Transcript Capacity Assessment & Treatment Model (CAT)

Capacity Assessment &
Treatment Model (CAT)
Ciona Regev, LCSW
Harris County Hospital District
Baylor College of Medicine
7/16/2015
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Harris County Hospital District
(HCHD) Demographics

300,000
residents in
Harris County
are 65 years
and older
 HCHD served
>21,000 patients
over 65 in FY
2005
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0.80%
14.50%
0.20%
Hispanic
47%
African
American
Caucasian
Asian
34%
Other
Race Distribution in HCHD
2007 Data
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Geriatrics Program
Geriatric
Consults
HOUSE
CALLS
CLINIC
GERIATRICS
PROGRAM
SNU
APS
NH
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Nature of Problem

80% of patients in our geriatric
clinic are viewed as vulnerable
elders:
a. self-neglecting behaviors & exploitation
b. compromised quality of life/co-morbidities
c. higher mortality rate
d. reduced ability to live independently/ safely
f. Reject/ cannot use services (medical,
financial, social)
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Nature of Problem – Cont.

Our clinic lacks systematic protocol
and effective evaluation/ intervention
for our vulnerable patients with impaired
capacity
Practice – secondary vs. early intervention
 Patients - repeated ER/ admissions/ APS
 Clinicians - lack training/ guidance

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Proposal: Capacity Assessment &
Treatment (CAT) Model

Develop a comprehensive structured
evaluation process of vulnerable elders’
decision-making capacity to live safely
and independently in the community

Goal: design a user friendly screening
tool kit of capacity for clinical practice
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Approach to the Problem

9/08-9/10: Phase I - Development
 Design
and evaluate screening tool
kit’s reliability and validity
 Evaluate results and make appropriate
refinements

10/10-8/09: Phase II - Implementation
 Pilot
and re-evaluate CAT in the clinic
prior to replication into other HCHD
site/s
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Phase I: Development
9/08-12/08: Finalize assessment
 1/09-4/09: Finalize other components
(referrals, intervention, other areas of
assessment)
 Generate qualitative and quantitative
evaluation of outcomes and measures
 5/09-8/09: Pilot screening tool kit in clinic
and re-evaluate/ refine as needed

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Phase II: Implementation

10/09-12/09: Generate protocol for training,
mock up, and training clinicians

1/10-3/10: Implementation and data collection
(base line)

4/10-8/10: Data Collection (F/U), evaluation,
and refinement
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Measurable Outcomes
A. Design a reliable and effective screening process
1. Measure reliability and validity of tool kit

Measure inter-rater reliability tool kit

Measure predictability of model on specific
parameters
2. Compare outcomes of new patients’ clinical
evaluation with caregivers’ survey on patients’
performance
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Measurable Outcomes- Cont.
B. Increase clinicians’ satisfaction with
utilization of tool kit
Collect data on clinicians’ satisfaction
with effectiveness of tool kit on base-line &
f/u

C. Increase patients/caregivers
satisfaction with evaluation process

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Collect data on patients/caregivers’
satisfaction on f/u visits
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Sustaining CAT

Tailor and replicate model to potential sites will
increase effectiveness and utilization of model

Training and teaching new clinicians and trainees will
promote credibility of CAT

Network and partnership with community and
healthcare settings will market CAT to provide
continuity of care

Market CAT to probate court and legal services will
provide a more reliable assessment of POA/
guardianship
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Key Stakeholders

Stakeholders encompass primarily HCHD
and Baylor College of Medicine (BCM)
a. HCHD: clinical staff; administrative staff;
departmental support
b. BCM: clinical consulting team
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Stakeholders Alignment

Enhance quality of life and quality and service to
patients/ caregivers

Promote effective process for clinical practice &
education

CAT will increase revenues for expanding consulting
services & expertise to community at large

Long term benefits will reflect on cost cuts for repeated
unnecessary ER visits and re-admissions
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Challenges

Resources (support staff/ time
constraints)

Navigating in large complex institution

Commitment
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Preliminary Data

Phase I:
 limited data – completing design of the
assessment components and
outcome/ measures
 Adopted
new screening tools into
clinical practice
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Learning Curve

Marketing proposal to key stakeholders
engaged me in exploring new territories:
lobbying to primary key stakeholder
 learning to navigate a delicate ‘political
map’ to promote proposal


Process of change in major system is
lengthy, challenging involving intricate
hierarchy
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Opportunities….

Being a clinical social worker engaged in
design of new model within the geriatric
community is most exciting and
overwhelming at times, especially as I
work with the academia and a medical
school
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Acknowledgements
Quentin Mease Geriatric Clinic
Cheryl Cleary, BS-ORT
Jane Kirk, BSN
University of Houston
Geri Alder, PhD
Tiffany Garza, BSW
Harris County Hospital District
Mari-Ellen Sharp, MSN
Sara Dorsey, MSW
Dinah Godwin, MSW
Denny Anderson, MBA
Practice Change Fellows
Atlantic Philanthropies & John Hartford Foundation
University of Texas Health Science Center at Houston
Carmel Dyer, MD
Baylor College of Medicine
Kathy Agarwal, MD
Ursula Braun, MD
Kristin Cassidy, BS
Sanda Khin, MD
Mark Kunik, MD, MPH
Aanad Naik, MD
Julia Reyer, MD
George Taffett, MD
Nancy Wilson, MSW
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