Feedback for Quality Improvement Addiction Research Institute Kelly Alanis Michelle Steinley-Bumgarner

FQI Project Overview Funded by: The Texas Department of State Health Services Objective: Develop a system to enhance quality improvement of a Behavioral Healthcare network (NorthSTAR) serving indigent and Medicaid clients in a seven-county service area in north Texas Process: Obtain feedback from network enrollees and direct treatment staff to assess the quality of treatment processes as well as provider staffing and organization

Systems Infrastructure for Quality Improvement Positive Outcomes Treatment Process Program Change Structure, climate, & resources How does this all fit together? Program Structure Organizational Climate Program Resources

NorthSTAR Fast Facts Service region includes 15% of the total population of Texas Serves 22% of the State’s consumers of mental health services Serves 32% of alcohol and chemical abuse clients in Texas YTD monthly average number of persons receiving chemical dependency services: 1,273

NorthSTAR Treatment Modalities Residential / Inpatient Intensive Outpatient Supportive Outpatient Aftercare Ambulatory Detox Methadone Adults Adolescents

Instruments Survey of Organizational Functioning (SOF): overview of organization from staff’s perspective * Motivation * Resources * Staff Attributes * Organizational Climate Client Evaluation of Self and Treatment (CEST): overview of organization from clients’ perspective * Treatment Motivation * Psychological Functioning * Social Functioning * Treatment Process Program Training Needs (PTN): overview of training needs from staff’s perspective * Training Needs * Preferences * Barriers

Typical Results The next several slides illustrate the typical results format as reported to agencies. For presentation purposes, only SOF results are provided for this example. CEST and PTN reporting is similar.

Mean SOF Responses for Agency X vs. NorthSTAR 5: Strongly Agree 4.5 4: Agree 3.5 3: Undecided Concern? Click bars. 2.5 Concern? Click bars. 2: Disagree 1.5 1: Strongly Disagree Typical results chart provided to agencies Program Needs Guidance Staff Needs Training Pressure For Change Offices Are Adequate Staffing Is Adequate Training Is Adequate Computers Are Adequate Internet / Email Available Professional Growth Occurs Staff Are Effective Staff Have Influence Staff Are Adaptable Has Sense of Mission Staff Work Together Well Staff Have Autonomy Communication Is Good Stress Is High Program Is Open To Change Motivation Resources Staff Attributes Organizational Climate

Mean SOF Responses: Agency X vs. NorthSTAR Section Scale Agency Average NorthSTAR Average Motivation for Change Program Needs Guidance 2.45 2.59 Staff Needs Training 2.49 2.54 Pressure For Change 2.60 2.85 Resources Offices Are Adequate 3.86 3.75 Staffing Is Adequate 2.44 3.35 Training Is Adequate 4.04 3.52 Computers Are Adequate 4.08 3.40 Internet / Email Are Available 3.83 3.72 Staff Attributes Professional Growth Occurs 3.90 3.77 Staff Are Effective 4.18 4.17 Staff Have Influence 3.96 3.82 Staff Are Adaptable 3.93 3.92 Climate Has Sense Of Mission 3.66 Staff Work Together Well 3.84 Staff Have Autonomy 3.43 3.79 Communication Is Good 3.30 3.65 Stress Is High 2.91 Program Is Open To Changes 3.50 3.67 Same data as illustrated in previous graph

Percent Extreme SOF Responses: Agency X vs. NorthSTAR Section Scale Agency Average NorthSTAR Average Resources Offices Are Adequate 0% 4% Staffing Is Adequate 38% Training Is Adequate 3% Computers Are Adequate 2% Internet/Email Available Staff Attributes Professional Growth Occurs 13% Staff Are Effective Staff Have Influence 1% Staff Are Adaptable Climate Has Sense Of Mission Staff Work Together Well Staff Have Autonomy Communication Is Good Stress Is High 16% Program Is Open To Changes Extreme scores represent the percentage of individuals whose responses may indicate a reason for concern. Extreme scores are scale averages of 2 or lower (disagree or strongly disagree) -- an exception is the Stress scale which is counted as extreme if individuals score a 4 or higher (agree or strongly agree).

Mean SOF Responses Across All Agencies: Staffing Is Adequate 5: Strongly Agree 4: Agree 3: Undecided Scale specific response distribution across all agencies 2: Disagree 1: Strongly Disagree Back

Mean SOF Responses Across All Agencies: Stress Is High 5: Strongly Agree 4: Agree 3: Undecided 2: Disagree 1: Strongly Disagree Back

Staffing Is Adequate: Items 58. There are enough counselors here to meet current client needs. 92. A larger support staff is needed to help meet program needs. ® 110. Frequent staff turnover is a problem for this program. ® 111. Counselors here are able to spend enough time with clients. 112. Support staff here have the skills they need to do their jobs. 113. Clinical staff here are well-trained. Back

Stress Is High: Items 50. You are under too many pressures to do your job effectively. 66. Staff members often show signs of stress and strain. 80. The heavy workload here reduces program effectiveness. 97. Staff frustration is common here. Back