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Welcome to
Aunt Martha’s Youth Service Center
            Theodora Binion, Director
   Division of Alcohol and Substance Abuse
    Illinois Department of Human Services

              February 10, 2012
Organizational Overview
       Our Mission                     By the Numbers
Aunt Martha’s mission is to    Founded:                     1972
be a caring community          Locations:                    49
resource for children, youth   Communities Served:          645
and families.                  Budget (Total):           $70,612,400
                               Employees (Total):           1,099
                                              Salaried      935
                                            Volunteer        94
                                       Ind. Contractor       70
Organizational Structure                                Board of
                                                                                             Directors




                                                                                                              Chief Executive
                                                                    President
                                                                                                                  Officer
                                                               C. Gary Leofanti
                                                                                                                 Raul Garza




                        OPERATIONS                                                                                                                                       ADMINISTRATION




                                                                                    HEALTHWORKS &
COMMUNITY-BASED                 CHILD WELFARE            EDUCATION &                   EVENING                                                       HEALTH CARE    Chief Financial
   SERVICES                       SERVICES              YOUTH SERVICES                REPORTING                                                         SERVICES        Officer
                                                                                       CENTERS
                                                                                                                                                                     Chris Nordloh



Senior Vice President         Senior Vice President      Vice President               Vice President                                Medical Director               Chief Compliance
 Community-Based             Child Welfare Services     Education & Youth         HealthWorks & Evening                             Dr. Jennifer Byrd                   Officer
      Services                                            Programming               Reporting Centers
                                 Karen Sneade                                                                                                                        Mary Martin
    Jerry Lowell                                            Jill Eitel              Dr. Theresa Miller


                                                                                                               Director                 Director
                                                                                                            Health & Dental        Health Business                   Chief Quality
                                        Children's                                                        Business Operations        Operations                         Officer
    Behavioral Health
                                        Reception                                                           Jamie Dornfeld           Gary Bevills                   Ernie Gonzalez
    Services Division
                                          Center


                                                                                                                      Division Manager
      Vice President
                                     Division Manager                                                                     Health Care                                  Director
    Community-Based                     Residential
         Services                                                                                                         Social Services                          Policy & Advocacy
                                          Services
       Warren Wood                                                                                                    Roshanda Jackson                              Marsha Conroy
                                       Giselle Doyle




    Community-Based                   Teen Parenting
       Services
                                     Services Network




                                     Division Manager
                                        Foster Care
                                       Marc Smith
Our Employees
      Gender
  20%
                               Average Tenure of
           80%                 Current Employees:
                                    4.21 Years

 Female      Male

Race/Ethnicity                     Advancing
                               Employee Education
      6%                Associate’s Degree:    4%
26%          50%        Bachelor’s Degree:     32%

 18%                    Master’s Degree:       12%
                        MD or Ph.D.:           12%
 African-American
 Hispanic or Latino
 White
 Other
Our History
• Drop-In Center
• Counseling Services
• 1st Foster Homes



• Family Planning Services
• 1st Group Home



• Employment Training
The 1980s
                  ‘83
       • Program Plus (Parents
         Learning Universal Skills)
                  ‘85
       • Named Head Start Site
                  ‘86
       • Comprehensive
         Community-Based Youth
         Services
                  ‘87
       • Project New Chance
The 1990s
             ‘90                             ‘96
• 4 New Group Homes             • School-Linked Health
             ‘92                  Centers in Aurora and
• Youth Substance Abuse           Chicago Heights
  Treatment Services
             ‘94                             ‘97
• 3 New Group Homes             • Joint Commission
             ‘95                  Accreditation
• 2 New Group Homes                          ‘99
• Lakehouse Diagnostic          • Federally Qualified Health
  Shelter                         Center Status
• Transitional Living Program
The 2000s
               ‘00                                     ‘06
• Joint Commission Accreditation      •   Joint Commission Accreditation
                ‘02                   •   Health Center
• 2 New Health Centers                •   Residential Shelter (CRC)
               ‘03                    •   Group Home
• Joint Commission Accreditation                       ‘07
• Health Center                       • 2 New Health Centers
• Transitional Living Program         • Transitional Living Program
               ‘04                                     ‘08
• 2 New Health Centers                • 4 New Health Centers
               ‘05                                     ‘09
• Health Center                       • 2 New Health Centers
• HealthWorks                         • ARRA Funding (IDS & CIP)
• Transitional Living Program
• ARRA Funding (FIP)
• Chicago Southland
  Health Conference
• Partnering for Solutions
  Child Welfare Conference


• Health Center
• Park Forest Hall of Fame
• 2nd Annual Partnering for
  Solutions Child Welfare
  Conference
Adult Education             Parents Too Soon
                               (Healthy Families Illinois)
    Cook County Works
                                     Pregnant and
   Early Learning Center
                                    Parenting Teens
Home Instruction for Parents
                                   Safety Networks
  of Preschool Youngsters
                               Summer Youth Employment
iLab – Community Technology
          Center                    Teen Parenting
                                   Service Network
         Life Skills
                               Teen Pregnancy Prevention
     Parenting Classes
                                       Work First
   Parenting Techniques
     Education Series             Youth Participation
Basic Center               Residential Shelter
  Emergency Shelter Care        Specialized Foster Care
   Foster Home Licensing       Street Outreach Program
     Homeless Services              System of Care
     Housing Advocacy           Traditional Foster Care
       On Your Own            Transitional Living Program
Pathways Independent Living    Youth Housing Advocacy
     Residential Group
      Home Services
Community
   Counseling Services
       (Title XX)
Comprehensive Community
  Based Youth Services
Comprehensive Prevention
  Differential Response
Evening Reporting Center
   Gays and Lesbians
  Advocating Diversity
     Intact Families
    Pre-Trial Services
Adolescent & Adult                Men’s Clinic
    Substance Abuse
                                 Mobile Health Center
       Treatment
                                      Oral Health
    Behavioral Health
                                      Pediatrics
  Centering Pregnancy
                                     Primary Care
Comprehensive Prevention
                                Recreation & Wellness
Family Case Management
                              Targeted Intensive Prenatal
     Family Planning
                                  Case Management
       HealthWorks
                                      Teen Clinic
     HIV Prevention
                                 Teen Parent Services
 Illinois Breast & Cervical
                               Women’s Health Services
      Cancer Program
                                    (OB/GYN)
Aunt Martha’s Health Center
350,000

300,000

250,000

200,000                       DEVELOPING
          LEARNING TO BE           A                 EXPANDING ACCESS TO
             AN FQHC        COMPREHENSIVE           COMPREHENSIVE MODEL
150,000                         MODEL
                                                                                 Patients
100,000                                                                          Visits
 50,000

     0
          CY    CY    CY    CY    CY    CY    CY     CY     CY    CY       CY
          '00   '01   '02   '03   '04   '05   '06    '07    '08   '09      '10
                              UDS Reporting Year
The People We Serve
                                 Aunt Martha's         Illinois' CHCs       All CHCs
60.00%

50.00%

40.00%



                                             55.45%
                                            52.47%
                                                      39.74%
30.00%
               37.67%
                        31.24%
                                 37.54%



20.00%                                                                                      15.22%
                                                                          7.51%        10.84%
10.00%
                                                                  5.46%
                                                               1.60%              5.28%

 0.00%
              Uninsured                   Medicaid/CHIP          Medicare         Other 3rd Party

         Source: UDS Summary Report – 2010. Grantee, State and National - Universal
Primary Care Services
   Patient Centered Medical Home
   • Patient-centered, Physician-directed
   • Care that is effective and efficient

  Chronic Care Management Model

    Women’s Health Services
           Family Planning
       Obstetrics/Gynecology
Breast and Cervical Cancer Screenings
Cost Efficient, Comprehensive Services


$600                                                     $600
                                  $562          $588
$550                    $538
$500                                           $510      $518
                    $451        $477
$450
                                                                        $485
$400             $454                        $430        $426
$350                           $374

 $300
          2006           2007              2008          2009           2010

             Aunt Martha's            CHCs in Illinois   CHCs in U.S.
Oral Health Care Services
     Cleaning               X-Rays
                         Dental Hygiene
      Fillings
                           Education
     Sealants
                      Routine Check-ups &
Fluoride Treatments          Exams
    Extractions            Root Canals

              Aunt Martha’s
      Personal Dental Questionnaire
 4 Simple Questions Can Make a Difference
Cost Efficient, Coordinated Dental Services
 60,000
                                                                       Cost Per Dental Patient
                                                    $400
 50,000
                                                    $350                                    $358     $372
                                                                       $333     $344
                                                     $300
 40,000             Patients
                                                                                                   $274
                                                     $250           $247      $248      $259
                    Visits                                                                                   $255
                                                     $200                                           $249
 30,000
                                                     $150       $181                   $195

 20,000                                              $100                   $128

                                                      $50
 10,000                                                $-
                                                             2006       2007         2008          2009      2010
         -
                                                            Aunt Martha's       CHCs in Illinois      CHCs in U.S.
             2004       2006       2008    2010
               2003            2004       2005    2006       2007              2008            2009            2010
Patients       1,257           2,087      3,239   6,179     13,459            15,413           20,294         25,248
Visits         2,030           2,412      5,379   10,377    22,546            30,902           44,713         55,539
Cost Efficient, Coordinated Dental Services
 60,000
                                                                     Cost Per Dental Patient
                                                    $400
 50,000
                                                    $350                                $358       $372
                                                                     $333     $344
                                                     $300
 40,000             Patients
                                                                                                 $274
                                                     $250          $247     $248     $259
                    Visits                                                                                 $255
                                                     $200                                         $249
 30,000
                                 According to the most recent data $195
                                                   $150     $181
                               available for state and national levels
 20,000                                            $100          $128
                                (calendar year 2010), Aunt Martha’s
                                serves 15 percent of all the patients
                                                    $50
 10,000
                               receiving dental services from a BPHC
                                                     $-

                                         grantee in Illinois. 2007
                                                         2006         2008                       2009      2010
         -
                                                            Aunt Martha's     CHCs in Illinois      CHCs in U.S.
             2004       2006       2008    2010
               2003            2004       2005    2006       2007           2008            2009             2010
Patients       1,257           2,087      3,239   6,179     13,459          15,413          20,294          25,248
Visits         2,030           2,412      5,379   10,377    22,546          30,902          44,713          55,539
The Care Management Model at Work
      Health          Treatment in
                      % of Patients Plan % with Treatment
                                         Compliance         % of Patients
      Center          Active Treatment      Completed       Non-Compliant
  Carpentersville          68%                32%                 -
 Chicago Heights           62%                38%                 -
    Hazel Crest            60%                40%                 -
  Iroquois County          92%                 8%                 -
  South Holland            54%                46%                 -
  Southeast Side           59%                33%               7%
  Vermilion Area           83%                16%               1%
Women’s Health Ctr.        46%                54%                 -
Behavioral Health Care Services
               Child & Adolescent
             Psychiatry and Therapy

              Individual Counseling

           Comprehensive Diagnostic
            Evaluation & Treatment

                 Telepsychiatry
Reaching children and families in some of Illinois’
          most isolated communities
Cost Efficient, Coordinated Mental Health Services
 35,000                                                       Cost Per Mental Health Patient
                                                                              $655                      $653
                                                      $700        $600                     $605
 30,000                                                                       $569          $572
                                                      $600
                                                                                                          $529
 25,000
                                                      $500                                 $559
                                                                 $541
                                                                              $493                       $462     $493
 20,000
                                                       $400

 15,000                                                $300

                Patients                               $200
 10,000
                Visits
                                                       $100
  5,000
                                                        $-
         -                                                     2006      2007             2008           2009      2010
               2004        2006      2008   2010              Aunt Martha's          CHCs in Illinois      CHCs in U.S.

                2003              2004      2005    2006       2007             2008               2009             2010
Patients         210              945       878     2,632      3,916            4,757              6,265            7,647
Visits           625              2,793     3,515   11,731     21,819          26,120              31,474          35,704
Cost Efficient, Coordinated Mental Health Services
 35,000                                                       Cost Per Mental Health Patient
                                                                              $655                      $653
                                                      $700        $600                     $605
 30,000                                                                       $569          $572
                                                      $600
                                                                                                          $529
 25,000
                                                      $500                                 $559
                                                                 $541
                                                                              $493                       $462     $493
 20,000
                                                       $400

 15,000                             According to the most recent data
                                                      $300
                                  available for state and national levels
                Patients
 10,000
                Visits
                                  (calendar year 2010), Aunt Martha’s
                                                      $200

                                   serves 15 percent $100all the patients
                                                      of
  5,000
                                   receiving behavioral health services
                                                        $-
         -                           from a BPHC grantee in Illinois.
                                                             2006  2007   2008                           2009      2010
               2004        2006      2008   2010              Aunt Martha's          CHCs in Illinois      CHCs in U.S.

                2003              2004      2005    2006       2007             2008               2009             2010
Patients         210              945       878     2,632      3,916            4,757              6,265            7,647
Visits           625              2,793     3,515   11,731     21,819          26,120              31,474          35,704
The Care Management Model at Work
      Pt. Not Hospitalized during                                        90.21%
              treatment

Pt. reports symptom improvement                                             92.27%
          within 3 months


            Compliant with Meds                                          90.72%


                                                              85.30%
               # appts attended


                                                                                     96.39%
                 Consent Signed


                                                       81.96%
          Medical/Physical in File


                                     70%   75%   80%    85%        90%       95%       100%
The Care Management Model at Work
100%
 90%
 80%
 70%
 60%
 50%
 40%
 30%
 20%
 10%
  0%




            Under 18   Under 21   adult
Cross-Integration and the
           Evolution of Aunt Martha’s
• This notion is not new.
• Our services were born out of client needs
  –   Youth needed someone to talk to (counselors)
  –   Drug use (substance abuse services)
  –   Kicked out (foster homes)
  –   Pregnant (prenatal and family planning)
  –   Jobs (employment)
  –   Kids (childcare)
Core Training for All Employees
• 4 hour training
• Help you better serve clients and patients by teaching
  you what cross-integration is, and why and how we do it
• Lecture, discussion, group activities, video, software
  demonstrations, Q&A
• 6 Modules
  –   Understanding Cross-Integration
  –   Knowledge of current programs, services, locations and eligibility
  –   Using the Client Referral System
  –   Using the Cross-Integration application
  –   The “VIP” protocol
  –   Accountability and Making it Real
Making Connections and Coordinating Care




   Our Cross-Integration System enables employees to search a
centralized database of each client's service history at Aunt Martha's.
Aunt Martha’s Cross-Integration System




    Once a record is selected, staff can:
    1. Review Client History;
    2. See the Client's Location on an interactive map; or,
    3. View Suggested Programs for the client.
Aunt Martha’s Cross-Integration System




    The list of Suggested Programs can be changed by
     adjusting a filter of selected client characteristics.
Aunt Martha’s Cross-Integration System




When a Suggested Program is selected, the interactive map is updated to
show:
1. The client's home address; and,
2. The Locations where the selected program provides its services.
Aunt Martha’s Cross-Integration System

                  From within the Cross-Integration
                  System, employees can generate an
                  electronic referral to any of Aunt Martha's
                  programs.


                  The status of each record created in our
                  Referral Tracking System can be
                  monitored by our managers to ensure
                  that it is acted on and closed in a timely
                  manner.
Aunt Martha’s Cross-Integration System

                            From within the Cross-Integration
                            System, employees can generate an
           From July 2010 through June 2011 any of Aunt Martha's
                            electronic referral to
         (FY11), a total of 3,821 requests were
                            programs.
        logged in the Referral Tracking System.

                         The status of each record created in our
                         Referral Tracking System can be
                         monitored by our managers to ensure
        More than 3,100 requests have already closed in a timely
                         that it is acted on and
                been logged in FY12.
                         manner.
Cross-Integration,
   Coordinated Care & Collaboration
• Services organized from the
  client’s perspective
• Integration of child
  welfare, juvenile justice and
  education services with the
  Medical Home
• Alignment with local
  networks of health care and
  social service providers in
  every community
• Implementation of systems
  to enable communication and
  simplify access and the
  coordination of care
Client Experiences – Case Study
A 17 year old young man accessed services through our
street outreach program and was referred to our homeless
shelter when we discovered he did not have a permanent
residence. At the shelter he received help with
interpersonal skills, like skills, academic enrollment and job
preparations skills.

Using our integrated network he also received services at
our health center, participated in youth leadership
opportunities and discharged to job corp with his HS
Diploma where he is learning carpentry skills.
Client Experiences – Case Study
An 18-year old female from Haiti was brought to Aunt
Martha’s by the police after it was discovered that she was
homeless. She participated in our life skills programs, re-
enrolled in school and began working toward reunifying her
family.

When she left Aunt Martha’s, she moved into the home of a
family member and began aftercare. The family struggled.
Eventually, the young woman was referred to our
Greenhouse Shelter to ensure she continued to her work in
school, job preparation and family communication.
Bringing the Value to Life
  Telling the Stories of our Patients & Clients




If Ernie sends the five or six bullets Karen asked him for about the
           value added initiatives, we can use them here.
Incorporating SBIRT Into
        Aunt Martha’s Model of Care
• Previous Experience with Similar Tools
  – Depression Screening Tool
  – Dental Health Questionnaire
• Automated Patient Check-In
  – Phreesia demonstration
• Our Adult Patients in South Suburban Cook
  County
Incorporating SBIRT Into
Aunt Martha’s Model of Care

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Presentation to DASA Director 20120210

  • 1. Welcome to Aunt Martha’s Youth Service Center Theodora Binion, Director Division of Alcohol and Substance Abuse Illinois Department of Human Services February 10, 2012
  • 2. Organizational Overview Our Mission By the Numbers Aunt Martha’s mission is to Founded: 1972 be a caring community Locations: 49 resource for children, youth Communities Served: 645 and families. Budget (Total): $70,612,400 Employees (Total): 1,099 Salaried 935 Volunteer 94 Ind. Contractor 70
  • 3. Organizational Structure Board of Directors Chief Executive President Officer C. Gary Leofanti Raul Garza OPERATIONS ADMINISTRATION HEALTHWORKS & COMMUNITY-BASED CHILD WELFARE EDUCATION & EVENING HEALTH CARE Chief Financial SERVICES SERVICES YOUTH SERVICES REPORTING SERVICES Officer CENTERS Chris Nordloh Senior Vice President Senior Vice President Vice President Vice President Medical Director Chief Compliance Community-Based Child Welfare Services Education & Youth HealthWorks & Evening Dr. Jennifer Byrd Officer Services Programming Reporting Centers Karen Sneade Mary Martin Jerry Lowell Jill Eitel Dr. Theresa Miller Director Director Health & Dental Health Business Chief Quality Children's Business Operations Operations Officer Behavioral Health Reception Jamie Dornfeld Gary Bevills Ernie Gonzalez Services Division Center Division Manager Vice President Division Manager Health Care Director Community-Based Residential Services Social Services Policy & Advocacy Services Warren Wood Roshanda Jackson Marsha Conroy Giselle Doyle Community-Based Teen Parenting Services Services Network Division Manager Foster Care Marc Smith
  • 4. Our Employees Gender 20% Average Tenure of 80% Current Employees: 4.21 Years Female Male Race/Ethnicity Advancing Employee Education 6% Associate’s Degree: 4% 26% 50% Bachelor’s Degree: 32% 18% Master’s Degree: 12% MD or Ph.D.: 12% African-American Hispanic or Latino White Other
  • 6. • Drop-In Center • Counseling Services • 1st Foster Homes • Family Planning Services • 1st Group Home • Employment Training
  • 7. The 1980s ‘83 • Program Plus (Parents Learning Universal Skills) ‘85 • Named Head Start Site ‘86 • Comprehensive Community-Based Youth Services ‘87 • Project New Chance
  • 8. The 1990s ‘90 ‘96 • 4 New Group Homes • School-Linked Health ‘92 Centers in Aurora and • Youth Substance Abuse Chicago Heights Treatment Services ‘94 ‘97 • 3 New Group Homes • Joint Commission ‘95 Accreditation • 2 New Group Homes ‘99 • Lakehouse Diagnostic • Federally Qualified Health Shelter Center Status • Transitional Living Program
  • 9. The 2000s ‘00 ‘06 • Joint Commission Accreditation • Joint Commission Accreditation ‘02 • Health Center • 2 New Health Centers • Residential Shelter (CRC) ‘03 • Group Home • Joint Commission Accreditation ‘07 • Health Center • 2 New Health Centers • Transitional Living Program • Transitional Living Program ‘04 ‘08 • 2 New Health Centers • 4 New Health Centers ‘05 ‘09 • Health Center • 2 New Health Centers • HealthWorks • ARRA Funding (IDS & CIP) • Transitional Living Program
  • 10. • ARRA Funding (FIP) • Chicago Southland Health Conference • Partnering for Solutions Child Welfare Conference • Health Center • Park Forest Hall of Fame • 2nd Annual Partnering for Solutions Child Welfare Conference
  • 11.
  • 12. Adult Education Parents Too Soon (Healthy Families Illinois) Cook County Works Pregnant and Early Learning Center Parenting Teens Home Instruction for Parents Safety Networks of Preschool Youngsters Summer Youth Employment iLab – Community Technology Center Teen Parenting Service Network Life Skills Teen Pregnancy Prevention Parenting Classes Work First Parenting Techniques Education Series Youth Participation
  • 13. Basic Center Residential Shelter Emergency Shelter Care Specialized Foster Care Foster Home Licensing Street Outreach Program Homeless Services System of Care Housing Advocacy Traditional Foster Care On Your Own Transitional Living Program Pathways Independent Living Youth Housing Advocacy Residential Group Home Services
  • 14. Community Counseling Services (Title XX) Comprehensive Community Based Youth Services Comprehensive Prevention Differential Response Evening Reporting Center Gays and Lesbians Advocating Diversity Intact Families Pre-Trial Services
  • 15. Adolescent & Adult Men’s Clinic Substance Abuse Mobile Health Center Treatment Oral Health Behavioral Health Pediatrics Centering Pregnancy Primary Care Comprehensive Prevention Recreation & Wellness Family Case Management Targeted Intensive Prenatal Family Planning Case Management HealthWorks Teen Clinic HIV Prevention Teen Parent Services Illinois Breast & Cervical Women’s Health Services Cancer Program (OB/GYN)
  • 16. Aunt Martha’s Health Center 350,000 300,000 250,000 200,000 DEVELOPING LEARNING TO BE A EXPANDING ACCESS TO AN FQHC COMPREHENSIVE COMPREHENSIVE MODEL 150,000 MODEL Patients 100,000 Visits 50,000 0 CY CY CY CY CY CY CY CY CY CY CY '00 '01 '02 '03 '04 '05 '06 '07 '08 '09 '10 UDS Reporting Year
  • 17. The People We Serve Aunt Martha's Illinois' CHCs All CHCs 60.00% 50.00% 40.00% 55.45% 52.47% 39.74% 30.00% 37.67% 31.24% 37.54% 20.00% 15.22% 7.51% 10.84% 10.00% 5.46% 1.60% 5.28% 0.00% Uninsured Medicaid/CHIP Medicare Other 3rd Party Source: UDS Summary Report – 2010. Grantee, State and National - Universal
  • 18. Primary Care Services Patient Centered Medical Home • Patient-centered, Physician-directed • Care that is effective and efficient Chronic Care Management Model Women’s Health Services Family Planning Obstetrics/Gynecology Breast and Cervical Cancer Screenings
  • 19. Cost Efficient, Comprehensive Services $600 $600 $562 $588 $550 $538 $500 $510 $518 $451 $477 $450 $485 $400 $454 $430 $426 $350 $374 $300 2006 2007 2008 2009 2010 Aunt Martha's CHCs in Illinois CHCs in U.S.
  • 20. Oral Health Care Services Cleaning X-Rays Dental Hygiene Fillings Education Sealants Routine Check-ups & Fluoride Treatments Exams Extractions Root Canals Aunt Martha’s Personal Dental Questionnaire 4 Simple Questions Can Make a Difference
  • 21. Cost Efficient, Coordinated Dental Services 60,000 Cost Per Dental Patient $400 50,000 $350 $358 $372 $333 $344 $300 40,000 Patients $274 $250 $247 $248 $259 Visits $255 $200 $249 30,000 $150 $181 $195 20,000 $100 $128 $50 10,000 $- 2006 2007 2008 2009 2010 - Aunt Martha's CHCs in Illinois CHCs in U.S. 2004 2006 2008 2010 2003 2004 2005 2006 2007 2008 2009 2010 Patients 1,257 2,087 3,239 6,179 13,459 15,413 20,294 25,248 Visits 2,030 2,412 5,379 10,377 22,546 30,902 44,713 55,539
  • 22. Cost Efficient, Coordinated Dental Services 60,000 Cost Per Dental Patient $400 50,000 $350 $358 $372 $333 $344 $300 40,000 Patients $274 $250 $247 $248 $259 Visits $255 $200 $249 30,000 According to the most recent data $195 $150 $181 available for state and national levels 20,000 $100 $128 (calendar year 2010), Aunt Martha’s serves 15 percent of all the patients $50 10,000 receiving dental services from a BPHC $- grantee in Illinois. 2007 2006 2008 2009 2010 - Aunt Martha's CHCs in Illinois CHCs in U.S. 2004 2006 2008 2010 2003 2004 2005 2006 2007 2008 2009 2010 Patients 1,257 2,087 3,239 6,179 13,459 15,413 20,294 25,248 Visits 2,030 2,412 5,379 10,377 22,546 30,902 44,713 55,539
  • 23. The Care Management Model at Work Health Treatment in % of Patients Plan % with Treatment Compliance % of Patients Center Active Treatment Completed Non-Compliant Carpentersville 68% 32% - Chicago Heights 62% 38% - Hazel Crest 60% 40% - Iroquois County 92% 8% - South Holland 54% 46% - Southeast Side 59% 33% 7% Vermilion Area 83% 16% 1% Women’s Health Ctr. 46% 54% -
  • 24. Behavioral Health Care Services Child & Adolescent Psychiatry and Therapy Individual Counseling Comprehensive Diagnostic Evaluation & Treatment Telepsychiatry Reaching children and families in some of Illinois’ most isolated communities
  • 25. Cost Efficient, Coordinated Mental Health Services 35,000 Cost Per Mental Health Patient $655 $653 $700 $600 $605 30,000 $569 $572 $600 $529 25,000 $500 $559 $541 $493 $462 $493 20,000 $400 15,000 $300 Patients $200 10,000 Visits $100 5,000 $- - 2006 2007 2008 2009 2010 2004 2006 2008 2010 Aunt Martha's CHCs in Illinois CHCs in U.S. 2003 2004 2005 2006 2007 2008 2009 2010 Patients 210 945 878 2,632 3,916 4,757 6,265 7,647 Visits 625 2,793 3,515 11,731 21,819 26,120 31,474 35,704
  • 26. Cost Efficient, Coordinated Mental Health Services 35,000 Cost Per Mental Health Patient $655 $653 $700 $600 $605 30,000 $569 $572 $600 $529 25,000 $500 $559 $541 $493 $462 $493 20,000 $400 15,000 According to the most recent data $300 available for state and national levels Patients 10,000 Visits (calendar year 2010), Aunt Martha’s $200 serves 15 percent $100all the patients of 5,000 receiving behavioral health services $- - from a BPHC grantee in Illinois. 2006 2007 2008 2009 2010 2004 2006 2008 2010 Aunt Martha's CHCs in Illinois CHCs in U.S. 2003 2004 2005 2006 2007 2008 2009 2010 Patients 210 945 878 2,632 3,916 4,757 6,265 7,647 Visits 625 2,793 3,515 11,731 21,819 26,120 31,474 35,704
  • 27. The Care Management Model at Work Pt. Not Hospitalized during 90.21% treatment Pt. reports symptom improvement 92.27% within 3 months Compliant with Meds 90.72% 85.30% # appts attended 96.39% Consent Signed 81.96% Medical/Physical in File 70% 75% 80% 85% 90% 95% 100%
  • 28. The Care Management Model at Work 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Under 18 Under 21 adult
  • 29.
  • 30. Cross-Integration and the Evolution of Aunt Martha’s • This notion is not new. • Our services were born out of client needs – Youth needed someone to talk to (counselors) – Drug use (substance abuse services) – Kicked out (foster homes) – Pregnant (prenatal and family planning) – Jobs (employment) – Kids (childcare)
  • 31. Core Training for All Employees • 4 hour training • Help you better serve clients and patients by teaching you what cross-integration is, and why and how we do it • Lecture, discussion, group activities, video, software demonstrations, Q&A • 6 Modules – Understanding Cross-Integration – Knowledge of current programs, services, locations and eligibility – Using the Client Referral System – Using the Cross-Integration application – The “VIP” protocol – Accountability and Making it Real
  • 32. Making Connections and Coordinating Care Our Cross-Integration System enables employees to search a centralized database of each client's service history at Aunt Martha's.
  • 33. Aunt Martha’s Cross-Integration System Once a record is selected, staff can: 1. Review Client History; 2. See the Client's Location on an interactive map; or, 3. View Suggested Programs for the client.
  • 34. Aunt Martha’s Cross-Integration System The list of Suggested Programs can be changed by adjusting a filter of selected client characteristics.
  • 35. Aunt Martha’s Cross-Integration System When a Suggested Program is selected, the interactive map is updated to show: 1. The client's home address; and, 2. The Locations where the selected program provides its services.
  • 36. Aunt Martha’s Cross-Integration System From within the Cross-Integration System, employees can generate an electronic referral to any of Aunt Martha's programs. The status of each record created in our Referral Tracking System can be monitored by our managers to ensure that it is acted on and closed in a timely manner.
  • 37. Aunt Martha’s Cross-Integration System From within the Cross-Integration System, employees can generate an From July 2010 through June 2011 any of Aunt Martha's electronic referral to (FY11), a total of 3,821 requests were programs. logged in the Referral Tracking System. The status of each record created in our Referral Tracking System can be monitored by our managers to ensure More than 3,100 requests have already closed in a timely that it is acted on and been logged in FY12. manner.
  • 38. Cross-Integration, Coordinated Care & Collaboration • Services organized from the client’s perspective • Integration of child welfare, juvenile justice and education services with the Medical Home • Alignment with local networks of health care and social service providers in every community • Implementation of systems to enable communication and simplify access and the coordination of care
  • 39. Client Experiences – Case Study A 17 year old young man accessed services through our street outreach program and was referred to our homeless shelter when we discovered he did not have a permanent residence. At the shelter he received help with interpersonal skills, like skills, academic enrollment and job preparations skills. Using our integrated network he also received services at our health center, participated in youth leadership opportunities and discharged to job corp with his HS Diploma where he is learning carpentry skills.
  • 40. Client Experiences – Case Study An 18-year old female from Haiti was brought to Aunt Martha’s by the police after it was discovered that she was homeless. She participated in our life skills programs, re- enrolled in school and began working toward reunifying her family. When she left Aunt Martha’s, she moved into the home of a family member and began aftercare. The family struggled. Eventually, the young woman was referred to our Greenhouse Shelter to ensure she continued to her work in school, job preparation and family communication.
  • 41. Bringing the Value to Life Telling the Stories of our Patients & Clients If Ernie sends the five or six bullets Karen asked him for about the value added initiatives, we can use them here.
  • 42. Incorporating SBIRT Into Aunt Martha’s Model of Care • Previous Experience with Similar Tools – Depression Screening Tool – Dental Health Questionnaire • Automated Patient Check-In – Phreesia demonstration • Our Adult Patients in South Suburban Cook County
  • 43. Incorporating SBIRT Into Aunt Martha’s Model of Care

Notas do Editor

  1. GARZAThe story of Aunt Martha’s actually begins in 1969, when Park Forest formed a Youth Commission to advise the Village Board about the challenges that the area’s young people were encountering. The Youth Commission was also responsible for recommending strategies to address the needs and challenges it uncovered.In 1972 the Village allocated funds to hire a full-time Youth Worker to:Conduct a more thorough analysis of the needs that had been identified by the Youth Commission; and,Provide guidance and lead the development of programs and initiatives.By the end of 1972, the majority of the Youth Worker’s time was being spent training the volunteers – including youth and adults – who would staff the new walk-in counseling center for runaways and alienated youth. The drop-in center was called Aunt Martha’s, and it opened in December of 1972. The Youth Worker, Gary Leofanti would act as its executive director (in addition to his duties as a Village employee).
  2. GARZA
  3. GARZA
  4. GARZA
  5. GARZA
  6. GARZA
  7. GARZAUsers & Encounters by Calendar Year2000 – 3,611 Users – 16,293 Encounters2001 – 4,370 Users – 13,702 Encounters2002 – 6,138 Users – 19,819 Encounters2003 – 10,373 Users – 33,114 Encounters2004 – 16,427 Users – 51,152 Encounters2005 – 24,530 Users – 81,096 Encounters2006 – 35,655 Users – 118,223 Encounters2007 – 54,590 Users – 174,911 Encounters2008 – 62,387 Users – 201,381 Encounters2009 – 79,967 Users – 273,014 Encounters2010 – 84,751 Users – 310,668 Encounters
  8. BYRD
  9. Primary Care ServicesHealthWorks, Family Medicine, Internal Medicine, School-Based Health Care, Immunizations, Laboratory Services, Medication Management & Assistance, HIV/AIDS Services, Walk-in ServicesMay want to highlight specialty clinics like Teen Clinic and Men’s Clinic.Women’s Health ServicesFamily Planning, Obstetrics/Gynecology, Pre- and Postnatal Care, Immunizations, Pregnancy Tests, Pap Smears, Breast Cancer Screenings, Cervical Cancer ScreeningsOur Women’s Health Services are integrated with programs that provide education, access to other resources in the community and serve as a social support system for many of our patients. (i.e. Healthy Start, Family Case Management, Targeted Intensive Prenatal Case Management and Teen Parent Services)In Calendar Year 2010:Obstetricians & Gynecologists provided almost 29,000 visits;Case Managers and Patient Educators provided more than 13,000 visits.# of Prenatal Care Patients who Delivered in 2010: 1,232
  10. Aunt Martha’s Total Cost Per Total Patient is 12% lower than the average for Illinois’ health centers, and 23% lower than the national average.WHAT DOES THIS MEAN?WE SEE MORE PATIENTS AND WE DO IT MORE COST EFFECTIVELY THAN THE COMPETITION.
  11. KEY POINTS:Care Management ModelPersonal Dental QuestionnaireCalendar Year 2010 Stats:25,248 Patients55,539 Visits, including: - 26,320 oral exams - 11,693 restorative procedures - 5,994 extractions and other surgical proceduresFACTS ABOUT KIDS ORAL HEALTH CAREDental care is the single greatest unmet need for health services among children.Every year, 17 million disadvantaged children do not receive the dental care they need.Tooth decay is the most common childhood disease. It affects nearly 60 percent of children.80 percent of dental disease is concentrated in just 25 percent of children – those who come from poor families that face disproportionately high barriers to getting care.
  12. Nearly 30% of our health center patients received dental services in CY 2010.State Average: 14.81%National Average: 19.26%Aunt Martha’s Dental Cost Per Dental Patient is 10% lower than the average for Illinois’ health centers, and 34% lower than the national average.WHAT DOES THIS MEAN?WE SEE MORE PATIENTS AND WE DO IT MORE COST EFFECTIVELY THAN THE COMPETITION.
  13. Nearly 30% of our health center patients received dental services in CY 2010.State Average: 14.81%National Average: 19.26%Aunt Martha’s Dental Cost Per Dental Patient is 10% lower than the average for Illinois’ health centers, and 34% lower than the national average.WHAT DOES THIS MEAN?WE SEE MORE PATIENTS AND WE DO IT MORE COST EFFECTIVELY THAN THE COMPETITION.
  14. Calendar Year 2010 Stats:7,647 Patients, including: - 5,527 (72%) diagnosed with depression or other mood disorders - 1,547 (20%) diagnosed with anxiety disorders - 3,019 (39%) diagnosed with attention deficit and disruptive behavior disorders 35,704 VisitsFACTS ABOUT KIDS BEHAVIORAL HEALTH CAREChildren’s Behavioral Health Problems are WidespreadAlmost one in five (1/5) young people have one or more mental, emotional and behavioral disorder.One in 10 youth has mental health problems that are severe enough to impair how they function at home, school or in the community. Early Detection and Intervention Are CriticalResearch supported by the National Institute of Mental Health indicates that half of adults with mental, emotional and behavioral disorders were first diagnosed by age 14 and three-fourths were diagnosed by age 24.Factors that predict mental health problems can be identified in the early years, with children and youth from low-income households at increased risk for mental health problems. Need for Improved and Expanded Mental Health Services for Children & Youth is Well-DocumentedIt is estimated that less than one in five (1/5) children receive the appropriate needed treatment.
  15. 9% of our health center patients received mental health services in CY 2010.State Average: 4.30%National Average: 4.38%Aunt Martha’s Mental Health Cost Per Mental Health Patient is 27% lower than the national average.WHAT DOES THIS MEAN?WE SEE MORE PATIENTS AND WE DO IT MORE COST EFFECTIVELY THAN THE COMPETITION.Our psychiatric staff represents 22% of the total psychiatric FTEs in all of Illinois’ community health centers.LIMITATIONS- Ideal continuum for FQHC BH is less seriously mentally ill patients- Who already access the FQHC for medical careEven though We already see well over 100 with a diagnosis of schizophrenia FINANCIAL LIMITATIONS- 330 Funding provides limited funding for uninsured FQHCs cannot be the primary provider of BH services to the Seriously Mentally IllBI-DIRECTIONAL INTEGRATIONGreat potential, but…- Needs to be funded- FQHCs need Change of Scope to provide primary care in CMHC Practice has to recognize that regular productivity is less SUMMARY- FQHCs can be a model for the integration of primary and behavioral healthcare - Successful implementation requires effective systems and management- BH should be integrated into all areas of clinic functioningFQHC-CMHC collaboration is promising but should not be viewed as an alternative to CMHCs for Seriously Mentally Ill
  16. 9% of our health center patients received mental health services in CY 2010.State Average: 4.30%National Average: 4.38%Aunt Martha’s Mental Health Cost Per Mental Health Patient is 27% lower than the national average.WHAT DOES THIS MEAN?WE SEE MORE PATIENTS AND WE DO IT MORE COST EFFECTIVELY THAN THE COMPETITION.Our psychiatric staff represents 22% of the total psychiatric FTEs in all of Illinois’ community health centers.LIMITATIONS- Ideal continuum for FQHC BH is less seriously mentally ill patients- Who already access the FQHC for medical careEven though We already see well over 100 with a diagnosis of schizophrenia FINANCIAL LIMITATIONS- 330 Funding provides limited funding for uninsured FQHCs cannot be the primary provider of BH services to the Seriously Mentally IllBI-DIRECTIONAL INTEGRATIONGreat potential, but…- Needs to be funded- FQHCs need Change of Scope to provide primary care in CMHC Practice has to recognize that regular productivity is less SUMMARY- FQHCs can be a model for the integration of primary and behavioral healthcare - Successful implementation requires effective systems and management- BH should be integrated into all areas of clinic functioningFQHC-CMHC collaboration is promising but should not be viewed as an alternative to CMHCs for Seriously Mentally Ill
  17. GARZA
  18. Services organized from the client’s perspective.Founded as a result of the Park Forest Youth Commission.FQHC designation requires that Board includes patient representation.Care Management Model – personalized assistance to help patients navigate the system.Full integration across continuum of child welfare, juvenile justice, education and health care services.HealthWorks and CRC as examples of how healthcare services have been combined with child welfare services.In Fiscal Year 2011, employees logged more than 1,000 referrals to other programs or services in the Aunt Martha’s system.Aligned with other health care and social service providers in every community.Partnerships with 291 health care, dental and behavioral health-related providers and organizations.Partnerships with 535 education and social service-related providers and organizations.Partnerships with 688 religious institutions and organizations.Partnerships with 385 government, civil service and other institutions and organizations.Integrated IT system to enable communication and simplify access to services.Cross-Integration System, which unifies the records of clients whose service information is maintained in multiple, program-specific systems.Client Referral System.‘Request Appointment’ function on the agency’s website, which is linked to and has logged more than 2,800 requests in the Client Referral System since December 2010.
  19. THIS SLIDE IS ABOUT HOW WE ARE EXTENDING OUR RESOURCES BEYOND THE PEOPLE WE SERVE DIRECTLY AND MAKING THEM AVAILABLE TO OTHER ORGANIZATIONS IN THE COMMUNITY.