Continuous Quality Improvement within a System of Care Context

Continuous Quality Improvement within a System of Care Context Brigitte Manteuffel, Macro International, Inc. Beth Dague, Project Director, Cuyahoga Tapestry Chris Stormann, Evaluator, Cuyahoga Tapestry Teresa King, Family Lead, Cuyahoga Tapestry

Objectives • Understand a basic framework for Continuous Quality Improvement • Understand how to use data to inform your community‘s CQI processes • Learn, through real examples, the importance of collaboration among evaluators, managers, families and other key stakeholders, to generate effective improvement strategies • Learn how to "close the loop" by asking and answering the question: Are our improvement strategies working? • Identify tools and other resources available to communities to develop and strengthen their own CQI processes.

What is Continuous Quality Improvement (CQI)? • Program reflects the wishes and needs of the community being served • Program continually improves and moves toward meeting program goals • Outcomes are measured, monitored and achieved

CQI Key Principles • Is an ongoing process that requires a team approach with multiple perspectives • Starts with a program logic model • Involves using data to identify whether implementation is consistent with the logic model • Requires real dialogue around areas in need of improvement and what can be done to improve • Focuses on developing an infrastructure to address the problems; not just a one time solution

Data-driven Tools to Support CQI • Key to the CQI process • If done correctly, allows you to: • Assess whether implementation is following what was defined in the logic model • Identify areas where plans have deviated and why • Reassess priorities or expectations • Identify and implement improvement plans

Systems of Care CQI Framework Continuous Quality Improvement

Logic Model as the Framework for CQI • Start with a logic model • Identify desired outcomes • Desired outcomes provide guidance for developing performance measures

Comprehensive Community Mental Health Services for Children & Their Families >> Accountability >> >> Adaptation >> Logic Model Population System of Care Strategy Outcomes Guiding Principles Practice Outcomes • Service providers integrate system of care principles and values into practice • Children and families receive coordinated and useful services and supports in the community Child and Family Outcomes • Children's distressing symptoms are reduced • Children have improved ability to function at home, in school, and in their community • Improved family functioning and reduced caregiver strain System Outcomes • Families are full partners in policy and implementation • Agency partnerships are broadened and deepened • Comprehensive, coordinated, efficient, and accountable service array is developed • Resources are appropriately allocated and utilized locally • System of care is sustained with stable, long-term funding • Child and family satisfaction with services is improved Practice Context • Practices have traditionally promoted the use of restrictive placements and services • Service providers need to meet multiple needs of children and families that cross agency boundaries • Need coordination among service providers Child & Family Context • Children under 22 years of age and their families • Diagnosis of emotional, behavioral, or mental disorder • Level of functioning in family, school, and/or community environments is limited • Two or more community agencies involved • Disability must be present at least one year System Context • Federal Center for Mental Health Services funds and supports systems of care with: Leadership, Technical assistance, Consultation, Evaluation • Local matching funds and resources • Need for comprehensive array of community-based, culturally competent and family-focused services • Need for family advocacy • Family-focused: Services and supports should consider the needs and strengths of the entire family. • Individualized: Services and supports should be tailored to the needs and strengths of each child and family. • Culturally competent: Services and supports should be sensitive and responsive to the cultural characteristics of children and their families. • Least restrictive: Service planning should balance a child and family's need to interact in school and community settings with the most appropriate services and supports. • Local Service Delivery Process: The mission of the Comprehensive Community Mental Health Services for Children and Their Families Program is to encourage the development of intensive community-based services for children with serious emotional disturbance and their families based on a multi-agency, multi-disciplinary approach involving both the public and private sectors. System entry, service planning, service provision, and review/monitoring of the care of individual children and families Individualized & flexible services/supports Community memberpartners Family & child partners >> Quality Improvement >> Core Values are Family-drivenCulture-based Evaluation and feedback to support improved service delivery Local agency & organization partners State & Federal agency partners • Community-based: Services and supports should be provided in the child and family's community. • Accessible: Access to services and supports should not be limited by location, scheduling or cost. • Interagency: Core agencies providing services and supports should include mental health, child welfare, juvenile justice and education. • Coordination/collaboration: Partner agencies, providers and organizations should provide a seamless system of services and supports for children and families. Community ownership and planning • Local Infrastructure Development: Governance, management, quality monitoring and array of services/supports << Using Best/Current Research << << Internal Evaluation <<

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Cuyahoga Tapestry System of Care(Cleveland, Ohio) The CQI Process and Collaboration Using the CQI Progress Report

Community Collaboration: Our experience.… • Being a pilot site is a wonderful thing • Interpreting the measures and delving into the details • Understanding the meaningfulness of the data at the local level • Being comfortable with saying “I have no idea what this means” • It says right here we are terrible! • It says right here we are great! • Staying strengths-based

CQI Collaboration with Local and National Partners • Forming a CQI team/workgroup • Prioritizing the indicators • Talking about how to affect and monitor change • Providing information to the community about the CQI data • Drawing on past experience • Networking with other grant communities • National partners and supports

Providing Information to the Community about the CQI data : Seeing the Big Picture √++ Total site score and domain score

Identifying Priorities: Start Small… But Start Somewhere!

Next Steps • Continue to understand the measures better • Be an active consumer and developer of CQI • Work closely with providers and “change agents” to get buy-in…people must believe these are meaningful indicators if they are going to act on them • Start a “what can I do about this?” dialogue

Next Steps • Build strategies for change around priority indicators • Connect with TA partners and look at available supports to help improve • Implement change strategies • Closely watch performance in future CQI reports • Hard to get it right the first time, be ready to try new strategies

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Resources from the National Evaluation to Support CQI The CMHS CQI Benchmarking Initiative

CQI Benchmarking Initiative Purpose • Use data to guide quality improvement activities • Support technical assistance planning and resource allocation • Track progress toward meeting program goals and objectives • Ensure quality of outputs and outcomes of the sites, program partners, and the branch

CQI Progress ReportPrimary Objectives • Provide a data-driven tool to support CQI • Support data-driven technical assistance • Produce national and community/site level data reports • Track progress/performance over time • Promote utility-focused data reporting

CQI Benchmarking InitiativeProcess • CQI Development Team • Broad representation from program stakeholders • Consensus on key areas to measure and on indicators • Modeled after program goals and objectives • Launched reports in April 2005 • Encouraged community feedback

CQI Progress ReportKey Areas of Performance • The CQI Progress Report is organized into 6 key areas of performance to include: • System Level Outcomes • Child and Family Level Outcomes • Satisfaction with Services • Family and Youth Involvement • Cultural and Linguistic Competency • Evidence-based Practices

CQI Progress Report

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Contact Information • Brigitte Manteuffel (Macro International, Inc): Brigitte.A.Manteuffel@orcmacro.com • Beth Dague, Project Director, (Cuyahoga Tapestry): dague@cccmhb.org • Chris Stormann, Evaluator, (Cuyahoga Tapestry): cstorman@kent.edu • Teresa King, Family Lead, (Cuyahoga Tapestry): king@cccmhb.org

Continuous Quality Improvement within a System of Care Context