putting cqi into action starting early together allegheny county, pa (pittsburgh) sarah thurston,...
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Putting CQI Into ActionStarting Early TogetherAllegheny County, PA
(Pittsburgh)
Sarah Thurston, Quality Assurance Team
Brief Background
• Allegheny County has received three system of care grants since 1998– Through the grants, have served 0-25 yr olds
in nine neighborhoods– First two grants have graduated from funding
and have transitioned to other models (i.e. billing)
– Current grant is Starting Early TogetherStarting Early Together, early childhood focus serving 0-6 yr olds
1998 Grant
2001 Grant
CQI plan built around values-based service delivery process
2005 Grant SET
Pursued High Fidelity Wraparound service delivery model
2009Discontinued credentialing for HiFi
Intermediate Outcomes (Years 2-4)
Partner Community LevelCommunity Network Teams are fully developed and active
Program staff are skilled and well-trained Children from diverse settings and racial/ethnic backgrounds are referred to and enrolled in local programsLocal programs enroll 25 children/yearCommunity Network Teams identify and develop local services/supports/resourcesService planning efforts engage all key partners and result in sustainable plansLocal programs develop and begin implementing sustainability plansParticipation in evaluation activities is strong
Practice/System LevelSocial marketing plan is implemented
Provider trainings are well-attendedUse of evidence-based practices increasesInteragency transition plans are in placeSOCI staff provide regular updates to key representatives from the PA Office of Child Development and Commission on Children and FamiliesSOCI staff actively participate in local early childhood collaborative meetings SOCI staff actively participate in federal system of care training/TA opportunitiesSOCI staff actively support local system integration initiatives
IMPACT(Years 5&6)
Partner Community LevelCaregiver/child/family relationships are strengthened and functioning improves
Family/consumer satisfaction with the system of care is highChildren/families receive appropriate and effective services, treatments and supportsDisparities in access to mental health services decline among racial minorities and children in foster careFamilies are empowered and support each otherLocal infrastructure for SOCI program is fully developed and self-sustaining
Practice/System LevelPublic awareness of early childhood mental health issues and effective mental health promotion strategies increase
Provider capacity to identify and treat/address early childhood mental health issues in an effective and culturally-competent manner increaseFamily/provider awareness of formal/informal services and how to access them increaseService/system integration and transition practices improveFederal/state/local partnerships are developed
MEAR
CART & National Outcomes Study: YSS-F, MSSC
National & Local Outcomes Study: CGSQ, PSI
National Outcomes Study: MSSC, CCSP
Local MIS
Local MIS
Tracking of committee memberships & activities
Family & provider focus groups
Informal agency self-report
“Stuck” in the middle with you…
CQI Process
So what next?
Intermediate Outcomes (Years 2-4)
Partner Community LevelCommunity Network Teams are fully developed and active
Program staff are skilled and well-trained Children from diverse settings and racial/ethnic backgrounds are referred to and enrolled in local programsLocal programs enroll 25 children/yearCommunity Network Teams identify and develop local services/supports/resourcesService planning efforts engage all key partners and result in sustainable plansLocal programs develop and begin implementing sustainability plansParticipation in evaluation activities is strong
Practice/System LevelSocial marketing plan is implemented
Provider trainings are well-attendedUse of evidence-based practices increasesInteragency transition plans are in placeSOCI staff provide regular updates to key representatives from the PA Office of Child Development and Commission on Children and FamiliesSOCI staff actively participate in local early childhood collaborative meetings SOCI staff actively participate in federal system of care training/TA opportunitiesSOCI staff actively support local system integration initiatives
We already
regularly view &
discuss data from the local
MIS
How do we convert more
referrals to enrollments?
Build new partnerships or utilize existing ones to
accomplish data collection – you don’t have to do it all
yourselves!
Local academic institutions
Agencies/providers
Community groups
So we called in our university partner…
And we built a plan.
ACTION: Tweaking
data collection
MIS DATA: # of Referrals, # of Enrollments
PHASE 1: Focus groups and interviews
RESULTS: Problems with
communication
ACTION: Spokesperson
training
MIS DATA: # of Referrals, # of Enrollments
PHASE 2: Phone
interviews
RESULTS: Problems with # of contacts
Shared with
admin staff
Shared
with
Team
Lea
der
staf
f
Ongoing PHASE 2: Phone interviews
with MIS data
And so on, and so on…
Are staff implementing the process appropriately?
Are we reaching families where they are?
SET Stoplight
Report
SET ReferralReport
Build in regular and consistent opportunities for data sharing,
feedback from stakeholder groups, and creation of action
plans.Community Evaluation Team Meeting
Operations Meeting
Advisory Committee Meeting
23%
9%
6%
5%
5%
5%5%
38%
Caregiver, 38%
Early Intervention, 23%
CYF, 9%
MH provider, 6%
Head Start, 5%
Phys Health Provider, 5%
Family Support Ctr, 5%
Other (school, childcare, etc),5%
0
2
4
6
8
10
12
14
Jan 08 Feb 08 Mar 08 Apr 08 May 08 Jun 08 Jul 08 Aug 08 Sep 08 Oct 08 Nov 08 Dec 08
Referred Enrolled Ever Enrolled
REFERRAL
REPORT
ST
OP
LIG
HT R
EP
OR
T
Team Leaders use reports as a staff supervision tool
Administrators use reports as program
monitoring and systems
discussion tool
IMPACT(Years 5&6)
Partner Community LevelCaregiver/child/family relationships are strengthened and functioning improves
Family/consumer satisfaction with the system of care is highChildren/families receive appropriate and effective services, treatments and supportsDisparities in access to mental health services decline among racial minorities and children in foster careFamilies are empowered and support each otherLocal infrastructure for SOCI program is fully developed and self-sustaining
Practice/System LevelPublic awareness of early childhood mental health issues and effective mental health promotion strategies increase
Provider capacity to identify and treat/address early childhood mental health issues in an effective and culturally-competent manner increaseFamily/provider awareness of formal/informal services and how to access them increaseService/system integration and transition practices improveFederal/state/local partnerships are developed
CART & National Outcomes Study: YSS-F, MSSC
Based on National
Outcomes data, families were reporting a
high level of satisfaction
with services. But were the study tools capturing
enough about family/SET staff
interactions?
Are families satisfied with SET staff??
So we partnered with an existing Allegheny County project of NAMI
(National Alliance on Mental Illness) …
And we built a plan.
CART Consumer Action Response Team
Phone interviews with
enrolled & recently
graduated families
RESULTS: Confusion about
‘graduation’
ACTION 1: Training for
families about graduation
Shared with
admin &
office staff
And so on, and so on…
Develop survey with CART staff
ACTION 2: Each office
wrote a plan of correction for
any other issues
Revise survey with CART staff
JULY 2010: Phone interviews with
enrolled & recently graduated families
Referrals to Enrollments?
Referral Details?
Service Delivery?
Service Satisfaction?
What is the SET experience?
as often as they will come.
Short term = more
energy, more time
Long term = more
efficient, less time
Bring as many people to the table as possible…
Make your efforts serve multiple purposes…
be the “Swiss Army Knife” of CQI / Evaluation!