Ramsey County

Report date
March 2017

What has been most instrumental to your progress?

In 2016, we were able to make progress in three aspects of our Program:

1. Direct Service
2. Evaluation
3. Community Engagement and Outreach

1. Direct Service: A new CPS was assigned to this program in February and continues to serve clients. From February to October (last date that data is available) the CPS had served 13 individuals, providing over 140 face-to-face visits. The results of her services are captured in our Evaluation Report, and point to the impact of having community support provided to individuals following a mental health crisis. These services have been important for the individuals being served by improving individual recovery outcomes. The services are also important in that they are providing information and data that shows a positive impact on the overall system of care - allowing the Alliance to consider how to advocate for and incorporate increased community support services in to the continuum of care.
2. Evaluation: We were able to successfully complete a comprehensive evaluation of the services provided in 2016. The Improve Group produced a report in December 2016 that captured quantitative and qualitative outcomes for the program. The report captures the types of services that were provided as well as the impacts of the program. The report helps understand the types of individuals who were referred to the program, the services they were provided, and the impact it had on their recovery outcomes and the system as a whole. The impacts include: Participants getting access to needed services; Reduced utilization of higher acuity services; and Improved recovery outcomes. This report will be used by the Alliance to advocate the need for more community supports.
3. Outreach on the impact of CPS: A CPS networking group was formed in support of this program. This was a very valuable piece of the project, allowing CPS to network with one another, share services and referral ideas, and support one another through some challenging work environment issues. As this group got together, they determined it would be helpful to put together a presentation for Hospitals on how to best incorporate CPS in to inpatient psychiatric units. With support from the Alliance, the CPS were able to develop a training for our Hospital partners on how to effectively incorporate CPS in to the hospital environment. The presentation was given at St. Joe's and United Hospitals and is being scheduled for Regions hospital.

Key lessons learned

Throughout 2016, the program has been challenged by a low number of referrals from Hospitals and Crisis Residential. We had projected a significant need for the program and the potential for having too many referrals and a long waiting list. Instead we have additional capacity in the program, with staff availability to serve more individuals should they be referred. the CPS assigned to the program works part-time for this program and part-time for another program, which may impact here availability if her other program is busier. There has also been staff turnover and challenges at the Hospital partners that may have impacted referrals. As part of our program support in 2017, we are looking at how to increase referrals to the program.

Reflections on inclusive, collaborative or resourceful problem-solving

For this reporting period, the Collaborative element has been the most important. The collaboration between the Alliance and Ramsey County to get the program staffed and supported was critical to continuing the staffing. Another collaboration was between our main referral source - the Urgent Care for Adult Mental Health - and our CPS staff. The relationship and collaboration was essential to getting individuals in to the program, and the relationships between Urgent Care staff and the program staff was key to the success of understanding client needs and supporting the client following the referral.

Other key elements of Community Innovation

I would say that the Alliance's relationships along with the CPS staff relationships make this project and the program successful. We have all of the right individuals and organizations around the table to make this program successful as well as connect individuals served with the right resources.

Understanding the problem

We have more clarity on the ability of a CPS to provide impactful community support to individuals following a crisis that improves recovery outcomes and reduces system costs. We continue to explore how to make this a sustainable part of the continuum of care. The Alliance is working in 2017 to identify joint fundraising efforts, and community support is being discussed as a priority.

If you could do it all over again...

Don't worry about the program being overwhelmed with referrals - Spend time and energy marketing and promoting the program prior to its launch as well as continually as it is operating. We would like to serve more people in order to improve the validity of the data we're collecting and improving more individuals and making a bigger impact on the system.