HCHCHC Partnerships: Collaborations that work

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HCH/CHC Partnerships Collaborations that work

• Billings, Montana

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Yellowstone County Demographics

• Billings- largest city in Montana
• County population- 138,213 people
• Land mass of 2,635 square miles
• 49.1 persons per square mile
• 11.1 of Yellowstone County residents below
  poverty level
• 93 of total population is Caucasian
• Borders 2 American Indian Reservations Crow and
  Northern Cheyenne
• 2006 Census estimate

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The face of homelessness in Billings

• 37 of Montanas homeless reside in Yellowstone
  County- 54 of those are not sheltered
• Our local shelters provided over 56,400 nights of
  shelter last year

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Billings HCH Program Staffing

• Physicians Assistant
• Nurse Practitioner
• Case Manager
• Substance Abuse Counselor
• Mental Health Counselor
• Outreach Worker
• Administrative Assistants

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Problems Identified

• Isolation of staff
• Physically and socially
• Black Sheep syndrome
• Decreased job satisfaction
• Disconnect between services offered at CHC and
  HCH clinics
• Turnover of staff
• Decreased communication

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Changes Implemented

• Structure changes
• Primary goal to integrate HCH services
• Assurance that same standard of care is provided
  even though the method location of delivery
  differs

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Structure Changes Staffing

• All HCH staff are cross trained for HCH and CHC
  clinics
• All work part-time HCH/part-time CHC
• Same disciplines for HCH/CHC have same
  supervisor/same expectations
• Attend discipline specific group staff meetings
  as well as all-staff meetings

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Structure Changes Staffing

• Outcomes
• Improved consistency
• Feeling of being connected
• Linking HCH staff with peers for support and
  guidance
• Improved continuity for clients who may access
  care at more than one location
• Fewer concerns raised about not feeling a part of
  the group

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Structure Changes Staffing

• Improved awareness of other peoples jobs
• Mandatory training on culture of poverty, culture
  of homelessness, culture of illness, followed by
  customer service training
• Consistency with collaboratives (diabetic and
  depression)
• Same process, same protocols

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Structure Changes Internal Integration

• Ancillary Services
• Pharmacy
• Dental
• Mobile dental equipment
• Project Homeless Connect
• Reserved appointment slots
• CHAP
• MAP
• Substance Abuse treatment
• Working towards unified mental health services

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Structural Changes External Partners

• Statewide HCH Network
• Mayors Committee on Homelessness Billings Area
  Resource Network
• Community Crisis Center
• Governors Council on Homelessness

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Structural Changes External Partners

• Hospital rounds by case manager
• Part of discharge planning of homeless
• Ability to connect clients to the larger
  community health center system

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Structural Changes External Partners

• State-wide HCH Network
• Consistency with services
• Improved communications
• Partnerships with grants
• EHR Planning Grant
• Expansion Grant

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Still need work

• No EMR
• Paper charts
• Copy time
• Clerical time
• Need to continue to improve/maintain
  communications

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