Sharing Lessons Learned in Building a Statewide Central Intake System

Alicia Bowker, NJ Department of Children and FamiliesLaura Taylor, Central Jersey Family Health Consortium

This work was completed with grant funding from the Health Resources and Services Administration (HRSA).

Overview• Introductions and Audience Polling• Theme 1: Building Central Intake in NJ

• NJ Context• NJ Experiences• Group Discussion

• Theme 2: Core System Components• NJ Context• NJ Experiences• Group Discussion

• Theme 3: Basic Central Intake Hub Operations• NJ Context• NJ Experiences• Group Discussion

Introductions

Alicia BowkerHome Visitation Program Specialist

NJ Department of Children and Families

Laura TaylorDeputy Director

Central Jersey Family Health Consortium

1. What State/Territory/Tribal Nation do you represent?

2. What is your role within that context?a. Local Partner/Implementing Agencyb. Funder/Managing Entityc. Research and Evaluation Entityd. Fiscal Entitye. Other

Live Polling/Question & Answer

Live Polling/Question & Answer

3. What is your level of experience thus far with a Central Intake system?a. Explorationb. Installation (identifying and acquiring resources)c. Newly Implementing d. Fully Implementing

4. What are you hoping to gain from this presentation?

Theme 1: Building Central Intake in NJ

Building Central Intake: NJ ContextHome Visiting (HV)

• By 2015, 65 programs in all 21 NJ counties, serving more than 7,000 families per year• Each county offers 3 HV models: Healthy Families America (HFA), Nurse-Family

Partnership (NFP), Parents as Teachers (PAT)Central Intake (CI)

• Started in 2010 expanded to reach all 21 counties in Fall 2015• Aims

- Simplify referral process- Connect families efficiently to services based on needs and eligibility- Improve care coordination- Maximize appropriate use of resources- Eliminate duplication of effort

• Receives over 30,000 screens per year• CI Refers to many different services, including home visiting

Building Central Intake: NJ Context- History

HFA modelin 19 cities1500 familiesBirth to Age 5Title IVB/TANF

Child Welfare ReformHFA statewide expansion1800 families–Birth to Age 5

TANF Funds – 2004-05HF, NFP, PAT

(2006-07)State $$

1995 2000 2005 2010 2015 2018

CI in 3 more

countiesMIECHV

2012

CIsustained thru State + Federal

dollars

Evidence-Based Home Visiting (HV)

Central Intake (CI) Expansion

CIin one county

State DCF2007

CI in3 new counties

ACF–2008MIECHV

CI in 8 more countiesNJ-DOH

2014

CI to link HV within the MCH System

in 2 citiesHRSA Healthy Start

2002

8

↑ capacity / multiple modelsPregnancy to Age 3

NFP & PAT(2008-09)ACF grant

↑ HV availability3 models in all 21 counties

HF, NFP, PAT5,000+ families

2011/2012 MIECHV Funds1st NFP site JJDP-2002

HV Workgroup 2,400 families

BIM Programs

CI in last 6

countiesRTT-ELC

2015

Building Central Intake: NJ Context- Contracting with Agencies

Agency County Funding Source

Central Jersey Family Health Consortium

HunterdonMercerMiddlesexSomerset

DOHDOHDCFDCF

Children’s Home Society MonmouthOcean

DOHDOH

Partnership for Maternal & Child Health of Northern New Jersey

BergenHudsonMorrisPassaicUnion

DOHDOHDOHDCFDOH

Prevent Child Abuse New Jersey Essex DCF

Agency County Funding Source

Project Self-SufficiencySussexWarren

DOHDOH

Robins’ NestCumberlandGloucesterSalem

DCFDCFDCF

Southern New Jersey Perinatal Consortium

AtlanticBurlingtonCamdenCape May

DOHDOHDOHDOH

Building Central Intake: Breadth of Current System

Referrals Received by Central Intake

02000400060008000

100001200014000160001800020000

FY15Q1/2

FY15Q3/4

FY16Q1/2

FY16Q3/4

FY17Q1/2

FY17Q3/4

FY18Q1/2

• Over 200 prenatal care providers and 375 community-based organizations refer pregnant and parenting women to Central Intake.

Building Central Intake: NJ Experiences

• Examples of challenges encountered and how those challenges were addressed

• Examples of key actions that were critical for success

Building Central Intake: Group Discussion

1. What funding sources has your state or municipality used to build and support Central Intake?

2. Was there a champion for Central Intake? 3. What have your experiences been in cross-departmental

collaboration in working to build Central Intake?

Theme 2: Core System Components

Core System Components: NJ Context- Engaging Referring Providers

2009 2012 2014Regional & Statewide Initiative• Expand PRA to all NJ Medicaid Providers

Central Intake Initiative• NJDOH/NJDCF Joint Venture• Create single point of entry process for EBHV• Utilize PRA form as referral mechanism• Build referral, triage, and client tracking modules

(PRA/SPECT)

Statewide (NJDOH)• Improve access to preconception, prenatal,

and interconception care• Expand CI to every county• Expand EBHV to every county• Add CHW services to high-risk communities

Core System Components: NJ Context- CI Data System

• Single Point of Entry for Client Tracking (SPECT)o Perinatal Risk Assessment (PRA)o Community Health Screen (CHS)

• Existing platform adapted to incorporate Central Intake functions

• Designed to enable referrals and follow-up activities between prenatal providers, managed care organizations, hub partners, and community-based agencies

• Built in reports and CQI features

Core System Components: NJ Context- Standardized Screens

Perinatal Risk Assessment (PRA)

• Utilized by prenatal care providers

• Screens for medical and psychosocial risk factors

• Mechanism for providing referrals to community based services

• Authorization form for payment by the Medicaid Managed Care Organizations

Core System Components: NJ Context- Standardized Screens

Community Health Screen (CHS)

• Utilized by Community Health Workers, CI staff, and other social service providers

• Screens for medical and psychosocial risk factors

• Not limited to pregnant women

• Mechanism for providing referrals to community based services

Core System Components: NJ Context- Partnering Programs

• Standardized reporting mechanism and definitions

• Submitted quarterly• Many data elements obtained from

SPECT• Contains process and outcome

indicators• Reports shared with key stakeholder

groups

Core System Components: NJ Context-Performance Monitoring, CQI, Evaluation

Time to Assign to Home Visiting (HV) and Time to Enrollment in HV

Central Intake (CI) receives

referral

CI assesses client needs, eligibility, & interest in

Home Visiting

CI assigns client to Home

Visiting Site

Home Visiting Site does

outreach to Client

Home Visiting Site enrolls

Client

7 Days 44 Days

• As CI and HV outreach time increases, the odds of enrollment in HV significantly decreases.

Core System Components: NJ Context-Performance Monitoring, CQI, Evaluation

Central Intake (CI) Contact Attempts

Central Intake (CI) receives

referral

CI assesses client needs, eligibility, & interest in

Home Visiting

CI assigns client to Home

Visiting Site

Home Visiting Site does

outreach to Client

Home Visiting Site enrolls

Client

• Among families with at least one CI contact attempt:• CI made an average of 2 contact attempts per family. • 56% of families were successfully contacted by CI.

• 43% of families with a successful hub contact prior to home visiting referral enrolled in home visiting compared to 26% of families with no successful hub contact.

Core System Components: NJ Context-Performance Monitoring, CQI, Evaluation

Core System Components: NJ Experiences

• Examples of challenges encountered and how those challenges were addressed

• Examples of key actions that were critical for success

Core System Components: Group Discussion

1. What strategies are being used to outreach to potential referring providers and how are relationships with referring providers maintained over time?

2. What data system is used for Central Intake? Was this an existing data system that was supplemented or a system that was created specifically for your CI?

3. How do you measure the functioning of your CI? What indicators do you use to measure performance?

Theme 3: Basic Central Intake Hub Operations

Basic CI Hub Operations: NJ Context- CI Hub Staffing• Program Coordinator

• Administrative oversight, implementation, and evaluation• Integration and alignment of hub services with other community partners• Direct supervision of the Community Liaison and CI Specialist

• Can be integrated with the Community Liaison role

• Community Liaison• Develops and maintains relationships with hub partners and community-based agencies• Provides education to prenatal care and community-based agencies on the referral

process• Ensures data quality and addresses concerns and questions regarding linkages to

services

• CI Specialist• Conducts outreach to clients, assesses needs, provides support, referrals, and linkages• Is knowledgeable about community resources and providers

Basic CI Hub Operations: NJ Context- County Business Rules

• Business rules are developed with hub partners and serve as a mutually agreed upon set of rules. Accommodations are often made based upon:• Family choice of program/service• Language or cultural needs of family• Program Capacity/Level of Service Needs• Matching family needs based upon hub

partner specialties/areas of expertise• Reviewed annually • Provides a detailed narrative of the

CI hub’s Decision Tree

Basic CI Hub Operations: NJ Context- Decision Tree

The Decision Tree illustrates the step-by-step process for how

incoming referrals should be triaged to

hub partner programs

Basic CI Hub Operations: NJ Context- Outreach Policies & Procedures

• Initial contact attempt conducted within 2 business days• Contact methods vary by hub • Outreach period of 2 weeks

• CI Specialist identifies client needs and determines eligibility for services and programs

• Utilizes Business Rules as guidance for triage to hub partner programs

• If unable to contact client, CI hub may, based upon Business Rules, close referral or assign to hub partner program for further outreach

• CI hub conducts follow-up activities for 2 weeks with client to ensure linkages were successful

• Hub partners responsible for continuing follow-up activities with client

• Follow-up attempts and outcomes of referrals are documented in SPECT by both CI and hub partners

Basic CI Hub Operations: NJ Context- Client Follow-up

• CI hubs provide regular feedback to referring providers• List of referrals submitted by the provider• Hub partner or service client was referred to• Outcome of the referral

• Data Sharing Agreements required

• SPECT system has built in report feature

Basic CI Hub Operations: NJ Context- Provider Feedback

• Community Advisory Boards (CAB)• Hub partners, community-based agencies, and consumers• Meets quarterly

• County Councils for Young Children (CCYC)• Shared leadership model• Developed to strengthen maternal and child health and early childhood

service connections• CI CABs may align with CCYC structure via subcommittees

Basic CI Hub Operations: NJ Context- Community Collaboration

Basic CI Hub Operations: NJ Experiences

• Examples of challenges encountered and how those challenges were addressed

• Examples of key actions that were critical for success

Basic CI Hub Operations: Group Discussion

1. What staffing pattern does your Central Intake utilize?2. How do you balance having state expectations for Central

Intake with communities wanting to customize their business rules to their own context and needs?

3. What communication strategies or feedback loops have been developed between the Central Intake agency and referring partners, home visiting programs, etc.?

Many thanks to the team!

Johns Hopkins Bloomberg School of Public Health

New Jersey Department of Children and Families

New Jersey Department of Health

Lori Burrell Anne DugganJack Dagg

Lakota Kruse

Lenore Scott Daniela Guarda

Anne Lilly

Alana Ponder-Green

Alicia BowkerBethany Andrade-Siddiqu