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Implementing Cluster Based Planning at Your Agency

Cluster-Based Planning is about seeing your clients in a different way. It is like taking a new magnifying glass with more power and stepping off to one side to look at a scene you have looked at for years. To do this requires retraining your mind, your sensitivity, and your perspective to gain a new understanding of the organization’s consumers/patients. And the more you use your new perspective, the better skilled you become, and the more progress clients will make in their recovery and/or in building resilience.


“A Cluster Is A Subgroup Of A Larger Population In Need That Shares Common Problems, Strengths, Treatment History (Or Lack Of Treatment History), Social Or Environmental Context,
And/or Life Situations.”

People

Youth Who Have Been Sexually, Physically or Emotionally Abused

People

Women Addicted to Crack & the Exciting Life Style

People

Adults with Trauma Histories Who Struggle With Anxiety & Depression, And Who Have Difficulty Moving Forward With Their Lives

People

Adults with Severe Substance Abuse, Mental Health and Community Living Problems


Staff Training

Implementing Cluster-based Planning begins with gaining a thorough understanding of the subgroups of consumers served by your agency or organization. Synthesis consultants provide Basic and Intermediate Cluster Assessment Workshops for your clinical, case management, nursing, supervisory, and other staff serving the following populations:

  • Adults with Severe and Persistent Mental Health Issues (8 Clusters)
  • Youth with Behavioral Health Issues (including SED) (10 Clusters);
  • Men with Substance Use Disorders (8 Clusters); or
  • Women with Substance Use Disorders (10 Clusters)

These workshops provide 7 to 8 hours of training following which staff can begin to use their new knowledge to assess current and future clients. The Basic Workshop provides information on the conceptual underpinnings, the Cluster Based Planning framework, and how clusters were identified and described. Cluster Descriptions are holistic bio-psychosocial pictures of strengths, mental health issues, addictive behaviors, educational/vocational challenges or achievements, social and community functioning, and physical health conditions as individuals have interacted with others around them, with treatment providers, and with the community at-large, over an extended period of time. During the Basic Workshop participants are given the opportunity to review Cluster Descriptions and jointly identify “Good Examples” from their caseloads or experience that represent the members of each cluster.

The Intermediate Cluster Assessment Workshop focuses on Within-Cluster Diversity, the Complexity in the lives of many clients/families; and the importance of understanding the Individual and Shared History of the members of each cluster. In the Intermediate Workshop, participants discuss some complex cases that make assessment of cluster membership more difficult. They also learn to create a “Timeline” to help understand the client’s history.

Basic and Intermediate Cluster Assessment Manuals are provided for each staff member.


CLUSTER ASSESSMENT, CONSUMER ENGAGEMENT
AND JOINT RECOVERY PLANNING**

Following formal training, agency staff begin to assess current and future clients for cluster membership. As they work with their clients, individual providers can use the Cluster Descriptions as tools to engage consumers in a therapeutic/recovery process. Through these discussions, clients (including families) also learn that they are not alone in having lived difficult and challenging lives and that they need to make changes so that their future picture is different from their past. Using Cluster-based Planning, consumers can feel more confident that their treatment provider understands them. This is because they now know that the provider has helped others like them achieve the types of outcomes they desire.

Helping a client with his/her recovery thus becomes an ongoing process of coming to a mutual understanding of:

  • Where They Have Been
  • Where They Are Now In The Context Of Their History (Individual And Shared Cluster History)
  • Where They Want To Go (What Are Their Goals), And
  • What They Need To Do and/or What We Need To Do To Help Them Make Progress Toward Their Goals

Coming To This Understanding Enhances Your Ability To Match Your Clients With The Most Appropriate Best Practice Or Evidence-Based Services, At The Right Time.

**    Synthesis Staff Are Available To Provide Technical Assistance And Additional Training To Facilitate The Process Of “Making It Real” In Your Organization.


DESCRIPTIVE REPORTS, THE ANALYES OF SERVICE UTILIZATION, BILLINGS, AND OUTCOMES DATA, AND PREDICTIVE ANALYTICS

Once the Cluster Assessment has been made, the Cluster designation is typically added to the agency’s Electronic Health Record and then becomes a very powerful “variable” that can be used in the analyses of demographic, service utilization, cost/billings and outcomes data. These data can be also uploaded to Synthesis, Inc. (with a HIPAA Business Associate Agreement) for analysis or analyzed in-house by your agency. For example Cluster Prevalence and Incidence Reports can identify current and emerging target populations that can inform program development. Cluster designation can also be merged with billing data to identify patterns of service utilization and billings by cluster. The appropriateness of the use of high levels of services can be determined based on a more holistic understanding of the client that goes beyond diagnosis, gender, ethnic group, payer source (e.g. Medicaid, Medicare or Dually Eligible) and current symptoms.

Over the years we have seen differences in service utilization, outcomes performance and billings by Cluster in a variety of settings. Hospitalization rates of adults with Severe and Persistent Mental Health Issues (SPMI) have also differed consistently by cluster. Outcomes for youth being served by mental health agencies have also differed meaningfully by cluster. In addition, analyses using classification approaches (e.g. CHAID) have indicated that risk factors predicting outcomes differ by cluster for adults with SPMI.

In general, over the last 25 years we have found:

  • Types And Amounts Of Services Differ By Cluster
  • Hospitalization Rates Differ By Cluster
  • Goals/Challenges/Desired Outcomes Differ By Cluster Or Can Be Better Understood By Cluster
  • Preferred Service Packages Created By Workgroups Of Providers, Consumers, And Family Members Differ By Cluster
  • Level of Care Service Configurations May Differ by Cluster
  • Performance On Outcomes Differs By Cluster
  • Risk Factors Predicting Outcomes Performance Are Likely to Differ By Cluster




INTEGRATION OF PRIMARY CARE WITH BEHAVIORAL HEALTH SERVICES

BARRIERS TO INTEGRATION AND COLLABORATION

  • Lack of a Common Understanding Of The Situation, Issues, Or People
    • Need for an Integrative Conceptual Perspective
    • Need For A Common Language, A Common Way Of Describing The People to Be Served
    • Failure To Recognize Systematic Diversity Within Population (except for diagnoses)
  • Lack of a Common Vision Of The Goals
  • Lack of a Common Plan To Address Needs Or Achieve Goals
    • Silos (Organizational and Programmatic)
    • Reimbursement Systems That Do Not Support Integration Of Care
Paradigm

WHAT DOES CLUSTER-BASED PLANNING PROVIDE?

  • A More Holistic And Life History-driven Model
  • Recognition Of The Systematic Diversity Within Larger Populations in Need
  • Prose Cluster Descriptions That Provide the Platform for Collaboration. They contain pictures of the shared histories of those to be served. This allows all involved (including consumers) to be on the same page about the complex life issues that the cluster members have and may continue to face.
  • A Better Way of Communicating With Consumers to Create a Sense of Hope and a Recovery Partnership.
  • A Better Way to Match Cluster Members to Service Packages and To Manage Care. Diagnosis (psychiatric or other medical) is not enough.


IN SUMMARY

 

Cluster-Based Planning gives you a clear view of the people you are serving; and with this knowledge, helps you work together with them to identify what services they need. The holistic pictures C-POM provides can give you and your organization a renewed focus that can be used in the following ways:

  • To Organize Your Clinical Knowledge To More Effectively Meet Client Needs
  • To Engage Consumers In An Ongoing Discussion Of Their Own Past Lives; Their Current Functioning And Emotional Status; Their Longer-Term Views; And Their More Immediate Recovery-Oriented Goals
  • To Interpret Data From Outcomes Measurement Systems
  • To Initiate and Evaluate Performance Improvement Efforts
  • To Analyze and More Effectively Use Service Utilization Data, Consumer Feedback, Incidents/Risk and Cost Data
  • To Re-Engineer Services
  • To Prepare Community Education or Marketing Materials
  • To Develop Agency Service Plans and Budgets
  • To Negotiate Performance Contracts and Rates
  • To Identify Staff Recruitment and Development Needs
  • To Meet Certification and Accreditation Standards

Learn More About
Synthesis, Inc. & Cluster-Based Planning

Contact:
Bill Rubin, MA, CEO
Synthesis, Inc.
3049 Olive St.
Columbus, OH 43204
Phone: (844) 437-1337

E-mail: synthesis@synthesisincohio.com