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Milwaukee County Behavioral Health Division

NIATx ORP Change Project Enhanced Handoffs in Mi-LINC Gena de Sousa, Project Director Janet Fleege, WIser Choice Project Director Kit Van Stelle, ORP Evaluator Dr. Michael Nunley, Program Evaluator. Milwaukee County Behavioral Health Division.

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Milwaukee County Behavioral Health Division

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  1. NIATx ORP Change ProjectEnhanced Handoffsin Mi-LINCGena de Sousa, Project DirectorJanet Fleege, WIser Choice Project Director Kit Van Stelle, ORP Evaluator Dr. Michael Nunley, Program Evaluator Milwaukee County Behavioral Health Division

  2. Milwaukee Linking Individuals to a New Chance:Mi-LINC • Target: Men and women returning to Milwaukee after prison release • 6+ months prior to release: • Intake screen by Central Intake Unit (CIU) • Client chooses providers • During 6 months prior to release: • Recovery Support Coordinator (RSC) reach-in visits • Single Coordinated Care Plan (SCCP) begun • At release: • RSC contacts client, convenes Recovery Support Team (RST) • Clinical treatment begins immediately after release

  3. Why Handoff Matters • Mi-LINC builds onto WIser Choice, Milwaukee County’s recovery oriented system of care, which includes 70+ providers (Central Intake, Clinical, Recovery Support Coordination and Recovery Support Services) • Over 80% of reentry clients who attend first appointment stay in treatment at least 30 days • Reentry clients who complete an episode of treatment are half as likely to be reincarcerated • A warm handoff communicates to the client a welcoming invitation to their recovery journey

  4. PLAN • Problem: Appointments were not made at time of intake screen, so many clients were released without a treatment appointment at the chosen provider • Aim:  Scheduling of treatment appointments prior to release from prison • Goal: Increase to 100% • Baseline: 28% • Change Cycles: Jan 1, 2012 – Aug 20, 2012 • Total improvement: 76%

  5. DO • Appointment with treatment provider scheduled 45 days prior to release • Included: • CIU staff • RSC staff • Provider Network • Better communication between CIU, RSC, RST, community providers (treatment, recovery support services), correctional institutions, and community corrections staff

  6. STUDY

  7. STUDY

  8. ACT Adopt!

  9. LESSONS LEARNED • COMMUNICATION! COMMUNICATION! COMMUNICATION! • Enthusiasm wanes; procedural changes are needed for stable change. • Client status review (monthly) • CIU internal changes (process, tracking) • Success achieved only with TEAM effort!

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