To manage our Community Health we need to know what’s happening with our populations, engage our partners and develop an Activation process with a Team focus towards better outcomes.
The Community Health Activation Team (CHAT) is an innovative approach to community prevention based on the National Prevention Strategy (NPS) which aims to guide the nation in the most effective and achievable means for improving health and well-being. The model prioritizes outreach, care coordination and prevention by integrating recommendations and actions across multiple settings to improve health and save lives. There are 4 strategic directions and 7 priority areas. The strategic directions create the web to fully support individuals in leading longer and healthier lives.
The priority areas focus to reduce the burden of the leading causes of preventable death/illness.
CHAT uses an activation approach towards rapid access and care coordination/prevention education for the service delivery. The activities of the CHAT team are guided by the following:
- Engaging the community and encouraging realistic steps by creating opportunities to experience success while sector building.
- Activating the community and target populations once engaged. We know if the community partners don't understand their role, they will hesitate to take action and will be less likely to be pro-active.
- Activation requires a community centered approach to population health.
- There is a distinct variation in both activation and engagement for each high risk community we target. Through measuring our care coordination, educational activities and outcomes this allows CHAT to:
- Know where and to who we need to activate support;
- Target the types of support and information populations need;
- Evaluate our efforts to increase activation;
- Evaluate the quality of activities provided.
By developing collaborative partnerships between CHAT and community sectors, coordinated care offers an opportunity to share information in a timely manner and ensure that a person is being linked to safe, effective and rapid behavioral health care. The phrase “behavioral health” is used to describe service systems that encompass prevention and promotion of emotional health; prevention of mental and substance use disorders, substance use, and related problems; treatments and services for mental and substance use disorders; and recovery support. CHAT provides a mechanism to examine and prioritize quality prevention, treatment, and recovery elements at the community, consumuer, and population levels. A few CHAT programs include:
- In-Jail Nurse for Pregnant Mothers
- Drop Out Prevention
- Early Childhood Court Navigator
- Children's Crisis Unit Navigator
- Citizen Addition Recovery
- Evidence Based SUD and MH Education
- Smoking Cessation
- Injury Prevention
- Parenting and Life Skills
Historically, the majority of funding for both mental health and substance abuse has:
- Been focused on deep end service lines for direct care;
- Primarily used for those identified as high-utilizers and/or high risk populations;
- Lacked effort toward innovative front end strategies;
- Lacked effort towards a front end community health integrated model;
- Linked front end efforts towards measurable metrics and outcomes that impact the community or population health.
Many of the populations serviced by CHAT cycle lead to de-compensation and create immense costs for multiple publically funded systems. With CHAT, transition from these systems to home, or other post-acute care settings, is managed to avoid this cycling and reduce cost. At the same time CHAT addresses population health through targeting high risk communities by building healthy/safe communities, expanding quality prevention services, empowering people to make healthy choices and eliminating health disparities.
Mental health outreach and prevention has been largely absent within any continuum while substance abuse prevention usually focuses on programs aimed at individual behavior change or early intervention while an integrated strategy never marries the two in any type of holistic approach. And even to a lesser degree, the focus on an integrated community approach seldom utilizes community environmental strategies to prompt community population health change. CHAT does all of this.
BayCare Behavioral Health is dedicated to not only providing direct treatment services to those in need, but also in reducing the number of individuals who may need services in the first place by placing a strategic focus and repurposed funding on community health, outreach and prevention strategies at the front end of the service continuum. We have been able to:
- Prioritize community prevention efforts to improve health and save lives.
- Deploy a comprehensive plan for better health and wellness.
Our leadership has provided multiple community and state presentations to share with other leaders this innovative and comprehensive public health approach to improve the overall health and wellness of individuals and families in their communities. Presentations have described the development of the community health model, empowering communities and individuals to make healthy choices, and key discussions on developing a business model to address this approach which aligns with healthcare reform. A few of the major presentations include:
- 2015 Advancing Health and Wellness Recovery - Florida BH Conference
- 2016 Providing Value in Challenging Times - Florida BH Conference
- 2015 World Congress Integration
In addition, our 2016 strategic plan focuses, in part, on CHAT expansion:
- Outline the buisness modeling changes and reommendations for the Ambulatory Division to continue gaining traction in addressing population health (consumer value proposition, financial formula, key resources, etc.)
We are at a stage of organizational development marked by program expansion through diversified revenue streams that enable innovative and rapid program implementation supported by strategic community needs programming and focused on population health.
Since implementation of the CHAT program 2014, the CHAT model has been able to secure funding through multiple opportunities and continuously is seeking resources, grants and collaborative partners to expand and measure this approach. Some of the sustainability efforts to date include:
- Repurposing of general revenue funding @ $857,215.
- Legislative budget requests funding @ $300,000
- Tobacco training and cessation project funding @ $5,000.
- Meaningful Use funding utilized for field based connectivity.
- Developed collaborative link with local coalitions and school boards for project planning, efficiencies and resource sharing.
- Market exposure and branding through presentations, collaborative projects and interface with hospital based system of care.
While randomized controlled trials of traditional clinical treatments can often show direct influence on health outcomes within a relatively short period, community interventions such as CHAT can demonstrate influence on intermediate variables, and may not be able to report direct links to health outcomes within a short window. Thus, studies of community-based efforts rarely capture cost. When cost information is available, it can be hard to separate program costs from research costs. Amidst these challenges, providing holistic care to those with the greatest need has proven to be complicated. However we do know:
- Prevention works;
- Care coordination is critical to link high utilizers;
- Sequential intercept mapping targeting high risk populations is efficient;
We believe CHAT is a highly replicable model and aligns with the theory of disruptive innovation and is matched with an innovative business model to realign the front end of our system.
Measuring the impact of our holistic approach to community prevention is a continuous evolving process. We developed a clustering of 63 metrics that we are continuously refining from community environmental capacities, to morbidity rates, to care coordination, to evidenced based education, etc. Our vision was that by enhancing community capacity, we can alter the inequities that underlie the environmental risk factors. Metrics include:
- Decrease number of drug related lethal levels at death by 20% each year over previous year.
- Increase perception of risk for prescription drug use for combined middle and high school students over each previous cycle.
- Decrease number of youth involuntary exam initiations (Baker Acts) for youth aged 4-17 by 5% each year over previous year.
- Increase # of families receiving information on how to reduce unintentional injury - mortality rates of youth by 10% over baseline.
- Increase enrollment in Early Childhood Court by 25% over 2015.