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Interpersonal Violence PreventionTopic Call 6

A System for Gathering Information for Improvement

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IVP Staff & Participants

Bekah Hunt, M.P.A.

Coordinator

Jen Leonardo, Ph.D.

Improvement Advisor

Team

Alaska

Colorado

Connecticut

D.C.

Florida

Guam

Indiana

Kentucky

Missouri

Nebraska

New Hampshire

New York

CNMI

Pennsylvania

Tennessee

Vermont

Rebecca Willmer

Tech Guru

Participants

Jane Taylor

Improvement Advisor

Team


Agenda

• Building the System of Improvement

◦ Goals of and Steps for Managing a system for gathering information for improvement

• Process Measure Deep Dive

• Run Chart Rules & Creation

• Story Board Review


Building the System of Improvement

1. Establishing Constancy of Purpose

2. Understanding the Organization as a System

3. Designing and managing a system for gathering information for improvement

4. Conducting planning for improvement and integrating it with CoIIN planning

5. Managing and learning from a portfolio of improvement initiatives

Source: The Improvement Guide, Pg. 312


Goal of Gathering Information

MeasurementChange or

Improvement


Designing and managing a system for gathering information for improvement

Source: The Improvement Guide,

Pg. 319

StepFrom the Improvement

Guide

What it looks like in the CS

CoIIN

1Direction• determining what is to be collected

and analyzed

Select your process measures

2Collection:•obtaining the information from a

variety of sources

Gather your data and submit

monthly reports

3Analyzing:•Extracting some opportunities and

priorities for improvement

Review and compare your run

charts

4

Dissemination:•Furnishing the conclusions and

priorities in formats that are

understandable to consumers

Share with the team•Celebrate progress

•Encourage more movement

•Reinforce systems thinking


Measures Selected

0

1

2

3

4

5

6

Nu

mb

er

of

Str

ate

gy

Te

am

s

Alaska CNMI D.C. Florida Guam Indiana Kentucky

Missouri Nebraska New Hampshire Pennsylvania South Carolina Tennessee


Process Measure #7

Percent of parents/caregivers who participate in an evidence-based parenting program. Selected by: IN, KY, NE, NH, PA

Recommended

Primary Drivers

Recommended

Secondary Drivers

Relevant Change Ideas

PD2. Reduced

exposure to

violence, trauma,

and adverse

childhood

experiences

among children

and adolescents

SD1. Safe, stable,

nurturing, and

empowering

relationships and

environments for

children,

adolescents, and

families

1. Provide education, support, and

parenting skills development during

home visits, including training in infant

care giving, positive reinforcement

techniques, and non-violence discipline

methods (e.g. Nurse-Family Partnership,

Healthy Families America, Early Head

Start)

FL, NE, PA

2. Increase implementation of

evidence-based parenting programs,

such as the Triple P Positive Parenting

Program, Incredible Years,

Strengthening Families, and Period of

PURPLE Crying® Program

FL, NE, NH,

PA


Process Measure #7Percent of parents/caregivers who participate in an evidence-based parenting

program. Selected by: IN, KY, NE, NH, PA

Nebraska

New Hampshire


Run Charts on the website

Run charts are generated

from your monthly report

submissions

• Visit your

state/Jurisdiction page

• Scroll down to and click

on the topic tabs

Download all your data

Edit past reports


Collaborative Run Charts on the website

Generated from everyone’s

monthly report submissions

1. Visit the topic team page

2. Scroll down to the Topic

Reports and Data section

3. Click the Collaborative run

Charts tab


Process Measure #11Percent of health and social service professionals trained in evidence-based early

identification, assessment of risk, referral, and treatment for interpersonal violence, traumatic stress, and associated symptoms. Selected by: IN, MO, PA

Recommended

Primary Drivers

Recommended

Secondary Drivers

Relevant Change Ideas

PD3. Increased

collaboration and

coordination to

improve access to

interpersonal

violence

prevention

programs and

services

SD 1.Increased use

of evidence-based

screening tools,

assessments, and

treatment

approaches for

interpersonal

violence and

adverse childhood

experiences

1. Train pediatricians, family practitioners, home

visitors, community health workers, youth

workers, and school social workers on evidence-

based early identification, assessment, and

referral of mental health problems, trauma, and

risk of interpersonal violence

AK,

FL,

GU,

SC

2. Train mental health professionals in the use

of culturally appropriate and evidence-based

treatment frameworks for interpersonal

violence, traumatic stress, and associated

symptoms (e.g., cognitive behavioral therapy,

multi-systemic therapy with psychiatric

supports, attachment-based therapy, dialectical

behavior therapy, dynamic deconstructive

psychotherapy, and the Attachment, Self-

Regulation, and Competency Framework)

FL,

GU,

IN


Run Chart Rules & Creation

Rob O’Connor


Run Charts: Step by Step

•Step 1:• Decide what data you need. Is it already being

tracked or do you need to collect it?

• Determine the timeframe & number of data collection points

•Step 2:• Gather your data



• Step 3:

• Graph your data• On the Y-axis, set up a scale that corresponds with your

measure (some CS CoIIN run charts will have a secondary Y-axis as a bonus!)

• On the X-axis, set up a scale that corresponds with your measurement timeframe

• Plot your data on the chart, placing one dot at each measurement point

• Draw a line through your dots

• Find the median and draw a line at the median value

• Mark the timing of your change

• Excel, Word, and other programs can help!

• For example…


12

15

19

17

14

19

16

14

16

10

10

11

11

12

11

12

13 MEDIAN

Month # Referrals Median

January 4 5

February 3 5

March 2 5

April 4 5

May 7 5

June 8 5

July 9 5

August 8 5

September 6 5

October 5 5

November 4 5

December 5 5

January 3 5

February 4 5

March 3 5

April 6 5

May 7 5

June 8 5

July 10 5

August 3 5

• No expensive

software to buy!

• No tricky formulas!

• Everyone can do it,

and some will even

enjoy it!

• There is a link to an

excel tutorial in the

pod above with more

information!

This is all you need.

Got Excel?



0

2

4

6

8

10

12

Nu

mb

er

of

Re

ferr

als

Month

Strong Beginnings Referrals by Month from

January 2014 to August 2015

Number of Referrals Median


0

5

10

15

20

25

30

0

10

20

30

40

50

60

70

80

90

100

Ma

y-1

4

Jun

-14

Jul-

14

Au

g-1

4

Se

p-1

4

Oct-

14

No

v-1

4

De

c-1

4

Jan

-15

Fe

b-1

5

Ma

r-15

Ap

r-1

5

Ma

y-1

5

Jun

-15

Jul-

15

Au

g-1

5

Se

p-1

5

Oct-

15

No

v-1

5

De

c-1

5

Jan

-16

Fe

b-1

6

Ma

r-16

Ap

r-1

6

Ma

y-1

6

Jun

-16

Jul-

16

Au

g-1

6

Se

p-1

6

Oct-

16

No

v-1

6

De

c-1

6

% women w/ +screen for MD not already in EB services who were offered and verbally accepted a referral to EB services

N womenw +MD screennot in EB svcs that wereoffered a referral forsvcs

Goal = 75%

Start testing

motivational

interviewing

Start testing

Mothers and

Babies

Start testing

new PHQ-9

policies and

procedures

Oakland County Michigan Health Division

Provisional

Median for Year 1



• Step 4:• Make sense of your results by examining your

data• Do you see a shift in your data? Are there 6 or more

consecutive points on one side of the median line?

• Do you see a trend in your data? Are there 5 consecutive points all headed in the same direction (up or down)?

• Do you see an astronomical point? Is there a single data point that is clearly set apart from the others?


Run Charts: Hints and Tips

• Every process will have some variation• Be cautious about assuming that variation

from the median has meaning

• Be sure to track data over enough time points• This will help you identify the true median and

the true level of variability within the process


Example of a shift

0

10

20

30

40

50

60

70

80

0

10

20

30

40

50

60

70

80

90

100M

ay-1

4

Ju

n-1

4

Ju

l-1

4

Au

g-1

4

Se

p-1

4

Oct-

14

No

v-1

4

De

c-1

4

Ja

n-1

5

Feb

-15

Ma

r-1

5

Ap

r-1

5

Ma

y-1

5

Ju

n-1

5

Ju

l-1

5

Au

g-1

5

Se

p-1

5

Oct-

15

No

v-1

5

De

c-1

5

Ja

n-1

6

Feb

-16

Ma

r-1

6

Ap

r-1

6

Ma

y-1

6

Ju

n-1

6

Jul-1

6

Au

g-1

6

Se

p-1

6

Oct-

16

No

v-1

6

De

c-1

6

East Bay- % of women who initiate breastfeeding


Example of a trend

0

5

10

15

20

25

0

10

20

30

40

50

60

70

80

90

100

Ma

y-1

4

Ju

n-1

4

Ju

l-1

4

Aug

-14

Sep

-14

Oct-

14

No

v-1

4

De

c-1

4

Ja

n-1

5

Fe

b-1

5

Ma

r-15

Apr-

15

Ma

y-1

5

Ju

n-1

5

Ju

l-1

5

Aug

-15

Sep

-15

Oct-

15

No

v-1

5

De

c-1

5

Ja

n-1

6

Fe

b-1

6

Ma

r-16

Apr-

16

Ma

y-1

6

Ju

n-1

6

Ju

l-1

6

Aug

-16

Sep

-16

Oct-

16

No

v-1

6

De

c-1

6

Carolina Health Centers NFP- % of women with one or more evidence-based service contacts


Example of an astronomical point

0

5

10

15

20

25

0

10

20

30

40

50

60

70

80

90

100

Ma

y-1

4

Ju

n-1

4

Jul-1

4

Au

g-1

4

Se

p-1

4

Oct-

14

Nov-1

4

Dec-1

4

Ja

n-1

5

Fe

b-1

5

Ma

r-15

Ap

r-15

Ma

y-1

5

Ju

n-1

5

Jul-1

5

Au

g-1

5

Se

p-1

5

Oct-

15

Nov-1

5

Dec-1

5

Ja

n-1

6

Fe

b-1

6

Ma

r-16

Ap

r-16

Ma

y-1

6

Ju

n-1

6

Jul-1

6

Au

g-1

6

Se

p-1

6

Oct-

16

Nov-1

6

Dec-1

6

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 10 10 10 10 10 10 10 9 8 0 0 0 0 0

HV CoIIN- % women w/ +screen for MD this month offered a referral to EB services


Example of an astronomical point

0

5

10

15

20

25

0

10

20

30

40

50

60

70

80

90

100

Ma

y-1

4

Ju

n-1

4

Jul-1

4

Au

g-1

4

Se

p-1

4

Oct-

14

Nov-1

4

Dec-1

4

Ja

n-1

5

Fe

b-1

5

Ma

r-15

Ap

r-15

Ma

y-1

5

Ju

n-1

5

Jul-1

5

Au

g-1

5

Se

p-1

5

Oct-

15

Nov-1

5

Dec-1

5

Ja

n-1

6

Fe

b-1

6

Ma

r-16

Ap

r-16

Ma

y-1

6

Ju

n-1

6

Jul-1

6

Au

g-1

6

Se

p-1

6

Oct-

16

Nov-1

6

Dec-1

6

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 10 10 10 10 10 10 10 9 8 0 0 0 0 0

HV CoIIN- % women w/ +screen for MD this month offered a referral to EB services

0

2

4

6

8

10

12

14

0

10

20

30

40

50

60

70

80

90

100

Ma

y-1

4Jun

-14

Jul-1

4A

ug-1

4S

ep-1

4O

ct-

14

Nov-1

4D

ec-1

4Jan

-15

Fe

b-1

5M

ar-

15

Ap

r-15

Ma

y-1

5Jun

-15

Jul-1

5A

ug-1

5S

ep-1

5O

ct-

15

Nov-1

5D

ec-1

5Jan

-16

Fe

b-1

6M

ar-

16

Ap

r-16

Ma

y-1

6Jun

-16

Jul-1

6A

ug-1

6S

ep-1

6O

ct-

16

Nov-1

6D

ec-1

6

Ingham County


Storyboard Review

Child Safety CoIIN 27

Child Safety CoIIN: More Than Just Spare Change!

• Bekah (Hunt) Thomas, M.P.A.Child Safety CoIIN Manager,Children’s Safety Network (617) 618-2178

• Jen Leonardo, Ph.D.Improvement Advisor,Children’s Safety Network(617) 543-9473

• Jenny Stern-Carusone, M.S.W.Child Safety CoIIN Manager,Children’s Safety Network(541) 414-4240

• Elizabeth Edgerton, M.D., M.P.H.

Director, Division of Child, Adolescent and

Family Health,

HRSA, Maternal and Child Health Bureau

• Erin Reiney, M.P.H.

Director of Injury and Violence Prevention,

HRSA, Maternal and Child Health Bureau

• Jennifer Allison, Ph.D.

Director, Children’s Safety Network

• Bethany Miller HRSA, Maternal and Child

Health Bureau

• Rebecca Willmer

Communications Director,

Children’s Safety Network

• Rob O’Connor

Research Assistant,


• Karen Solis

Technology Director,


• Wendy Davis

Child Safety CoIIN Senior

Advisor,

National Improvement

Partnership Network

• Mary Mackrain, M.Ed.

Child Safety CoIIN Senior

Advisor,


• Rebecca Spicer, Ph.D.,

M.P.H.

Director,

CSN Economics and Data

Analysis Resource Center

• Jane Taylor, Ed.D

Improvement Advisor,



Purpose: Provide support and leadership to

states and jurisdictions to form collaborative

partnerships to increase the adoption of

evidence-based child safety interventions at

state and local levels resulting in reduced

deaths, hospitalizations and emergency

department visits.


Aim Statement

By June 2017, the CS CoIIN will reduce deaths, hospitalizations, and emergency department (ED) visits resulting from incidents in the five selected topic areas of Child Passenger Safety, Falls Prevention, Interpersonal Violence Prevention, Suicide and Self-Harm Prevention and Teen Driver Safety for youth age 0-19 by promoting effective use of PDSA cycles, data collection and Quality Improvement Methodolgy. Our goals are as follows:

• Decrease the rate of injury-related mortality among 0-19 year olds by 11.7% relative to the participating state/jurisdictions’ baseline rate for the CS CoIIN topic areas.

• Decrease the rate of injury-related hospitalizations 0-19 year olds by 8.6% relative to the participating state/jurisdictions’ baseline rate for the CS CoIIN topic areas.

• Decrease the rate injury-related ED visits among 0-19 year old by 8.4% relative to the participating state/jurisdictions’ baseline rate for the CS CoIIN topic areas.


Process Measures & Goals:1. PDSA Submissions

Process Measure Goal

1. Percent of Strategy Teams submitting PDSAs

Monthly

100% of participating Strategy Teams

will submit at least one PDSA Monthly

Changes Tested

In March, 2016, we provided training on

PDSA development at the Learning

Session #1 and then launched our online

submission system for PDSAs in April.

We began adding PDSA submission

reminders to all topic call

communications in May 2016 and

Improvement Advisors began providing

online feedback on all submissions.

0

10

20

30

40

50

60

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16

Nu

mb

er

of

Str

ate

gy

Te

am

s

% o

f S

tra

tegy

Te

am

s S

ub

mit

tin

g

Percent of Strategy Teams Submitting PDSAs

Percent of Strategy Teams Submitting PDSAs

Mean

Goal

Number of Strategy Teams

Goal


Process Measures & Goals: 2. Monthly Report Submissions

Example where some data is availableProcess Measure Goal

2. Number of Monthly Reports submitted Every strategy team will submit one

report a month (Currently 43 strategy

teams)

Changes Tested

In March, 2016, we provided training on how to

use the website and submit monthly data

reports. We established a regular reporting date

for the entire CoIIN and launched a monthly

update email in June 2016 that included a

reminder for data reporting. We also added this

reminder to monthly topic call materials. In

August 2016, we issued a recurring calendar

reminder to the entire CS CoIIN listserv.

Additionally, in July 2016 we conducted 1:1

outreach calls followed by a survey requesting

teams to identify the process measures they

were reporting on.

0

10

20

30

40

50

60


Nu

mb

er

Number strategy teams submitting a report

each month

Number of Monthly Reports Submitted*


Mean

Goal


Process Measures & Goals:3. Participation in Monthly Topic Calls

Example where some data is availableProcess Measure Goal

3. Percent of enrolled state/jurisdictions

participating in Topic Calls

100% of participating

states/jurisdictions will participate in

monthly topic calls

Changes Tested

We launched monthly topic calls for each

of the five CS CoIIN topics in April 2016.

Calendar reminders are sent to teams a

week prior to each call and follow up

emails with materials are shared a few

days after the call. We instituted a short

evaluation in May 2016 and used

feedback to help develop topic-specific

presentations for future calls.

0

10

20

30

40

50

60

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Topic Call Participation

Percent of enrolled states/jurisdictions participating in Topics calls

Mean

Goal


Goal


Process Measures & Goals:3. Participation in Monthly Topic Calls (By Topic Team)

0

2

4

6

8

10

12

0%

20%

40%

60%

80%

100%

Apr-16 May-16 Jun-16 Jul-16 Aug-16

TDS Topic Call Participation

0

2

4

6

8

10

12

0%

20%

40%

60%

80%

100%


CPS Topic Call Participation

1

3

5

7

9

11

13

15

17

0%

20%

40%

60%

80%

100%


IPV Topic Call Participation

1

3

5

7

9

11

13

0%

20%

40%

60%

80%

100%


SSHP Topic Call Participation

1

2

3

4

0%

50%

100%


Falls Topic Call Participation

Goal

Goal

Goal

Goal

Goal


Process Measures & Goals:4. Teams Showing Improvement

Process Measure Goal

4. Percent of strategy teams showing

improvement.

65% of teams reach a 3.5 on the

improvement scale by the end of the

collaborative.

Changes Tested

Currently, only teams who submit

monthly reports receive an assessment

on the assessment scale; many strategy

teams are not yet appearing on the

chart. At least 30% of the teams have

moved past forming and planning and

are active. We are optimistic that more

teams will move into the testing phase

soon, and are encouraging that by

focusing on moving past developing to

testing and implementing at Learning

Session 2.

2% 2%7%

2%

12%

20%

30%

21%

2%

2%

14%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

March April May June July August

1: Forming 1.5: Planning

2: Activity 2.5: Testing

3: Modest Improvement 3.5: Improvement

4: Significant Improvement 4.5: Sustainable Improvement

5: Outstanding Sustainable Results


CS CoIIN as a System

The purpose of this system is to create informed

collaboration and implementation of effective evidence

based approaches

Individuals and Organizations involved

Resources required

Clients or beneficiaries

• Participating

States/Jurisdictions

• Experts and Faculty

• CS CoIIN Staff

• Evidence based

practice/programs

• Change packages

• Website

• Adobe Connect

• Outlook

• Mailing Lists

• PowerPoint

• The Internet

• The Improvement Guide

• Knowledge of Injury Topic

• Children/Families

• Strategy Teams

• Child Injury Prevention

Field

Outcomes that benefit clients or beneficiaries

Measures

• Skills to overcome

barriers and

challenges to

prevent childhood

injuries

• Improvement

capability and

knowledge of high

leverage changes to

achieve the aim

• % teams submitting

PDSAs

• % teams submitting

monthly reports

• % teams attending

monthly topic calls

• % Strategy Teams

showing

improvement

Identify CoIIN

participants

Identify key topic

areas

Develop change

packagesQI training:

• PDSA

• Data collection

and reporting

• Testing vs

Spread

Driver Diagram and

Process measure

selection

Strategy

Team

development

PDSA testing cycle

Change

Package

revision

Monthly data collection

and analysis

Adopt/Adapt/Abandon

ideas

EBP

presentations

Orient participants


Lessons Learned

We planned We found We learned

To have all members signed

up and ready to participate in

topic calls in April

Team membership

continues to fluctuate

More time onboarding the teams

and a robust on-line archive of

webinars and resources will allow

more members to sign up and get

up to speed quickly

For all strategy teams to

participate in topic calls

Not everyone can make

it at the times selected.

Others forget

Archived recordings for later

viewing, and reminders the week

before and day of the topic call will

allow for more participation

That outcome data would be

difficult, but not impossible

for many strategy teams to

collect

Some but not all

strategy teams are able

to collect outcome data

Sharing success stories, and

continually developing technical

assistance tools, like the data

outcome worksheet, will allow more

states to find and report outcome

data


Lessons Learned

We planned We found We learned

For all members to leverage

the website

Not everyone could

access or understand

the site, leading to

lower PDSA and

monthly report

submissions

One-on-one TA and User guides and

communication about:

• Data reporting

• Adding members

• PDSA submission

• Feedback flows

Provide clarity about the purpose,

benefit and use of the website.

For all strategy teams to

conduct tests of change right

away and quickly move to

implementation and spread

Many teams are stuck

in the development

phase because of how

complex the system is

Complex systems require more

time for set up and management

and more attention to

understanding the system.


We wonder if next we should . . .

• Reiterate the importance of and process for testing changes on each topic call

• Send a special edition update highlighting how some teams are collecting outcome data

• Re-launch the outcome data worksheets with the ICD-10-CM mapping

• Incorporate the use of ‘goals’ and setting 90 day aims

• Revise Change Packages to refine the strategies and articulate new or improved measures

• Explore strategies for engaging front line workers


SUGGESTIONS OR QUESTIONS?

We’re

listening.


Upcoming Topic Calls

October 26th & 27th 2-4pm ET

Learning Session 2

Submit Your Story Board by October 3rd!

November 17th , 2016, 3-4pm ET

Spreading Evidence Based Programs State-Wide


Thank you for your participation

Please take a moment to complete our short evaluation:

https://www.surveymonkey.com/r/P7PVSBC

Questions or Comments? Contact:

[email protected]

617-618-2178

Check out the IVP Topic Page for Topic Team Resources

https://www.surveymonkey.com/r/P7PVSBC

mailto:[email protected]

http://www.childrenssafetynetwork.org/coiin/topic/interpersonal-violence-prevention

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