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News at Telecare
At the California National Alliance on Mental Illness (NAMI) Annual Conference 2019 in Newport Beach, California, Telecare’s Sarah Nudel and Robin Weintraub were honored to present on the Behavioral Health Court Model, a specific program type designed to serve individuals who have mental health needs and are involved with the criminal justice system. We are pleased to share the presentation below.
Mental Health and the Justice System: Behavioral Health Court Model Puts Teams on the Same Page
Telecare Corporation has provided services to individuals with serious mental illness and co-occurring justice involvement issues for more than 15 years. The focus of this year’s NAMI CA presentation was the Behavioral Health Court (BHC) model, a treatment modality that Telecare offers for the community through programs in Orange County and San Diego County, California.
Program Model Overview
The BHC model has been a productive and effective model to support individuals with serious mental illness who are on probation, to help them regain and maintain stability, fulfill the obligations of their probation requirements, prevent recidivism into the criminal justice system, and take steps toward a healthier future, a more stable life, and meaningful roles in the community.
The Behavioral Health Court Model is a collaborative process with multiple stakeholders. Here’s the BHC role breakdown:
Mental Health Professionals
Focus on mental health treatment
Sensitive to privacy
Mental health visits at home/in the field
Teach effective choice-making
Seek to awaken internal motivation
Focus on accountability
Monitor conditions of release (COR)
Perform visits and searches at home
Focused on compliance, not choice
Use COR and sanctions as external motivation
Learn More About the Model
Program length is a minimum of 18 months, but members typically stay 2-3 years.
BHC is a day program model where clients participate in groups based on where they are in their recovery process in the program. Programming focuses on evidence-based practices to support recovery, reduce criminogenic behaviors, and support the individual in making forward progress in the program. Case managers link members to community resources.
After graduation, members are transferred to outpatient clinics at an equal or lower level of care depending on the presenting need.
Sarah Nudel, Administrator at PROPS, CORE, and BHC
Robin Weintraub, Administrator at Whatever It Takes (WIT)
Telecare is pleased to welcome and introduce the newest member of our executive team, Sharon Heckel. Sharon recently joined Telecare as Senior Vice President and Chief Human Resources Officer, bringing over 25 years of human resources management and consulting experience in health services and other industries to Telecare.
“We are delighted to welcome Sharon to the Telecare family, serving in this crucial role," said Anne Bakar, Telecare President and CEO. "She brings a wealth of experience from larger healthcare organizations, as well as entrepreneurial experience from her work in startup environments, family-owned businesses, and consulting. She understands the importance of adapting to the the changing reimbursement climate while reinforcing the culture and values that bind us together. She has already had a positive impact on our workforce planning and process of engagement.”
Most recently, as Vice President of Human Resources at Clorox, Sharon was responsible for the successful delivery of HR functions and development of a positive employee experience across Clorox’s domestic and international operations.
“I am thrilled to be part of Telecare," said Sharon. "The company's mission, the strength of our employee population, and the unique needs of the people we serve drew me here. I look forward to working with Telecare to seal our reputation as an employer of choice in behavioral health, providing our employees with fulfilling jobs and meaningful careers.”
Across the nation, 60 million adults aren’t receiving adequate primary care, 33% of adults with serious mental illness aren’t receiving any mental health services, and 90% of people with substance use conditions aren’t receiving any care for their substance use.
Yet individuals with co-occurring SMI and substance use are often among the highest utilizers in their systems of care. At Telecare, these co-occurring conditions are very prevalent: 70% of our clients are also dealing with substance use. The majority of these individuals do not recognize that their substance use is affecting their health and wellness, aren’t currently considering treatment, and aren’t considering a change in their use of substances.
In August 2018, Telecare’s Vice President of Operations, David Heffron, and Director of Special Projects - Substance Use Treatment Services (SUTS), Scott Madover, presented at the Substance Use Disorder Statewide Conference put on by the California Department of Health Care Services. We are pleased to share their presentation, “Reaching the Unreachable: Engaging People with SUTS in Pre-Contemplation Phase,” and their ingredients for success below.
Download a PDF of the Presentation
Reaching the Unreachable: Engaging People with SUTS in Pre-Contemplation Phase
So how do we help people who not yet ready for change? How can improve health and wellness — when a person does not recognize the impact of substance use in their life?
We begin from a place of curiosity, conversation, information, and engagement — for staff and clients — and we cultivate an environment where change might be possible.
As part of Telecare’s Whole Person Care initiative, we developed and launched a curriculum called Co-Occurring Education Groups (COEG). The 16-week curriculum is intended to address the shared challenges providers and systems face: reaching the “unreachable” through respect, engagement, education, and ongoing support.
COEG Basic Framework
Each session in the 16-week curriculum covers a different topic of discussion: from understanding addiction, to recognizing triggers, to reflecting on one's hopes and goals. In some of Telecare’s programs, groups are offered weekly; in others, groups are offered several times a week. Each group is moderated by a trained staff member and takes 60 to 90 minutes to complete. Due to Telecare’s many types of programs, the curriculum was designed to supplement — not replace — the regular clinical services that a program already delivers. Likewise, the curriculum does not contain service-line specific information, therefore, almost any program can use the materials. The groups are open, so new participants can join a group at any time. This flexible drop-in format gives individuals ownership over their future.
Ingredients for Success
Keep on going
Teach it all
Share the facilitation
Stick to the script
Educate and explore
Show respect and non-judgment
Keep groups open
Schedule groups regularly
September is National Recovery Month. This month, we’re featuring inspiring stories, news, and information to continue to support and spread a stigma-free environment.
How Technology Improves Access to Behavioral Healthcare — HealthTech Magazine
Mental Health America’s Voter Toolkit — Mental Health America
We are thrilled to announce Telecare’s newest administrators. Click the images below to find out more about their programs.
Summer is one of the busiest times at Telecare. Our Start-Up Team is currently deployed across California to support the launch of programs designed in partnership with new and existing customers. From May through July, Telecare opened the following programs, and more are coming soon. To explore Telecare’s full list of locations, click here.
- Now Open: TREEhouse North (Anaheim, CA)
- In May, Telecare's newest crisis residential program, TREEhouse North, opened as part of Orange County Health Care Agency's efforts to expand its network of crisis care. Similar to TREEhouse South, which opened in Mission Viejo in July 2017, TreeHouse North provides voluntary, short-term services, typically lasting 7 to 14 days. The team of peer counselors and licensed professionals provides co-occurring capable services for people who are experiencing a behavioral health crisis and may also have substance use issues.
- Now Open: TRAC/TMRS Expansion (Modesto, CA)
- In June, one of Telecare's oldest Stanislaus County programs expanded its services to join the Stanislaus CARE team, a multi-agency team providing services to people experiencing homelessness and co-occurring mental illness.
- Now Open: TEIR Expansion (Stockton, CA)
- In July, Telecare's early intervention program serving San Joaquin County's youth expanded from 25 to 50 slots to meet the growing community needs. Telecare is pleased to support efforts to address mental health issues at the earliest stages to help people prevent or minimize the negative effects of untreated symptoms of mental illness.
- Now Open: Sausal Creek Redesign (Oakland, CA)
- In July, Telecare's crisis walk-in clinic completed the redesign of its services to meet the evolving needs of their community by adding a medication clinic and case management. Over the years, Sausal Creek has served Alameda County as a 24/7 crisis walk-in.
In recent months, many public figures came forward and discussed their experience with mental health in major news outlets across the country. Here are some resources we found inspiring:
- This Story has Already Stressed Ryan Reynolds Out — The New York Times
- Danny Rose's openness about his mental ill health is commendable — The Guardian
- Waking Up with Ariana Grande — Vogue UK
- Camila Cabello reveals what the hardest thing about going solo was — Cosmopolitan
- Gabourey Sidibe Reveals Battle with Bulimia and Suicidal Thoughts in New Memoir: Listen to an Excerpt from the Book — People Magazine
May is Mental Health Month!
In 2010, Telecare began a journey to Whole Person Care, bringing greater focus on healthcare and substance use services into our behavioral health programs.
With limited resources to draw upon, we needed to be cost-conscious and choose approaches that offered the greatest impact and leverage.
In April 2018, we shared our journey and lessons learned in an iPoster session at NatCon18.
View a PDF of the Presentation
As we began to develop our Whole Person Care plan, we found that we needed to address the training challenges of our geographically diverse and multidisciplinary workforce. Telecare has nearly 3,500 staff spread over seven states and a very diverse workforce of behavioral health providers and nursing staff. The entire range of our staff needed to understand the importance of whole health as well as have knowledge of co-occurring substance use and chronic health conditions, and be able to use tools to engage clients and enhance motivation through stage-matched conversations. To address this, we developed an 18-hour Whole Person Care eLearning program that covers stages of change, substance use and addiction education, as well as significant facts on chronic health conditions, culminating in an earned certificate.
Clinical Practice Improvement
We needed to update and enhance our current clinical practices to include whole health education and lifestyle modifications, as well as explore clinical models for coordinated care that improve outcomes and reduce costs for customers.
Our Co-Occurring Education Groups (COEG) were developed to reach people in pre-contemplation and contemplation stages of change around substance use. We also created “Smart Sets”: Decision trees that enforce key elements of health integration and identify touchpoints for motivational enhancement. We also partnered with customers to build new coordinated care clinical models that improve outcomes while reducing costs. We tested and refined new processes and then disseminate them broadly to the rest of our programs. Finally, we identified several interdependent evidence-based practices and developed a clinical framework to bring them to staff, matching the critical skills to staff roles and client acuity levels.
The people we serve often do not understand their high-risk physical health conditions, nor do they have fact-based information on the effects of substance use on their health. To assist our mental health providers in regularly educating and engaging clients in conversations around their health conditions, Telecare created easy-to-read, visually-engaging handouts that present a range of whole health topics, including blood pressure, body weight, diabetes, and asthma. The handouts provide education on facts and effects about each condition and offer suggestions for how to manage or prevent the condition. They also inform and empower clients by suggesting lifestyle changes that can directly improve their health and wellness.
Staff have reported increased confidence initiating conversations by using these handouts, and clients report that they are learning information about their conditions for the first time. We have translated these handouts into six threshold languages to increase accessibility. Our workforce benefits from the handouts as well: staff report that they are using the handouts to learn about and manage their own chronic health conditions.
Telecare’s Partners in Wellness, the first mental health Pay for Success program in the nation that incorporates our Whole Health tools, is surpassing its success targets, with excess savings of more than $500,000 in the first year. Another program, Inland Empire Health Plan (IEHP), a population management program for high utilizers, has shown statistically significant reductions in psych inpatient, psych ER, medical ER, and IOP utilization, as well as increased contacts with their primary care physicians. (See poster for more details.)
We have learned that the following practices greatly enhance our ability to integrate Whole Person Health into our programs:
Educating our senior leadership team first. Senior leaders must fully understand and be "on board" with new practices and clinical models before roll-out to the company at large.
Engaging all staff to see health equity as a social justice issue, which helps us advocate for the people we serve.
Communicating clearly and consistently to ensure comprehension and buy-in from staff.
Adapting plans as funding appears and disappears; being nimble allows us to keep up with changes in the healthcare environment.
And finally, remembering that small steps matter! Sustaining momentum is important when introducing and learning from new models of care.
Kent Eller, MD, Telecare Chief Medical Officer
Shannon Mong, Telecare Director, Innovation Initiatives
Faith Richie, Telecare SVP of Development
Telecare Whole Person Care Brochures and Information
Reaching the Unreachable (Substance Use)
Care Coordination Case Study (IEHP)
Health & Wellness Curriculum (Physical Health)
The Morning Huddle (Data-driven Care)
At NatCon2018, Telecare hosted a lunch and learn presentation sharing initial results from our PFS program, an overview of the PFS model, a clinical overview of the program, and learnings for other systems interested in possible implementation. We are pleased to share the presentation and findings below.
Alternative Payment Models:
Pay for Success
In the first year of operation, Partners in Wellness saved more than $508,482 above the target savings. The program reduced usage well over the target rate for all services, including 81% over the target of psychiatric emergency services visits and 100% over the target for state hospital days. Significant clinical results were also shown: after a year, people with higher depression, psychosis, and drug and alcohol use scores showed significant improvement over time. Anxiety levels (measured through screenings) also improved, as well as physical health measurements such as HDL-C scores.
PFS Model Overview
Telecare's Partners in Wellness program is an innovative six-year, performance-based contract to deliver publicly-funded services. Telecare is at risk to deliver the savings targets outlined in the contract by reducing clients' use of psychiatric hospitals, psychiatric emergency services, state hospitals, and other mental health services while also ensuring each client’s whole-person wellness. The performance targets are set to fully pay for the program (in savings) and return additional savings at the end of the six years. Dr. Keith Humphreys of Stanford University objectively evaluates the program results. From the RFP process beginning in December 2014 through the January 2017 official launch of the program, more than two years of work went into the development of this program.
What's Different About Pay for Success?
Pay for Success programs, including Partners in Wellness, include several areas of additional measures and tools, and a higher degree of data analytics, than other programs typically provide. (Click on the chart to the right to see an outline of some of these differences.)
PFS Clinical Model Overview
The clinical care model for Partners in Wellness uses several tools to engage with consumers, also known as partners, on multiple fronts. Physical and mental health are measured through screenings and assessments, and a "whole health" care plan is created in partnership with the persons served. From there, the multidisciplinary team — including several peer specialists — works with the partner to ensure they have adequate housing, medications, physical health supports, care coordination, and assistance in developing recovery tools as they work toward their wellness and recovery goals. Data from health measures and a daily "Wellness Snapshot" are entered and used to produce a Huddle Report that prioritizes the team's treatment and intervention planning in their morning huddle. A monthly report tracks partners' progress over time. Treatments are adjusted as needs change.
One of the most important lessons we have learned in our first year of operations is how crucial it is to have a firm understanding of the community in which we are working, as well as strong relationships within that community. Factors such as other community resources, housing costs, and Conservator or Public Guardian Policies can all make a big difference in the outcomes of Pay for Success programs like Partners in Wellness.
Faith Richie, Telecare SVP of Development
Shannon Mong, Telecare Director of Innovation Initiatives
Gail Lapidus, CEO of Family and Children's Services
Download a PDF of our presentation on Pay for Success.
Partners in Wellness in San Jose, CA
Family and Children’s Services’ Women In Recovery, in Tulsa, OK
Read Mental Health Weekly's coverage of the first Pay for Success initiative to focus on mental health.
Telecare is excited to attend National Council's NATCON2018 in Washington, D.C., April 23 - 25. We are presenting at two forums during the conference. Dr. Kent Eller, SVP and Chief Medical Officer, and Shannon Mong, Director of Innovation Initiatives, will be presenting a Whole Person Care poster session. Shannon will also be presenting a Pay for Success Model Lunch-n-Learn with Faith Richie, SVP of Development.
Join us for Breakfast
In addition to our regular booth, we will be hosting an informal breakfast at the Gaylord National Resort & Convention Center, Magnolia 2 Conference Room, on April 24.
Let us know if you'd like to join us! Send your RSVP to Cynde Burgstahler at firstname.lastname@example.org.
Get ready! May is Mental Health Month, and to celebrate, we've found some excellent resources you can share in your communities.
- The wait is over! Mental Health America creates a fabulous toolkit every year filled with fact sheets, infographics, template social media posts, press releases, and more! Download your copy here.
- NAMI also creates an excellent resource page with talking points, infographics, social media suggestions, and more. Check out the NAMI Mental Health Month resource page for more information.
- The National Council for Behavioral Health created resources to make outreach efforts even easier. Download infographics on women's mental health, how to help a friend in need, and identifying behaviors in teens that might be warning signs. Check out their resource page here.
- Winter weather got you down? Here are some ways to cope with Seasonal Affective Disorder.
- Across the pond, Princess Kate launches Mentally Healthy Schools, a program that will provide free mental health resources for school teachers and school staff in the UK so that they can better detect and help students experiencing mental health challenges.
- Here are 15 little things you can do to improve your mental health in 2018.
- Mental health advocate, and person with lived experience, Demi Lovato, will be offering free group therapy to fans on her 2018 Tell Me You Love Me tour.
- Have a partner with a mental health diagnosis? Here are 20 Ways to Help a Partner Living With Mental Illness.
Telecare has made recent improvements to our operational structure to provide better leadership for our programs and better service to our customers. To read more about our leadership changes, click here.
This month, we are pleased to introduce our newest Vice President of Operations, Michael Sherbun, as well as welcome our other newest leadership staff below!
Michael Sherbun, VP of Operations
"I am passionate about this field and assuring treatment is available for all those who are in need," said Michael. "I look forward to continuing the rich culture that Telecare has created and expanding our service wherever needed to enhance access to mental health treatment. I truly love what I do, and am fortunate to be with a company as great as Telecare."
Michael will oversee three of our Psychiatric Health Facilities—Heritage, Willow Rock Center, and Santa Cruz—as well as Santa Cruz CSP, Gladman MHRC, Sausal Creek, and our two contract service hospitals, Ohio Valley General and Providence Milwaukee.
As Telecare works to ensure a strong workforce for the future, we also want to make sure there is a big enough pool of qualified leaders to meet our organizational needs. To support this, we introduced an Emerging Leaders Program, a skills-building curriculum for existing Telecare employees who are committed to developing themselves as leaders.
"We set up this training in an attempt to grow our own leadership within the organization," said Suzanne Rudnitzki, Senior Vice President of Human Resources at Telecare. "How nice would it be early in your career if someone reached out and said, 'You know, I think you really have potential, maybe I can help you get the leadership skills to take you to the next level.'"
Fifty employees applied for the twenty-five-slot program, which began in January and will run through October. The program consists of 10 full-day trainings and kicked off with a presentation from Telecare’s President and CEO, Anne Bakar.
Over the course of the program, future leaders will be educated in cutting-edge tools and research on management and leadership presented by experienced facilitators, as well as new approaches and skills to foster impact, effectiveness, collaboration, and sustained commitment. The program will conclude with a project aimed at improving Telecare that the cohort will present to senior leadership, including Anne.
"At the end of our program, these emerging leaders will have to make choices. Would they like to apply for a leadership position? What would they like to do with the tools they’ve just been taught?" said Suzanne. "We'll help them leverage their learning and get connections with corporate leaders and resources to help them excel in their career here, with the added benefit of their deep knowledge of the organization."
Last month, we introduced our Workforce Development Plan and how Telecare will use this blueprint to strengthen our organization and hire more than 2,200 qualified individuals by 2020 to staff our new and existing programs. We shared key actions we are currently taking as a result of our workforce research, including advocating for Peer Certification in California, which coincides with our company-wide goal of having two full-time peer staff at every program by the year 2020.
This month, we share some specific things we are doing internally at Telecare to build a better workforce for the future!
At Telecare, we want our employees to stay with us for the long-term. Our data shows that if an employee stays with Telecare past six months, it is more likely that they will stay at Telecare for five years or longer. One of the key factors in determining whether a new employee will stay with the company beyond the six-month mark is their onboarding experience. Those first few days with Telecare are so critical in terms of communicating our culture, our history, and the essence of the important work that we do with the people we serve. To this end, we created and launched a new and improved New Hire Orientation.
In this process, the first two days of every new hire's experience at Telecare are spent with a range of leaders and facilitators who educate new staff on our history, scope, mission, culture, and our recovery philosophy, as well as all the required information they need to be successful in their career at Telecare. We use activities that fully engage the new hires in learning, building connections, and gaining a consistent foundation of knowledge as they begin at Telecare. The feedback since launching this new orientation has been extremely positive, and we look forward to developing this further as we continually improve the onboarding process.
We are looking at creative ways to interview and hire as we expand into more geographically diverse areas. For example, we are implementing video interviewing as a way to increase efficiency in some locations, as well as making it more convenient for potential new hires to apply to Telecare.
In addition, we are exploring ideas such as relocation assistance and sign-on bonuses for leadership roles in our more rural or harder-to-serve areas. Our hope is that this will encourage great people to join Telecare in areas that are traditionally more difficult to staff, where they can grow their careers, wherever their career paths may take them. Our hope is that they stay and grow with Telecare!
Specialized Learning and Coaching
As we look to the future and envision the leadership we will need, we are strongly aware that many of our best leaders emerge from existing staff. The leaders who have grown within Telecare become our best culture carriers and our strongest advocates. To support this growth, we have implemented several new tools for developing leadership within Telecare.
- We have a passion for investing in our leaders. The goal of the Emerging Leaders Program is to empower, elevate, and connect the next generation of leaders within Telecare. Emerging Leaders is a 10-month (one full day each month) program that assembles a select cohort of emerging leaders and guides them through a rigorous, relevant, and applied curriculum. Our first Emerging Leaders Program is currently in session, and initial feedback has been positive.
- Our Leadership Success Series for hiring managers provides essential Human Resources training as well as key problem-solving techniques, management coaching, and additional tips for being an excellent leader.
- We recently restructured our regional leadership roles, localizing program oversight on a regional basis, and elevating key leadership staff to roles in geographic regions with which they are already familiar with. This has created better customer relations, deeper connections with local care systems, and opportunities for staff to grow.
We believe in the potential of our staff to grow within Telecare, developing into leaders who attract like-minded people who want to join Telecare and contribute to the amazing work that happens here every day, now and into the future.
By 2025, the behavioral healthcare field will face moderate to severe workforce shortages in nearly every sector. Telecare Corporation alone will need to hire nearly 2,200 qualified individuals by 2020 in order to staff our new and existing programs. To address this shortage and to plan for our future staffing needs, Telecare has created a Workforce Development Plan.
A Workforce Development Plan is a snapshot that captures the current metrics of the organization: the number of employees, certain demographics, what types of jobs are currently available, vacancy rates, turnover rates, and more. The organization then looks at how its products and services are likely to change in the future, and uses this knowledge in tandem with the metrics to develop a plan to build its workforce for the future.
One of the reasons this plan is so important at Telecare is that our “product” is excellent care for people with complex mental health and physical health needs. Our workforce, especially front-line staff and local leaders, are the ones who deliver this care. Having a stable and high-performing workforce is absolutely essential at our organization. It is one of our primary goals and measures of quality.
Another important reason Telecare undertook this workforce planning effort was to more clearly see the areas where we, as a company and as an industry, may have gaps that we must actively work to address. Two gap areas that we uncovered were in the areas of peer positions and licensed professionals.
For example, as we refined our “Two by 2020” goal, which is to have two peer positions (at minimum) on staff at every Telecare location by 2020, we noticed that in California the standardization of peer training and peer qualifications is not robust. As a result, we have begun to advocate for standardized training for peer positions, which will help Telecare to hire well-prepared peer staff, and could also help the overall field in California by establishing more widely recognized criteria for those roles and by providing a clearer path for individuals to advance their careers.
An additional example is the need for licensed professionals. In creating our plan at Telecare, we have included ways to maximize our ability to attract the outstanding professionals that are already in the field, as well as ways to build bridges between learning institutions and our workplace. One of our strategies we are implementing will be to centralize and coordinate our intern function in the organization, so that we have a pipeline of new graduates that could be successful, and stay and build their career at Telecare.
Key Findings for Telecare’s Workforce Development
A number of key findings emerged during the process of creating a Workforce Development Plan specifically for Telecare.
1. We must be creative to hire nearly 2,200 employees by 2020.
With a clear goal in mind and a clear understanding of our current recruiting processes, we recognized the need to go beyond the standard process of recruiting by using new and creative tactics to attract and keep these 2,200 new employees. We have already tapped into our existing leadership workforce and have developed a host of unique strategies that will broaden our reach and visibility with potential new staff.
2. We need to maintain staff diversity as we serve increasingly diverse communities.
The second key finding recognized that we are a richly diverse company and this diversity is one of Telecare’s most important assets. We are diverse not only in terms of ethnicity and language, but also age, and this adds to the deep culture of Telecare. As the clients and communities we serve also become more diverse, our workforce will need to mirror that trend.
3. We are a passionate group of people who thrive with a strong mission and culture.
The third key finding was the extent to which our employees—both current and former—positively regard their experience at Telecare and strongly relate to our mission and our culture. They love their teams and coworkers. Our task then becomes the way in which we leverage that positive regard and continue this trend for future employees. One way we are achieving this is through our revamped New Hire Orientation, which welcomes new employees into our culture on day one and follows them through their first few months on the job as they acclimate and become a part of their new team.
Next month, we will take a deeper look at what we are doing more specifically at Telecare to build a better workforce for the future!