S1E8 - Safe Alternatives For Everyone Committee, or “SAFE”
The SAFE committee was created to provide clinical support and shared responsibility to COAAA staff that are facing health and safety concerns for the consumers we serve. This episode gives us the history of SAFE, an overview of when someone should bring a case to SAFE, and an understanding of the support and expertise offered during the meetings. Learn from Clinical Manager Sarah Hall and ADRN Division Director Linda Gillespie in this important episode.
Let me know what you think of this podcast, as well as any ideas you have for an episode. Email me at kwhite@coaaa.org!
Copyright 2024 Central Ohio Area Agency On Aging
Transcript
Welcome to Pretend I Know Nothing About. I'm Katie White, your host administrator of COAAA. Today we'll be learning about SAFE. The SAFE committee with Linda and Sarah. Let's get into it. And I've got Linda Gal and Sarah Hall with me here today. Good morning.
Linda [:Good morning.
Sarah [:Thanks for having us.
Katie White [:Sure. Linda, let's start with you. Can you introduce yourself? Tell us about your role and your program and department?
Linda [:My name is Linda Gillespie, I am the director for the Aging and Disability Resource Division and I have been here 35 years as of last month. And we do a variety of things in the ADRN division, including all of the screening and assessment and enrollment determinations for people applying for the Passport or Assisted Living waiver programs. We do the annual reassessments for people enrolled in the MyCare waiver program. We do Provider relations where we oversee about 600 different contracts that we have with community service providers under Passport Assisted Living, our Title Three program. And we also subcontract with Franklin County Office on Aging and Source Point in Delaware County to monitor their providers. And we do a variety of educational and outreach activities, including evidence based disease programming, things like learning how to manage chronic conditions or overcoming the fear of falling. We do educational opportunities for professionals as well as for civic groups like the Kiwanis or Lions Club or church groups. And we do Medicare outreach and education and operate our caregiver support program.
Katie White [:Housing.
Linda [:Housing is the big one. Yeah, we operate our housing program where we just in the last few years have been able to obtain funds to actually assist people who are at risk of eviction or unable to pay their utilities. And so we actually can help people remain in their homes by just providing them with short term assistance to get over. It started with that's, it actually started a little bit before COVID but then we got kind of an influx of funds during COVID to help people who lost their jobs or weren't able to work anymore because of getting sick themselves and therefore no longer able to pay for their rent or their utilities. And as I said, we are able to keep people in their homes and help them get back on their feet again.
Katie White [:So for those listening, if you aren't familiar with Linda, take a look@the.org chart. Linda is the first division director we've had on, so you can see all that is underneath her. And let's go now to Sarah.
Sarah [:Hi, I'm Sarah Hall, I'm a social worker. I've been at COA almost 13 years.
Katie White [:Wow.
Sarah [: care Ohio actually started in: Katie White [:Great. Some kind of some quick upward mobility all the way to clinical manager now, which is excellent.
Sarah [:Clinical manager?
Katie White [:Yes.
Sarah [:Maybe one day I'll be a director. Who knows.
Katie White [:Here we go. See, we'll just keep moving everybody through the ranks. Okay. Obviously we've got a ton of clinical experience in the room with us and so we are going to focus on talking about Safe. So when did safe start? How did it come to be? Who wants to give me the overview of Safe?
Linda [: st reference I could find was: Sarah [:Ideas and sometimes that's a really hard place for our staff to be in. So coming to the Safe Committee and kind of reviewing a case and hearing from people with a lot more experience than them that we can't do much more than you're doing right now, can sometimes help them to be okay with that. I also think we hear a lot of really great work described to us in Safe. And so I think that that's one of the best things. We see how talented our staff are and how committed they are and we're able to kind of give them that feedback that they've really done what they can and they've been creative in working with these individuals and really making some sort of difference. So giving that feedback is really key to the committee too.
Linda [:And I also think it's a great learning experience for newer staff, whether it's a new staff, person bringing a difficult case or person just serving on the committee and hearing these difficult cases. And we do have visitors, we have students who will listen in and other new staff who won't actually be part of the committee. But it's part of the orientation, I think, for most staff in the agency is to listen in on a couple of different Safe committee presentations so that they can learn and realize that, yes, they're going to most likely run into some difficult situations, but they're not alone and we have a support system for them.
Katie White [:That's great. So it's not only feedback and advice and additional things to think about, but it is that peer support and saying you've done a great job, you've covered everything. Unfortunately, the reality is this is a challenging situation. So how exactly does it work if someone wants to join the committee or just attend or send in a case? Kind of walk me through how that works.
Sarah [:Sarah so every six months we do a rotation for Safe and we send an invite out to most of the clinical staff, get an invite to participate as a member of Safe. And we try to have equal representation, especially across the large program. So we might have like two to four individuals on Safe from a large program and then the smaller programs, we do want to make sure they're involved too. We do have quite a few members that are standing members on Safe. They're dedicated members of Safe that will always be on. Mainly it's our heavy hitters like Linda and other directors who we really want to hear their opinions and takes on harder cases because they bring a lot of experience. But also they're ultimately in charge of these programs, so we want them involved in the decisions we're making so anyone can join. We have seasoned staff on Safe. We also have staff that are pretty brand new to the agency because we do see it as a really great learning experience. One of the things with being a member of Safe or presenting unsafe is good practice for sharing your opinions and ideas in a safe space where we're all supportive and you can kind of put out ideas even if you're new. Even students sometimes speak up and safe about suggestions. They have community resources they're aware of, too.
Linda [:It's a judgment free zone.
Katie White [:That's great. Yeah. Because there really is something too, that when you're coming in and a lot of people have worked here a long time, it can feel intimidating, I'm sure, to say, oh, wait, I might have an idea. So that's great. That's a good experience for people.
Sarah [: We meet most weeks. One is an: Katie White [:So if they're going for the li.
Sarah [:Or the lisws just the LISW.
Katie White [:Just the li. Okay. Got it. Great. So twice a week, if there's cases.
Linda [:It'S once a week. It's alternating weeks. So this week is Thursday, next week will be Wednesday.
Sarah [:Okay.
Katie White [:And so you send out an email, I believe, right, to all staff saying, send in your cases. Kind of walk me through some of that too.
Sarah [:Once a week, we send out an email and invite folks to bring a case to Safe. They would just email either Linda or myself to get on the schedule. People do email regularly outside of those time periods too, and we'll put them on the schedule. Occasionally we'll have something more urgent come up that we can't wait for a meeting for Safe. And so we'll gather whoever we can in the committee together and meet impromptu for case managers. And we do that at least a few times a year with little fanfare. Easy to do.
Katie White [:Once upon a time when I was a volunteer guardian, I actually was able to come to Safe. Diana, by way of Julia, who was running volunteer guardian at that time, invited me in and it was, it was really great to just say I'm having this challenge, and then to kind of think through that 360 view of it, of how we might be able to find some success. So when would someone bring a case? Kind of talk to me about what really lends itself to coming to Safe?
Linda [:Anytime that health and safety are a concern for a consumer, whether it's because of their own actions or the actions of others, if we're concerned about their ability to stay in the community as opposed to an institution, or if enrollment is jeopardized, often we have cases come for people who are not yet enrolled on the program. So an assessor will have seen somebody that they're considering enrolling but have concerns about health and safety. And so assessors will bring cases as well and kind of get the opinion of the committee as to whether this is a case that we could support and hopefully improve by enrolling on the program or not. If a client is putting themselves or others at risk, and they don't understand the consequences of what they're doing if they're not adequately being served by service providers. And that's jeopardizing their ability to stay at home. Anytime there's concerns about legal intervention, such as a potential need for a guardian or the need for APS to get involved, there are times when people will bring a case to Safe where a referral has been made to APS, APS has declined the referral, and yet we're still very concerned about the situation that's going on. And anytime a person is at risk of being disenrolled due to health and safety reasons, we don't want to abandon people who we have been providing some support to. But health and safety is one of the criterion for the program, for all of our programs. And it's actually a waiver assurance that's required by the federal government that we only keep people on the program when we can assure their health and safety okay. And so if we're considering disenrolling due to that reason, then we want that to be a joint decision. Again, part of that shared responsibility.
Katie White [:And are you documenting the cases that come in case something happens? And you can say, we reviewed it with this team and that sort of thing.
Sarah [:So in the client record, the case manager would be responsible for basically saying that they took the case to Safe. And we've had that come up in record reviews. We've had really challenging client situations where, say, a managed care plan might look into it further and they see, oh, what is Safe? And we can tell them, well, we brought this case before a multidisciplinary committee to kind of review what was going on, the interventions in place, and to make sure we feel like we have our ducks in a row. And that's actually really been helpful in talking to auditors and kind of explaining how we make decisions. And it does get documented in each of the client records. They're responsible for just documenting that they brought the case to Safe and kind of noting the suggested interventions that they're aging to follow up on.
Katie White [:The more I talk to people and learn about the different programs, it's not that we're just doing our due diligence, but no matter the level, no matter the program, it seems to me that we're forever working towards clinical excellence and going above and beyond. And so I have a lot of pride and awe when I learn about these things. There's the worst of the worst potentially that we're seeing and going out there and having to try to work in, and the way everybody kind of comes together and supports each other, it's really incredible to learn about. So what area typical situations that come to Safe? You want to talk me through? Any examples or if you have a little data you want to share?
Sarah [: % the first quarter of: Katie White [:So you've got some data you need? It kind of sliced and diced.
Sarah [: s do we want to look out for?: Katie White [:Okay.
Linda [:And we've collected stats for a long time, but as Sarah said this year, we really wanted to dig deeper into that. So instead of just saying yes, this was a behavioral health issue, we're recording what type of issue and other details so that we can drill down more into the data that we are collecting. One of the other scenarios that we see sometimes is fairly often actually, is that it's not the client or the consumer, him or herself that's the issue, but it's the people that they surround themselves with.
Sarah [:Interesting.
Linda [:Either people living in the home or neighbors who are creating problems that jeopardize services to our consumer. Drug use, weapons in the home, neighbors. Sometimes we have people who have squatters living in their homes and they don't know how to get rid of them.
Katie White [:Some exploiting going on.
Linda [:Right.
Sarah [:We see a lot of financial dependence with older adults and their caregivers and maybe adult children that are exploiting them because they don't have their own income. We see abusive relationships because of that. A lot of the folks we work with feel responsible for their adult children and they will bend over backwards to kind of accommodate them in situations we sometimes would view as abusive. Yeah, a lot of problems from the folks that are not the older adults in a lot of the scenarios.
Katie White [:The biopsychosocial whole piece, right. It's not just about the individual, it's the whole thing. And so when there is a really tough case and the staff member has done everything they can do and it just is going to continue to be an unsafe situation, what do we do for staff? Do we have them go to EAP or how do we support staff? I would imagine that would be difficult for a case manager or someone in that scenario.
Sarah [:We definitely educate on EAP and encourage that and encourage people to take the feelings they're having seriously and really process those. As a social worker, I always encourage people to be in their own therapy and be sorting out the feelings they have from work and their family life and that kind of thing. We also sometimes will pull in usually someone's supervisor, their direct supervisor is there at Safe. And so if we see something really concerning, we really encourage the supervisors to continue to follow that and follow up with the person on how they're coping. Are they losing sleep? Are they doing okay and checking in?
Linda [:One of the things we've done, too, in just the last couple of years is include somebody from the volunteer guardian program on each of the Safe committees. So Wendy attends the Thursday mornings and Jane attends Wednesday afternoon Safe meetings so that they can speak to issues around guardianship, power of attorney, other legal kinds of things that might need to be considered.
Katie White [:I should have them on here soon. That way when somebody listens to this and they want to learn more about VGP, it's ready to go.
Sarah [:Well, some of what we do in Safe is talking staff through the fact that often what we're doing is not a one and done thing. It's a long term relationship and some semblance of safety, some increased safety based on the services we can provide for people that's helping people be more safe. And over time, as you build relationships, maybe you're going to be able to increase that level of safety or increase that level of service to make sure people are getting their needs met. And so just encouraging people that right now it might not be where you want it to be, but you might be working with this person for another two years and you might make great strides. Someone who doesn't accept services after you build a relationship with them, maybe slowly you can get them to take an Ers or you can do home delivered meals, or maybe two years from now they'll have a home health aide taking out their trash. So really reminding people that this is a long game rather than a short term intervention.
Linda [:And along those same lines, we encourage staff to bring the same case back to Safe. As things change, especially if they worsen, they can always bring a case back. I know of a couple of case managers who have brought the same person back to Safe to discuss multiple times over a period of a few years, and in some regards the situation may be better, but then there could be backsliding or new developments. So I think that's an ongoing support to case managers too, as they're dealing with these specific cases and realize that we'll always be there.
Katie White [:Yeah, and knowing that there's some consistency too, it's like, I'm going to bring it back to Safe and everybody's going to know what I'm talking about. And we're kind of on that journey together.
Sarah [:One of the things that I think is neat about Safe, that's not a primary driver of Safe, though, is that we're hearing all of these really difficult cases and client situations and we as a team can kind of start to identify and tease out what are the most challenging things for our staff working in the field. And we can respond to that by inviting trainings in and talking with the supervisors and the managers about what we're seeing in the field. And it kind of gives us a larger level perspective for the whole agency. Whereas I might just hear stuff in my program now, I'm hearing things in ten programs. Recently, we had a lot of the presence of guns was really common in our Safe cases and that's caused us to kind of think about staff safety in the field and what we want to do with that. We're considering some additional technology. We've decided to have people kind of list their visits out on their calendars. So we always have a record of where people are. And some of that came from seeing this bigger picture and Safe and I.
Katie White [:Would imagine even thinking through some different policies.
Sarah [:Right.
Katie White [:As we run into situations more and more, maybe we need to really think about having a hard stance or a policy on something like that.
Linda [:And clinical practices too, which has been one of our ongoing committees over the years. Often the protocols or best practices that they've developed are driven by cases just like what's being brought to Safe.
Katie White [:Okay, that's so interesting. And it makes great sense, right? Like starting to hear themes and then bringing in trainings. I love that. So do you have a success story or usually I ask people what their favorite story is, which might not be quite appropriate for Safe, but is there any kind of success story you might be able to share?
Sarah [:So I had someone on my team and I was on Safe at the time. She was working with an older gentleman who lived with his wife in an apartment. The apartment itself had a lot of drug activity, like the apartment complex. And the wife actually became addicted to drugs, prescription opiates, and he was declining. He has Ms, had a ton of pain. His pain wasn't well treated and it was even more poorly treated as people started filching his pain meds. And so his wife's addiction problem was kind of spiraling out of control. There were people in and out of the house and because he didn't have access to pain meds to treat his pain, his wife actually dosed him with fentanyl more than once and he went to the hospital. So obviously this doesn't start off sounding like a success.
Katie White [:Just doing some deep breathing over here. I'm already stressed.
Sarah [:Yes, it was very stressful. Luckily, the clinician working with him, Hannah, is very talented and was very invested in building a relationship with this family and building some trust. And so she came to Safe pretty early on after his first hospitalization, just like, how should I approach this? And we ended up linking her with Spark and React. So Spark is I'm not going to get the acronym, but Spark works with folks who are encountering the fire department who could better be served by social services in some capacity. And react is a program that is with Columbus Fire. Coaaa actually has a social worker on that team and we go out and meet with folks after an overdose to try to encourage treatment. And so a social worker and a firefighter go out and meet them where they're at, talk to them about their overdose, offer them things like narcan education, about treatment options, et cetera. So she ended up linking with React. They all went out on a visit. This was after some time of her building rapport and trust with the family and kind of planting the seed, and they went out and actually got his wife into treatment. That day on of his barriers for caring for himself was he was worried about his wife, and so if she would get treatment, he was willing to go to a nursing facility to better treat his pain and be more comfortable. And so she went to treatment and he went to a nursing facility, and I think he's still in the nursing facility, but that to us was a big success because there were so many barriers. She was not interested in treatment, he was not interested in leaving the home if she was going to be in the home alone. He was so worried about her. And we were able to kind of get that situation to a safer place, and I'm really happy he's more comfortable now.
Katie White [:Absolutely. That's so impressive. And about how long did all of that take? I would imagine quite some time.
Sarah [:So it was kind of a couple of months of planning before React went out. But once React went out, we were already at a place where she was ready to make a change. So she got in treatment same day.
Katie White [:That's incredible. So we're coming to the end here, and I always like to give each person an opportunity to kind of just share some final thoughts, what you think or want staff to know about Safe. So, Linda, what are your final thoughts?
Linda [:I think it's a great resource that people need to remember as they're dealing with these difficult cases. Sometimes we don't have any cases to discuss in a particular meeting, but my guess is that there are those cases out there that could be brought to Safe. I don't want people to feel intimidated by bringing a case, which I think is kind of natural. They're putting it all out on the line there as to what the situation is, what they've done, and there are all these other people there who could be judgy, but we make an effort, every effort, not to be.
Katie White [:I didn't think about it as a vulnerability, but it is. Yeah, you're right.
Linda [:So really, that's probably the biggest thing, is don't hesitate at all to bring a case, even if you feel like there's probably ten other cases that are worse that somebody else might have. If you're feeling uncomfortable about a situation, then by all means bring it.
Sarah [:Yeah, I would second that. I think people do feel vulnerable and they're very busy. Everyone's very busy. And so I think sometimes people don't want to add an extra thing or they're nervous to present. I just would remind people, your supervisor will be there with you, and they can copresent with you if you're. Nervous about it. Let your supervisor do the talking. It's worth getting the resources. I think Safe is one of those things that I'm glad we're introducing staff to early on, because I think that it's really tied into the core values of coaaa and just really speaks to the level of support we want to offer staff and we bring our most talented individuals into a room and give you advice. And so it's very valuable to the work folks are doing, but it's also just helps tremendously to just see that level of shared responsibility and support. And remember, you're not out on an island doing this work.
Katie White [:And so just one more time, if an individual wants to find some information about Safe or sign up to come. Linda, can you share again where they might find info and how they know to attend?
Linda [:So we have a folder on the shared drive, so it's work files and then COA. Shared Information and resources, I think is the name of the folder. And when you open that, there's a folder on Safe, and it includes suggestions of when to bring a case to Safe, the ground rules for people who are on the committee, and including that we're not there to judge anybody, and there's a presentation form that we ask everybody to fill out that just kind of gives a synopsis of what's going on. So that form is there, and then all of our statistics are there as well. So it's work files, COA information and resources, and then Safe.
Katie White [:And then they watch for those emails that come out and then email Sarah or Linda to get on the agenda.
Linda [:Right. So I send out the emails usually on Mondays for the Thursday meeting. Sarah sends them out for the Wednesday meetings and just respond to whichever one of us sent out.
Sarah [:And I'd encourage anyone who has an interest in serving on Safe, even if you are kind of new to do so, I think it's a really worthwhile experience. You learn a lot. You learn a lot of resources, make some connections in the agency, and you could get some independent license supervision too.
Katie White [:And if you don't have a case and you're not sure about joining as a committee member, you can always email just to attend to learn. Right? Okay, great. Thank you both so much. You'll both be back in different capacities to talk about more specifically about your division, Linda, and about Molina, Sarah, but thank you both for coming together today to share more about SAFE.
