Spotlight Series Article, Sponsored by Welligent
“Let’s do it our way. Let’s lead with a little bit of audacity,” said Scott Zeiter, Grafton Integrated Health Network Executive Vice President/Chief Operating Officer, reflecting on the leadership team’s decision to fundamentally change its approach to measuring client success and demonstrating quality of care.
Grafton Integrated Health Network serves children and adults with complex intellectual, autism spectrum and/or psychiatric disabilities and is headquartered in Winchester, Virginia. Its consulting division, Ukeru Systems, provides training throughout the country in trauma informed care, and an alternative crisis program that does not use restraint or seclusion.
At its inception over 60 years ago, Grafton took what was then a unique approach to serving its clients. Staff actively leveraged each child’s innate strengths and interests to help them overcome their challenges. One of the first students loved horses, for example, and every lesson plan used horses and riding as the metaphor to convey the information. This strength-based person-centered perspective is now ubiquitous throughout our industry. According to Mr. Zeiter, this became completely clear to him when he interviewed with the first CEO of Grafton, who explained to him that, “Ruth Birch’s philosophy was to ‘find out what the kid’s interests are, find out what they are good at, and go from there.’”
With this philosophy as a guide, Grafton worked to provide the best possible care for their clients. For years, clinicians at Grafton sought to uncover and understand each child’s strengths and interests to establish a connection and build trust. This emphasis on providing individualized care for every child presented a challenge for Grafton as clinicians were creating their own way of documenting their clients’ care, drafting their own treatment plans and goals. Care and treatment outcomes were based on subjective observations that were reflected in treatment plan notes that weren’t consistent and measurable. Grafton wasn’t able to quantifiably measure outcomes that demonstrated the quality of care they provided, or the improvements their clients experienced.
Jim Gaynor, former CEO of Grafton, asked a simple question when he arrived in 2002: “How many of your treatment plan goals are you achieving?”
“The teams thought they were achieving about 80%, but weren’t sure,” Zeiter said. “They had to ask themselves, ‘How do you hit a goal that you don’t know how to measure?’ Ultimately, they determined that they were only hitting 30% of their goals.”
Realizing that Grafton was unable to consistently and accurately capture, document, and report the quality of client care, individually or collectively, was the impetus for Grafton leadership to begin the process of making fundamental organizational change.
Organizational change of any kind is hard. Reviewing and objectively assessing 60 years of “We’ve always done things this way,” presented a daunting challenge. Bringing representatives from all parts of the organization together to review existing processes and procedures and contribute to the development of a new plan was the critical features in Grafton’s ability to successfully execute its organizational transformation. This transformation took well over 15 years and went through multiple iterations.
First, a concept called “goal mastery” was developed to set the basic rules and expectations for goal writing and assessment of progress. This process was ultimately patented by the organization. Goal Mastery was adapted to a software application that automated much of the goal ‘rating’ and even provided staff with a goal-writing wizard that helped them construct goals
with fidelity to the model. Now it is being integrated with a clinical approach embedded in empiricism that answers the question “how” in regard to Goal Mastery. At its core is the “Foundation of Care.”
“Having everyone at the table to develop Foundation of Care allowed for input from all sides,” Mr. Zeiter said. “And more importantly, achieved buy in and support from all stakeholders.” The end result was a method for organizational consistency that is presented in an understandable manner, that allows the staff to apply a common philosophy rooted in empirically based care.
Grafton’s Foundation of Care is built on the concept of providing a continuum of care individualized for each client based on their level of acuity and risk.
The Foundation of Care process begins with developing a treatment plan. Applying consistent and established protocols, each treatment plan is still individualized to the client’s strengths and interests.
Treatment goals were simplified and reworked with a singular focus on the ‘behaviors of concern’ that brought the client to Grafton services in the first place. “The fundamental purpose is to address and measure improvement of the behavior of concern,” Mr. Zeiter said. “Goals are created to be measurable, track progress, and confirm achievement.”
Outcomes are now tracked in three ways at Grafton. First is assessment: each client receives a specific battery of assessments, at a predetermined frequency, to demonstrate skill acquisition and the impact of services.
Second is Goal Mastery: a structured system that identifies, monitors, and evaluates client progress. The goal is established at the beginning of care and is defined in observable and measurable terms. A “minimum growth” line from the baseline to the target frequency of a behavior, of concern, provides the team with a benchmark for clinical decision support.
Third is the attainment of treatment plan objectives. For consistency, at each session, clinicians apply a Likert scale to rate the client’s progress on their treatment plan objectives.
Grafton’s ability to consistently and accurately track a client’s progress means more than collecting data and measuring outcomes. It offers transparency for the client’s family or caregivers. Clinicians can be more specific when discussing a treatment plan and progress toward goals, offering greater insights and reassurances.
“When clients leave Grafton, their families will see a measurable improvement in their child’s behavior,” Zeiter said. “And more importantly, by sharing the treatment plan, we can show them how this was accomplished. This demystifies how we’re achieving these goals. We’re able to teach caretakers how to continue working with their child in a consistent, healthy, and effective way. Plus, we can teach them how to track and confirm that improvement continues post treatment with us.”
Optimally, Grafton’s ability to consistently compile client data also provides the potential to accurately gauge outcomes, link overall treatment goal performance to various methods of care, identify trends of care that are most impactful and efficient, and demonstrate the quality of care it provides to any key stakeholder group.
To realize this potential, Grafton leadership team made the decision to invest in the technology required to capture, compile, and analyze their clients’ data, accurately track their progress towards their goals, and ultimately the effectiveness of their treatment.
“Capturing outcomes data in behavioral healthcare is not easy. How do you know that your success is not just conjecture?” Mr. Zeiter said. “This journey has taken us to the land of statistics (terrifying to most of us), and to the world of the information technology industry (quite a place).”
Grafton opted to partner with Welligent and implement their electronic health record platform.
“It is so important to capture and analyze the data correctly – which means that the interface with the clinician and provider must be seamless and easy to use,” Mr. Zeiter said. “In partnering with the Welligent team, we’re able to leave the technology to the experts, it’s a world of sophistication we don’t have.”
“Welligent is the technology that allows us to compile, manage, and interpret data to track our performance and ultimately informs our clinical and organizational decisions.”
Founded in 2001, Welligent is a fast-growing EHR software development firm and vendor that provides a fully integrated, cloud-based EHR platform and mobile apps to help you work smarter. We have complete solutions that can streamline your practice management, clinical documentation, revenue cycle and more.
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Together we can better serve behavioral health, human services, public health, foster care, I/DD, and student health communities across the country.
Grafton Integrated Health Network is a multi-state behavioral health care organization serving children, adolescents, and adults with complex behavioral health challenges.
With nearly 60 years of clinical experience and data in behavioral health and intellectual disabilities, Grafton is uniquely qualified to deliver improved outcomes. We often take – and, based on clearly defined indicators, are successful with – the most challenging clients, many of whom have a co-occurring diagnosis.
Grafton collaborates with communities, families and other health care organizations to provide the best possible care and achieve better outcomes.