The Use of Guiding Principles to Support Clients through the

Intake ProcessKathy KingDeb Pultz

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Outcomes

We want you to leave our session with:1) an appreciation for listening to your clients’ voice when establishing

Guiding Principles; 2) an understanding of how Guiding Principles can frame service

delivery and, 3) a curiosity to explore how you might further plan and provide

service delivery based on Guiding Principles.

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TEAMClientsStaff

ManagersSenior ManagementExecutive Director

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Why worry about documentation:• 8 hours per week is spent charting (average)• If our organization is spending 23% of staff budget on

charting, want to make sure:• Benefits the client• Addresses risk management• Efficient and effective time on charting direct client

care

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Domain Oriented Recovery Record: DORR

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Graduation

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Guiding Principles 5,6,7

Guiding P. 1 - 4

Peel Back the Layers

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3 Sites: One Service (Case Management- MH)

Client Focused Guiding Principles (GP)

□ 1. Support client ASAP.□ 2. Same staff whenever possible.□ 3. Client leaves with something.□ 4. Follow-up call if on waiting list.□ 5. OCAN Self OCAN Staff Recovery Plan□ 6. OCAN frames Recovery Process.□ 7. Assessment + Plan + Do + Evaluate = DORR = DARE = PDSA.□ 8. Trauma Informed Approach (training May/June 2019).

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Model of Improvement: PDSAPDSA Based on Guiding Principles

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Client Focused Guiding Principles

1. Support client ASAP.2. Same staff whenever possible.3. Client leaves with something.4. Follow-up call if on waiting list.5. OCAN Self OCAN Staff Recovery Plan6. OCAN frames Recovery Process.7. Assessment + Plan + Do + Evaluate = DORR = DARE = RP = PDSA.

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Guiding Principle: Supporting Data

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Our Motto at CMHA-CT

We include our clients in projects, workshops, trainings and committees.

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Experience Based Design: Emotional Mapping17

Guiding Principles : 14: Accessing Service

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Experience of Clients Accessing Service: CMHA-CT

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

110%

1a) PhoneCMHA

1b) Walk intoCMHA

1c) CMHAphoned me

2. Discussedmy needs

3a) Continuewith worker

3b) Newworker

4a) Next appt 2wks

4b) On waitinglist

5) Contact mewhile on

waiting list

6) OCANcompleted

7) Wrote downtips

PERC

ENT

OF

POSI

TIVE

RES

PON

SES

PROCESS STEP #

Tell story once. I matter. On the list!.

Feel naked.

HELP

Not again! Don’t forget me!

3 most positive steps/what’s working

3 most negative steps/pain points

LEGEND

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Client Responses: Accessing Service n=10

Yes!“decreases my anxiety when

there is a plan”

Supported“tell my story once ”

Connected“like to stay with one

worker”

Frustration“not again”

Anxious“why do I have to

see a different worker?”

50%50%

Depressed“after 1 month it feels like I don’t

matter”

Guiding Principles 14 (PLAN): Clients - Accessing Service

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10

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60

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Very Important Important Medium Importance Slightly Important Not Important Not Sure

Level of Importance: Response to QuestionsReported in Percentages: n = 13

Receive service as soon as possible from a worker?

Receive service from the same worker?

Receive check-in phone calls, texts, or emails when you are on a waiting list to see a worker?

Receive a written summary of tips discussed at your appointment?

Guiding Principles 14: Organization (ACCESS)

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0

0.5

1

1.5

2

2.5

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3.5

# of Staff from Referral to Case Manager

Implement Change Ideas based on our GP

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ACCESS Process Map

1. Pending Assessment2. Intake3. Entry into Functional

Program

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ACCESS Process Map

OCAN initiated/completed:Intake OR Functional Program client helps to determine this

(consulted with Ministry)

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ACCESS Process MapALL Guiding Principles

1. Support client ASAP.2. Same staff whenever possible.3. Client leaves with something.4. Follow-up call if on waiting list.5. OCAN Self OCAN Full (Core/Staff). 6. OCAN frames Recovery Process.7. Assessment + Plan + Do + Evaluate

= DORR = DARE = RP = PDSA.

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ACCESS Process Map

A client can speak with the worker as the client transitions from initiating contact to screening assessment program service.

A client can now transition from an initial contact to a functional program within one day.

Dependent on the client & staffing resources.

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Stretching

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We do not want anyone to pull a muscle!We are trying some large and small stretches that give staff an opportunity to try out new approaches and processes.

Decreasing Client Time in ACCESS1) Focus on decreasing the amount of

time a client spends in Intake2) Focus on Screening

3) Using GAIN SS (NE LIHN requirement and best practice)

4) Removing Intake Referral form5) Decreasing Intake Screener from 6

pages to 1 page.

6) Ensuring Main Concerns are using Domain Oriented language changes in CRMS in the back end so Ministry still receiving their information in their categories (on Ministry To Do List)

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Decreasing Client Time in ACCESS

• Only case managers from the CM team working ACCESS (intake), not all MH workers:

• tighter, cleaner, less room for error.

• Rotate all CM team workers as opposed to just having one or 2: • less chance the client sees more than one person

• The staff working ACCESS follow up with a client they have seen that day:

• Client does not have to see a new worker, adjust to a “differentapproach”, and retell their “story”.

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Study our G. P. Change Ideas

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Act on our G. P. Change Ideas

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GP # 3: Leaving with Something ADAPT

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Acting on our Change Ideas: Based on our G. P.1) Changed ACCESS office hours back to 8:30-4:30 (previously First Step and Triage)2) Weekly Case Management meetings (staff choice re: client selection)3) All staff do the 1 page intake screener (formerly 6 pages)4) Only Case Management staff work ACCESS (staff take on clients immediately;

regardless of length of time required to assist)5) Most of the time the client only has to see one staff (ACCESS worker will follow up

the next day if need be)6) No Wait List now (follow up calls will be made by ACCESS worker if need be)7) Staff are encouraged not to prolong discharging clients (they can return at any time

without delay)8) Take away letter (with self identified goals - services they are best suited for - and self

directed homework)9) Post Cards are given to new clients (Assess, Plan, Review and current homework)

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Next Steps:Does decreasing wait times, decreasing number of staff a client sees, giving clients tips/strategies in written format at the end of the appointment, follow-up phone calls with clients on a waiting list, completing and updating OCANS and Recovery Plans, using a Domain Oriented Recovery Record, and taking a Trauma Informed Approach

enhance client’s ability to meet recovery goals? (OCAN met/unmet)

increase needs met over a shorter span of time? enhance rate of graduation/discharge?

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SummaryGuiding Principles through a QI lens (Model of Improvement =PDSA)

After one hour do you have an:1) appreciation for listening to your clients’ voice when establishing

Guiding Principles,2) understanding of how Guiding Principles can frame service delivery

and, 3) urge to explore how you might further plan and provide service

delivery based on Client Based Guiding Principles? 43