Assessment and Treatment Alternatives Inc A Licensed NonProfit

Assessment and Treatment Alternatives, Inc. A Licensed Non-Profit Psychiatric Clinic

Comprehensive Evaluations Philadelphia Department of Human Services Montgomery, Delaware, and Bucks Counties Office of Children and Youth Probation and Parole Public Defenders Office and Private Attorneys Community Behavioral Health, Community Care Behavioral Health, Magellan Behavioral Health (MA and Commercial), and Aetna

Disclaimer: In an era of recession, lay-offs, and governmental budget crunches, humor is appreciated. Ken Farbstein and Jon Korczykowski provided guidance and support during ATA’s NIATx implementation. All sarcastic and / or semi-insulting comments are made purely in jest, and should not result in any form of retribution.

The ATA NIATx Goals: Intake and Assessment: Decrease the no show rate / increase show rate Decrease the wait time for assessments Therapeutic Engagement: Increase the frequency of “successful discharges” / decrease the frequency of “drop-0 uts” Maintain counselor resiliency with staff collaboration and personal care / development.

Review: NIATx Pre-Assumptions It won’t work. It will be too hard to change. No one (clients and staff) wants to change. Change is impossible. Change can’t be measured. It will cost ATA too much money.

Simple Surprises: [Most of] the staff were open-minded. [Most of] the staff were energetic. The administrators received interesting and, at times, appropriate feedback. The changes made did not cost a lot of money.

Goal 1: Intake and Assessment Make it simple with one phone number. Have one point of contact with calls going directly to the right person. Always have a person answering the phone, never a machine. Insure follow up to confirm appointments. Calls to client two weeks before, one week before, and night before appointment. Emails to client, DHS Worker, DHS Supervisors, BHRS staff, case manager, and CBH Member Services. Letter sent day appt scheduled, and one week prior to appt.

Changes made: Separate phone number for intake removed. All calls for intake now come to the main ATA switchboard / receptionist. Answering Machine removed from the Scheduling Department, formally consisting of 2 staff that share duties, changed to specific duties for each staff member. All intake calls go directly to one person in the Scheduling Department. Confirmation of appts assigned to other staff member. Appointment date and time confirmed via letter when appt date is set, calls prior to appointment and emails.

The Zen of Ken likes statistics. Ken likes to gather data. Ken uses Excel, a calculator, and long division. FACT: Ken has wind-chimes tinkling softly in the background during the ATA / NIATx calls. FACT: Ken’s dog yaps loudly during ATA / NIATx calls. Suspicion: Ken is wearing robes and sandals during ATA / NIATx calls.

There is no disputing the data: Show rate Baseline – January 1 – January 31: Show rate February 1 – February 20: 79% Show rate February 11 – February 25: 88% Show rate February 20 – March 13: Show rate March 16 – March 27: Show rate March 30 – April 10: 84% Show rate April 20 – April 24: Show rate April 27 - May 8: 74% 81% 66% 73%

My efforts at graphing, with no help from Ken: May 11 - May 22 Apr 27 - May 8 Apr 20 - Apr 24 Mar 30 - Apr 10 Mar 16 - Mar 27 Series 1 Feb 20 - Mar 13 Feb 11 - Feb 25 Feb 1 - Feb 20 Jan 1 - Jan 31 0 10 20 30 40 50 60 70 80 90 100

In other words: Baseline show rate: 74% Average show rate after NIATx changes: 80% An average increase of 6% However, if we remove the two outlying weeks……. (Ken says we should, citing possible confounds to the data, and the desire to look good for his boss) Adjusted show rate after NIATx changes: 83. 5% An average increase of 9. 5%

Ken screams “Show me the money!” Wind chimes tinkle softly in the background. Average cost per evaluation: $316. 66 Current average quantity of evaluations scheduled per week: 87 Average increase in quantity of evaluations per week: 8. 265 Approximate increase in revenue: $316. 66 x 8 [more evals per week] = $2533. 28 per week $2533. 28 x 48 [weeks] = $121597. 44 per year

Jordan deserves a reward:

Back to reality / possible confounds: Despite using 48 weeks as a conservative multiplier, vacations, weather, summer, staff fluctuations, and unpredictable factors can drastically change weekly show rates. Data for this portion of the NIATx Project was gathered from January 1 through May 22, 2009, statistically ATA’s busiest months. Projected increases are for billing, and do not factor actual dates revenue is received.

None the less, Ken also deserves a reward:

Goal 2: Therapeutic Engagement Increase the frequency of “successful discharges” / decrease the frequency of “drop-0 uts” Assess how our staff engage clients. Utilize a trained actor to portray a client, complete a “walk through”, and provide the ATA NIATx team feedback on the client perspective. Train our staff on customer satisfacti 0 n. A Customer Service Training was held for all administrative and clinical staff.

The Professional Actor: Interesting fact: According to Freud, all lies have some grain of truth.

The Professional Actor: Jon Korczykowski, completely on his own, designs a “mock patient” to go through the ‘intake process’. Jon role-plays a City of Philadelphia administrative worker who is addicted to internet pornography and is afraid that his obsession will interfere with his job. Interesting.

The Walk Through Jon calls the ATA intake department, and has trouble remembering his name. Jon has trouble recalling his ‘address’. Jon provides the intake department an address of a car dealer on Broad Street. Jon makes, and then reschedules his appointment. Jon arrives at ATA non-shaven, wearing ripped clothing, smelling of stale beer and cigars. While ‘in role’, Jon proceeds to wink at me in the lobby. My staff shake their heads in disapproval.

Feedback Lots of paperwork. Unclear as to why his waiting area was separate from the others. The Consent to Treat and Confidentiality forms were imposing, concerning, and harsh. ATA was ‘neat and clean’, comparatively… Meeting with the intake staff and clinicians was pleasant and professional.

Customer Service Training The Financial Impact of Service Customer Service is an Attitude not a Department Standing Out From the Competition Doing the Basics Better: Greetings, Holds, Transfers, Returning Calls Vocabulary Styles of Listening Removing Obstacles to Listening Practicing Proactive Listening Habits Handling Customers With Listening Problems Telephone Techniques Understanding Styles Applying to Customer Relations and Team Building Listening Skills Understanding the Levels of Customer Service Documenting Customer Concerns Personality Styles Attitude is a Choice that is Controllable A Formula for Success Having Influence in the Organization Focusing and Prioritizing the Top Expectations of Customers Creating a Service Mission Statement to stay Focused Attitude Internal and External Customers Internal Service is just as Important as External Service Customer Expectations Repeat Business Keeping Customers Calm with Words Persuasive Language Patterns to Gain Cooperation Angry Customers

Therapeutic Engagement… Difficult to operationally define success, but: February 2009 Successful discharges: Never started, this case discharged: Client discharged to a higher level of care: Client dropped out of care: Total discharges for February 2009 Clients completing therapy successfully: 10 13 1 1 28 48%

Therapeutic Engagement Following feedback from walkthrough and Customer Service Training, April 1 through May 31, 2009: Successful discharges: Never started, thus case discharged: Client discharged to a higher level of care: Client dropped out of care: Total discharges for this period Clients completing therapy successfully: A 28% increase in satisfaction. 16 3 0 2 21 76% Numerous confounding variables indentified. But, Ken is pleased.

Goal 3: Maintain counselor resiliency with staff collaboration and personal care / development. Didactic clinical trainings with food. Clinicians like pizza. The first training consisted of the presentation of a clinical article, discussion, and pizza. Subsequent trainings were clinician led. Staff response was high, and this became an event for discussion of articles and celebrations of weddings, babies, etc. To further increase staff morale, ATA golf shirts were given to clinicians.

Goal 3: Staff Collaboration Following the initiation of the clinical discussion group, an Agency Development Group was formed with 3 clinicians and one administrator. This group is clinician led and focuses on improving agency procedures. For example: The most recent CBH Credentialing and Compliance Report was shared with the Agency Development Group. They will provide feedback to other clinicians and advise the ATA Board on the implementation of our Corrective Action Plan.

Final Directions Ken would like us to apply the procedures from Goal 1 to therapy sessions. We provided Ken with various reasons as to why this would not work. He was insistent that we try. I faked a bad connection and hung up the phone. We will continue to collect data on all three initiatives. Goal 3 has become self-aware and is actively evolving. Jon’s computer has been seized by the government. No further comment can be offered.