An Overview of Process Improvement Project at the Center for Community Health (CCH)

1. An Overview of Process Improvement Project at the Center for Community Health (CCH) Presented by:Desiree A. Crevecoeur-MacPhail, Ph.D. Research Psychologist, UCLA ISAP UCLA

2. What is Process Improvement? • A series of actions taken by owners or operators to improve business • The key to process improvement is the inclusion of those who work for or otherwise “run” the organization. • Customers are served by processes • 85% of customer related problemsare caused by organizational processes • To better serve customers, organizations must improve processes CUSTOMERS = CLIENTS

3. Why Organizational Change? • Small changes do increase client satisfaction. • Satisfied clients are more likely to show up and continue their treatment. • More clients in treatment make your work more rewarding. • More admissions and fewer drop-outs improve the bottom line.

4. UCLA ISAP/Center for Community Health (CCH) Process Improvement Project • The Center for Community Health (CCH) is a state of the art facility designed to provide primary care, mental health, and selected substance abuse treatment services to the homeless population that occupies the Skid Row area of Los Angeles.

5. CCH Population Information • During the 2009-2010 fiscal year, CCH provided primary health care services of approximately 9,000 patients. • Approximately 1,500 received mental health services and a similar number received HIV related services • However less than 100 individuals were assessed for substance use or abuse problems and zero attended the group treatment sessions available on-site.

6. UCLA ISAP/Center for Community Health (CCH) Process Improvement Project • To address these issues SAPC and the UCLA ISAP worked with the staff of CCH, Homeless Health Care, and Volunteers of America to examine the agency processes and structure to ascertain ways to: • Increase patient participation in assessments • Increase referrals and • Increase on-site treatment

7. Issues that Interfered with Integration • Different departments within CCH did not know of the existence of the other. Medical staff did not know that substance use treatment was available on-site. • Doctors and other medical staff were not referring patients to staff for assessment, referral, or treatment. • Need ways to motivate patients to attend group counseling sessions. Patients may go to for primary care and not be interested in AOD treatment; however, AOD use is adversely affecting their health.

8. More Issues • Breakdown in feedback loop between the substance use disorder assessment and referral staff and doctors. • A need for additional information on the link between substance use and poor health outcomes.

9. Different Departments Did Not Know of the Existence of the Other • Solution: All staff was informed of the availability of assessment, referral and on-site substance use treatment

10. Medical staff were not referring patients for assessment, referral, or treatment. • Solution: Motivational Interviewing training was provided for all staff to give providers additional tools to help with patients who are resistant to treatment. • Solution: The hours that the assessment staff was on-site were hung on the door of the assessment office and if staff had to step out, the time of their return was also noted on the door.

11. Need ways to motivate patients to attend group counseling sessions. • Solution: Doctors were provided with raffle tickets to give to patients to encourage them to attend groups counseling sessions. In addition, attendees were also given raffle tickets at the door. • Solution: Refreshments (coffee, water, snacks) were provided for those who attended the group counseling sessions.

12. Breakdown in feedback loop between the substance use disorder assessment and referral staff and doctors. • Solution: The decision was made to ensure that the staff completed a disposition form that noted what happened if and when the patient showed for the assessment. When the patient shows for the assessment, the disposition form is completed with information regarding what the next steps are.

13. Need additional information on link between substance use and poor health outcomes. • Solution: UCLA provided the substance use treatment staff with several pamphlets that can be re-ordered from the source on ways to discuss substance use, substance use and health, prescription medication misuse, etc.

14. Group Session Improvements As a result of these and other efforts, great improvements were noted in the group attendance. Below is the average weekly attendance. January– October 2011.

15. Assessment Improvements Assessments and referrals have also shown some increases over the last several months. January – October 2011

16. Conclusions • The process improvement work conducted at CCH over the course of about five months resulted in significant improvements in the utilization of the substance abuse treatment services available on-site. • Given the desire to increase the number of assessments/referrals and the utilization of the on-site group counseling sessions, process improvement was successfully used to enact small changes to address and potentially improve the outcomes in these areas.

17. Conclusions • Increasing the opportunities for CCH patients to obtain treatment for substance use disorders will serve to increase the success of other medical treatments and reduce the exacerbation of certain disorders due to the consumption of alcohol or illicit drugs. • With this project, we have demonstrated that with a focused effort and some creativity, despite limited funds, a problem that has plagued the system for over a year can be resolved resulting in better treatment for patients.

18. Questions? Comments?

19. Contact Your Presenter Desiree A. Crevecoeur-MacPhail, Ph.D. (310) 267-5207 email: desireec@ucla.edu