Capacity Assessment & Treatment Model (CAT)

Capacity Assessment & Treatment Model (CAT) Ciona Regev, LCSW Harris County Hospital District Baylor College of Medicine (c) Ciona Regev, LCSW

Harris County Hospital District (HCHD) Demographics • 300,000 residents in Harris County are 65 years and older • HCHD served >21,000 patients over 65 in FY 2005 (c) Ciona Regev, LCSW

Geriatrics Program Geriatric Consults HOUSE CALLS CLINIC GERIATRICS PROGRAM SNU APS NH (c) Ciona Regev, LCSW

Nature of Problem • 80% of patients in our geriatric clinic are viewed as vulnerable elders: a. self-neglecting behaviors & exploitation b. compromised quality of life/co-morbidities c. higher mortality rate d. reduced ability to live independently/ safely f. Reject/ cannot use services (medical, financial, social) (c) Ciona Regev, LCSW

Nature of Problem – Cont. • Our clinic lacks systematic protocol and effective evaluation/ intervention for our vulnerable patients with impaired capacity • Practice – secondary vs. early intervention • Patients - repeated ER/ admissions/ APS • Clinicians - lack training/ guidance (c) Ciona Regev, LCSW

Proposal: Capacity Assessment & Treatment (CAT) Model • Develop a comprehensive structured evaluation process of vulnerable elders’ decision-making capacity to live safely and independently in the community • Goal: design a user friendly screening tool kit of capacity for clinical practice (c) Ciona Regev, LCSW

9/08-9/10: Phase I - Development Design and evaluate screening tool kit’s reliability and validity Evaluate results and make appropriate refinements 10/10-8/09: Phase II -Implementation Pilot and re-evaluate CAT in the clinic prior to replication into other HCHD site/s Approach to the Problem (c) Ciona Regev, LCSW

Phase I: Development • 9/08-12/08: Finalize assessment • 1/09-4/09: Finalize other components (referrals, intervention, other areas of assessment) • Generate qualitative and quantitative evaluation of outcomes and measures • 5/09-8/09: Pilot screening tool kit in clinic and re-evaluate/ refine as needed (c) Ciona Regev, LCSW

Phase II: Implementation • 10/09-12/09: Generate protocol for training, mock up, and training clinicians • 1/10-3/10: Implementation and data collection (base line) • 4/10-8/10: Data Collection (F/U), evaluation, and refinement (c) Ciona Regev, LCSW

Measurable Outcomes A. Design a reliable and effective screening process 1. Measure reliability and validity of tool kit • Measure inter-rater reliability tool kit • Measure predictability of model on specific parameters 2. Compare outcomes of new patients’ clinical evaluation with caregivers’ survey on patients’ performance (c) Ciona Regev, LCSW

Measurable Outcomes- Cont. B. Increase clinicians’ satisfaction with utilization of tool kit • Collect data on clinicians’ satisfaction with effectiveness of tool kit on base-line & f/u C. Increase patients/caregivers satisfaction with evaluation process • Collect data on patients/caregivers’ satisfaction on f/u visits (c) Ciona Regev, LCSW

Sustaining CAT • Tailor and replicate model to potential sites will increase effectiveness and utilization of model • Training and teaching new clinicians and trainees will promote credibility of CAT • Network and partnership with community and healthcare settings will market CAT to provide continuity of care • Market CAT to probate court and legal services will provide a more reliable assessment of POA/ guardianship (c) Ciona Regev, LCSW

Key Stakeholders • Stakeholders encompass primarily HCHD and Baylor College of Medicine (BCM) a. HCHD: clinical staff; administrative staff; departmental support b. BCM: clinical consulting team (c) Ciona Regev, LCSW

Stakeholders Alignment • Enhance quality of life and quality and service to patients/ caregivers • Promote effective process for clinical practice & education • CAT will increase revenues for expanding consulting services & expertise to community at large • Long term benefits will reflect on cost cuts for repeated unnecessary ER visits and re-admissions (c) Ciona Regev, LCSW

Challenges • Resources (support staff/ time constraints) • Navigating in large complex institution • Commitment (c) Ciona Regev, LCSW

Preliminary Data • Phase I: • limited data – completing design of the assessment components and outcome/ measures • Adopted new screening tools into clinical practice (c) Ciona Regev, LCSW

Learning Curve • Marketing proposal to key stakeholders engaged me in exploring new territories: • lobbying to primary key stakeholder • learning to navigate a delicate ‘political map’ to promote proposal • Process of change in major system is lengthy, challenging involving intricate hierarchy (c) Ciona Regev, LCSW

Opportunities…. • Being a clinical social worker engaged in design of new model within the geriatric community is most exciting and overwhelming at times, especially as I work with the academia and a medical school (c) Ciona Regev, LCSW

Acknowledgements Quentin Mease Geriatric Clinic University of Houston Cheryl Cleary, BS-ORT Geri Alder, PhD Jane Kirk, BSN Tiffany Garza, BSW Harris County Hospital District Practice Change Fellows Mari-Ellen Sharp, MSN Atlantic Philanthropies & John Hartford Foundation Sara Dorsey, MSW Dinah Godwin, MSW University of Texas Health Science Center at Houston Denny Anderson, MBA Carmel Dyer, MD Baylor College of Medicine Kathy Agarwal, MD Ursula Braun, MD Kristin Cassidy, BS Sanda Khin, MD Mark Kunik, MD, MPH Aanad Naik, MD Julia Reyer, MD George Taffett, MD Nancy Wilson, MSW (c) Ciona Regev, LCSW

Capacity Assessment & Treatment Model (CAT)