholic

Chairities

Child Care

CourtsCriminalCivilJuvenile JusticeFamily CourtDivorce

Head Start

Team-basedIntegrated

Intake

Head Start Providers

Federal Dept.of HHS

Federal Dept. of Education

Criminal Justice Ecosystem

Complexity of the Health & Human Services Ecosystem

State Health & Human Services

Local Social Service Agencies

Information Technology

State DepartmentOf Education

Multi-Discipline

Client Plan & Review

WIA

PortalClient dataProvider dataReferral dataPerformance

Workflow &Scheduling

TANF

EBT

Data Warehouse

BI ToolsEAI Tools

State Tax

Suppliers

One Stop CentersMultiple LocationsInterdisciplinaryPre-eligibility AssessmentEmergency AssistanceChild careService Delivery (e.g. Empl.)Facilitate Self-service

Secured Internet

Police

Banks ClientsUnited WayHospitals

Network of Community Service

Providers

SACWIS

Child Support

Integrated Case Management

Food Stamps

Child Welfare Caseworker

Team

Child SupportCollections

Income Sec.Caseworker

Team

K-12 Education Ecosystem

Workforce Inv.Child Welfare

Foster CareProtectiveAdoption

Public HealthMental Health

SubstanceAbuse

Treatment

ERP

Schools

RevMax

MedicaidTANF

Regional State & Local Client Plan & Assessment Teams

Productivity &Collaboration

IntegrationTechnologies

Provider Management

Compliance Management

Human Resource Management

IT Management

DepartmentManagement

Microsoft Architectural Vision

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DHHS Change Vision 2015

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Intake and Eligibility — Opportunity with Health Reform

Outreach and Navigation — Budget related opportunities

Practice Model Re-Design with Stratified Case Types — Define levels of intervention and train to expectations and the role of a family advocate

Accountability — What does this look like

Change Management

Fiscal Year 2012 Budget

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Areas of Practice

Feedback from our work to date:

If we identify redundancies will they translate into efficiencies that will save money? And if so what happens?

Eligibility – even if you get it right without the right outcomes the eligibility intervention could be misplaced

Capacity of current staff and their willingness to learn – a huge challenge

Assumption as well that if you get clients to the right places then outcomes will be achieved – how would you evaluate this assumption and what is the basis for it and why do we believe that there is a high probability of success with this approach

Technology – the what, the why and the how and will it streamline and improve process and outcomes?

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Integrated Eligibility Blending and Braiding Funds Confidentiality Evidenced Based Practice InteroperabilityPlace Based Initiatives in the Context of:a. Health Reformb. TANF Reauthorizationc. Medicaid Waiversd. Home and Community-based Servicese. Universal Pre-Kf. Employment Strategiesg. Housing First and 10 year plans to end chronic Homelessnessh. New American Strategiesi. Equity in Service Deliveryj. Role of Technology in Supporting Integrated Practice

The Policy Conversation

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Questions and

Discussion