State: KY Type: Promising Practice Year: 2014

Green River District Health Department is located in Western, Kentucky. The HANDS program provides home visiting services with the outcome goal to assist with healthy pregnancies, healthy baby/toddler and to ultimately build stronger families within our community. A Standard of the program is to provide weekly face to face supervision with staff. This is a vital piece of the HANDS program as it allows review of caseload, mentoring, and modeling of the parallel process. The strength based program approach that supervisors model during the face to face supervision demonstrate how staff can return that process with their families that they serve. Compliance percentage was lower prior to the initiation of Skype within program. Supervisory visits were also costly and required increased time in travel to meet with staff. Goals: Increase percentage of staff having weekly meetings with supervisor Maintain standards of HANDS program Decrease travel time resulting in more effective time management Decrease travel expenses Utilize Skype as an initial step in pioneering a complete EMR system within the program. Practice was implemented through a mutual collaboration of HANDS, Information Systems (IS) and Financial department staff. Web cameras were installed in the counties on each HANDS staff computer. The IS department provided group instruction during staff meetings, initially assisted each employee with individual instruction on use and gave an outline process for staff to reference back if needed. Positive outcomes resulted with: Decreasing 448 hours per year of travel between supervisors Financial improvement with less travel paid Increased supervision with yearly percentages from 73% in 2010 to 88% in 2013. The benefits of increasing the supervision rates allow for staff to recognize and utilize the parallel process with their families in the community. The hours that were decreased from travel for the supervisor allowed the supervisor time to outreach into the community to speak at community events and awareness to community partners about the HANDS program. Ultimately this has lead to more referrals from community partners outside of the Local Health Department. With all objectives being met, some of the factors leading to success of the practice were: collaboration within the Local Health Department to assure a quality plan, use of the multi-disciplinary approach among departments and staff within our own program having input. HANDS impact on the community is an evidenced based program showing improvement within families having safer homes, fewer premature babies, fewer low birth weight babies, and fewer developmental delays. HANDS role within the community is to build stronger, more empowered and independent families. We know meeting with staff weekly for supervision is an important belief of the HANDS program to empower our own staff so they can outreach within the community. It was our goal with implementation of Skype to assure we improved this within our program site.
The Green River District Health Department located in Western, Kentucky has 189 employees who serve approximately 213,000 citizens in our seven county region. The HANDS program is just one of the many programs we serve in Daviess, Hancock, Henderson, McLean, Ohio, Union, and Webster counties. The public health issue addressed is costly travel to other counties to provide a standard of weekly supervision with percentage rate of supervision visits below standard. Staff who work in the six other counties outside of Daviess County as well as supervisors felt the impact of the difficulty in setting and keeping weekly supervision times. HANDS staff total 22 staff in seven counties serving approximately 250-260 families per year. With implementation of Skype we have been able to reach 100% of staff in outer counties on a weekly basis. In the past, attempts for the supervisor to meet with staff within the same geographical area on specific weekdays did not always prove effective due to schedule conflicts with the families served, staff schedules or unpredictable events such as weather resulting in decreased weekly supervision. Current use of Skype shows quality improvement with increased percentage rates of weekly supervision, staff confidence to have face to face access to supervisor at any given time, and mentoring/encouragement on a consistent weekly basis. It has proven beneficial as each supervisor can be more productive and efficient in their job duties by decreased travel time. We have seen financial improvement to the program's travel budget. The flexibility of Skype has assisted the worker as they are able to see families at any given time and reschedule with supervisor accordingly. The use of Skype has not been utilized by any other HANDS program. It is unique in utilization of technology, outreach to the employee in outer lying counties and fiscal awareness.
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Goals of this practice were to have *compliance increase in weekly face to face supervision with staff *assure supervision goals met such as building trust, rapport building, building on workers strengths, accentuating their positives and offering problem-solving strategies during supervision time * time-management * fiscal responsibility. Success in objectives came from using a team approach with all HANDS staff in asking how they would feel about use of this practice with intended goals stated. We approached the state HANDS program to assure this could be considered as face to face, gathered multi-disciplinary team, requested input from HANDS team, and set projected time frame to implement. We gathered knowledge from our local health department information systems department on equipment needed and cost. Our financial department assessed the budget and projected our savings and at that time a projected time frame of two-four months was set as start date. We than met weekly as a multi-disciplinary team to look at all angles of project and after implementation met to assure goals being achieved and any unforeseen issues addressed. This internal process had many different entities involved to achieve success. The LHD and HANDS collaborates with many community partners for referrals into our agency. The use of Skype resulting in a more efficient program allows HANDS to serve more families within our district resulting in better community outcomes. Start up cost to initiate Skype resulted in need for extra monitors at 221.10 and 10 Logitech Webcams = 999.35 for a total of $1220.45
Achieved objectives of compliance in weekly supervision increased as evidenced by : The year 2010, before Skype implemented, the rate of supervision occurred 73% of time. In April of 2011, Skype was initiated and percentage increased to 81%. In 2012 it again increased to 83% and as of this year we are currently at 88%. The objective of supervision goals are noted to be met as consistency in weekly supervision allows these goals to be maintained. Objective of time management shows 468 travel hours saved per year. Fiscal responsibility showed estimated savings at $6564.00 per year based on travel reimbursement only. Evaluation of practice came from data sources of the finance department, TA site visit reports and internal HANDS review. Performance outcome of goals were measured by reports from site audit, internal review reports that indicated increase in weekly supervision. Financial reports maintained shows the decrease in paid travel reimbursement. Data analyzed came from reports from previous years and feedback from staff on evaluation of Skype. Based on results of improvement in many areas and maintaining HANDS standards we have continued with initial plan.
The different disciplinarians involved were able to input their knowledge in areas that initially we did not think of such as: IS recognizing the assurance of HIPAA needed in the Skype process, and the finance department noting additional monitors available within agency not being utilized. Within the LHD this project has brought awareness to other members of the multi-disciplinary team as to the benefits and role HANDS staff provide to the community. This collaboration assisted in working together as a health department team versus individual departments and proved to gain overall increased communication inside each health department. Cost analysis; FY 2010-2011 supervisor travel mileage reimbursement = $6628.00 FY 2012-2013 = supervisor travel reimbursement= $64. This being an average cost savings of $6564.00/year. With the purchase of equipment required to initiate this project at $1220.45 it shows that within the first year we recovered all but 3592.00 and by the end of the following year we were ahead by $2972.00 thus taking 1.6 fiscal years to pay for the system. This comparison comes only from the cost of travel to the cost of equipment and does not factor in the salary amount for the 468 hours of travel yearly in supervision time. Our stakeholder being our LHD is very supportive in our goals achieved and progress with this innovative project. We will continue to Skype with staff on weekly basis to assure effective communication as well as have started to initiate Google chat during times of small group training when access to supervisor is beneficial.
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