Notes from the Field: Quality and Accountability in Healthcare
The Affordable Care Act gave focus and momentum to quality and accountability in healthcare. As we debate the future of healthcare in our country, this should continue to be a focus of any changes or reforms. Value-based healthcare—the concept of linking payment to performance or outcomes achieved relative to costs, rather than the volume of services provided—will continue to be implemented and tested across the healthcare system. Here at Thresholds, that means several things: investing in integrated care and workforce development, partnering with insurers, advocating for standardized measures of value, and developing an evaluation strategy that will lays a foundation for value based care within a fee for service environment.
One part of our strategy is to elevate and focus on process measures, instead of outcome measures. What is a process measure? Process measures are the steps, activities, or evidence-based practices that lead—or you believe lead—to a particular outcome. For example, important process measures in behavioral health include how many consumers with a diagnosis of schizophrenia receive diabetes screening, how many consumers are counseled to stop smoking, and how many consumers have created an action plan to manage their illnesses. Process measures improve quality and can reduce cost by reducing variation in care, and in the process, allowing you to test what outcomes the process measure leads to. Process measures allow providers to systematize their care and allow you to know why you are getting the outcomes you are.
An important process measure that the evaluation department has been tracking is how many of our clients are connected to one of our three integrated care partners. Evidence shows that consistent primary care correlates with lower mortality rates and better management of chronic conditions. As Atul Gwande points out in a recent essay on the value of primary care in the New Yorker, “ … the more complex a person’s medical needs are the greater the benefit of primary care.” For persons with serious mental illness, being linked to a primary care or integrated care partner, with whom we share a philosophy of care and have an ongoing relationship, increases this benefit.
In sum, value-based care has renewed urgency for answers to how to document success and impact. While it is important to document success, it is equally as important to identify those processes, steps and practices that lead to good outcomes. Insofar as processes are often recorded as administrative data, these data are often easier to export, track, and report on than outcome data. Identifying, tracking, and reporting on process measures is a necessary step to improving care and showing good outcomes.
To learn more about Thresholds Evaluation Department, visit thresholds.org/evaluation
Donor Spotlight: Healthcare Foundation of Northern Lake County
Thresholds is excited to feature the Healthcare Foundation of Northern Lake County (HFNLC) in our June donor spotlight. The HFNLC, incorporated in June 2006, was funded by the sale of the Saint Therese Medical Center and Victory Memorial Hospital. These two institutions provided compassionate healthcare services to Waukegan and the surrounding communities for most of the 20th century, laying the groundwork for HFNLC’s commitment to solving persistent problems within the healthcare system.
Since first supporting Thresholds nearly a decade ago, HFNLC has made grants to our organization totaling $50,000, most recently supporting Thresholds’ Lake County Program. Thanks to generous support from the HFNLC, the Thresholds Lake County Program had the resources needed to hire a Nurse Care Coordinator. The Nurse Care Coordinator plays an instrumental role in connecting our clients to the full range of health care services needed for a successful recovery. Working closely caseworkers, medical providers, and the broader community, the Nurse Care Coordinator creates a comprehensive education and treatment plan that addresses each client’s mental illness and physical health.
We are grateful to the Healthcare Foundation of Northern Lake County. Because of their support, individuals in Lake County who are experiencing serious mental illness have access to life-saving services. Thank you for believing in Thresholds and the people we serve!
Donor Spotlight: The Charles & M.R. Shapiro Foundation
In this donor spotlight, Thresholds is excited to feature The Charles & M.R. Shapiro Foundation. Since 1958, the Charles & M.R. Shapiro Foundation has supported a range of issues from the arts and academics to medical research and social services. The foundation made its first gift to Thresholds in 1984 and has since donated $253,000 to our organization.
Most recently, The Charles & M.R. Shapiro Foundation has supported our General Operating Fund. General operating support is vital to Thresholds’ success and a key reason for our continued growth. In fiscal year 2017, Thresholds served more than 15,000 individuals experiencing serious mental illnesses across more than 30 unique programs that employed nearly 150 clinical teams. Each of our programs is tailored to meet the unique needs of specific populations experiencing mental illnesses, including: youth, veterans, mothers and their children, individuals exiting the prison system, homelessness, and the deaf or hard of hearing. Gifts to our General Operating Fund give Thresholds the flexibility needed to ensure all of our programs are fully supported.
The Charles and M.R. Shapiro Foundation has been a dedicated partner of Thresholds for more than 30 years. Because of this, Thresholds can continue offering our clients life-saving, community-based services. We are grateful to the Charles and M.R. Shapiro Foundation and could not do this work without them!
Thresholds Named Best & Brightest Company to Work For in 2017
Chicago, IL – Thresholds has once again been named one of Chicago’s 101 Best and Brightest Companies to Work For in 2017 by the National Association for Business Resources. This award is bestowed to companies that distinguish themselves as having the most innovative and thoughtful human resources approach. An independent research firm evaluates each company’s entry based on key measures including compensation, benefits, engagement, retention, employee achievement recognition, communication and shared vision, diversity and inclusion, work-life balance, and community initiatives.
Thresholds has over 1,400 employees working at more than 30 programs throughout the city of Chicago, adjacent suburbs, and nine Illinois counties, in more than 100 total locations. Thresholds promotes a diverse and supportive culture that empowers employees and rewards their accomplishments.
“Thresholds is successful because of our amazing workforce. Our staff have challenging jobs, and they do them with the most amazing heart and drive. I’m inspired by their dedication every day, and I’m thrilled that through this award, the work they do to make Thresholds great is being recognized,” says Mark Ishaug, Thresholds CEO.
“Companies that recognize that their employees are the key to their success achieve staying power. Our 2017 winners create their human resource standards to ensure employee satisfaction and they set standards for every business to aspire toward,” said Jennifer Kluge, President and CEO of MBPA. “We are proud to honor this year’s winners.”
Thresholds congratulates all recipients of this award, especially fellow nonprofit organizations who also share a strong commitment to serving the community. On Monday, July 17, 2017, Thresholds will be honored alongside fellow award winners at a luncheon at the Chicago Marriott Southwest in Burr Ridge, Illinois.
For current, open employment opportunities at Thresholds, please visit our career page.
Thresholds Statement on President’s Proposed FY18 Budget- Drastic, Inhumane Cuts to Medicaid and Social Safety Net
Chicago, IL – Yesterday, President Trump introduced his FY18 budget plan, taking aim at healthcare and safety net programs that provide a line of support for our country’s most vulnerable. The proposed budget would slash more than $600 billion from Medicaid over 10 years, make destructive cuts to disability programs and federal food assistance, and pave the way for onerous work requirements.
Such devastating Medicaid cuts would result in millions of people across the country losing access to mental health and substance use treatment and healthcare for other medical needs. As Illinois begins to address the opioid epidemic and its long-standing mental health crisis, the President’s budget would hamstring the state’s ability to combat these very real and serious problems.
The President’s plan also calls for harmful cuts to Social Security Disability Insurance and Supplemental Security Income, often the only income sources for individuals living with a serious mental health condition, and allows states to impose work requirements for accessing Medicaid and wrap-around supports, an unnecessary barrier, particularly for those who are unable to work due to their illness. Imposing work requirements only compounds the challenges individuals living with mental illnesses currently face – a population which experiences unemployment at more than three times the rate of the average American, often because of their illness.
If enacted by Congress, the President’s budget plan will dismantle our nation’s healthcare and safety-net system, pulling the rug out from under millions of Americans. Those living with mental health and substance use conditions will be especially hard hit by the proposed budget.
Simply put – Illinois cannot afford these cuts; and neither can the hundreds of thousands of its residents living with mental health and substance use disorders.
It is often said that a budget is a moral document. This proposal does not reflect a commitment to fighting the opioid epidemic or the mental health crisis. It is rooted in neither compassion nor common sense.
We strongly oppose this proposal and we ask fellow advocates and those representing us in Congress to stand with us. We urge our elected officials to make good on their pledges to stand up for the people living with mental health and substance use disorders by rejecting the President’s introduced FY18 budget and ensuring the funding necessary for treatment and supports that provide a path to wellness and recovery.
Press Contact: Emily Moen, Director of Public Relations and Marketing, 773-572-5172
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By Lydia Zopf, Program Director of the Thresholds Veterans Project
6:00 AM – I’m up bright and early. I get myself ready and throw the essentials in my work backpack – tablet, snacks, water, pencil pouch, cell phone, and 3 small gifts to raffle off for staff appreciation.
7:15 AM – I’m at the Thresholds program site, and we’re getting ready for the day: hot coffee is in the kitchen, the multipurpose room is set up for an iRest meditation group, we have fresh pens and welcome signs for new staff, I complete an inventory of our naloxone (a medication to interrupt a drug overdose) supplies, the “Boss Board” is updated with information and announcements for clients, and Motown music can be heard in the background.
8:30 AM – There are two veteran clients waiting in the lobby, eager for their 9:00 AM appointments. One client is currently homeless, and he’s here today to get ready to meet with his new landlord and sign a lease to his very own apartment. The other client is wearing dress pants and a tie, nervously fidgeting as he prepares himself for a job fair.
10:00 AM – I check my email: I approve the proposed schedule of retreats at Chicago Botanic Garden, send a STAR award (given to Thresholds staff members who went above and beyond) to the Recognition Committee, review a draft of a grant proposal, ask another program director for ideas about where a veteran client can board a pet while he is out of town for a few weeks, send out a calendar appointment for Clinical Supervision at the end of the month, remind my LCPC (Licensed Clinical Professional Counselor) group to review an article before our next meeting, and confirm the day/time that YAP (Thresholds Young Adult Program) clients will come to our site and serve a meal to the veterans.
11:15 AM – The team leader and I hit the road. We stop by a client’s apartment to help him pay his rent and show him how to call the pharmacy to refill a prescription. The client is upset about a fight that took place down the block last night, so we spend some time helping him create a plan to stay safe and set up a time to visit him later in the week. Then we stop by a Puerto Rican restaurant to pick up sandwiches for lunch. Finally, we arrive at a school and walk into a 4th grade classroom, where 25 nine-year-olds have a long list of questions for us – What was it like to be separated from your family while you were deployed overseas? What was it like coming back home? What does a community support specialist do? How do you teach veterans about meditation? The Veteran Team Leader and I do our best responding to their questions, but we soon realize that these 4th graders already hold the key to the universe. I jump in an Uber to get back to the office while the team leader goes off to another visit with a veteran.
2:45 PM – Back at the office, I send out an email to my staff to announce the winners of three gadgets I raffled off (a selfie stick, a stylus pen, and a tablet cover). Staff also share suggestions for self-care in a long “Reply All” email chain. I clean up one of the group rooms and put art supplies away. I send a quick text message to confirm dinner plans (tacos, again). I help a new staff person finalize a care plan for a client and explain what a natural support is. I sign three more care plans and an annual MHA (Mental Health Assessment). I return a few phone calls and confirm my meetings for tomorrow.
4:30 PM – I’m getting ready to leave for the day, and a client shows up unexpectedly. He lost a file folder that contained personal documents and copies of applications for various public aid services. He has an appointment with CHA (Chicago Housing Authority) in the morning and doesn’t feel prepared. I invite him in and set him up in the computer lab, where he checks his email and Facebook. I look through his records and find the information he needs, make copies, and hand him a new file folder with everything for his appointment tomorrow. I can tell he is relieved because his shoulders are relaxed and his breathing has slowed a bit. I help him plan ahead for the morning: he sets an alarm on his phone and double-checks the CTA route. After he leaves, I document everything in Smartcare (Thresholds’ electronic record keeping software) and send a text message to the CSS (Community Support Specialist).
5:00 PM – I’m finally ending the day. In my car, I roll down the windows and put on the latest episode of The Moth. I take a deep breath and remind myself how grateful I am to have a home, good health, and a great deal of hope.
Lydia Zopf is the Program Director of the Thresholds Veterans Project. The Veterans Project includes homeless outreach, housing services, supported employment, peer-driven supports, substance use treatment, integrated physical and mental health services, and trauma-based therapies. Learn more about the Thresholds Veterans Project here.
The Power of a Job: Thresholds Supported Employment
Jobs transform lives. They provide purpose, routine, and financial freedom – all of which play a key role in recovery from mental illnesses. As Area Director for Little Caesars Pizza, Quizhpe Luz is one of the many employers who partner with Thresholds to provide competitive career opportunities to our clients through our supported employment services. “I believe in giving people a chance,” Quizhpe said, “that’s why I decided to work with Thresholds.”
In 2011, Quizhpe was introduced to Zekkina, a member of Thresholds Deaf Program who was working with supported employment to find a job, and invited her to join the Little Caesars team. Hiring Zekkina proved to benefit them both, filling an open position with an excellent employee and giving Zekkina a feeling of connection and empowerment. Reflecting on her life before employment, Zekkina shared “I was bored and had bad mood swings at home. Now I enjoy working, keeping busy – and no more mood swings.”
Quizhpe emphasized the importance of equality on her team in both respect and responsibility. “The team doesn’t treat Zekkina any differently,” she said, “they hold her accountable just like everybody else.” While Little Caesars training already incorporated multiple learning and communication styles, Quizhpe says working with Zekkina inspired her to seek out American Sign Language worksheets to better communicate with her.
Zekkina’s strong work ethic and positive contributions to Little Caesars have motivated Quizhpe to hire several more Thresholds clients and provide them with the same chance to succeed. “It feels wonderful to give someone a job. You’re making a difference in someone’s life, seeing their smiles as they start their career is payback for anything.”
Thresholds supported employment services provide clients with opportunities to build skills, prepare for interviews, match clients with employers based on their unique interests, and provide ongoing support both before and after the hiring process. To learn more about Thresholds supported employment services, visit thresholds.org/employment.
Advocacy: Raising Our Voices to Move Mental Health Forward
By Amber Kirchhoff
On May 1, Thresholds kicked off Mental Health Awareness Month by convening people with lived experience, health care and human service providers, and policymakers from across the state for our annual Mental Health Policy Forum. The Policy Forum served not only as an opportunity to learn from national experts and experienced state leaders, but as a chance to reimagine ourselves as advocates for the reforms and investment needed to transform the mental health system.
During the Policy Forum, several members of Illinois’ mental health community spoke of commonly faced challenges to accessing the care and supports needed to manage mental health conditions. Because of stigma and a general lack of information about mental illnesses, often many years go by before receiving a diagnosis. Even with an awareness of a mental health condition, accessing treatment and housing can be extremely difficult because of the underfunded, overly complex system of care that is currently in place. As a result, far too many spiral into disability, begin to self-medicate, cycle in and out of the hospital, or find themselves entangled with the justice system.
These tragedies are avoidable and Illinois can and must do better. We as advocates play an important role in bringing about needed changes and ensuring that no one is allowed to continue to fall between the cracks. Like most other health conditions, mental illness is treatable. In order to build a system that works, we must strengthen early identification and treatment, build service capacity so everyone who needs care gets it, ensure affordable housing as a foundation for treatment, grow the mental health workforce, and improve insurance coverage for proven treatments. Together this package of policy solutions represent the bedrock of our Road Map to Mental Health Reform.
Mental Health Awareness Month provides an important opportunity to challenge stigma and to start conversations about the critical need for treatment that works. At Thresholds, we work to advance those conversations and inspire mental health advocates all year round. As a community, we know what works; and together change is possible.
Amber Kirchhoff is an experienced public policy professional who has worked both in state government and with non-profit organizations. Currently, she holds the role of Policy Associate at Thresholds, supporting the agency’s government relations and advocacy efforts. Prior to joining Thresholds, Amber served as a Policy Analyst under the administration for former Illinois Governor Pat Quinn. She previously earned a Master’s of Political Science through the Civic Leadership Program at the University of Illinois at Urbana-Champaign.
We are deeply disappointed that in spite of the hard work of our advocates, and the urging of millions across the country, the U.S. House voted today to pass the American Health Care Act (AHCA), putting the health coverage of 24 million Americans in jeopardy. Millions will lose access to affordable healthcare if this bill makes it to the President’s desk. The House vote on the AHCA is a vote to slash Medicaid – the primary payer of mental health and substance use treatment – by $880 billion, weaken protections for pre-existing conditions, and undercut the Essential Health Benefits requirement, which guarantees that benefits like mental illness and substance use treatment are covered.
That said, the fight is NOT over. In order to become law, the bill will need to pass the Senate and then be signed by the President. We must not let this happen.
Thank you for making countless calls, showing up to town halls, and posting on social media to stop the AHCA. We must continue this fight in the Senate, and we hope that you will join us.
Throughout this next phase, we will share important updates and opportunities to take action. Both Senator Dick Durbin and Senator Tammy Duckworth of Illinois have been outspoken supporters of the Affordable Care Act and we thank them for their leadership on this critical issue.
Thresholds remains committed to preserving health coverage and access to treatment, and we know you do too. Onward, together.
Press Contact: Emily Moen, Director of Public Relations and Marketing, 773-572-5172
Donor Spotlight – The Martin Foundation, Inc.
Thresholds is proud to feature The Martin Foundation, Inc. in our Donor Spotlight. Established in 1953 by Lee and Geraldine Martin, The Martin Foundation, Inc. has created a legacy of philanthropy, making transformative gifts that support a range of issues, including: education, women and children, the arts, and the environment.
Since 1983, The Martin Foundation, Inc. has been a generous partner to Thresholds, most recently supporting our Homeless Services Program. Our Homeless Services Program provides a variety of innovative programs that engage and empower individuals experiencing homelessness and mental illness on their journeys to recovery. Our Mobile Assessment Units (MAUs) are a key component of our Homeless Services Program, acting as the vital link that connects individuals to services and resources. Each MAU canvasses streets, shelters, CTA lines, and other areas where homeless individuals congregate. After meeting immediate needs and completing the intake process, MAU’s refer these individuals to the most appropriate Thresholds program, which link them to housing and comprehensive support services. Today, Thresholds has eight Mobile Assessment Units. Last year, they engaged nearly 3,000 homeless individuals.
We are grateful to The Martin Foundation, Inc. for their long-time partnership. In their more than 30 years of support, they have donated over $200,000 to Thresholds, giving hope to thousands of individuals experiencing serious mental illness.