January 23, 2015 This product is supported by Florida Department of Children and Families Substance Abuse and Mental Health Program Office funding.

 Block Grant Requirements  Evidence-Based Practice Fidelity Site Visit Overview  Discussion and Feedback  Case Studies  Upcoming Events

 Block grants are noncompetitive, formula grants appropriated by Congress.  This provides the foundation for safety net services in Florida.  Federal grants with federal legal requirements that apply to every aspect of the process - Department  SAMH Program  Contracts  Licensing  Revenue Management  Budgeting - Managing Entities - Providers that receive federal dollars (all providers that receive Department funding) SAPT Block Grants Overview

 Pregnant and Parenting Women  Intravenous Drug Users  Individuals receiving services related to communicable diseases (specifically Tuberculosis and Human Immunodeficiency Virus)  Individuals receiving prevention services Substance Abuse 42 U.S.C. s. 300x-21 SAPT Block Grant Priority Populations

Primary medical care Pediatric care Gender-specific treatment Preference in admissions Waiting list Interim services within 48 hours days for admission Interim services within 48 hours Risk assessment On-site HIV testing Pre/post-test counseling Priority Populations

Twenty Florida providers were randomly selected to participate Prior to the site visit, providers: Conduct a self-review of a specific EBP Use the fidelity monitoring tool protocol Conduct client record reviews Identify areas in the agency that need improvement Identify areas that could benefit from technical assistance (TA)

 Selected based on experience and knowledge of process improvement and specific selected EBP  Conduct on-site visits  Complete EBP fidelity tool review reports ◦ Client records review ◦ Program review  Identify best/promising practices used by provider  Conduct the site visit exit interview and provide positive feedback  Offer technical assistance as needed

 To ensure a successful site visit agencies are asked to: ◦ Have materials and source documents accessible for peer mentor team ◦ Designate a contact person ◦ Have staff team available to work with peer mentors ◦ Provide a place for the peer mentor team to work ◦ Invite local SAMH supervisor, managing entity or community coalition representative to entrance and/or exit meetings only

Background of EBP Fidelity Site Visits  Block Grant requirements ◦ Independent peer reviews are required by 45 C.F.R. ◦ 5% of contracted entities must be reviewed ◦ Quality and appropriateness of services ◦ Substance abuse and mental health systems ◦ EPB implementation across all providers (FY 08-09)

 Peer Review Process mandated by DCF  5-days long  2 Peer Mentors  Audit “feel” to the process  DCF attended open/exit meetings

 Florida won STAR-SI Grant 2006 ◦ NIATx process improvement model ◦ Created an open process ◦ Providers/ DCF/Peer Mentors  New EBP Initiative FY ◦ Created a “True Peer Review Process” ◦ Providers volunteered for visit ◦ 2 Peer Mentors ◦ 1 DCF staff present for the entire process ◦ Technical assistance available for providers

 Evolution Continues ◦ Providers randomly selected ◦ New block grant priorities checklist ◦ 2 peer mentors (for treatment providers) ◦ DCF/ME invited to attend Exit meeting ◦ No technical assistance available

Site Visit is Scheduled…Now What?  Call provider one week before  Ask… o Confirm contact person o Confirm location of site visit o Review BPP checklists are completed o Ensure 6 client file reviews have been completed o Ask if provider has EHR (plan for this) o Assist provider with any questions o Engage and create positive expectations

Diversity in Staff  It is important to have good representation of the agency during the staff visit  There are multiple areas of review and a diverse staff can provide more comprehensive feedback (360 degree)  Consider who may be beneficial to participate ◦ Clinical Staff ◦ Director/Manager ◦ Others?

Using Motivational Interviewing to Solicit Information Many agencies have electronic health records (EHRs).  It’s helpful to have the agency EHR staff available during the site visit.  How should conversations about the site visit be handled with program staff present?

 Open-Ended Questions ◦ Asking open-ended questions helps you understand your clients' point of view and elicits their feelings about a given topic or situation. ◦ Helpful with facilitating dialog

 Listen Reflectively ◦ Reflective listening is a way of checking rather than assuming that you know what is meant. ◦ Check for understanding  Is there clarity to what information is provided?  If not, have staff walk you through some of the navigation of the EHR.

 Develop Discrepancy ◦ Motivation for change is enhanced when clients perceive differences between their current situation and their hopes for the future. ◦ Work to raise awareness of processes which do not align with the desired outcome.  For example, you would like to demonstrate the clients are benefiting from the EBP but the EBP is not discussed in the clinical record (progress note).

 Affirm ◦ Support the self-efficacy of the agency by affirming the work that is done. ◦ For example, you are doing a good job with “X”. How can we make sure to capture the work you are doing?

On the best/promising practice (BPPs) checklists, which questions are key in identifying if BPPs are being implemented by an agency?

You’re conducting an EBP fidelity site visit and you’re about to review the best/promising practice checklists. The provider informs you that none of the checklists apply to their work. What do you do?

Upon arriving for the site visit, you discover that the provider has not adequately briefed their staff. They are unaware of the purpose of the site visit and they have not completed the client reviews or the best/promising practice checklists. What do you do?

March TBD June TBD