HomeMy WebLinkAbout2324-21 Follow-up Behavioral Health Practices Improvement (Final 7-3-24)Health Services Follow-Up Behavioral Health Practices Improvement 23/24-21 July 2024
Follow-up Report
Health Services –
Behavioral Health
Practices Improvement
(Original report #22/23-9 issued September 2023)
The Office of County Internal Audit:
Elizabeth Pape, CIA, CFE – County Internal Auditor
Aaron Kay – Performance Auditor
Audit committee:
Daryl Parrish, Chair - Public member
Phil Anderson - Public member
Jodi Burch – Public member
Joe Healy - Public member
Summer Sears - Public member
Kristin Toney - Public member
Patti Adair, County Commissioner
Charles Fadeley, Justice of the Peace
Lee Randall, Facilities Director
To request this information in an alternate format, please call (541) 330-4674
or send email to internal.audit@Deschutes.org
Recommendations
9
Health Services Follow-Up Behavioral Health Practices Improvement 23/24-21 July 2024
Table of Contents:
1. Introduction ....................................................................................... 1
Background on Department and Original Audit ......................................................... 1
2. Follow-up Results .............................................................................. 2
3. Appendix A: Updated workplan (status as of July 2024) .............. 4
4. Appendix B: Objective, Scope, and Methodology .......................... 7
Objective and Scope ....................................................................................................... 7
Methodology ................................................................................................................... 7
Health Services Follow-Up Behavioral Health Practices Improvement 23/24-21 July 2024
Deschutes County Office of the Internal Auditor Page 1 of 7
1. Introduction
Audit Authority
The Deschutes County Audit Committee has suggested that
follow-ups occur within nine months of the report. The Audit
Committee would like to make sure departments satisfactorily
address recommendations.
Background on Department and Original Audit
The Deschutes County Health Services Department includes the
Deschutes County Behavioral Health (Behavioral Health) division,
which operates as the Community Mental Health Program for the
County. Behavioral Health plays a vital role in promoting mental
health, supporting recovery, and providing compassionate care to
individuals coping with behavioral health challenges, substance
use disorders, as well as intellectual and developmental
disabilities. Behavioral Health was concerned about improving
and ensuring the consistency of productivity among clinicians
across the division.
The review focused on developing an understanding of practices
used by highly productive Behavioral Health clinicians to leverage
best practices to improve overall productivity. Additionally, it
included reviewing the supporting operational systems, client
workflows, scheduling, and division productivity measures.
The Behavioral Health division utilized many effective
performance measures. However, there was room within the
division’s productivity measures system to improve the following
areas:
• developing appropriate productivity measures for staff;
• clarifying expectations for the staff;
• accurately reflecting the time clinicians spend on client care;
• equitably distributing cases within teams; and
• enhancing the division's ability to identify community needs for
resource allocation.
Health Services Follow-Up Behavioral Health Practices Improvement 23/24-21 July 2024
Deschutes County Office of the Internal Auditor Page 2 of 7
EPIC, Behavioral Health's electronic health records system,
features a collection of documentation aids collectively known as
smart tools. Broadening the promotion, utilization, and training
on these tools could greatly assist with the documentation
requirements faced by all clinicians in the division.
The division could refine its onboarding processes for new
employees and provide clearer guidelines regarding the
supervision of interns.
When clinicians in downtown Bend need to provide services
outside their workplace and division fleet vehicles aren't readily
available nearby, their productivity is affected as they spend time
finding and using alternative transportation options.
Recommendations included:
• going through the process to develop appropriate productivity
measures;
• reviewing the accuracy of the data contributing to measures;
• creating a library of smart tools;
• evaluating onboarding processes;
• clarifying the policy for intern supervision; and
• optimizing fleet utilization at downtown Bend locations.
2. Follow-up Results
The follow-up included nine outstanding recommendations
agreed to by the department. Figure I provides an overview of
the resolution status of the recommendations. The details of the
follow-up are included at the end of the report in Appendix A. In
interpreting the status, Internal Audit may sometimes raise or
lower the status provided by the department based on
communication received from the department.
Health Services Follow-Up Behavioral Health Practices Improvement 23/24-21 July 2024
Deschutes County Office of the Internal Auditor Page 3 of 7
With this follow-up, fifty-six percent (56%) of
the outstanding recommendations have been
fully addressed. As indicated in the provided
responses, the department has improved
training, onboarding, intern supervision, and
caseload distribution. They have set goals to
resolve the majority of the recommendations
by the end of 2024 with the help of a
consultant.
Finding a viable solution to the downtown
fleet availability issue required more
resources than the County could provide.
Health Services will continue to support the
downtown clinics and their fleet needs.
Despite these ongoing efforts, Internal Audit
has marked the status as completed due to
the attempts made by Health Services and
the timeline needed for any potential
solution.
Figure I –
How were
recommendations
implemented?
Health Services Follow-Up Behavioral Health Practices Improvement 23/24-21 July 2024
Deschutes County Office of the Internal Auditor Page 4 of 7
3. Appendix A: Updated workplan (status as of July 2024)
Recommendation Status Resolution
Goal
Updated Comment
It is recommended
Behavioral Health go
through the process
to develop
appropriate
productivity
measures as well as
clarify expectations
for staff.
Underway January-25 Behavioral Health has started three
workgroups to dive into the root causes
of the challenges related to our current
productivity standards. Each workgroup
has a goal of creating one solution to an
identified problem by the end of 2024.
Utilization Management - focus on
caseload management, intakes and
discharges. We are moving towards a
contract with third party consultant who
specialize in helping organizations reach
maximum efficiencies and outcomes.
Administrative Burden workgroup -
focused on reducing excessive admin
burden in our EHR, documentation and
processes.
Clinical Vision Workgroup - focused on
guiding the clinical vision of the
department and ensuring our services
are of the highest quality as well as
identifying gaps in care and solutions to
those gaps.
It is recommended
Behavioral Health
review the accuracy
of the data
contributing to
clinician workload
measures.
Underway January-25 The above section also addresses this
area and our work with the consultant
will review all of our current data and
collection methods to identify gaps and
solutions for improvement.
It is recommended
Behavioral Health
strengthen the
controls for first
treatment
appointment
Underway Initially
July -24
Moved to
January-25
While we have strengthened and
improved our FTA's and the timelines,
there is more comprehensive work to be
done. Our work with the consultant will
address this more fully.
Health Services Follow-Up Behavioral Health Practices Improvement 23/24-21 July 2024
Deschutes County Office of the Internal Auditor Page 5 of 7
Recommendation Status Resolution
Goal
Updated Comment
assignment and
client discharge.
It is recommended
Behavioral Health
use the caseload
measures to promote
a more equitable
distribution of work
within teams.
Completed July-24 We have improved the distribution of our
caseloads and are applying a more
equitable distribution across teams
where we can. Our work with the
consultant will build on this through the
use of their caseload management tools.
It is recommended
Behavioral Health re-
evaluate the
division’s flexibility to
actively respond to
the broader needs of
the community.
Completed July-24 We have continued to provide our
training through consultation to improve
training and expertise across the
organization. Since this audit, we
completed the following trainings for
staff:
IDD and Behavioral Health
Working with Families
Suicide and Homicide Risk
Auditors Note:
These training opportunities expanded
clinicians' knowledge and reduced the
industry's typical specialization barriers.
As a result, the department is now better
equipped to allocate staff to areas with
the greatest need.
It is recommended
Behavioral Health
create a
comprehensive
library of division-
approved smart tools
to improve clinical
documentation
efficiency and
provide training to
Underway January-25 The Administrative Burden workgroup is
actively working on this and we expect to
have this completed by the deadline.
Health Services Follow-Up Behavioral Health Practices Improvement 23/24-21 July 2024
Deschutes County Office of the Internal Auditor Page 6 of 7
Recommendation Status Resolution
Goal
Updated Comment
clinicians on how to
use them.
It is recommended
Behavioral Health
evaluate the
onboarding content,
procedures, and
supervision to better
integrate new
employees.
Completed January-24 A 2-month evaluation process has been
implemented.
It is recommended
Behavioral Health
clarify the policy for
supervision of
interns.
Completed January-24 Since the audit, a policy has been created
for supervision of interns and a stipend
was implemented to support staff who
take on this extra duty.
It is recommended
Behavioral Health
coordinate with the
Road and Facilities
Departments to
explore solutions for
the downtown Bend
locations’ fleet needs.
Completed July-24 This measure is dependent upon
Facilities and the Road Department to
explore solutions for the downtown
Bend locations fleet needs. To date, I'm
not aware of any solutions that have
been proposed. We will continue to find
ways to support the Downtown Clinic
and our fleet management, but it will be
ongoing and on our own timeline since
given we don’t have the authority or
resources to make the truly meaningful
change that needs to happen downtown.
Health Services Follow-Up Behavioral Health Practices Improvement 23/24-21 July 2024
Deschutes County Office of the Internal Auditor Page 7 of 7
4. Appendix B: Objective, Scope, and Methodology
Objective and Scope
Objective:
The objective was to follow up on recommendations from the
original audit.
Scope and timing:
The follow-up included nine recommendations from the internal
audit report for Health Services – Behavioral Health Practices
Improvement 22/23-9 issued in September 2023. The original
internal audit report should be referenced for the full text of the
recommendations and associated discussion. The follow-up
reflects the status as of July 2024.
Methodology
The follow-up report was developed from information provided
by Holly Harris, Behavioral Health Director. Follow-ups are, by
nature, subjective. In determining the status of recommendations
that were followed up, we relied on assertions provided by those
involved and did not attempt to independently verify those
assertions. The updates received were included in Appendix A.
Since no substantive audit work was performed, Government
Auditing Standards issued by the Comptroller General of the
United States were not followed.
“Audit objectives”
define the goals of
the audit.
Health Services Follow-Up Behavioral Health Practices Improvement 23/24-21 July 2024
Deschutes County Office of the Internal Auditor
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