King County’s Jail Health Services (JHS) release planning program provides assistance and guidance to high-needs individuals as they exit the jail. Release planning serves those with priority conditions, including pregnant women, HIV patients, those with acute or chronic health conditions, mental health issues, substance use disorders, and others particularly vulnerable at release from jail. Release planning helps these inmate-patients engage with and transition to social and health services with the goal of improving health outcomes, addressing social needs, and, ultimately, reducing emergency room visits and jail recidivism.
In order to help these individuals address these underlying issues that often contribute to recidivism or emergency room visits, release planners work with these inmate-patients to ensure that they understand and can access needed health and social services upon release. This can include setting up benefits, medical appointments, nursing care, crisis respite, coordinating mental health and substance abuse treatment, and other social services.
King County JHS Release Planners (from left to right):
Rebekah Clinger-Prince, Kim Powers, Jennifer Woodard, Sherri Charleston, and Ashley Mitchusson
Release Planning Manager Meagen Condon was unavailable for the picture.
Unfortunately, until recently, release planners lacked good mechanisms to quickly identify inmate-patients most in need of release planning, to communicate with inmate-patients seeking help, or address the gap between the many inmate-patients who could benefit from release planning assistance and the limited sessions available via one of the five release planners.
Release planning typically received about 300 – 400 of these requests per month. This resulted in a back log of over 100 inmate-patients waiting for services. The release planners also saw that many of those on the wait list just needed clarification on information and community resources rather than full release planning coordination.
This process could frustrate everyone involved. Inmate-patients with release planning needs waited behind others who found out, only after waiting themselves, that they actually needed a different service. The release planners themselves knew that a better process to communicate with inmate-patients could better serve both sets of inmate-patients.
Creating Continuous Improvement in Release Planning
This all changed when release planner Jennifer Woodard participated in Creating Continuous Improvement (CCI), a Lean training curriculum that JHS has developed in order to provide managers and team leads with the Lean tools and know-how to guide work units through process improvements. Woodard recognized the release planning program had a challenge—and an opportunity—to improve its services to high-needs inmate-patients through better outreach and communications.
Working with CCI trainer Rebecca Cole to learn about and implement Lean concepts, Woodard and her team devised a plan for release planners to meet groups of inmate-patients, between 6 and 12 at a time, in order to provide general information about release planning and other services available, as well to improve the screening and referral process.
Lean’s focus on the customer (in this case, the inmate-patients) provided a key insight that helped the team design the eventual ‘triage group’ approach. “What we heard was that the inmate-patients just wanted to know that someone had seen their request and wanted to get better answers,” says Woodward.
JHS’s “Creating Continuous Improvement”
Creating Continuous Improvement was developed as a starting point to develop a Lean culture in which staff are engaged in reducing waste and creating value for their customers.
CCI is an application-based learning approach with three elements: classroom learning; one-on-one coaching with a Lean coach; and application with the work team. The class is designed this way, so that the participants can develop the learning within their existing work schedule and apply it right away, increasing the likelihood that they will retain what they learn.
Woodard confirmed that this approach—combining classroom Lean learning with one-on-one coaching and real world process change implementation—made it easier for her to learn and adopt the concepts than would have occurred in a classroom alone. “It was cool to go back to the team and actually do it with them. And without the coaching it would have been almost impossible.”
That the team was now in greater control of their own work also proved invaluable. “Our success required everyone participating. We all had our normal work and nothing was removed from our plates to get this done. At first, it was hard to grasp how we could be saving time and eliminating waste when we were in the process of developing this stuff. But the team really enjoyed deciding what their own standard work should look like.” Seeing that they could make their own work more productive and fulfilling made it easier for all of them to buy in and commit the extra time and effort.
These triage groups provide the release planners and inmate-patients a forum to communicate in a timely manner. The inmate-patients who would benefit from release planning services learn about the program and are scheduled for intake appointments within three days. The inmate-patients who in the past wouldn’t have been seen (because they didn’t need release planning coordination) now get their questions answered. Often, release planners are also able to direct these people to other beneficial services such as unemployment and job-training services.
“The big success story,” says Woodard, “is that we were able to reach a much larger number of folks and give them a better understanding of what our services are or are not. By doing the groups we have freed up time to do more therapeutic release planning with folks not just crisis management.”
Thanks to the triage groups, release planners like Woodard have been able to reach many more inmate-patients and provide more release planning services in a shorter amount of time. For example, in five recent group sessions of one hour each, 55 inmate-patients were seen and 24 were identified as needing further intensive release planning services. In the past, a typical intake for just one inmate-patient—who might not have needed comprehensive release planning—might have taken 30-to-45 minutes.
All of which means that release planners are now helping perhaps five times as many inmate-patients, and doing so more effectively. Thanks to the triage groups, inmate-patients have their questions answered right away, those needing intensive release planning services are identified, and the wait time to be seen has been substantially reduced.
The release planning team is now focused on stabilizing the group process and has begun working on a second process that will better identify those housed in the infirmary who need release planning services.