Stars Community Services has had outstanding CANS/ANSA completion rates. We interviewed them to highlight this accomplishment and find out directly how they achieve it. Great job Stars team! Hopefully other providers will benefit from learning about your processes.

Interviewees:

• Veronique Lee-Director of School Based Services
• Katie Keech-Transition Age Youth (TAY) Program Supervisor
• Esmeralda Gonzalez-Training Coordinator and CANS Collaborative Member
• Jeanie Lynch-Administrator
• Chris Lee-Quality Assurance Manager
• Mattie’ Nogaye-Northern Regional Director of Training

When asked what Stars staff attributed their stellar CANS completion rates to, they first stated “It’s required” candidly.  But there is more to it than that or every agency would have the same level of CANS completion rates.  They shared the following strategies that they think supports their outstanding completion rates.  They have Opening, 30-day, 6-month, Annual and Discharge document checklists which include the CANS as one of the required documents.  These checklists require signatures of the primary clinician and initials of supervisors and administrative staff are also required after they review the packets to help ensure all documents are present and complete for increased accountability.  On these they have a prompt to supervisors to print the CANS and scan these into the EHR which keeps the supervisor more engaged in ensuring that the CANS is completed and submitted.  Stars staff shared that their assessment and CANS are separate documents and though Stars has their own EHR, their primary clinicians enter their CANS directly into Objective Arts (OA).  This has allowed the Research department to extract the CANS data from OA and produce some  program level reporting.  The clinicians are also utilizing CANS rating decreases to track the improvements of their clients in their treatment.

Training seems to be another key factor that has supported high completion rates for Stars.  Veronique  Lee stated that they have an all-day CANS Certification Training in their New Employee Orientation including time built in for trainees to take the test and this usually occurs within 2 weeks of hire. There are different tiers of training after New Employee Orientation to train staff on the clinical loop.  Agency wide, Stars works to titrate trainings and do refreshers as well as provides program level trainings. Mattie’ Nogaye stated “It’s not a one stop shop”.  Stars has 4 Leadership staff that have been certified as CANS Trainers.  Having 4 Leaders is intentional to ensure that there is no void of training even when there is turnover or scheduling conflicts.  In addition, Esmeralda Gonzalez emails all clinical staff CANS related training opportunities provided through the CANS Collaborative as they arise and she is also readily available as a consultant on an ongoing basis for clinical staff.  When asked about any challenges they have had and how they overcame them, Chris shared that when the Praed Foundation switched to Schoox, the Training and QA department created a process map to ensure that CANS certifications were linked to the agency’s OA account. This helped prevent delays in staff being able to enter CANS in Objective Arts and so he stated he wished they had done this sooner.

It is clear that Stars has great systems in place to train and support their staff to not only get their CANS completed consistently when required, but also to hold themselves and each other accountable to a high level of compliance with all requirements which are in place to support their staff and the clients they serve.

Did you know Alameda Behavioral Health Care Services recently created two positions to support providers in utilizing the CANS and ANSA tools in a more coordinated and effective manner? Meet Christine Mukai, CANS Coordinator, and Michael Castilla, ANSA Coordinator.

Welcome to the team Christine and Michael!

Would you mind telling us a little about your job experience prior to coming into your new position?

Christine: My work experience started back in the late 90’s with SUD in NYC, then day treatment in LA, and outpatient in SF. Then I joined Alameda County in 2002 in outpatient, then to the AB3632 unit, which later became the ERMHS unit. The past 6 years have been with the CEC School based program until switching over to becoming the CANS Coordinator. I have used the CANS since 2014.

Michael: My work history has primarily been in Supported Employment. For eight years I assisted individuals with mental health, dual diagnosis, and with developmental disabilities to find and maintain employment. I’ve worked with adults and Transition Aged Youth populations. I’m currently working as a Social Worker Supervisor with In Home Support Services (IHSS). We serve Minor Children cases and assess their needs in order for them to remain safely in their homes and to avoid premature out of home placement. As a supervisor, I review the assessments provided by the Social Workers in my unit. We assess each individual’s Functional Index Ranking and work to promote independence.

What is the county’s current focus and future hopes for the CANS and ANSA tools?
Christine: The Alameda County Behavior Health (ACBH) is focusing on providing mental health and substance use services to limited income individuals and families. ACBH very recently had a logo and branding update to reduce the stigma and negative connotation towards people who suffer from mental health and substance use. The county is also putting efforts into providing a continuum of care and has recently started an FSP for wrap services under the Children and Young Adult System of Care.
The future for CANS is to have more users understand how it can be a tool that is useful beyond the needs and strengths assessment.  CANS can be helpful in treatment planning, engagement, supervision and understanding outcomes.

Michael: I am very eager to get started and will know more as I become immersed in my new role. I am a big proponent of recognizing people’s strengths and what they can do. My career for the last 12 years has been around assisting individuals with maintaining independence and utilizing natural supports. My passion is coaching and supporting others with discovering new goals. My hopes are to assist all program recipients with recognizing their strengths and finding success with meeting their goals and continuing to dream for more.  

What CANS or ANSA item do you most identify with?
Christine: The Sleep question is what I identify most with.  Good restful sleep is essential in daily functioning and it’s a good indicator to understand the other areas.  When I get consistent good sleep, I feel great and feel like I can conquer anything!

Michael: I most identify with Talents and Interests under Individual Strengths. I truly believe that we should continue to be curious with the world around us and to seek to improve our current talents as well as discovering new ones.

What is something that you do for fun?
Christine: Something I like to do for fun is go hiking or to the beach.

What is the last book you read that you enjoyed?
Michael: The last book that I really enjoyed was the “Power of Habit” by Charles Duhigg. I found it to be inspirational and very informative.

Westcoast Children’s Clinic (WCC) has committed itself to practice-improvement in countless ways that have benefited the entire Alameda County system of care. One recent innovation in their intake process is showing promise for increasing engagement, client voice & choice, and TCOM integration. Like many organizations, WCC has traditionally used an initial intake process that is somewhat divorced from assessment and treatment. In this old model, a clinically trained intake clinician would take calls, check Medi-Cal eligibility, and gather relevant information about the client/family presenting issues and needs. Following this hour-long phone intake, the intake clinicians would make clinical determinations about the general course of treatment and would match the client with a clinician who best suited the client’s needs. When clinically indicated, the intake clinician would refer the client to services elsewhere. Although this process was designed to ensure clinical excellence and is conducted with sensitivity to the client’s experience, there are potential disconnections in having a lengthy intake on the phone prior to starting even lengthier assessment process with another WCC team member.
 
In the Spring of 2018, WCC formed a pilot group of about eight clinicians. All were TCOM champions interested in helping to improve engagement practices within their organization. Each was selected by a supervisor or director who recognized their ability to embed TCOM principles into their engagement, assessment and treatment activities. The group was involved in the development and implementation of a strategy to infuse these principles more fully into the WCC intake process.  The resulting pilot approach is called Collaborative Initial Evaluation and it differs from their traditional intake process in significant ways.

The largest difference is that the initial phone contact with a client is very brief and is used primarily to set up a face to face meeting with a Collaborative Initial Evaluation clinician.  This clinician would work with the client for up to 30 days, effectively conducting screening, intake and assessment in an integrated manner as the client’s needs become clarified. In this approach, there is no decision made about the course of treatment without the family’s input. Rather, needs and goals are discussed over the course of the month, allowing the clinician to centralize a relational and deferential stance with the client while also gathering all the information necessary for a complete clinical assessment. To ensure that TCOM and Communimetric principles are at the heart of this process, the clinician and client follow a comprehensive but concise guide. The semi-structured guides lead them through a collaborative conversation about the client’s hopes for transformation in all the potentially relevant life domains covered in Alameda County’s version of the CANS. As this process unfolds, the client’s “top needs” are identified, and only at that point is there a clinical determination of the recommended course of treatment – which could involve ongoing work with the clinician conducting the Collaborative Initial Evaluation or transfer to a better suited clinician.
 
The shift in practice has not been without challenges, but even the challenges have been constructive. For example: Some clinicians have found it challenging to conduct a 30-day evaluation while knowing they may end up transferring the work to a colleague. The tension between relationship building and time-bound information gathering demanded a more pointed approach to assessment. In reflection, some clinicians shared that they worried this approach would feel “intrusive.” If the assessment and treatment are expected to be done by the same person, this fear of intrusion can result in an “either/or” approach where “relationship building” is emphasized over concrete assessment of needs. Collaborative Initial Evaluation forces a “both and” resolution of this tension - giving clinicians the opportunity to sharpen their clinical assessment skills even more while still maintaining their commitment to respectful, relational work.
 
Westcoast Children’s Clinic has since introduced the practice across one of their programs – infusing the implementation process with the wisdom gained from the pilot group. All clinicians in this group were trained in performing the initial evaluations and in “taking a handoff” from another clinician. And all received additional training in team-based care. As this new phase unfolds, WCC continues to refine the protocol, discovering new ways to determine early on what course of assessment and treatment is best given the client’s emerging strengths, needs and goals.  The hope is that this practice will eventually be introduced agency-wide and that it can be shared with and replicated/improved by other organizations. Any questions about this innovative practice can be directed to Cinthya Chin Herrera, Psy.D, WCC Assistant Director of Training (cchinherrera@westcoastcc.org).

In this summer edition of the Alameda TCOM newsletter, our spotlight agency is Portia Bell Hume Behavioral Health and Training Center (aka The Hume Center). Founded in 1993, The Hume Center started as an outpatient program serving the unserved population in Central Contra Costa County.  It now offers 15 programs providing comprehensive behavioral health services across Alameda, Contra Costa, San Francisco, and Santa Clara counties.  
 
The Hume Center began its implementation of the TCOM tools three years ago. The Hume Center caught our attention for being one of the first behavioral health organizations in Alameda County that trained all of their clinical supervisors as CANS trainers.  Today it gains recognition for its implementation practices that align with the TCOM philosophy.

Over the past few years, The Hume Center has seen transformation in their services, beginning with intake assessments, noting that the CANS and ANSA structure has helped to ensure a highly comprehensive assessment.   Clinician Dr. Jamie Sayers, a 5-year Hume veteran, valued many aspects of the implementation.  Dr. Sayers described the CANS and ANSA as "really helpful," and went on to say, "I’m glad we update it as frequently as we do.”  Per Dr. Sayers, the county requirement to update the assessment at 6-month intervals has ensured routine review of progress in treatment, which has helped to highlight changes beyond the areas being tracked through treatment plans. Knowledgeable supervisors were listed as critical to this process.  At The Hume Center, supervisors help to highlight treatment priorities and assist clinicians in developing the “golden thread” between the assessment and treatment plan.
 
One program manager and clinical supervisor, Dr. Shannon Stovall, weighed in on what makes The Hume Center unique in its use of the CANS & ANSA. She noted that they integrate training on the CANS and ANSA at the beginning of every training year, discussing how to use these as tools for conversation as well as to assist in monitoring clients’ needs. This has shifted the use of the CANS & ANSA to more than “just a form,” and instead has influenced conversations on clinical teams. Dr. Stovall reminds, “One child, one CANS,” emphasizing the importance of minimizing over-assessment of children, and encouraging providers to collaborate with one another and with families with the aim of identifying a shared vision for care. Now that’s what we call Transformational Collaborative Outcomes Management!

The TCOM Spotlight article will highlight the way agencies within Alameda County are utilizing the CANS and ANSA tools in their practice. One organization will be highlighted in each newsletter.

Fred Finch Youth Center (FFYC) started implementing the CANS tool in 2014 and is deeply committed to the CANS implementation.  The organization chooses a CANS-related focus each year so that the CANS can be more than just a form for staff.  They felt it was important that CANS become a beneficial and collaborative process for both the organization and the youth and families it serves. For this reason, they’re our first TCOM Spotlight agency!

The first point of focus was to train staff to effectively work with the tool. FFYC supervisors all became CANS trainers. This not only allowed them to adapt the training to their programs, but also provided a consistent internal CANS certification training for new staff. This structure allows FFYC supervisors to regularly interact with the CANS and its related training materials. 

The second focus area was on improving the use of CANS data to inform treatment, as well as using the tool in collaboration with youth and families. FFYC adapted a training from the TCOM Collaborative which focused on integrating CANS items into treatment planning. The training was provided to all clinicians using the tool.  FFYC has trained clinicians to run reports that inform their treatment planning efforts. The reports also help clinicians to assess their own effectiveness in achieving positive outcomes for youth.  Supervisors were also trained to generate reports and look for trends related to program staffing and within caseloads. This information is then utilized to identify training needs, support clinicians who may feel stuck with a youth or young adult, or determine individual and group practice for a program.

FFYC has also identified program-specific goals related to CANS outcomes. The goals allow them to look at service effectiveness at both the program and agency level. QA staff at FFYC create and distribute quarterly program reports to illustrate progress towards the targeted goals.  They also host an ongoing CANS Data Advisory Group meeting, in which clinical and executive staff make decisions about how to use data, determine what data to focus on, and decide how to measure and build on improvements.
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The CANS has provided Fred Finch Youth Center with a shared language within and between internal programs, external organizations, and with the youth and family they serve.  This has served to align efforts and is a big piece of their work to provide effective trauma informed care.

If you know of an organization that deserves the center stage for their stand out implementation or cool and innovative practices with CANS and/or ANSA tools, please share their story through the Contact page.