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(“Familiar Faces”). This is the shared common goal of a systems coordination effort underway in King County.

Brook Buettner, Familiar Faces Initiative Manager
Email: Brook.Buettner@kingcounty.gov
Phone: 206-477-8715

What is Familiar Faces?

The Familiar Faces initiative is work centered on creating a system of integrated care for complex health populations. Familiar Faces refers to a population defined as individuals who are frequent utilizers of a King County jail (defined as having been booked into jail four or more times in a twelve-month period) and who also have a mental health and/or substance use condition.

Learn more about our Familiar Faces Initiative:

A Vision for the Future

The vision for Familiar Faces puts the client at the center of a care team that includes the flexibility to address the level of care and specific needs of the individual, regardless of payer. This vision was developed collectively with cross-sector partners to achieve the following outcomes:

  • improved health status
  • improved housing stability
  • reduced criminal justice involvement
  • reduced avoidable hospital emergency department use

This work is closely aligned with and informed by other transformational systems work in King County, including Equity and Social Justice, Physical and Behavioral Health Integration, the Accountable Community of Health, the MIDD Plan and developments related to Washington’s 1115 Medicaid Waiver

About

Many social conditions contribute to the systems that churn individuals through institutional and crisis oriented responses that create “familiar faces.” The goal is to transform systems to create a health and human services response to Familiar Faces, rather than a criminal justice one. This work requires examining the many existing systems and approaches to the complex social problems facing individuals with behavioral health conditions, many of whom are homeless and lack access to basic needs.

The King County Health and Human Services Transformation Plan and the implementation of the Affordable Care Act brought new opportunities to improve health and social outcomes for the Familiar Faces population. Two key elements are guiding this new effort and are transforming how King Count does business: Working across silos and sectors to partner in a better way; and putting the people and communities at the center of decisions about funding, policy and programs, known as Collective Impact.

In 2013, King County, in partnership with community stakeholders, developed a plan for an accountable, integrated system of health, human services, and community-based prevention – referred to as the King County Health and Human Services Transformation Plan . The Plan has the goal that by 2020:

The people of King County will experience significant gains in health and well-being because our community worked collectively to make the shift from a costly, crisis-oriented response to health and a social problem, to one that focuses on prevention, embraces recovery, and eliminates disparities.

The plan called for an initial focus on areas where improved performance is most critical – for the individuals and communities experiencing the poorest outcomes. The plan also had to align with and be fundamentally committed to the larger King County goal of achieving equity and social justice for county residents.

Following preliminary scoping conversations with internal and community stakeholders during 2014, one of the initial populations of focus that emerged was individuals with a mental health and/or substance use disorder who are high utilizers of the local criminal justice system – specifically, the King County Jail. These became our “Familiar Faces.” Many of these individuals experience complex chronic health conditions including: histories of trauma, substance use disorders, mental health and chronic homelessness. These individuals experience instability in many aspects of their lives and are familiar to the various service and provider crisis systems.

The Familiar Faces population was selected as an initial focus with the theory that if system improvements could be made that resulted in better health and social outcomes for these individuals, then the lessons learned would have much broader implications for how our region moves forward with the larger opportunities emerging as a result of the Affordable Care Act.

The implementation of the Affordable Care Act has brought new opportunities for the community to work together to achieve the Triple Aim of better health, better care, and lower costs for this initial focus population. These changes include expanded Medicaid coverage, the statewide integration of the mental health, substance use disorder, and physical health systems, and the emerging Accountable Communities of Health and system delivery reform efforts in Washington state.

While there is no shortage of programs in the region that are designed to address the needs of the Familiar Faces – many of which produce excellent results as stand-alone programs – overall fragmentation, uncoordinated care, poor outcomes and growing costs persist for the health, social services, and criminal justice systems, and for our community overall. In short, despite the number of these programs the overall health and social outcomes for the Familiar Faces has not improved.

A new approach was necessary to achieve the vision called for in the King County Health and Human Services Transformation Plan and to improve health and social outcomes for the Familiar Faces population. Past efforts had generally been programmatically focused and failed to affect broad cross-sector policy changes. Two key elements are guiding this new effort and are transforming how we do business:

  • Working across silos and sectors to partner in a better way,
  • Putting the people and communities at the center of decisions about funding, policy and programs. 

Partners from across different sectors are using a Collective Impact approach, which commits the group to a common agenda for solving a specific social problem. The Familiar Faces population is engaging in services across a number of different silos, funded by different sources, consisting of different programs. This work is testing whether lasting improvements for Familiar Faces can be achieved by bringing different sectors together to focus on a set of shared outcomes. 

A second aspect of the Transformation Plan is the importance of putting people and communities at the center of identifying and solving problems. This differs from past efforts to improve health and human services, where the focus was on filling gaps rather than improving client outcomes. This past approach has resulted in a patchwork of services that have been deemed “program-centric” rather than “people-centric,” and has ultimately failed to produce improved outcomes for Familiar Faces.

Familiar Faces are individuals who are high utilizers of King County jails, having been booked four or more times in a twelve-month period while also experiencing a mental-health or substance-abuse condition. In King County, there are more than 2,000 individuals during any 12-month period that are considered Familiar Faces.

While there is no shortage of programs in the region that are designed to address the needs of the Familiar Faces – many of which produce excellent results as stand-alone programs – overall fragmentation, un-coordinated care, poor outcomes and growing costs persist for the health and human services, criminal justice systems, and for our community overall. This Cost Analysis discusses the proportion of King County resources devoted to Familiar Faces.

A Design Team worked collectively to map systems currently in place and design the Future State Vision. This cross-sector team included representatives from housing providers, substance use providers, mental health providers, community health centers, Medicaid Managed Care Organizations, Washington State’s Health Care Authority and Department of Social and Health Services, King County’s Public Health department and Department of Community and Human Services, the City of Seattle, criminal justice organizations including courts, police, and the King County Department of Adult and Juvenile Detention. In addition, a wide-range of community-based organizations, hospital systems and peers participated in the mapping work to ensure a comprehensive review and approach.

The current Familiar Faces population (identified by the number of bookings and behavioral health conditions) are a sentinel population that will help guide system transformation. Strategies implemented for Familiar Faces are both scalable and system-wide, and will inform an integrated health and human services system that not only prevents individuals from becoming Familiar Faces, but also illustrates a system that benefits all people in King County who have behavioral health issues.

Implementation Strategies

The Familiar Faces initiative is leveraging existing and emerging opportunities including expanded Medicaid coverage, the statewide integration of the mental health, substance use disorder, and physical health systems, Accountable Communities of Health and system delivery reform efforts in Washington state.

New efforts are also underway: 

The new Intensive Care Management Team provides comprehensive and integrated services to adults who 1) are experiencing behavioral health challenges (mental health conditions and/or co-occurring substance use issues), 2) need an intensive level of community-based support, and 3) may be experiencing homelessness. The program is a hybrid mixture of diversion and reentry, and it tests a whole-person care approach. It is being piloted with 60 individuals who will receive behavioral health services, primary care for physical health, housing and assistance from the King County Prosecuting Attorney’s Office, to quash warrants.

Leadership from a national Managed Care Organization and King County’s Jail Health Services are developing a pilot program that will allow managed-care Community Health Workers to enter the King County jails and conduct release planning and transitional care services for its members. This pilot will test innovative ways to coordinate care and share data and address continuity of care and social-determinants of health for individuals leaving the jail(s). It will also lay the foundation for other managed care organizations to do similar work in the future.  Currently, United Healthcare staff are providing reentry transitional support to members leaving the SCORE jail.

King County is developing a comprehensive, integrated client-level health and human services data system to serve both direct care and population-level analysis. King County is also a part of the White House Data Driven Justice Initiative that aims to use data to identify and break the cycle of incarceration, equip first responders with the tools they need to divert individuals from jail, and use data-driven pre-trial risk assessment tools to inform pre-trial release decisions.

Currently, service providers do not have information needed regarding client housing, health, and behavioral healthcare utilization to make appropriate and efficient care decisions. King County already houses a range of client-level data including Medicaid claims, behavioral health, Veteran’s, developmental disabilities, homelessness services and housing data, county-provided employment services data, and county and municipal jail booking and release data. Only small portions of these datasets are currently integrated, and as such, the comprehensive integrated data system will further integrate these data.

The integrated data system will allow for the following functions: (a) enabling individual client “lookup” for direct care coordination, (b) identifying high risk groups based on flexible criteria, for system-level care coordination, and (c) extracting datasets, based on flexible criteria, for analysis of population health, program evaluation, and costs.

King County is looking to leverage two different technical tools in order to enhance collaboration and connections for care teams working with Familiar Faces. One tool, known as the Emergency Department Information Exchange (EDIE), is a proprietary data-sharing and real-time notification system currently used by many healthcare providers in Washington State. The second system is the Washington State Health Care Authority’s sponsored Clinical Data Repository (CDR), known as Link4Health, which is under development with primary support from federal funding.  Initial focus on using EDIE with the ICMT Vital team is underway.


King County, in collaboration with criminal justice stakeholders, are currently exploring the development of a coordinated multi-jurisdictional system to remediate legal barriers that contribute to client recidivism and wellbeing. Prosecutorial diversion will provide direct prosecutorial access to providers serving “Familiar Faces” in order to 1) access criminal justice information for the purposes of identifying legal barriers and program eligibility (e.g. housing), 2) quashing warrants, and 3) file dismissals of charges.  The initial prosecutorial resource position is with the King County Prosecuting Attorney’s office and is supporting Familiar Faces being served by the ICMT Vital team and may soon expand to support MCO reentry pilots.

King County and other stakeholders are in the planning phase of developing a Single Diversion Portal that will enable first responders (law enforcement, fire, and other first responders) to quickly access resources to help divert individuals with mental health or substance use disorders from utilizing jail and emergency departments that are often an inappropriate and costly response to the crises.

Governance

In early 2016, the Familiar Faces Steering Committee was formed to provide ongoing guidance and support to the implementation of improvement strategies. The Steering Committee is closely aligned with the Physical and Behavioral Health Integration Design Committee, Accountable Community of Health, and developments related to Washington’s 1115 Medicaid Waiver.

The Steering Committee is a formal collaborative of community partners that meets regularly to provide leadership support and assist in removing barriers to achieving the vision for Familiar Faces. 

The Familiar Faces Steering Committee provides strategic direction for Familiar Faces. Members include representatives from housing, criminal justice, courts, health and human services sectors as well as former Familiar Faces who represent consumer voices. More about membership.
The Familiar Faces Initiative relies on the advice of its Advisory Board, made up of people with lived experience in the criminal justice system. Their input helps shape Familiar Faces strategies and participate in broader system transformation efforts.
  • August 4, 2016: Meeting cancelled
  • July 7, 2016: Summary
  • June 2, 2016: Summary
  • May 5, 2016: Summary
  • April 7, 2016: Summary
  • March 3, 2016: Summary
  • January 21, 2016: Summary
  • January 6, 2016: Summary 
Familiar Faces Steering Committee Members- September 2017
Last name First name E-mail address Agency Sector
Aman Heather Heather.Aman@seattle.gov City Attorney of Seattle Prosecutor
Asefaw Tashau tashau_asefaw@uhc.com United Healthcare Managed Care Organization
Balducci Claudia claudia.balducci@kingcounty.gov King County Council Council
Benet Jesse jesse.benet@kingcounty.gov King County BHRD Behavioral Health and Recovery-Diversion & Reentry Services
Bragg Jason jasonbraggprp@gmail.com Familiar Faces Advisor Advisor
Brennan Stephanie stephanie.brenna@kingcounty.gov King County Attorney's Office
Brown Siobhan siobhan.brown@chpw.org Community Health Plan of Washington Managed Care Organization
Buettner Brook Brook.Buettner@kingcounty.gov Department of Community and Human Services Familiar Faces Manager
Cahill Caedmon caedmon.cahill@seattle.gov Seattle Civil Rights Office
Camelio Jeanne Jeanne.Camelio@kingcounty.gov King County BHRD Behavioral Health and Recovery-Diversion & Reentry Services
Cates Chris chrisc@etsreach.org Familiar Faces Advisor Advisor
Chayet Elise echayet@uw.edu Harboriew Hospital Hospital
Clark Todd Todd.Clark@kingcounty.gov King County Jail Jail
Condon Meagen Meagen.Condon@kingcounty.gov King County Jail Health Services Correctional Healthcare Provider
Conley Michelle michellec@etsreach.org Evergreen Treatment Services REACH Program Community Provider
Daugaard Lisa lisa.gaugaard@defender.org Public Defender Association Community Provider
Donohue Karen karen.donohue@seattle.gov City of Seattle Municipal Court Presiding Judge
Erickson Travis travis.erickson@kingcounty.gov Public Health - Seattle & King County Public Health
Folz Brigitte ebgf@uw.edu Harborview Behavioral Health Community Behavioral Health Provider
Gale Chloe chloeg@etsreach.org Evergreen Treatment Services REACH Program Community Provider
Gilvar John john.gilvar@kingcounty.gov Public Health - Seattle & King County Healthcare for the Homeless Network
Green Lamont lamont.green@seattle.gov Seattle Civil Rights Office City of Seattle Civil Rights Office
Hafer Erin erin.hafer@chpw.org Community Health Plan of Washington Managed Care Organization
Hayes Patty Patty.Hayes@kingcounty.gov Public Health - Seattle & King County Public Health Department
Hayes William William.Hayes@kingcounty.gov Department of Adult and Juvenile Detention County Jail/Corrections
James Turina turina.james69@gmail.com Familiar Faces Advisor Advisor
Jones Betsy betsy.jones@kingcounty.gov King County Exectuive Dow Contstantine's Office Health and Human Potential Strategic Advisor
Kashyap Andrew andrew.kashyap@defender.org Public Defender Association Community Provider
Khandelwal Anita Anita.Khandelwal@kingcounty.gov King County Department of Public Defense Public Defender
Kowalcyk Mikel mikelk@etsreach.org Familiar Faces Advisor Advisor
Madden Tricia maddep2@uw.edu Harborview Hosipital
Malone Daniel dmalone@desc.org Downtown Emergency Services Center Community Provider
Mandella Karen karen.mandella@molinahealthcare.com Molina Health Care Managed Care Organization
McLaughlin Susan smclaughlin@kingcountyach.org King County Accountable Community of Health ACH
McLendon Hedda Hedda.McLendon@kingcounty.gov King County Department of Community & Human Services Homeless Housing Program
Nelson Dan daniel.nelson@seattle.gov Seattle Police Department Law Enforcement/ Crisis Intervention Team
Noble-Desy Patty Patty.Noble-Desy@kingcounty.gov King County Exectuive Dow Contstantine's Office Recidivism Reduction and Reentry
Olson Dusty dusty.olson@seattle.gov City of Seattle Human Services Department City human services agency
Plorde Michele Michele.Plorde@kingcounty.gov Public Health - Seattle & King County King County Emergency Medical Services Provider
Plumacher Sola sola.plumacher@seattle.gov City of Seattle Human Services Department Housing strategic advisor
Pugel Jim Jim.Pugel@kingcounty.gov King County Sherrif's Office Law Enforcement
Quinn Adrienne adrienne.quinn@kingcounty.gov King County Department of Community & Human Services County human services department
Rowe Genevieve Genevieve.Rowe@kingcounty.gov King County Department of Community & Human Services Evaluation
Ruskin David David.Ruskin@va.gov US Veterans Affairs, Puget Sound Healthcare
Sakuma Jeff jeff.sakuma@seattle.gov City of Seattle Human Services Department Housing strategic advisor
Satterberg Dan dan.satterberg@kingcounty.gov King County Prosecuting Attorney's Office Prosecutor
Spain Cindy cindy_l_spain@uhc.com United Healthcare Managed Care Organization
Srebnik Debra debra.srebnik@kingcounty.gov King County Department of Community & Human Services Data Support and Evaluation
Stone Gail Gail.Stone@kingcounty.gov King County Exectuive Dow Contstantine's Office Law and Justice Policy Advisor
Tucker Donna Donna.Tucker@kingcounty.gov King County District Court Presiding Judge
Walton-Anderson Natalie Natalie.Walton-Anderson@kingcounty.gov King County Prosecuting Attorney's Office Prosecutor
Wilson Sidney badrapsolo@gmail.com Familiar Faces Advisor Advisor connected to VOCAL-WA and Black Prisoner's Caucus

Data and Evaluation

One of the challenges in working to reduce acute care and jail utilization and improve care for Familiar Faces is to understand the population.   Early in the initiative, King County staff across various departments worked together to extract data that would help us get a clearer picture of the needs and utilization of Familiar Faces.   The result of that analysis is here. Notably, the analysis showed that behavioral health indicators were present for nearly all people who had 4 or more jail bookings during the observed calendar year.  The largest proportion of those bookings were due to non-compliance issues  - most commonly failure to appear in court.   Familiar Faces were also disproportionately people of color than the jail population which is already disproportionately non-white relative to the King County population.   Familiar Faces touch many other acute care services, but despite this high service uilitzation, less the 1/4 had contact with ongoing outpatient behavioral healthcare.

Evaluation of the Familiar Faces initiative began with defining the overall outcome indicators desired. The indicators are here. As the implementation strategies have begun only recently, the evaluation is still getting underway.   However, based on the population analysis, a baseline cost assessment has been conducted.The Intensive Care Management Team is being evaluated using a randomized controlled design.   Data collection is being conducted for this strategy, it’s associated prosecutorial resources, and the jail-managed care reentry pilot.

King County is developing a comprehensive, integrated client-level health and human services data system to serve both direct care and population-level analysis. King County is also a part of the White House Data Driven Justice (DDJ) Initiative that aims to use data to identify and break the cycle of incarceration, equip first responders with the tools they need to divert individuals from jail, and use data-driven pre-trial risk assessment tools to inform pre-trial release decisions.   A data map of current and desired data in linkages developed for the DDJ is here.

Currently, service providers do not have information needed regarding client housing, health, and behavioral healthcare utilization to make appropriate and efficient care decisions. King County already houses a range of client-level data including Medicaid claims, behavioral health, Veteran’s, developmental disabilities, homelessness services and housing data, county-provided employment services data, and county and municipal jail booking and release data. Only small portions of these datasets are currently integrated, and as such, the comprehensive integrated data system will further integrate these data.

The integrated data system will allow for the following functions: (a) enabling individual client “lookup” for direct care coordination, (b) identifying high risk groups based on flexible criteria, for system-level care coordination, and (c) extracting datasets, based on flexible criteria, for analysis of population health, program evaluation, and costs.   The system is being developed during 2017-8.  

Resources

King County Department of Community and Human Services provides the backbone support and hosts to the Familiar Faces Initiative. Executive Leadership is provided by the DCHS Director, Adrienne Quinn, and the Initiative Manager is Brook Buettner. Familiar Faces is also staffed by core leadership staff, Jesse Benet and Deb Srebnik of DCHS and Travis Erickson of Public Health of Seattle and King County.