Testing the Hypothesis

Posted on February 15, 2013 by

We are entering the interesting planning phase of a 5 day workshop for the Psych Services value stream. This will be the 2nd multi-day kaizen event aimed at redesigning onsite care and security for our highest risk RED patients in the King County Jail. In reflecting back, it is fascinating to see how far we have come improvements to daily processes and outcomes within ITR, even since the December Go-Live. This workshop, taking place in the coming weeks, is a large and complex one that addresses the mental health care, access, and security for highest risk mental health inmate patients. It will certainly “take a village” in terms of aligning the 2 divisions, DAJD and Jail Health, around common standards for care, access, and security.

This event is significant because we will be essentially testing the larger hypothesis for the value stream. We have successfully increased the capability to segment our Psych population as they arrive with existing resources. Instead of relying on heroics or specialists, we have developed capable and consistent processes up front that assess mental health status, risk to harm, and behavior. The next phase will connect the mental health assessment and housing placement processes to the RED psych unit which will be a co-located interdisciplinary DAJD JHS team. Among other things, it will define standards for access, design a standard process for diagnosis, and develop standard care plans and interventions for acuity specific mental health needs. It will balance access and care with safety and security of the unit. The care plan and # of visits for an inmate patient with psychosis could be quite different from a patient with a personality disorder. More frequent visits and interventions could be proactively completed on site and in real time, as opposed to batched visits with limited value added access to patients. The thinking is that early and frequent encounters will stabilize high risk patients, reducing overall jail risk in the process. Within this, is the acknowledgement that most of these RED inmate patients truly need help, and want help, and that an environment that is more open, accessible, and therapeutic may in fact reduce risk of harm to self and harm to staff.