California Health Care Improvement Projects (CHIPs)

Making Contingency Management for Methamphetamine Use Accessible to People Experiencing Homelessness

Contingency management (CM), which involves paying people to use less meth or engage in treatment, is the most effective treatment tool for methamphetamine use disorder. Compared to CM, other treatments (like medications, counseling, detox, and rehab) do not work well for meth use.

Despite this, CM is not widely available due to legal, political, and operational barriers. To address this in California, DHCS is implementing a CM pilot in some counties through the Drug Medi-Cal Organized Delivery System (DMC-ODS). However, not all individuals needing CM services are able to access the DMC-ODS. This is especially true for people experiencing homelessness, for whom transportation, social, stigma, lack of insight, and other barriers prevent them from accessing DMC ODS services.

Meth use is especially problematic as people experience homelessness enter permanent supportive housing (PSH). Housing First models mean that individuals entering PSH are not expected to be in recovery. Continued meth us in PSH can cause major behavioral disturbances that can put the individual, their neighbors, staff, and the building in harm's way.

Building Organizational Excellence Within Olive View’s Hospital Operational Leadership Team.

When thinking about organizational excellence within a health care organization, clinical efficiency and quality patient care immediately come to mind. Physicians and nurses who provide direct patient care take center stage. What about the radiology and lab staff whose images and test results ensure appropriate diagnoses? What about the schedulers that support patient access, the housekeepers that keep the environment clean for safe patient care, and the facilities management tradesmen who work to keep the lights on? My operational team consists of these ancillary and non-clinical staff who are similarly critical to the hospital. The purpose of my CHIP project is to develop my leadership team and provide them with the necessary soft and hard skills to drive behavioral transformation and performance improvement in alignment with the organization’s strategic initiatives.

Improving Birth Outcomes through Midwife Workforce Expansion

The aim of this project was to assess the strengths and limitations of student teaching for
midwife-led clinical practices in California through an anonymous survey. Decades of research
shows that midwives dramatically decrease maternal and fetal morbidity and mortality in labor.
and postpartum. As of 2020, in the US there are approximately 4 midwives per every 1,000 live
births. According to the American College of Nurse Midwives, to be on par with other
high-income countries with better outcomes, we need to aim for a minimum of 25 midwives per
1000 live births, a gap of 80,000 midwife providers. Unfortunately, expansion is bottlenecked by
the small number of clinical sites and trained midwives who teach/ precept midwifery students.
Advanced practice providers, in particular midwives, can help bridge the care gap by providing
gynecological care through the lifetime and obstetrical care to birthing persons. The survey
aimed to identify strategic ways to address the preceptor shortage and understand the tools that
midwives are already utilizing in teaching future generations of midwives.