AMCHP 2005 ANNUAL CONFERENCE
DELIVERING RESULTS, IMPROVING PREGNANCY & BIRTH
February 19-23, 2005
LEE HUNTER: --be working within Arizona and with the infrastructure that Katherine has just described to you, the community teams. With Southwest Institute for Families and Children with Special Needs we did apply for a maternal and child health grant and we're successful, I think, because we wrote it start working within communities. It is built within communities and we're going to talk a little bit about how that has emerged. We began also with a scientific process, we use PAR, Participatory Action Research, and so we brought some technical assistance to the communities in that whole process as well, but we're going to tell you a little bit more about how it actually got started. Some of the other initiatives in other communities of the five BCHA communities include electronic care coordination, training, direct support professionals, advocating for the pharmacy, and for training for families in that south Arizona community and electronic family profile and application process.
But we're going to talk about the Tri-City Prescott area, which is where Kim is from. We're going to highlight that and if you would look at your table; make sure that each of you have a worksheet like this. It's just a matrix with a lot of blanks and if everybody has, Linda has extra copies if you don't have one. Does anybody not have this? Okay, we need one in the back. What we would like you to do is to listen to our story. Kim and I are going to tell the story of how this initiative began and we would like for you to jots notes about the story, any notes that you'd like, but to listen for the key points, the key actions, or the key learning that you're hearing as we tell this story. We would like for you to come up with at least one key action or learning in each of the boxes. We're going to talk about partnership, which Rich mentioned earlier. We’re going to talk about planning and implementation and then Karen is going to talk about evaluation and so we hope that this will keep us awake and alive and interested so you have to listen and we, like Katherine, are glad that you're here. So Kim, tell how it started.
KIM STAMPER: All right, the story. I knew Lee because of OCEAN and our relationship there. The story actually started with the police lieutenant, Lieutenant Molinaro, who is a friend of mine because of Special Olympics. We work together and do a team there. Anyway and Laura knows that, this Lieutenant Laura, she knows that I do things within my community. She's not sure what it was, but she knew I was kind of linked to my community around special healthcare needs. So anyway, she called me one day kind of in a panic and she was at a scene with a few of her officers. There was a person there in a group home with developmental disabilities that was becoming very violent. She had two officers there and during this same time in Mesa, which is a lot larger city than ours, two people recently had died from police officers because they didn't know that they mental illness or they didn't know this developmental disability individual Didn't understand what they were trying to say.
So there was a couple of deaths and she was afraid, so she calls me and says, "I need help now. All I have is a 1-800 number from the State for developmental disabilities. Please tell me there's somebody local I can talk to I need them now." I did. I was able to give her a few names and a local number and she got them Johnny-on-the-spot, so she was able to dissolve what could've been a bad scene. And so later on we got together a few days later and we were talking because I said I also had a concern because my 17 year old son was becoming a lot more violent. He has mental retardation. He has cerebral palsy but he also has a lot--its autistic tendencies and he was becoming very violent towards us in the home. It was a hard thing for us to deal with and I knew things were so severe we may have to call the police our self. What is going to happen to my son? You know, where do they take a man like him and what's going to happen to us? And so we sat down and talked and she said there's not a whole lot in place, but this is what would happen and so we thought well we know in our community that they have issues from the police officers all the way to the families and also fire and everybody, so we thought how can we get together and do something about this?
LEE HUNTER: So Kim actually approached Karen with this idea of a first responder initiative and Karen you were happy to see them do that right?
KAREN BURSTEIN: We just received funding through our community initiative to support communities in some kind of capacity building at the local level and this was a perfect fit because this was an issue that a community had identified. That our role then was to be able to support the community in its development of an action plan that would benefit at the community level and our job was then to help track and facilitate and make this happen by a little bit of funding and a little bit of technical support.
LEE HUNTER: The grant, Building Community Health in Arizona , they're four basic goals around that grant and they universal application, care coordination, blending and braided funding, and integrated data. So I think you'll see, as Kim describes the project, how each of these components, or at least three of the four, were accommodated through this initiative. So how did you get started Kim?
KIM STAMPER: Okay, well we decided who needed to be the players at the table. We wanted to have our law enforcement. In our community it's called the Tri-City area. It's several cities put together so we have more than one city police and so we had three different cities to deal with and our county, which would be the sheriff, plus we had two different firefighter agencies that were onboard. I knew the fire chief from my church and so I went to him specifically. Laura, she went to the other officers that she knew even from Special Olympics who are the ones that might help us on this and see the benefit to this. So she gathered peers and she went to the other police chief and through the police department, then we linked up who are the EMT's and ambulance drivers that we need. We also got our behavioral health involved. Actually this is really a kickoff for behavioral health in our Tri-City team, because we needed that kind of education and we also got Adult Protective Services that weren't at the table before and that were very interested. So we started going through community and saying who would be interested in this. We also had the trauma intervention program that actually comes out after a bad incident to help with the family, so we had them involved.
LEE HUNTER: It was so exciting. I was very fortunate to be able to attend the committee meetings. It's just an hour and a half away and so it was so exciting to see this project evolve. I learned a lot about the first responder process, some things that helped me personally. We all did, didn't we?
KIM STAMPER: Oh, yeah.
LEE HUNTER: The 20 foot rule.
KIM STAMPER: Yeah with officers telling us this is the rule we have abide by. Officer safety is number one. In 20 feet anybody could hurt you, so if a person with a disability has a knife, right away at 20 feet they can become a victim so that was something families didn't know. There's a lot of things about the police that we did not know.
LEE HUNTER: They call it the circus is coming to town.
KIM STAMPER: Yeah.
LEE HUNTER: We had never heard that term before, but essentially that really is what happens when they come in and invade, right, Linda? You were talking about it last night, how they come and invade your home-
-
KIM STAMPER: Moving furniture and kids are freaking out.
LEE HUNTER: --leave a mess and—
KIM STAMPER: Yeah.
LEE HUNTER: --it is the circus coming to town. So it's been absolutely fascinating to watch the process evolve and to see how they came together and brought all the partners to the table. So let's talk a little bit about planning and implementation. One of the things that I did was to bring the PAR process to the community. I assisted in their strategic planning process, but they really identified the issue. We talked about problem, stating the problem, identifying a goal, coming up with a hypothesis, the strategies of how they were going to go about implanting the project, identifying the resources, and, of course, evaluation. The committee was very interested in using the PAR process and I took notes and organized them, but soon realized that it was their document and so they edited, they changed it. They took great ownership of the document itself.
KIM STAMPER: We actually meet monthly. We meet before our Tri-City team meeting so that we can do our work together for about two hours then we meet together afterwards with a bigger group and report out. We have a good database of our members. We're linked through our email, we have our own web site now through that, and we make assignments. We're an action team, so we're making assignments all the time and it is wonderful because the parents do this much and everybody else is--we're just orchestrating this and everybody--the officers were the ones going to our office supply stores and saying, "Well what is this going to cost? What is this going to cost?" They would come back and they--or they would get on the--they would research things online and so--I mean but the only thing as a parent--every meeting is led by parents, again, and--which is a great place for officers to see families even, you know, and firefighters to see families and they're not just the recipients of their service. They are the leaders.
LEE HUNTER: The grant provided resources for basic materials, but as Kim said they got lots of contributions from the community as well. The other role that I think we played was, coming from outside the community, was linking the community with another group that was working, the medical home group, that was working in the community and so they made links with the hospital and the ER staff and that sort of thing. We also provided an opportunity for them to link with others at the recent summit that we held. I wanted to tell a very quick story about, I think, the power of parent leadership. We had the Prescott Valley Police Department there and they realized that they needed the sheriff's office, so at the first meeting that the sheriff's representative attended he was quite resistant to the project. He said, "Well, you know, we have our own system and we can do this and we can do that."
And what was interesting is that the peers of the sheriff, the police from the other departments, began to confront him about him about, "Well, how might you work through this? How might we do this instead?" And so essentially the committee didn't have to deal with it, the peers were working with them to resolve the issue. And just at the right moment, Jessica, who is a parent leader, made some statements about--essentially what she was saying was this is the right thing to do, end of discussion. The parent leader component to that discussion was the power and everybody fell in line and so it's a marvelous process to watch when you--and I'm sure you all have had that experience.
KIM STAMPER: The neat thing is that because of everyone around the table we were able to address the HIPAA laws, because I know with Behavioral Health this confidentiality was a big thing, so how can we do this and we now have a developed a curriculum for first responders and a curriculum for families and providers, they’re a little different. The first responders is four hours long and they can use this certified as their updated--they just have to have so much training every year updated so this right away is through their curriculum. We developed the tool of a smart card where--it's very exciting because we have dispatch now involved and dispatch is flagged and the flag comes up on their screen and they tell the officer there's a smart card on scene.
That right away tells that officer or the firefighter that there's someone there with an individual, whether they're the ones that are in the situation right now or that are going to be observing the situation, so it gives a heighten awareness and so we have the trainings, we have the smart card, and through the grant, we're able to distribute the smart card and an entire packet, actually I brought one, but this packet of what will happen, for parents, how do you sign up. It's all voluntary based, but I'm telling you we hashed out every meeting to make sure that this was going to be compliant for everyone, even the families said that verbiage is not acceptable and so we were able to do that.
LEE HUNTER: Karen, if you want to come on up and go ahead and get your presentation ready. One of the things that we did early on was to talk about evaluation. We talked about what it is that we needed to look at in order to determine the success of the project and so, in fact, that discussion even determined some of the components of the initiative itself around dispatch and how that was going to work. So Karen is going to talk a little bit now about evaluation, if we can get that all plugged in.