Building Alliances For Safer Communities

1. Building Alliances For Safer Communities “What’s Working” Webinar Multnomah County Aging & Disability Services Gatekeeper Program

2. What we will be covering today: • Overview of the Gatekeeper Program • How to develop a program in your community • Key partners • Identifying a “hub” and a lead agency • Developing protocols • Sharing of information with partners • Engaging the business community • Sustainability • Q & A

3. What is the Gatekeeper Program? • It is an outreach effort to identify, refer, and respond to at-risk older adults and people with disabilities living in our community. • Gatekeepers are trained: • to identify warning signs • to call a Gatekeeper Referral number and report their concerns

4. Why does the Gatekeeper program exist? Linking services with those most isolated in the community is often not successful There are a number of reasons why high-risk older adults are unable, unwilling or resistant to seeking assistance. • Negative stigma associated with using “social services” • Pride and stoicism • Fear of losing control over their life. • Shame, suspicion or fear • Financial reasons • Mental health issues such as paranoia, memory loss, depression • Lack of information about what services are available or assistance they may qualify for

5. Who are Gatekeepers? Gatekeepers are nontraditional referral sources who come into contact with older adults or adults with disabilities through their everyday work or activities and who are trained: • to recognize warning signs and red flags that indicate an older adult/adult with disabilities may need some help/support • to report their concerns their local Gatekeeper Program • The Gatekeeper Model is a great fit with an Aging & Disability Resource Connection (ADRC)

6. Gatekeeper Structure Can Vary Multnomah County Profile • Housed in Type B Area Agency on Aging (AAA) • Part of 24/7 ADRC/Helpline • Referrals assigned internally to APS and case managers • Referrals also assigned to senior center case managers • All referrals logged into new ADRC call module and emailed to worker & supervisor • Program been operational for 25 years in Multnomah County

7. The Multnomah County Experience • Ray Raschko develops the first Gatekeeper Program in Spokane (1978) • Human Solutions in Portland started a Gatekeeper Program with three year grant, covering a geographic area of the County (1987) • Due to success of the program, absorbed by local AAA and expanded county-wide (1990) • Celebrated 25 Year Anniversary (2012) • Received Award funding from The Aging Network’s Volunteer Collaborative under the “What’s Working– Effective Practices” program (2012)

8. Gatekeeper Referrals in Multnomah County FY11/12 • 395 daytime Gatekeeper referrals received from the community: • 66% of the Gatekeeper calls were referred to Adult Protective Services • 49% of the calls were for people who were NOT already receiving services

9. Gatekeeper Referrals By Industry • Utility Companies 30% • Police/Fire/Rescue 15% • Social Service Agencies 11% • Anonymous 10% • Banks/Credit Unions 7% • The balance of referrals (27%) come from letter carriers, faith communities, housing managers, transportation providers, concerned neighbors, etc.

10. Gatekeepers are trained to recognize warning signs, red flags and other reasons to make a referral Any change in normal routine is critical.

11. Typical areas of potential warning signs are discussed during a training: • Communication • Financial • Caregiver Stress • Social Isolation • Emotional Health • Appearance of the Person • Physical Limitations

12. Warning signs for people in the field are also covered • Home needs repair and/or is inaccessible • Mail stacked up, old newspapers laying around • Strong odors on person and/or in home • Yard overgrown and neglected • Pets neglected and/or too many pets

13. What information should Gatekeepers report? •  Customer’s name • Date of birth or age, if known or approximate •  Address • Telephone number • A brief description of concerns, observations, what the customer has self-reported or disclosed • Gatekeeper’s contact information

14. Anonymity and Confidentiality This topic is covered during a training. It is an important protocol to address as you are developing your Gatekeeper Program. • Anonymous: Gatekeeper’s name will not be tied to the report or shared– total anonymity • Confidentiality: Gatekeeper’s name will be kept private to the client, alleged victim, alleged perpetrator, etc but will be on the report for follow up as needed

15. After the referral is made…what are some things we can do to help? • It will be very important to develop a simple and varied list of potential “next steps” and ways that your Gatekeeper Program will follow up once a Gatekeeper has called to make a referral. • Gatekeepers always want to know “now what?”

16. Client Choice Gatekeepers become concerned when they think that the person did not get help…we are not charged with “solving the problem”. It is important to cover the topic of Client Choice with Gatekeepers. • As an agency we value client choice • We follow up on EVERY gatekeeper referral that is made • Does everyone gets help or gets their “issue” resolved? --NO, they don’t Not everyone WANTS help.

17. What else Gatekeepers do to help? • Donate money – we receive donations through United Way’s Employee Giving Campaign • Donate time – some Gatekeepers enjoy volunteering for a community agency • Donate resources – Gatekeeper organizations provide in-kind resources like printing or sponsor holiday gift drives

18. Key Elements of a Gatekeeper Program • Identification of partners • Establishing a lead agency and a hub • Having memorandum of understanding or a working agreement with partners • Development of protocols & triage techniques • Mechanisms for sharing information

19. Identification of partners • Discuss with key leaders from community. • Interested parties generally include: • Utility Companies • Police/Fire/Rescue • Support Programs • Banks/Credit Unions • Letter Carriers • Housing • Transportation • Can you think of a group in your community?

20. Establishing a Lead Agency& a Hub • Area Agency on Aging • ADRC is a great a hub • Law Enforcement • Community Non Profit • Older Adult Mental Health Agency • A combined response • Lead Agency can partner with another agency for support like training

21. Memorandum of understanding or working agreement with partners • Adult Protective Services • Medicaid • Senior Centers • Advocacy Groups • Senior Corps RSVP Program • Mental Health • Developmental Disabilities

22. Protocols and triage techniques and sharing information • It is important to know how calls will be handled. Some considerations are: • Will there be a home visit? • What is response time? • What do you do with after hours calls? • How are calls documented and shared? • What information is shared with Gatekeepers? • How do your protocols fit with your agency’s confidentiality protocols? • How do you ensure consumers don’t “slip through the cracks”?

23. Protocols and triage techniques • Identify the client– are they already being served? If so  connect with their case manager • Where can new referrals (people who are not in the system and don’t have a case manager) be sent? • Is this an APS issue? • Is this a mental health crisis issue? • Is this an urgent issue/imminent danger? 911?

24. Consideration for sharing information • How will the various groups share information? • Is email secure/confidential? • Is there a call module with consistent format? • Are there back up procedures to ensure that the recipient is not out of the office and the referral sits for several days until their return?

25. Mechanisms for sharing information • Sharing with PARTNERS • Internal methodology for sharing • Sharing with external partners • Secure emails/HIPAA considerations • Share with mental health call center • Determine who you will need to share info with and how it will occur with follow up loop

26. Mechanisms for sharing information • Sharing with the Gatekeeper • What can you share back with the Gatekeeper? • When is it ok to share follow up information with the Gatekeeper? Must consider client confidentiality

27. Why this program is important to the business community • Helps customers achieve a better outcome • Good public/partnership to support consumer • Business wants to help but goes beyond their scope of work • Peace of mind that consumer will get some follow up • Gatekeeper referrals are welcomed – not seen as a “complaintant” • Able to provide good customer support while also managing business

28. Gatekeeper Program Sustainability • Identify start up and on-going funding; grants, reallocate existing resources, business community support, etc. • Important to have a designated coordinator for the program • Regularly communicate your successes • Engage your local elected officials

29. Questions or Comments?