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Spotlight on Innovations and Achievements: County of San Diego Health and Human Services Agency, Aging & Independence Services

Learn how this California AAA implemented a new cognitive screening program that has successfully identified clients who may be living with dementia but who do not have a formal diagnosis—and helped increase the ability of the agency to serve people living with dementia.

We're proud to highlight the award-winning work of the 2020 winners of n4a's Aging Innovations and Achievement Awards in this weekly spotlight feature. This week, we are focusing on the County of San Diego Health and Human Services Agency, Aging & Independence Services' FIRST: Boosting Dementia Capability Through Cognitive Screening program. The agency was a 2020 Aging Innovations Award winner in the Agency Operations category. The AIA Awards are made possible thanks to the support of Centene.
 
To increase the agency's dementia service capability and assist older adults who may be living with dementia, the County of San Diego Health and Human Services Agency, Aging & Independence Services (AIS) has implemented new cognitive screening protocols. The FIRST cognitive screening program is conducted with clients who meet specific criteria (older than age 65 with deficiencies in two or more activities of daily living or older than age 85). Those whose score places them in the at-risk category are encouraged to follow up with their doctors.
 
The program is one component of a larger dementia capability effort that was funded by ACL's Alzheimer's Disease Initiative: Specialized Supportive Services grant. This new practice is embedded into agency procedures, and an online training is provided for incoming staff. The new screening protocols require Adult Protective Services staff, In-Home Supportive Services intake social workers and Older Americans Act Title III B case management staff to provide cognitive assessments using one of two cognitive screening tools (Mini-Cog or AD8).
 
“We believe that by using standardized screening protocols, we are helping to normalize and take the stigma out of who is selected to be tested. The overall goal of our grant from ACL is to increase our agency's dementia capability and we feel that we have increased our capability in this area quite a bit,” said Jana Jordan, Principal Analyst, County of San Diego Health and Human Services Agency Aging & Independence Services.
 
The program has been successful at identifying clients who may be living with dementia but who do not have a formal diagnosis. Through 2019, 289 clients across agency programs were screened, with 184 clients (64 percent) receiving a score indicating they are at risk for dementia. Of those who scored at-risk, 113 (61 percent) consented to sharing their results with health care providers. Early diagnosis allows for appropriate treatment and life options planning while an individual is still able to make informed decisions about their future care.
 
“Dozens of staff now are more attuned to the needs of their clients and have the tools to approach the delicate issue of cognitive decline. Because large programs within our agency, such as Adult Protective Services, have incorporated the screening protocol, the issue of dementia has been elevated significantly,” said Jordan.
 
In response to the COVID-19 pandemic, AIS began conducting the AD8 screening via phone calls when home visits are not possible. Some programs have temporarily suspended screening activities, while others have been able to continue, including the FIRST case management program. The training on how to use the protocol and make physician referrals was designed to be conducted virtually with a video, so that component has continued unabated during the pandemic.
 
The screening portion of the program can be replicated with minimal staff time by adapting the AIS protocol and materials. AIS created a 30-minute online training to provide guidance on when and how to conduct screening and which assessment to use based on the context. Screening is conducted using publicly available tools that have no licensing fees.
 
To learn more about the County of San Diego Health and Human Services Agency, Aging & Independence Services' FIRST: Boosting Dementia Capability Through Cognitive Screening program, contact Naomi Chavez, Naomi.Chavez@sdcounty.ca.gov.
 
For more information about the 2020 winners, see the press release and read the book of winners! To read about past winners and find other best practices for your agency to consider, visit our Best Practices Clearinghouse page.

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