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EXHIB lT "D" <br />SMART GOALSComprehensive Healthcare <br />Professional Services Agreement <br />Page 18 <br />GOAL: Screen and make relevant behavioral health referrals to all persons presenting with ident ified <br />behavioral health needs at the KVH emergency department and other hospital departments as <br />requested. <br />Measures Data Sour'ce <br />Track number of people served, number and type of referrals made, number of <br />C-SSRS screenings completed, referrals made related to suicidal thoughts or <br />behaviors, number of ROI declinations,referral numbers by KVH department <br />lnternal Tracking <br />Sheet <br />Strategy #1:Screen all persons exhibiting suicidalthoughts or behaviors during <br />staffed program hours. <br />Measu ra ble Objectives: <br />Use the Columbia-Suicide Severity Rating Scale (C-SSRS)to screen all <br />persons exhibiting suicidal thoughts or behaviors. <br />Document and track all referrals made to address suicidalthoughts or <br />behaviors. <br />Strategy #2 Provide referral information to all assessed patients for behavioral <br />health resources or resources addressing Social Determinants of Health. <br />Measurable Objectives <br />Document and track specific referrals made. <br />Request release of information (ROl) to referral sources for the purpose <br />of monitoring follow through on referrals. Document and track each <br />request for ROl. <br />Document and track declination to sign ROI <br />Strategy #3 Respond to referrals in all KVH departments. <br />Measurable Objectives: <br />Track all referrals by KVH department to ensure L00% response to <br />referent that the referral was received. <br />SUCCESSFUL BENCHMARKS <br />NAME ONE ACTIVITY YOU WILL ACCOMPLISH FOR EACH REPORTING TIME INTERVAL <br />6 MONTHS <br />Staff is trained to use the C-SSRS and has developed and implemented a tracking system for <br />measuring all objectives. <br />12 MONTHS <br />Complete presentations to KVH departments and CHC Kittitas County staff about the CCM <br />program purpose and operation.