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, an approach 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 aligned with and was fundamentally driven by 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 legal system – specifically, the King County Jail. These became our “Familiar Faces.” Many of these individuals experience complex chronic health conditions including histories of trauma, mental health and substance use disorders, and chronic homelessness. These individuals experience instability in many aspects of their lives and are familiar to the various service 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, 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 Cost Analysis discusses the proportion of King County resources devoted to Familiar Faces. The 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.

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.

To kick off the Familiar Faces work, a design Team worked collectively to map systems in place at the time 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 Department of Community and Human Services, Public Health of Seattle and King County, the City of Seattle, criminal legal 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 individuals with lived experience 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 is guiding system transformation. Strategies implemented for Familiar Faces are both scalable and system-transformational. They will inform an integrated health and human services system that not only prevents individuals from becoming Familiar Faces, but also benefit all people in King County who have behavioral health issues.

The pilot 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 receive behavioral health services, primary care for physical health, housing, legal coordination and assistance from the King County Prosecuting Attorney’s Office, and Seattle City Attorney's Office.

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 to test the most effective service package to improve health outcomes. 

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 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 claims, Veteran’s, developmental disabilities, homelessness services and housing data, county-provided employment services data, and county and municipal jail booking and release 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 seeks to leverage different technical tools 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, along with exploration of the care plan function of that system. 

King County, in collaboration with criminal legal system stakeholders, is 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 ready to roll out a Single Diversion Portal, known as OneCall, that will enable first responders (law enforcement, fire, and others) 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. This tool will rely on integrated data and shared care plans to coordinate care, while actively protecting personal health information. 

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 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 centers the experience and wisdom of people who have direct experience with the systems we work to transform. The Familiar Faces Initiative relies on the advice of its Advisory Board, made up of people with lived experience in the criminal justice system to help set the agenda and identify appropriate solutions. Their input helps shape Familiar Faces strategies and participate in broader system transformation efforts.

• March 07, 2019: Summary

• November 01, 2018: Summary
• September 06, 2018: Summary
• June 07, 2018: Summary
• May 03, 2018: Summary
• April 05, 2018: Summary
• March 01, 2018: Summary
• February 01, 2018: Summary

• December 07, 2017: Summary
• November 02, 2017: Summary
• October 05, 2017: Summary
• September 07, 2017: Summary
• August 03, 2017: Summary
• May 04, 2017: Summary
• January 05, 2017: Summary

• October 06, 2016: Summary
• September 01, 2016: Summary
• 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 

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 to formulate a clearer picture of the needs systems 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--even more so than the general population booked into jails in King County. Familiar Faces touch many other acute care services, but despite this high service utilization, less the 1/4 had contact with ongoing outpatient behavioral healthcare, speaking to the failure of these systems to meet the Familiar Faces population's needs.

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 Emergency Department, 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.  

• Current State Map (Value Stream)
Future State Vision (Draft)

• Familiar Faces Population Analysis, Sept., 2015
• Familiar Faces Initiative Brief
• Familiar Faces Cost Analysis

• The Stepping Up Initiative
• The Data Driven Justice Initiative and Playbook
• Medicaid Transformation (1115) Waiver
• Prison Policy Initiative (national context)
• The Sentencing Project
• Law Enforcement Assisted Diversion (LEAD)
• Mental Illness and Drug Dependency (MIDD)
• Veterans and Human Services Levy

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.