Family Advocates
•Our Family Advocate program didn't meet our Service Reach Target/Goal of 1,500 mothers served, but our Service Reach Outcome for FY22 surpassed all years prior at 1,334 mothers reached, since the inception of the Family Advocate program. Service Reach Outcomes from prior years: FY21 (1171) and for FY20 (1296). Contact trending and engagement outcomes increased in April 2022, when COVID in person restrictions were lifted at THD on 4/11/22.
• Our programs Healthy Births Goal metric was recalculated in FY22 and data analyst continue to work on this metric. No set target has been established. Fiscal Year-to-Date (July 2021-June 2022) from data gathered from our BEST Dashboard, has our Healthy Births goal percentage at 10% for FY22. Healthy Births Goal metric is calculated and defined as the denominator=Medicaid births in Tulsa County for current fiscal year; numerator= OCHA leads the program receives who have 2 or more successful interactions with a Family Advocate prior to delivery.
• Discussions of setting a short-term goal to 7-10% and a long-term goal back to 25-30% have been discussed. Increasing the denominator to increase our Service Reach and Healthy Births Goal will include Family Advocates engaging with another OCHA lead (Soon to Be Sooners (STBS) mothers). Family Advocates continue to increase client engagements through our programs Special Car Seat Initiative and our CF Emergency Fund. Family Advocates are utilizing the Unite Us platform to streamline the referral process with other community partners.
• Program Conversion Rate – 2 month offset – a measure of engagement of mothers, and pregnancies, who are eligible for the program 2 months prior to the beginning of the fiscal year through 2 months prior to the end of the fiscal year. The target was 25% and the outcome was 29%.
• Cold Call Pick Up -Numerator- a measure of at least one engagement. Engagements = Outcomes of “spoke with client,” “Email/text interaction” or In-person interaction.” The target was 50% and the outcome was 61%.
Child Guidance
• Dr. Casey Newman, one of our audiologists, was serving a 10-month old client who was experiencing problems with sleeping, and had been treated for two ear infections already. Dr. Newman suspected that baby might have been having a reaction to her formula, and spoke with the baby’s pediatrician about her concerns. As a result, the pediatrician was able to provide the WIC program with a prescription for a more specialized formula. Within one week, the baby was sleeping through the night. The next time that the baby came in to see Dr. Newman, the baby was beginning to walk and talk.
• A mother and her two young children came into the Child Guidance clinic at our JOG location. She reported that the children’s doctor had referred them to the Tulsa Health Department for immunizations, as the family did not have insurance at that time. When they presented for the appointment with the Immunization clinic, they were directed to our Outreach services, who could help them apply for Sooner Care coverage. After meeting with Romelia in Outreach, the mother was then escorted to the Child Guidance clinic area. Shannon Culler, one of our Speech-Language Pathologists in Child Guidance, happened to have a cancellation that day, so she was able to immediately provide one of the children with a screening. In addition, Shannon provided the mother with education about our services. Together, they called and scheduled an appointment at our Central location, for a hearing evaluation. Shannon also introduced the Mother to Kim Whitty, one of our Child Development Specialists, who was able to schedule to Mother for future services. Before leaving the clinic, the Child Guidance clinicians escorted the Mother and her children to the WIC program, where they were able to schedule and appointment so that the Mother could apply for WIC services.
Accountable Health Communities
• This is the 5th year of five for the AHC program. This program was designed as a study by the CMS to determine if identifying and addressing health‐related social needs impacts health care cost and reduces health care utilization. The social needs addressed were 1) housing instability and quality, 2) food insecurity, 3) transportation needs, 4) utility needs, and 5) interpersonal violence. Client’s received a screening via their mobile device when they checked into the medical facility, and when the screening was completed, the needs were identified in real time with an automated resource referral being provided.
• There are close to 130 clinical delivery sites (i.e., emergency departments, primary and specialty care clinics, urgent cares, and care coordination groups), where screening is being done daily. The CMS model has officially ended, however, we are continuing the model for the next several months with some additional funding from the bridge organization.
• Erin Casteel, THD Navigator, made a follow up call to a beneficiary whose husband had recently died. After offering condolences, the client stated that she was able to use the resources that had been previously received and they were very helpful. The client stated that since her husband had passed away, that she had lost his income and insurance benefits the day he died and she was not sure how she was going to be able to pay all the bills that month and in the months to come. Erin was able to send the client additional resources for food pantries, utility, financial assistance, and resources for health insurance. Information was also given about grief counseling resources that might be helpful in the future. The client was very thankful for the follow up call and the timeliness of my call. She also said she was thankful for our program as it has given her hope in a time that she really needed it.
Immunizations
• THD worked to provide immunization access to Tulsa County individuals in locations convenient to the individual. Staff provided vaccines in a number of non-traditional locations such as homeless shelters (Salvation Army, Day Center), faith organizations, schools, day cares, community food events, Tulsa Housing Authority locations, congregate living facilities (Tulsa Boys’ Home, Sand Springs Home, Tulsa Women and Children’s Center), the Center for Individuals with Physical Limitations and others.
• THD values strong community partnerships with major health care systems, as well as individual clinics and providers. THD recognizes that providing immunizations, especially the Covid vaccines, depends on the work and efforts of all these partners. In a spirit of community health, THD is a resource for not only vaccine information but supplies of Covid vaccine to area pandemic providers. THD has provided approximately 70,000 doses of Covid vaccine to other area providers. It remains a goal for vaccine to be easily and readily available across the community to any individual who is seeking the vaccine and not missing opportunities to provide the vaccine.
Data
Family Planning
Family Planning
Adult Health
Adult Health
STI Program
STI Program
Accountable Health Communities
• There are close to 130 clinical delivery sites (i.e., emergency departments, primary and specialty care clinics, urgent cares, and care coordination groups), where screening is being done daily. The CMS model has officially ended, however, we are continuing the model for the next several months with some additional funding from the bridge organization.
• There have been over 2.8 million offers to screen since the beginning of the program and from those, over 477,000 responses have been collected. From those responses over 94,000 Oklahomans had at least one social need, with over 152,000 individual needs reported. The Navigation metrics are applicable only to Medicare/Medicaid patients, who are high risk, which means they have been to the emergency room two or more times in the last 12 months and have an identified social need.
• Over 11,000 Oklahomans are eligible for navigation services, with over 13,000 resolved needs.
Tuberculosis (TB) Program
• 2,679 unduplicated clients in the TB program
• Tulsa County had 11 active TB Cases in FY 2022 and 363 clients identified as Latent TB Infection
• THD has a treatment initiation rate of 88.9% and a completion rate of 75% for newly diagnosed TB disease for whom 12 months or less of treatment is indicated. The rate of treatment initiation is based on initiating treatment within 7 days of specimen collection for positive acid-fast bacillus sputum smear results.
Immunizations
• Provided 38,965 vaccines to 23,900 individuals in THD clinics, Caring Vans and community events during FY22. Included in that total are 13,742 individuals who received 16,968 Covid vaccines.