Whether you are a consumer,

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hether you are a consumer, a customer, prospective customer, an employee or even a potential employee, you are a part of the ProtoCall story.

This document, the first-ever Annual Report to Stakeholders, is one way we are striving to share this story more vividly—and by doing so, expand our reach and solidify our commitment to transparency.

We hope this direct communication from Leadership will both enlighten and inspire as we tell the story of a mission-driven or-ganization that shares a common goal with our stakeholders—to improve access to treatment resources for people and families in times of crisis. We will describe where we’ve been in the last year and where we intend to go in the year ahead.

What’s enclosed in the following pages represents our

continuing effort to demonstrate the depth of purpose and commitment that we share with our stakeholders. At the core of our common goal is a sincere desire to make the world a better place for our callers and our communities.

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The ProtoCall Story

Clinical Performance

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hile the financial story is an important one, we never lose sight of what we’re here to do: serve people in need. At the end of the day, it’s all about how well we perform our role within the clinical setting. To ensure that we’re offering a consistently excellent product to our valued stakeholders, we’re committed to offering our staff the best training—both at the start of their relationship with ProtoCall, and on an ongoing basis.

Staff Training

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n 2010, ProtoCall provided both training to new hires, as well as ongoing training sessions for our experienced staff. Our new clinical hire training process involves a total of 6 months of new hire orientation and performance review. Within that time, new hire’s receive 4 weeks of full-time training and 2 additional months of training in the call center. We match our hiring and training cycles with seasonal changes in call volume as well as attrition. In 2010, our new hire training lab hosted four new hire trainings totaling 640 hours of training.

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2010 Group Supervision Trainings

(in addition to “Open Groups”)

v Starfish Group—How Do You Shine? (Brandt Rigby, LCSW, ProtoCall Services)

v Giving and Receiving Peer Feedback Parts I & II (Brandt Rigby, LCSW,

ProtoCall Services)

v EAPs for Everyone (Christine Newton, MA, ProtoCall Services)

v Our Role: Striking the Right Balance (Shawn Mathis, MS and Karen

DeBolt, MA, ProtoCall Services)

v Understanding and Working with Thought Disorders Over the Phone (Sabrina Hadeed, MA, ProtoCall Services)

v Substance Abuse Assessment Over the Phone (Brandt Rigby, LCSW,

ProtoCall Services)

v Privacy and Security at ProtoCall (Jeremy Koehler, MA, ProtoCall Services)

v Emergency Preparedness and Workplace Safety (Heidi Smith, MSW,

ProtoCall Services)

v Elder and Vulnerable Adult Abuse Reporting (Brandt Rigby, LCSW, ProtoCall Services)

v Cultural Competency Self Assessment (Taken from Dan Gapsch, LPN,

at Washington Behavioral HealthCare Conference-June 25, 2010)

v Student Counseling Centers on Campus and ProtoCall’s Mission (Laura Schaefer, MS, ProtoCall Services)

v Screening Procedures at ProtoCall (Kristin Newby, MA, ProtoCall

Services)

v Walking in Recovery (Brandt Rigby, LCSW, ProtoCall Services)

v Comprehensive Suicide Assessment (Brandt Rigby, LCSW, ProtoCall

Services)

v Self-care at ProtoCall; Understanding our Scope of Work (Brandt Rigby, LCSW, ProtoCall Services)

v Client Rights (Brandt Rigby, LCSW, ProtoCall Services)

v Working with Parents and Children with Temper Tantrums (Brandt

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2010 All Staff Trainings

v Dialectical Behavioral Therapy: Coaching Strategies and Supervision Model (presented by Traci Jendrtiza, PsyD, of Portland DBT

Program, PC)

v NAMI of Multnomah County: In Our Own Voice (presented by members of local NAMI)

v Substance Abuse Clinical Theory and Intervention

(presented by Karen Merrill, LCSW, Reliant Behavioral Health EAP)

v Comprehensive Motivational Interviewing (CMI)™ and Brief Action Planning (B.A.P.)™ (Presented by Steven Cole, MD)

Open Groups

Once a month or bi-monthly, we have “open” groups where clinicians bring their own cases to discuss. This provides an opportunity for peer and supervisor-supported debriefing and the sharing of self-care strategies that help clinicians prevent emotional burn-out. Call center work can be emotionally

intense and often does not include the benefits of seeing clients improve. To promote clinicians’ sense of self-efficacy given

the scope of their role on the call, open groups also include “starfish” groups in which clinicians can share stories of calls in which they felt successful.

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The ProtoCall Story

Quality Assurance

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e work hard to give our staff members everything they need to achieve excellence in the services they provide. To make sure we–and they–are getting the job done, we constantly monitor performance with the best analytical tools and methodologies for assessing success. Our Quality Assurance process combines internal evaluation with external evaluation to gather feedback at a wide variety of levels.

Internal Evaluation

Call Monitoring

At the front line of our Quality Assurance process is real-time call monitoring. With this tool, members of the Clinical

Supervisor team can observe, rate, and provide immediate feedback to its clinicians. During the call monitoring process, clinician performance is evaluated in four key areas:

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Voice Quality. Performance is assessed on a five-point

scale from “Unsatisfactory” to “Substantially Exceeds

Expectations.” Expectations are met if the Clinician’s tone is respectful, empathetic, polite, friendly, and professional. The Clinician should be engaged, and show a knowledge of pacing and rapport-building that is appropriate for caller’s presentation and needs. Clinicians who additionally demonstrate client-cen-tered responsiveness in the face of difficult client presentation, or whose voice quality is used as a form of clinical intervention (resulting in a de-escalation of the caller) are scored as having exceeded or substantially exceeded expectations.

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v

Role Appropriateness.

Expectations in this area are met

if the Clinician engages in all of the necessary interventions when appropriate to the observed portion of the call, such as providing adequate pre-education, opening the door to

services, re-directing the caller and setting appropriate

boundaries, etc. The Clinician must not perform non-standard interventions or engage in any behaviors that undermine the pri-mary therapeutic alliance. Clinicians who meet all these

requirements even when there is pressure to go outside of their role, and who create a noticeable, positive impact on the caller are scored as having exceeded or substantially exceeded expecta-tions.

v

Follows Procedures.

In this area, the Clinician’s

adherence to account-specific procedures for call-handling, as well as ProtoCall’s clinical policies and procedures, is assessed. A binary “Yes” (met) or “No” (not met) is used for scoring.

v

Accurate Collection of Demographic Information.

In this area, the Clinician’s adherence to ProtoCall policy for collection of caller(s) first, last name, and telephone numbers is assessed. A binary “Yes” (met) or “No” (not met) is used for scor-ing.

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Clinical Supervision.

In 2010, a total of 441 calls

were observed in real-time by the on-duty Clinical Supervisor. Individual clinicians were provided feedback by the Supervisor and the overall results were used to make improvements to new and ongoing training.

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External Evaluation

Customer Feedback

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vital component of Quality Assurance is Customer Feedback. It’s a concrete, real-time measure of how our services are being perceived that provides us insight into where we can improve. Our Account Managers log each piece of feedback and seek to bring instances of negative or critical feedback to a complete and satisfactory resolution. In 2010, out of a total of 412,831 calls answered, we received 184 instances of critical customer feedback. The chart below outlines the areas in which feedback was received in 2010, and the number of instances associated with each.

Feedback Category Rate of Feedback Procedural 22 : 100,000 calls Clinical 22 : 100,000 calls Customer Service 5.5 ; 100,000 calls Data/Demographics 5.3 : 100,000 calls Documentation 3.8 ; 100,000 calls

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Sentinel Event Review

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ll calls containing content related to overriding client

self-determination are reviewed by the Clinical Supervisor team. These include events such as:

vDispatching emergency services vDuty to Warn situations

vChild, Elder, or Vulnerable Adult abuse reporting

The Clinical Supervisor Team evaluates the documented report according to the following assessment points:

Feedback Categories General

v Documentation Errors (spelling, grammar, etc.) v Conflicting documentation

v Incomplete sentences

v Documentation placement incorrect v Problem information was in intervention v Intervention information was in problem

Feedback Guidelines Presenting Problem

v Informative lead sentence

v Insufficient information in lead sentence

v Thorough documentation of presenting problem v Insufficient documentation of presenting problem v Thorough documentation of caller presentation

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Feedback Guidelines Assessment

v Thorough safety issue assessment v Insufficient safety issue assessment

v Suicidal ideation/intentional self-injury v Harm to others

v Violence and abuse v Substance abuse

v Psychiatric medication (if needed)

v Explanation for incomplete assessment (if applicable) v Appropriate level of care

v Inappropriate or conflicting level of care

Feedback Guidelines Interventions

v Thorough documentation of interventions/clinical justification v Insufficient documentation of interventions

v Appropriate consultation

v Failure to consult with supervisor

v Discussed confidentiality with caller (when appropriate) v Failure to discuss confidentiality when appropriate

v Explored least restrictive alternatives

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Feedback Guidelines Resolution/Plan

v Thorough documentation of safety planning v Inclusion of a contingency plan

v Insufficient documentation of safety planning

Narrative Feedback (as relevant)

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total of 175 calls met criteria as a Sentinel Event in 2010. This was up from 143 Sentinel Events in 2009 and 146 in 2008. Imminent harm to self (31.25%) and reporting non-imminent child abuse (31.26%) were tied for the most common need to breach confidentiality. In terms of documentation, 93.75% of Sentinel Events were rated as having “complete documentation”.

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The ProtoCall Story

Accreditation

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rotoCall demonstrates our commitment to ever-increasing quality by pursuing accreditation from leading accreditation ser-vice providers. In 2010, ProtoCall received accreditation from:

Commission on Accreditation of Rehabilitation Facilities (CARF).

CARF is an independent, nonprofit organization focused on advancing the quality of health and human service providers to ensure the best possible outcomes. In 2010, ProtoCall received its first-ever review by CARF, achieving its highest form of

accreditation: a 3 year accreditation as a Crisis and Information Call Center: Integrated: AOD/MH (Adults).

“ProtoCall is willing and committed to providing gold standard after hours and 24-hour telephone intake, assessment, triage, and crisis services to organizations and individuals in need of crisis and information call center services.” CARF survey results

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The ProtoCall Story

Technology

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taying on the cutting edge of technology is the backbone of ProtoCall’s success today and into the future. In this past year, we have experienced tremendous expansion and improvements in the area of information technologies, including:

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Outbound Call Management.

Through ProtoCall’s custom

software, Proteus, ProtoCall began offering customers the ability to provide their clients with a scheduled, outbound call from one of its counselors. The new programming, referred to as AUDRE, utilizes text-to-speech technology to create an inbound call to ProtoCall’s call center with the information needed to make a subsequent outbound call.

v

New Customer Relationship Management software.

ProtoCall’s Account Relations team purchased software to improve their ability to track and report on customer feedback as well as add efficiency to their daily work flow.

v

New Website.

In August of 2010, after several months of

development, ProtoCall launched a new website. Designed for simplicity and the clear statement of our mission, services, and value, the website has a personalized feel that tells the story behind the work we do on a daily basis. In fact, most of the pictures are of real ProtoCall staff who handle calls every day!

v

New E-mail Marketing program.

In order to more readily

communicate with customers en masse, ProtoCall subscribed to an e-mail marketing vendor. The e-mail marketing tool enables us to relay important information and updates to specific customer groups in a matter of minutes.

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v

New Phone System.

In November of this year, ProtoCall

purchased an entirely new telephone system, moving from an Avaya system to a Mitel system. The new phone system will have much greater capabilities such as call recording and caller ID as well as the ability to generate richer call detail reports with greater ease by multiple users.

v

Electronic Invoices.

In 2010, ProtoCall began sending customers

their invoice electronically—a method that is more efficient and more

environmentally friendly. By the end of 2010 almost all customers exclusively used the electronic format and discontinued paper statements. This will save over 22,000 pieces of paper annually!

The ProtoCall Story

New Business and Marketing

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rotoCall’s primary marketing message in 2010 was highlighting “who” a customer gets as being the important driver in their decision to choose ProtoCall over other similar providers. We highlighted this concept by us-ing pictures of real ProtoCall staff in our marketus-ing materials and on the new

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The ProtoCall Story

New Scheduling Methodology

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rotoCall tested and implemented two, new scheduling methodologies in 2010. The new methodologies were designed to improve efficiencies in scheduling (keeping costs down) while improving timely responsiveness to callers.

Flex scheduling was offered to a group of clinicians in September 2010. These clinicians were removed from their static, recurring schedule and placed into a pool of clinicians whose schedules would be adjusted on an ongoing basis to meet shifting call volume demands. The results have already demonstrated gains in efficiency across call center operations and effectiveness in placement of those staffed hours.

Mission-critical days were also introduced in June 2010. The term Mission-criti-cal refers to those specific days throughout the year when volume can be dramat-ically higher, such as many holidays when all or most of our customers re closed. Mission-critical days include many holidays where most, if not all, customers rely on us to take care of their clients. The results have shown improved performance and responsiveness to callers, and a more balanced workload across the clinicians working those shifts.

In addition to providing better planning for scheduling Mission-critical days, the new approach contributes to better balancing out of staff preferences for holiday time off for those special days that are important to them and their families.

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The ProtoCall Story

Customer Site Visits

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rotoCall frequently has the privilege to host our customers and prospects as they visit our call centers in Portland and Michigan. Since we don’t always get the chance to interact face to face with our partners – some of you we’ve never met face to face – having you come visit us is always a special opportunity. We love to show off our staff and our technology. More importantly, the

opportunity to review and demonstrate our systems with our customers consistently leads to greater understanding, process improvement, and better outcomes. And for our customers and prospects, it’s a great way to demonstrate due diligence and accountability to your own stakeholders!

In fact, we feel so strongly about the value of customers and prospects visiting our call centers, we’ll pitch in $200 towards the cost of your trip if you are coming to see us from more than 50 miles away from either location! (In the form of a credit on your next invoice.)

So consider this an open invitation from us to visit one or both our call centers. Give us a call and we’ll help you arrange your visit to our Portland, OR or Grandville, MI call centers. You’ll be able to spend time with our staff and watch in person what we do for your

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Conferences Attended

v Employee Assistance Professionals Association (EAPA) in

Tampa, FL

v Employee Assistance Society of North America (EASNA)

in Montreal, Canada

v National Council for Community Behavioral Health (NC

CBH) in Orlando, FL

v National Association for Rural Mental Health (NARMH) in

Denver, CO

v Association of University and College Counseling Center

Directors in Portland, OR

v Michigan Association of Community Mental Health Boards

in Lansing, MI

v The Big 10 Counseling Center Conference in East Lansing,

MI

v Washington Behavioral Healthcare Conference in Yakima,

WA

We also hosted staff from the Pick Up the Phone tour in association with the National Suicide Prevention Lifeline.

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The ProtoCall Story

Financial

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ike so many organizations, ProtoCall has been thrown

plenty of fiscal challenges in the past few years. In many ways, we feel lucky to have done as well as we have: top line revenues stayed flat, and (unlike 2009) we didn’t have to lay anyone off. Maintaining this level of performance wasn’t without sacrifice however. All ProtoCall employees went without compensation increases in 2010, had to pay a bit more for health care, and lost a few popular perks (like really good coffee).

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ut the real story in 2010 was not just “flat” financials. In the midst of the financial meltdown around us, the spirit of innova-tion and creativity brought forth many new ideas and progress on important issues throughout the organization. For example, new scheduling methodologies have created ways for staff to earn a 10% premium on their wage, while better meeting shifting demands in a 24/7 call center, and reducing the

overall cost of overtime. And even though actual sales stayed flat, our emerging market in Student Services grew

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n 2010, ProtoCall’s total call center revenue was approximately $5.6 million dollars–unchanged from 2009. However, changes in scheduling, call handling efficiencies, and a more selective sales strategy resulted in a net income of $99,000 for the year, up from a nearly break-even year in 2009.

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hile a 1.75% profit margin is nothing to brag about, it does represent movement in the right direction. With tremendous growth in our leadership team, successful achievement of CARF and AAS (American Association of Suicidology) Accreditations, and significant new customers in key market segments, we think that 2010 was a resounding success!

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n 2011, this trend is continuing. We hit the ground running with increased efficiencies in accounting practices, including a nearly 100% paperless billing system that we expect to save countless hours of labor (and trees) as well as speed up cash flows. We’ve also set out to work more closely with specific

customers to streamline procedures. Our own internal software has been improved such that procedural updates that used to take hours can now be updated in just minutes.

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nother example is the new phone system that ProtoCall just purchased for both the Portland and Grandville call centers. This represents a very large ($140,000) capital upgrade to

state-of-the-art call center technology. This new equipment will add benefits like call recording, greater business continuity, more full-featured workstations, easier reporting and analytics, and many other valuable features. Best of all, the new technology provides ProtoCall with the ability to reduce our nearly $7,000 a month phone bill by a substantial amount, enough to pay

for almost the entire monthly financing cost of the new system! (The install process has already begun and the cut-over date is anticipated on or about March 31. Much more on that to

follow.)

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n 2010, the vast majority of our customers experienced no increase in what ProtoCall is charging. In 2011 we remain committed to continued innovations and efficiencies with the goal of providing maximum value to customers and holding our costs as steady as possible. But our employees have also been rewarded for a successful year with the restoration of annual compensation increases. (We think that’s a real win-win!)

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ll in all, we are feeling more bullish on 2011 and are excited about investing in our staff, our technology, and our growth. We expect to market our value proposition more precisely in the EAP, Community Mental Health, and Student Services markets. We will get our message out through state and national confer-ences, direct mail, and even new referral promotions, and as a result we are projecting sales to reach a solid $6 million in 2011. (A schedule of our 2011 conference events is on page 20)

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any people at ProtoCall have worked very hard to make our 2010 story great and our 2011 story even greater. They brought optimism and creativity to a tough year, and we are grateful for their commitment to the mission and vision at ProtoCall.

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e thank our loyal customers for the trust they have placed in us and the opportunity to serve their consumers. We intend to honor that trust through successful financial stewardship and a continued investment in the future.

Megan Muecke

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The ProtoCall Story

What’s Next

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e believe that the need for efficient and scalable access to urgent and emer-gent care is more important than ever. In all of the markets we serve, whether it’s a Community Mental Health Center, Employee Assistance Program, or a Col-lege Counseling Center, our customers are telling us that the urgency is to figure out how do more with less without compromising on the care they provide. We’ve heard that over and over again.

We are committed to helping you meet these challenges through the application of sophisticated new technologies, intense scrutiny of our own operational

practices, and focus on an uncompromising quality of care. In the months and years ahead, I hope we will have many more opportunities to continue engaging with you around the things that really matter. The ProtoCall Promise is to

continue advancements in the form of high quality access, new technologies, and even greater cost containment in support of the people and communities you serve. We are honored by the trust you have placed in ProtoCall’s people and systems to help you improve access to the care you provide.

Thank you so much for letting us share our 2010 story with you. I hope you enjoyed reading it as much as we enjoyed sharing it with you.

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