Improving Professional Collaboration Between Child Welfare and Human Services / Behavioral Health

Most PDSA Collaborative agencies created or improved documentation guiding staff in collaboration work, ranging from desk guides to formal policies. Multiple agencies stated that the investment of time and resources to create these documents was worthwhile to clarify and streamline these processes and ensure that each family / consumer receives similar support. The formal policy and procedure documents that guide multi-unit professional collaboration are summarized below.

1. Cross-Unit Professional Collaboration Policy (Washington County)

Washington County created this Cross-Unit Professional Collaboration Policy that describes collaborative cross-unit meeting guidance through clarification on the staffing process, staff to be included, their roles, and what they hope to accomplish. Additionally, the team has created a referral process for supervisors to put families on a list to prioritize for staffing.

2. Procedure to determine dual enrollment and what information to provide: Monroe County Department of Human Services

Monroe County created this collaboration procedure document that describes guidelines on determining if the family is involved with other agency units, as well as to determine what information may be shared when collaborating on a joint family / consumer.

3. Collaboration Guidelines (Rock County)

Rock County created these Collaboration Guidelines that outlines the importance of collaboration in social work, defining direct service professional roles, meeting expectations, and overall guidelines. This agency also created this Guide to Collaboration that summarizes staff expectations, including what communication and collaboration should look like.

4. Cross-Unit Professional Collaboration Policy (Outagamie County)

The Outagamie County Cross-Unit Professional Collaboration Policy outlines the teaming process, how to share information while maintaining confidentiality, and how to conduct Snack and Chats.

5. Memorandum of Agreement between Oneida Nation Family Services – Indian Child Welfare Department & Oneida Nation Behavioral Health Services

Oneida Nation is creating a Memorandum of Agreement (MOA) between Indian Child Welfare and Behavioral Health. The MOA explains the need for interdependency between units, clarifies what information may be shared with or without a Release of Information (ROI), outlines when joint meetings will occur, and describes how to onboard new staff.

6. Memorandum of Operations for inter-unit agency collaboration (Portage County)

Portage County is developing a Memorandum of Operations which will include referral processes, communication expectations between programs, information sharing guidelines, and shared meetings.

Most PDSA Collaborative agencies created or improved documentation guiding staff in collaboration work, ranging from desk guides to formal policies. Multiple agencies stated that the investment of time and resources to create these documents was worthwhile to clarify and streamline these processes and ensure that each family / consumer receives similar support. The desk guides provided below include guides with program descriptions, flow charts and visual aids, and frequently used terms lists.

Program Descriptions

1. Program Descriptions and Collaboration Guidance between Human Services and CCS/CLTS (Dane County)

Dane County created this desk guide of unit and staff roles that assist in guiding the collaboration work across units.

2. Human Services Program Guide (Rock County)

This human services program guide describes the population served, what each program does, the referral process, timelines, and contact information.

3. Human Services Program Guide (Oneida County)

This Oneida County Human Services Program Guide describes each unit’s programs, capabilities, human services and social services work. The guide is used by front desk staff to direct people seeking services, and seeks to provide a warmer hand-off to other units as well as better and timelier information provided to families. It has also provided the opportunity for staff to review the work of other units and potentially recognize a gap in their knowledge regarding services available.

4. Desk Guide (Outagamie County)

The Outagamie County desk guide is a detailed description of programs.

Flow Charts and Visual Aids

5. Flow Chart of Internal Systems (Waukesha County)

Waukesha County’s flow chart of internal systems outlines the work of each unit including what each unit does, their responsibilities, specific timeframes that must be met, and defines acronyms.

6. Flow Chart Outlining Collaboration Steps (Clark County)

Clark County developed a flow chart that documents the new collaboration process. The flowchart begins with identifying families involved in multiple units on a weekly basis, determining a staff leader, describes the meeting to clarify details and roles before meeting with the family, and describes the family team meetings.

7. Flow Chart of Indian Child Welfare steps (Oneida Nation)

Oneida Nation created visual aids such as this Flow Chart of Indian Child Welfare Steps to clarify processes and outline what information is needed when collaborating.

8. AODA Enrollment Process Visual Aide (Oneida Nation)

This AODA Enrollment Process Visual is to assist direct service professionals in better understanding the AODA services process.

9. Accessing Mental Health Visual Aide (Oneida Nation)

This Accessing Mental Health Visual Aide is to assist direct service professionals in better understanding the mental health services process.

10. Flow Chart of Internal Systems (Portage County)

This flow chart directs persons who have program questions.

Frequently Used Terms

11. Key Words in Child Protective Services (Oneida Nation)

This Key Words in CPS document outlines many of the commonly used acronyms in Child Protective Services / Indian Child Welfare.

1. Team Contact List (Waukesha County)

Waukesha created a Team Contact List of all providers working with the family to distribute to family members to help them better connect with direct-service professionals.

2. Team Role Handout and Team Road Map (Lincoln County)

The Team Role Handout and the Team Road Map documents clarify the direct service professional working on the case, their role, what the work unit does, and how to contact the correct direct-service professional.

Some agencies created a system to track referrals made to other units, and those tools are available here:

1. Referral Tracking Spreadsheet (Washington).

Washington County uses a Referral Tracking Spreadsheet to track families / consumers that have dual enrollment. The spreadsheet is password protected, and Child Welfare and Behavioral Health supervisors have access to the spreadsheet to add cases. These cases are discussed at the end-of-month multi-unit meetings, or in email. The referring supervisor schedules all multi-unit team meetings.

2. Referral Tracking Spreadsheet (Adams).

Adams County uses this Referral Tracking Spreadsheet to ensure that referrals for dually enrolled families occurs, and all direct service professionals are notified of new shared cases or changes in the case.

1. New Meeting Process (Waukesha County)

Waukesha County developed a new process to guide units working with families / consumers receiving services from multiple county units. When these families are identified, the agency:

• • Hosts an internal agency collaboration meeting with all direct service professionals that work with the family to discuss their roles, responsibilities, and services. This meeting occurs before meeting with the family and the agenda is: Internal Collaboration Meeting Agenda.
  • A 30-day follow-up meeting amongst direct service professionals and the family is held. The standard agenda is the 30-Day Family Collaboration Meeting Template.
  • Documentation of roles and responsibilities is attached to meeting invitations.
  • Families are provided with the Team Contact List of all providers working with the family to assist family members know which provider to contact, when.

2. Creative Consult Collaboration Agenda (Outagamie County)

This Creative Consult Discussion Agenda guides teams of multi-unit professionals through agreed upon ground rules for creative brainstorming on a shared family that has complex or unmet needs.

3. Agenda to guide cross-unit case-planning meetings (Washington)

Washington County created this cross-unit case-planning meeting agenda outlining who is at the cross-unit case-planning meeting, what is their role, what problems have been identified, client needs, and ends with defining to-do actions and next steps. This agenda and specific questions are sent before the meeting to help participants be best prepared.

4. Initial Assessment Specific Questions for the Initial Collaboration Meeting (Adams County)

Adams County created this list of Initial Assessment specific questions to be asked in the initial collaboration meeting.

Agencies chose to create or improve how they hold meetings as a part of the Professional Collaboration improvement project, including new ways of holding:

• Interdisciplinary team meetings without the family present
• Interdisciplinary team meetings with the family present
• Multi-unit meetings
• Onboarding new staff

Interdisciplinary Team Meeting Without the Family Present

Teams who organized interdisciplinary team meetings before meeting with the family believed it allowed for open and focused discussions, coordination of roles, and better understanding of the situation. Staff felt these meetings allowed them to have more of a voice in helping the family / consumer, there was less staff defensiveness, and the process was clearer. This in turn allowed for subsequent meetings with the family to be focused, proactive, and enable all units to maintain a positive relationship with the family.

Additional ideas tried by teams include:

• Interdisciplinary teams for all dual enrolled families / consumers. Agencies shifted to holding interdisciplinary team meetings for most dual enrolled families instead of holding these meetings only during crisis. An example agenda is here: Internal Collaboration Meeting Agenda.
• 30-day follow-up meetings. Some teams immediately schedule a 30-day interdisciplinary follow-up meeting to ensure progress and direct service professional role clarity. These meetings begin by describing the family’s strengths and the direct service professional roles with the family. The standard agenda for one agency is the: 30-Day Family Collaboration Meeting Template.
• Resource sharing. Interdisciplinary teams’ problem-solve how to support families through community and agency supports. This allowed for improved knowledge of external resources and connected families to services faster.
• Supervisor Staffing’s. Supervisors meet and review shared cases and problem solve how to support families through community and agency supports. This ensures all appropriate units are involved with the family. These meetings did lead to an increase in shared knowledge of external resources, accelerating the process of getting families necessary services.
• Complex Case Consultations: Eau Claire County provided staff with an opportunity to bring their complex cases to an interdisciplinary meeting to brainstorm how to best work with the family / consumer. These cases were typically situations where the professionals were working to avoid an out-of-home care placement or were working to achieve permanency for a child or youth. Leadership organized an in-person one-hour meeting with three 20-minute slots that Lead Workers could sign up for if they wanted assistance problem solving.

The agenda: These meetings begin with a case presentation, identification of direct service professionals and their roles, description of what has been tried, what the child and family want, and concludes with brainstorming and next steps. The meetings were successful with staff demand requiring additional meeting opportunities to be offered. Staff appreciated meeting in-person and having the ability to work through complex and emotionally difficult cases with other staff.

Interdisciplinary Team Meeting with the Family Present

Interdisciplinary team meetings with the family / consumer were also important, with ideas including:

• Invite all direct service professionals: Some units invite other direct-service staff to attend in-person meetings with the family / consumer when they are scheduled.
• Ask the family / consumer their wishes: Another agency made a point to ask the family / consumer how often they want to meet with the interdisciplinary team.
• Provide family / consumer with contact sheet. Some agencies leave the family / consumer with a team contact sheet that clarifies the direct service professional working on the case, their role, what the work unit does, and how to contact the correct direct-service professional.

Multi-Unit Meeting

Multiple agencies found it beneficial to schedule standing cross-unit meetings to provide an opportunity for staff to ask questions, build relationships, and discuss specific cases as needed. Some agencies chose to include all staff, and others held these meetings at the leadership level. Specific ideas are:

• In-Person Monthly Meetings: Agencies hold standing monthly in-person multi-unit meetings to discuss programs, build relationships, and gain a better understanding of each other’s work. Some agencies discuss shared cases in these meetings, gather other’s ideas, and troubleshoot complicated case concerns. Overall staff appreciate these meetings as they are learning others’ roles to a greater extent and feel their perspective is being respected.
• Leadership and/or staff attend other unit meetings: Agencies encourage leadership and/or staff to periodically attend other unit meetings to gain insight, improve communication, and identify / discuss shared families.
• Case referral discussions. Some agencies provide time to determine shared family / consumers and make sure referrals are being made.

Onboarding New Staff

Multiple teams bring an additional focus on teaching new staff about the work of other units, as well as beginning to build relationships with all staff, earlier in their training.

Most teams provided their staff with additional learning opportunities about other units as many individuals began the collaborative with a limited understanding of other units’ work. These learning opportunities included:

• Unit presentations,
• Relationship building opportunities, and
• Exploring the client experience.

Unit Presentations (Snack n’ chats, Lunch and Learns, Food for Thought)

Many agencies hosted unit presentations directed at all-agency staff as an opportunity to learn more about a program and to improve the comfort of staff in reaching out to other units when they had questions or wanted to coordinate on a family / consumer. Many of these presentations had the following elements:

• Agenda: Presentations begin with a description of what each unit does, services provided, how referrals are made, statutory and policy requirements, the funding source, and the roles that direct service professionals have and do not have.
• Q and A: A Question-and-Answer session generally followed presentations to allow for open dialogue and to address concerns, misunderstandings, barriers, and program requirements.
• Food: Food was often provided to lend an air of informality and fun which helped in building relationships.
• Pre-Survey: Surveys provided before the event solicited topics for discussion to ensure attendees had their questions answered.
• Post-Survey: Surveys after the event measured if staff had a better understanding of the unit and felt more comfortable reaching out to the unit if they had a question.
• Written Guide: A written desk guide explaining each unit was provided to assist with memory retention.
• Scheduling: For ease of scheduling, many of these meetings were addended on to existing meetings.

Relationship Building

Relationship building was a key component for improving professional collaboration. Many teams had found that the lack of knowledge and relationships made it difficult to reach out and collaborate with others, leading to barriers when working with the family / consumer. To address this, teams built relationships in the following ways:

• Unit presentations: The unit presentations described above provided an informal and fun way to get all staff together to learn from each other and ask questions in a judgement-free way. Many stated they now feel more comfortable reaching out to other units.
• Cross-unit discussions of mission and misconceptions: All PDSA teams worked through the ‘System Comparison of Values and Principles’ handout where they discussed the mission, goals, and misconceptions about their program areas. This allowed groups to honestly discuss how facets of their different program areas can lead to tensions and/or miscommunications. One agency chose to do this activity with all staff from all program areas.
• PDSA Team project: The PDSA team itself brought together multiple staff and built relationships. Staff appreciate knowing and trusting each other’s work to a greater extent, and they understand each other’s communication style.
• Informal connection opportunities: The in-person connections forged in informal ways, such as through car rides to meetings or through agency-wide potlucks, allow for additional communication and recognition of each other when in the building.
• Positive culture leads to effective work: Many want to continue building these relationships throughout their agency, as they acknowledged it is difficult to get frustrated with another unit if you have a relationship with them. A positive work culture is critical for effective work.

Walk Through Activity

Some teams went through a ‘Walk Through Activity’ where they simulated being a family / consumer attempting to receive services from multiple units within the agency. Teams that attempted this activity were able to identify cumbersome and repetitive processes.

Voice of the Customer Interviews

Some teams interviewed families / consumers to ask them directly what their experience was working within multiple units. These experiences helped agencies identify a need for uniform language for the family / consumer, as well as frustration over being asked the same question multiple times. One agency stated that it was very powerful and important for them to learn what the families are hearing from the direct service staff, and to learn how the agency is presenting itself to families. This helped in reworking the processes to be simpler. At least one agency stated they would continue doing these interviews beyond the initial PDSA Collaborative request to better determine the effectiveness of services.

As professional collaboration often involves communication regarding a family / consumer receiving services at the agency, direct service professionals need to ensure this communication is done within the confines of HIPAA and confidentiality requirements. Many individuals expressed wanting to share family / consumer information across different units, but felt they were unable to due to the restrictions or were unclear on what could be shared with or without a signed Release of Information (ROI). Some agencies chose to clarify what could be shared, including:

• Updated the ROI documents for clarity.
• Leadership confirmed HIPAA requirements with their Corp. Counsel and received guidance on what information may be shared, and when.
• Collaboration procedures document / guides created that clarifies how to put a ROI in place.

Some direct service staff stated there was a need in their agency to better identify if a family / consumer is receiving services in a separate unit as that is not automatically known. Multiple different methods were tried by the agencies to better identify families receiving multiple services, described below.

Clerical Staff

The clerical staff in some agencies have access to multiple databases. When a new family / consumer is enrolled in services, the clerical staff search for that individual’s name in all databases to determine dual enrollment. One agency began asking clerical staff to search for dual enrollment and found this new process has helped greatly in identifying these situations and involving all direct service professionals from the beginning of the engagement.

Direct Service Staff

One agency has the direct service staff ask the family / consumer if they are receiving services from a different agency unit. An accompanying checklist with program descriptions assists the direct service professional.

Leadership

Multiple agencies had the leadership team be responsible for identifying dual enrollment. Ideas tried include:

• Leadership attends a portion of a separate unit’s meetings to identify new families / consumers.
• Leadership discusses cases with other leaders bimonthly, identify families in dual enrollment, ensure referrals are made, and brainstorm resources available.
• When a new family / consumer is enrolled, the supervisor searches for that individuals’ name in multiple databases. When dual enrollment is identified, an internal collaboration meeting is scheduled across direct service professionals to identify a point-person to maintain notes and schedule future meetings.

Monthly Meetings

One agency holds a monthly meeting across agency units and includes time for case referral discussions. When families are identified, they are documented in a referral spreadsheet.