It requires regular reports from bureaucrats and meetings about the performance statistics that they collect. The aim of such "Stat" programs is to achieve better outcomes: whether that means repairing potholes faster, driving the murder rate down or improving the water quality.
More than 20 large cities and a handful of counties now have Stat programs. Only a few of them apply the data-driven approach to human services.
One of the pioneers of Stat programs for human services is Reggie Bicha. In 2009, he created KidStat, a program focused on child welfare in Wisconsin. Two years later, he joined Colorado Gov. John Hickenlooper's administration to establish C-Stat.
Governing spoke with Bicha, who oversees C-Stat and the state's human services department, about how Colorado went from being one of the worst to one of the best states at getting benefits to unemployed and low-income people, and how it has nearly eliminated the use of physical interventions in state psychiatric hospitals. The interview has been edited for clarity and length.
Of all the metrics you’re tracking, which has made the biggest difference in helping people?
If you go back six to 10 years ago, Colorado was one of the worst performing states in the country when it related to making timely eligibility determinations for food assistance, family cash assistance and Medicaid. It was so bad that when the governor and I came into the office in 2011, we inherited a federal court order directing us to improve the timeliness of these eligibility determinations. When you came in for benefits, you had a 50/50 shot of getting eligibility determined in a timely way. And then if you looked at accuracy, you had worse than a 50/50 shot that you were actually going to get the right benefit that you should have been receiving.
C-Stat itself didn’t fix the problem. What C-Stat did was give us a framework and set a clear goal for helping us dig into what was contributing to our lousy performance for Coloradans in need. Now we are one of the best in timeliness in the entire country. That court order? We worked our way out of it. It is now gone as of January of this year. And our accuracy? We’re the second most improved state in the country. Today we’re among the very best in the country in ensuring that people get the right benefits at the right time when they need it most.
Can you give me an example of a metric that translated into a change in the way your department does business?
We oversee two state mental health psychiatric hospitals in Pueblo and Ft. Logan. We realized that our use of physical interventions and solitary confinement was excessive and was not aligned with what we thought was best practice. Most people who come to us have experienced multiple bouts of trauma some time in their lives, and we have to understand that experience to be in the best position to help. Simultaneously, we need to make certain that our interventions do not retraumatize people. If you are a woman dealing with schizophrenia who has been sexually abused, that’s a fair amount of trauma, and then having three men restrain you only subjects you to more trauma even though the physical restraint may have been intended to keep you safe.
At C-Stat, we were able to measure seclusion -- when it happened, the staff involved, the patient dynamics. We retrained our staff on how to engage differently with patients using an exercise called 'verbal judo' to help de-escalate people. We also created de-escalation rooms. (I call them mini-spas.) We turned rooms into proactive places where patients could go. They have recliners, sensory blankets, soft lighting, and soft music to help people figure out strategies to de-escalate themselves rather than working themselves into something that requires a physical intervention.
We also changed our philosophy. Rather than thinking that a physical intervention was a strategy that we used, we started to think that if we had to use those techniques, there was some sort of failure in our treatment approach.
All of that -- a new philosophy, new tools, reframing the discussion and holding ourselves accountable through C-Stat -- has nearly eliminated the use of the physical interventions in both of the mental health institutes. We’re really proud of that.
Stat programs in general tend to be controversial. What kind of pushback did you get about the program in Colorado?
Overall, the takeup has been quite positive across the board. Part of that is Gov. Hickenlooper. When he took his oath of office in his inaugural speech, he said we are going to be a government that measures everything that we do, so that gave me a mandate to establish this initiative and hold ourselves accountable.
We spent a lot of time going around the state and helping our partners understand that being focused on outcomes is not about a “gotcha” but rather about clarity of how we know that our patients, our clients and our residents are actually getting better and stronger. When they see that it has resulted in changes in laws, in new investments that might be necessary to add more staff to a situation or updated computer systems, they see that it's not just about blaming people.
In my reporting about Maryland State Stat and Baltimore CitiStat, I came across disagreement over how frequently reports need to be publicly posted and meetings need to be held. Has that changed at C-Stat over time?
We post public information quarterly. For our county partners, they receive their particular data on a monthly basis. Internally, every Wednesday, from 3 to 5, I’m meeting with one of my program areas, so each month, I’m touching every one of those offices.
Although it feels intense, we can’t make any justification for why it would be better to do it less frequently. The return for that investment has been pretty profound for our organization.
This article was originally published on Governing.
