One of our most important victories in last year’s 10-week Northern California Kaiser mental health strike was the establishment of five labor-management Model of Care committees.
Our recent experience with Kaiser has been mixed when it comes to Model of Care committees, but what’s different about these committees is that as part of our contract Kaiser has agreed to fund the committee’s recommendations — something that didn’t happen after our previous contract.
The first two committees to report out their recommendations this month were focused on expanding case management services and treatment tracks, which is a relatively new program in Northern California that directs qualifying patients into programs that provide weekly or twice monthly appointments over a limited period of time.
Both committees had a similar focus: Figuring out ways to lessen the burden on generalists, whose unsustainable caseloads force patients to wait far too long for follow-up therapy appointments — in violation of SB 221, the timely access to mental health care law we sponsored and passed in California.
To create pathways for patients to get timely, appropriate care, the committees made several recommendations including:
- Expanding treatment tracks, such as those focused on depression and anxiety, throughout the Northern California region and adding new treatment tracks focusing on personality disorders and trauma.
- Reducing barriers that keep people from being added to treatment tracks.
- Provide generalists with times to review caseload lists and determine which patients would qualify and benefit from being moved to a treatment track.
- Establishing a system to make sure that patients can navigate care pathways and get care that meets timely access standards without relying on generalists.
- Establishing consultation groups so that generalists can review cases with their colleagues.
- Expand case management services to include programs that would include children with severe and persistent mental illness, people with autism spectrum disorder and patients not currently receiving care from a therapist.
The ultimate outcome of these Model of Care committees will depend on Kaiser increasing its staffing to expand its services, and we will be pushing hard to make Kaiser fully implement the committee’s recommendations, which are a prerequisite for it being able to comply with state mental health access laws.
To learn more about the committees, read this Q&A (edited for length) with Jennifer Browning, a Kaiser steward in the North Valley region who served on the Treatment Track committee.
Q: You made the switch from being a generalist to a treatment track clinician. How has that gone?
A: Being a clinician in a treatment track program is so much better, and one of the big reasons why I’ve stayed at Kaiser. It’s very manageable and rewarding because I can see patients every week or every other week, and I can see them getting better. With Kaiser, it’s often more about getting patients through the mill and not getting them better — but the treatment track focuses on actually getting them better.
Q: Do treatment tracks have cut-off dates for patients?
A: There is a cut-off, and it depends on the patient and the treatment track. For my anxiety track, it’s often for two-to-three months. If a patient needs more care then we can help them get a referral outside of Kaiser.
Q: What was the impetus for the committee?
A: In bargaining we talked about the need to expand treatment tracks to help decompress the generalists caseloads, and to start treatment tracks for personality disorders and trauma. Those treatment tracks will begin in the Diablo Service Area. After a trial run, they should be expanded elsewhere in Northern California
Q: How did the committee go from your perspective?
A: It went very well. There were four clinicians and three management representatives. We met weekly from December through June. Everyone was very respectful. We listened to each other and valued each other’s opinions.
Q: What was most challenging for the committee?
A: The hardest portion was the decompression of the generalists caseloads, because it’s such a difficult thing to do. We will need many different treatment tracks in every service area in order to do that for the generalists. Our goal is to meet the SB 221 timely access standard (medically necessary follow-up therapy appointments within 10 business days) because right now it’s not anywhere close to being implemented for the patients of generalists.
Q: How did the committee come up with its recommendations?
A:We utilized best practice models and also did a lot of brainstorming — coming up with a bunch of ideas and trying to figure out how to make them work.
Q: How big a difference will it make If these recommendations are fully implemented?
A: I think it would really help with retention and recruitment. We’d be able to keep people here because we’d have more sustainable working conditions. And other providers would be more willing to work here.
Q: How did SB 221, our timely access law, factor into the committee’s work?
A: Without the requirements of SB 221, I think the whole thing would be different. A key part of the treatment tracks is getting patients seen at least once every two weeks. I’m not sure that would have happened without us passing the law. Instead of treatment tracks, Kaiser would have kept the status quo, stating it works.
Q: What is your takeaway from your work on the committee?
A: That it’s possible to have a positive working relationship with management if they have a similar goal — if they really want to see patients getting better and having a healthy system of care.
Q: Are you concerned about it being fully implemented?
A: Yes. We will need to be very persistent. On our Regional Professional Practice Committee, I’ll keep asking and trying to find out how and when we’ll be implementing these recommendations.
