System of Care Start-up Webinar Series 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

System of Care Start-up Webinar Series 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.

System of Care Start-up Webinar Series 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

System of Care Start-up Webinar Series 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

System of Care Start-up Webinar Series 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

System of Care Start-up Webinar Series Systems of Care CQI Framework Monitoring Progress: Evaluation Improving and Sustaining Change: Improvement Plans Theories of Change: Logic Model Continuous Quality Improvement

System of Care Start-up Webinar Series Logic Model as the Framework for CQI  Start with a logic model  Identify desired outcomes  Desired outcomes provide guidance for developing performance measures

System of Care Start-up Webinar Series 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. 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. Core Values are Family-driven Culture-based 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. Individualized & flexible services/supports Family & child partners Community member partners State & Federal agency partners Local agency & organization partners Community ownership and planning Logic Model Population Guiding Principles System of Care Strategy Local Service Delivery Process: System entry, service planning, service provision, and review/monitoring of the care of individual children and families Outcomes Local Infrastructure Development: Governance, management, quality monitoring and array of services/supports Comprehensive Community Mental Health Services for Children & Their Families >> Adaptation >> >> Accountability >> >> Quality Improvement >> << Internal Evaluation << << Using Best/Current Research << Evaluation and feedback to support improved service delivery

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System of Care Start-up Webinar Series Cuyahoga Tapestry System of Care (Cleveland, Ohio) The CQI Process and Collaboration Using the CQI Progress Report

System of Care Start-up Webinar Series 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

System of Care Start-up Webinar Series  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 CQI Collaboration with Local and National Partners

System of Care Start-up Webinar Series Providing Information to the Community about the CQI data : Seeing the Big Picture √++ Total site score and domain score

System of Care Start-up Webinar Series Identifying Priorities: Start Small… But Start Somewhere!

System of Care Start-up Webinar Series 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

System of Care Start-up Webinar Series  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 Next Steps

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System of Care Start-up Webinar Series Resources from the National Evaluation to Support CQI The CMHS CQI Benchmarking Initiative

System of Care Start-up Webinar Series 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

System of Care Start-up Webinar Series CQI Progress Report Primary 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

System of Care Start-up Webinar Series CQI Benchmarking Initiative Process  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

System of Care Start-up Webinar Series CQI Progress Report Key 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

System of Care Start-up Webinar Series CQI Progress Report

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System of Care Start-up Webinar Series Contact Information  Brigitte Manteuffel (Macro International, Inc):  Beth Dague, Project Director, (Cuyahoga Tapestry):  Chris Stormann, Evaluator, (Cuyahoga Tapestry):  Teresa King, Family Lead, (Cuyahoga Tapestry):