Building Grassroots Involvement in QI Projects Title I Quality Learning Network Presentation Carla Lewis, Ph.D. Director of Planning and Evaluation Project Hospitality August 1, 2006

2 Championing Innovation from the Bottom Up Caseworker “Creativity” New Technology Workshops (state-of-the art tools, “working smart”, leveraging pre- existing data to tell a story - see agenda) Caseworker “Creativity” New Technology Workshops (state-of-the art tools, “working smart”, leveraging pre- existing data to tell a story - see agenda)   To facilitate learning of new techniques and shifts in thinking about quality improvement   To empower staff with a skill set to understand quality and culturally competent programming   To generate possibilities and the motivation to engage in collaborative team driven QI projects

3 Championing Innovation from the Bottom Up Grassroots Gems: Using data from Consumer satisfaction reports to craft QI projects and more meaningful, focused work. Grassroots Gems: Using data from Consumer satisfaction reports to craft QI projects and more meaningful, focused work. Problems/Solutions “ Joining staff where they are at” Problems/Solutions “ Joining staff where they are at” The Vision, the Reality The Vision, the Reality Taking it down a Notch and “surprises from the field” Taking it down a Notch and “surprises from the field”

4 The “Bridge to Life” QI Project Criteria:  Inclusive (consumer/staff)  data driven  goal oriented: to increase engagement in group sessions for HIV+ Mental Health consumers at our one stop shopping SHINE Center Consumer Survey Results:  “raising the bar”-- More intensive, therapeutic work indicated for dually diagnosed (SPMI) consumers to maintain retention in critical services.  More resources are needed for higher functioning clients. “It’s not like 20 years ago. We can achieve so much more even with the disease”  Fine tuning programming to fit special needs subgroups is especially meaningful for consumers at the extreme end of the spectrum (3 to 5 years) according to quantitative and qualitative analyses of survey data.

5 The “Bridge to Life” QI Project (continued) QI Action Plan:  separate groups with clients from each end of the continuum (new and over one year)  More focused work with long term clients who may be struggling with high expectations, “coasting”, or redundant group work with newly diagnosed clients Rapid Cycle Pilot Test:  Invitations to a “Bridge to Life” closed group will be distributed  Designated Popular Opinion Peer Leaders will share and encourage participation  Post intervention group satisfaction feedback will be assessed.

6 Rapid Cycling Derived from Special Populations Consumer Surveys Target group: Sheltered, HIV +, mentally ill, substance abusing clients. Survey Recommendations:  More explicit and structured delivery of life skills services  Greater attention to consumer readiness, and distractibility  Built-in feedback mechanisms to facilitate more responsive and adaptive service delivery  Separating out life skill domains (e.g. hygiene, self care) with specific interventions and feedback mechanisms - a joint QI initiative for the O’Connor team  Establishment of baselines to gauge what works and does not work for each consumer

7 Program QI Response Intervention/Solution:  Staff implemented a highly promoted, explicitly labeled community “topic” meeting (e.g. self care, hygiene) with evaluation component (accompanied by shopping excursion) Results:  Pre Intervention - perceptions of life skills service delivery was below quality standards.  Post intervention - 100% of consumers were able to identify 3 important self care/life skills and 7 out of 8 (88%) felt the activity would help them when they moved into transitional or permanent housing

8 On “Buy-In” and Future Directions  The Quality Infrastructure  Trial and Error, Shuffling stakeholders  Putting QI on the radar day-to-day  Building teamsmanship (Peer in- reach)  New and Sustained QI Projects (the point person)  Shifts in Consciousness