Service Coordination in the Department of Social and Health Services

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Service Coordination in the Department of Social
and Health Services

• A Presentation of the Briefing Report
• Joint Legislative Audit and Review Committee
• June 26, 2006
• Presented by John Woolley, JLARC Staff

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Analysis of Service Coordination in DSHS
Background/Context

• JLARC directed analysis
• Look for answers to four questions
• Current efforts at coordination?
• Initiatives to improve information systems?
• Feedback from clients?
• Other states experiences?
• A lessons learned approach

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Report pages 1-3
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A Number of Lessons Learned
Background/Context
1. Current efforts at coordination?

• Initiatives take many different formsinvolve
  just parts of DSHS or involve many participants
  outside of DSHS and important to understand what
  is expected of an initiative.

2. Improve computer systems?

• Recent changes in information technologyan
  emphasis on enterprise-wide information and hub
  strategiescan facilitate information exchange
  and reduce information redundancy.

3. Feedback from clients?

• Client satisfaction surveys in place, but
  improvements needed to be more accurate.

4. Experiences of other states?

• Look at service coordination not as a single
  event fixed in time, but rather as an ongoing,
  continuous evolution.

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DSHS Provides Services to 2.1 Million Clients
Background/Context

• Single largest agency budget 8.5 billion per
  year, with 18,000 employees
• 2.1 million clients equals 1/3 of states
  populationmany get packages of services

Two Services 674,556 clients, 32
One Service 1,201,872 clients, 58
Three Services 171,808 clients, 8
Four or More Services 48,905 clients, 2
Data Source DSHS Research and Data Analysis,
Client Service Database for state fiscal year 2004
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Report pages 1-3
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Information Also Available on Clients Use of
Multiple Services
Background/Context

• 1/3 of Aging and Adult Service Clients get some
  Economic Services

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Report pages 1-3 Data Source DSHS Research and
Data Analysis Fiscal Year 2003
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Variety of Current Initiatives Considered Service
Coordination
Question One

• Answering Question 1 learned
• No Wrong Door has morphed no longer stand
  alone project
• DSHS coordination now part of ongoing strategic
  planning
• Looked at strategic plan and individual
  initiatives

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Report pages 5-9
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Strategic PlanStrategies Cross Organizational
Boundaries
Question One

• With 10 separate goals, no specific goal calls
  out Improve Service Coordination
• But detailed strategies specifically address
  boundary crossing issues

Report pages 5-9
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Initiatives Seek Solutions to a Variety of
Coordination Problems
Question One
Functional Family Therapy Family-based service engaging entire family, with a focus on reducing repeated criminal behavior. Juvenile Rehabilitation and County Juvenile Courts. (evidence-based practice)
A-Teams Collaborative case management for clients to maintain community placement. MH, DD, SA, DOC, AAA, RSN, local law enforcement
Childrens Mental Health Initiative Coordinate provision of MH services to children, with possible future goal of consolidation. Childrens and Health and Recovery.
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Report pages 5-9
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Many Initiatives With Diverse Expectations
Question One
Highly Developed

• Service coordination takes many different
  formsit can involve just parts of DSHS or
  involve many participants outside of DSHS.
• Importance of understanding what is expected by
  an initiative some are geared towards increased
  communication some are geared towards the
  coordination of services some are geared towards
  service consolidation, and many are a combination.

CONSOLIDATION - one system
INTEGRATION - bring all parts together
COLLABORATION - joint work effort and product
COORDINATION - systematically align efforts
COOPERATION - work together
COMMUNICATION - exchange information
Basic
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Report pages 5-9
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Coordination of Client Information Historically a
Problem
Question Two

• Looked at efforts at improving information
  coordination.
• From simple information (name, address, etc.) to
  more complex information (assessments, services
  needed, services provided)
• Efforts at eliminating silos

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Report pages 11-14
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New Technologies May Help Coordinate Information
Question Two

• Recent changes in information technologyan
  emphasis on enterprise-wide information and hub
  strategiescan facilitate information exchange
  and reduce information redundancy.

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Report pages 11-14
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Current Efforts Adopt Mixed Approach
Question Two

• Client Registry currently allows access to
  legacy information
• Information changes include
• Implementing enterprise planning
• Requested funds for Client (8M) and Provider
  (9M) hubs (2005-2007 biennial budget)
• Pragmatic approach major system replacement
  includes provider hub

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Report pages 11-14
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DSHS Formal Client Survey in Place
Question Three

• Formal survey of client opinions begun in 2001,
  conducted four times.
• 19 questions in total, two questions specific to
  service coordination.

• Clients asked if theystrongly agree, agree, are
  neutral, disagree, strongly disagree to
  statements
• Someone from DSHS helps us with services from
  all programs
• DSHS makes sure our services work well together

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Report pages 15-17
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Majority of Clients Agree With Both Questions
Question Three
First Service Coordination Question of Clients
Respondents Involved With Three or More Programs
Who Agree That DSHS Helps with Services From All
Programs
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Report pages 15-17
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Majority of Clients Agree With Both Questions
Question Three
Second Service Coordination Question of
Clients Respondents Involved With Three or More
Programs Who Agree That DSHS Makes Sure Services
Work Well Together
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Report pages 15-17
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JLARCs Consultant Experts Survey Can Be Improved
Question Three

• Overall design strong
• But positive bias likelyseven changes suggested
  to make results more meaningful, such as
• Rephrase from I am satisfied with service X to
  How satisfied are you with service X?

Reports Recommendation DSHS should develop a
plan to strengthen its client survey process so
that it produces more meaningful results. The
plan should address design features, survey
procedures, and the analysis and presentation of
data so that any potential positive bias is
minimized.

• When determining client attitudes towards service
  coordination, surveys must be very carefully
  designed and administered to avoid bias.
  Improvements should be made to DSHSs current
  methods.

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Report pages 15-17
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Considerable Body of Service Coordination
Literature Available
Question Four

• Experiences of other states and jurisdictions
  studied
• Common themes include
• Attentive to what initiative is attempting to
  accomplish
• Usually takes place at local level
• Takes time and a lot of effort not one event
• Impacts for clients not well documented or
  assessed

• There are a number of consistent themes learned
  from the literature. One is to look at service
  coordination not as a single event fixed in time,
  but rather as an ongoing, continuous evolution.

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Report pages 19-20
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Continuous Efforts Likely Most Important
1. Current efforts at coordination? A number of
current initiatives

• Initiatives take many different formsinvolve
  just parts of DSHS or involve many participants
  outside of DSHS and important to understand what
  is expected of an initiative.

2. Improve computer systems? Attempts to improve
information in place

• Recent changes in information technologyan
  emphasis on enterprise-wide information and hub
  strategiescan facilitate information exchange
  and reduce information redundancy.

3. Feedback from clients? Survey establishes
process for feedback

• Client satisfaction surveys in place, but
  improvements needed to be more accurate.
  Recommendation included.

4. Experiences of other states? There are lessons
from other states/jurisdictions

• Look at service coordination not as a single
  event fixed in time, but rather as an ongoing,
  continuous evolution.

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Report pages 21-22
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Concurrence With Reports Recommendation

• Both DSHS and OFM concur with the reports
  recommendation.
• JLARC Staff to contact for questions
• John Woolley
• Phone [phone]
• E-Mail woolley.john_at_leg.wa.gov