1. Block Grant Independent Peer Review 2015 Project Overview and Focus on Culturally and Linguistically Appropriate Services February 4, 2015

2. Page 2 Peer Review 2015 Agenda Overview of the Peer Review project – 5 min Self-study and Chart Review– 15 min Peer Reviews and Group Discussion – 5 min Focus on Culturally & Linguistically Appropriate Services and resources – 10 min NIATx change projects and optional tools (Nominal Group Technique for staff discussion) – 5 min Questions and next steps – 5 min

3. Overview Independent Peer Review is a requirement of Federal Substance Abuse Block Grant 5% sample every year Efficacy, Appropriateness, Quality of Service Independent of licensing or evaluation by state Expertise – match by modality NIATx principles used since 2006 – walk-throughs, process mapping, sociograms, Nominal Group Technique Data gathering through Chart Review and Self-Study In-Person Mutual Reviews on 5/1 will use all the written material – conversation is key; review form will document Page 3 Peer Review 2015

4. Calendar Now! Kickoff Call February 4 - April 15: Chart Review visits and Self-studies April 15 – April 30: sift through material, prepare to do Reviews May 1, 10 am - 2 pm: in-person Reviews, Lunch/Group Discussion Page 4 Peer Review 2015

5. Three thoughts… This is a process in which to be real with each other: given everything you have to do, how does your program embody ideals to which you aspire? Providing Culturally and Linguistically Appropriate Services is an ongoing process - no one gets there instantly, and ongoing attention to detail and feedback are needed This is a different context and deeper dive than the annual DPH CLAS Initiative self-assessment – another way to recognize the work you are already doing and support/share it. Page 5 Peer Review 2015

6. Self-Study Logistics Answer based on your understanding of your staff’s experience (except for the staff discussion at end) Flex to meet your needs and fit your program Questions ideally prompt substantial, thoughtful answers that help your partner really know your program when they review your Self-Study Submit via Fillable PDF, send to Deborah Strod AND to your partner. Page 6 Peer Review 2015

7. Self-Study Topics 1.Population Served 2.Assessment, Treatment, Discharge 3.Staff Demographics, Perspective, Resources 4.Other Services/Agencies involved with Clients 5.Staff Discussion related to CLAS: –What do we do well? –What could we do better? –What change would we like to try? The reviews you provide 5/1 will use almost the same framework as the discussion, but with wider scope – the whole program, not just CLAS Page 7 Peer Review 2015

8. Chart Review Logistics Confidentiality –Agency-specific forms as required –BSAS Peer Review Confidentiality form »Send a copy to Deborah Strod at DMA Health Review the questions first so you have them in mind as you read through the chart Consider both the usefulness of the chart, and what each chart shows about the care given Consider ahead of time whether your Electronic Health Record requires any special permissions or guidance to accommodate a reviewer Fillable PDF or Handwritten, as fits your needs Page 8 Peer Review 2015

9. Chart Review Topics 1.Admission Criteria/Intake Process 2.Assessment 3.Treatment Planning 4.Documentation of Treatment Implementation, Outcomes 5.Discharge and Continuing Care 6.Chart Use for utilization 7.Overall Impressions of Chart Page 9 Peer Review 2015

10. Peer Reviews and Group Discussion May 1st Peer reviewer will discuss with the reviewee –Self-study documentation –Chart Review results –Complete Reviewer Feedback form on reviewed program After about an hour roles will switch, and the reviewer becomes the reviewee for the second hour Lunch will follow the reviews Group Discussion about the review: Common issues? Common strengths? What surprised you? What did you learn? An aggregated report summarizing the strengths and opportunities, without identifiers, will be prepared for the Block Grant Application, and shared with participants who request it Page 10 Peer Review 2015

11. Disparities and Efforts to Address them Despite decades of efforts, documented disparities in Access and in Outcomes are experienced by people who are predominantly poor, and of color Among the efforts/mandates both ongoing & new at federal & state level Affordable Care Act mandates the US Department of Health and Human Services develop and evaluate an action plan to reduce racial/ethnic health and behavioral healthcare disparities, including increased preventive care and investments in community health teams SAMHSA Office of Behavioral Health Equity US Dept of Health and Human Services Office of Minority Health MA Health Disparities Council, formed after passage of 2006 MA Healthcare reform MA Office of Health Equity Page 11 Peer Review 2015

12. MA CLAS Initiative - Actions The MA CLAS Initiative’s manual takes the 15 National standards and organizes 6 action areas around them: Chapter 1 Foster Cultural Competence Chapter 2 Build Community Partnerships Chapter 3 Collect Diversity Data Chapter 4 Benchmark, Plan and Evaluate Chapter 5 Reflect and Respect Diversity Chapter 6 Ensure Language Access Page 12 Peer Review 2015

13. Enhanced National CLAS Standards 2013 Principal Standard: 1. Provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs. The remaining standards are divided into Governance, Leadership & Workforce Communication & Language Assistance Engagement, Continuous Improvement, & Accountability Page 13 Peer Review 2015

14. Enhanced National CLAS Standards 2013 Governance, Leadership and Workforce: 2. Advance and sustain organizational governance and leadership that promotes CLAS and health equity through policy, practices and allocated resources. 3. Recruit, promote, and support a culturally and linguistically diverse governance, leadership, and workforce that are responsive to the population inthe service area. 4. Educate and train governance, leadership, and workforce in culturally and linguistically appropriate policies and practices on an ongoing basis. Page 14 Peer Review 2015

15. Enhanced National CLAS Standards 2013 Communication and Language Assistance: 5. Offer language assistance to individuals who have limited English proficiency and/or other communication needs, at no cost to them, to facilitate timely access to all health care and services. 6. Inform all individuals of the availability of language assistance services clearly and in their preferred language, verbally and in writing. 7. Ensure the competence of individuals providing language assistance services, recognizing that the use of untrained individuals and/or minors as interpreters should be avoided. 8. Provide easy-to-read print and multimedia materials and signage in the languages commonly used by the populations in the service area. Page 15 Peer Review 2015

16. Enhanced National CLAS Standards 2013 Engagement, Continuous Improvement, and Accountability: 9. Establish culturally and linguistically appropriate goals, policies, and management accountability, and infuse them throughout the organization’s planning and operations. 10. Conduct ongoing assessments of the organization’s CLAS-related activities and integrate CLAS-related measures into measurement and continuous quality improvement activities. 11. Collect and maintain accurate and reliable demographic data to monitor and evaluate the impact of CLAS on health equity and outcomes and to inform service delivery. 12. Conduct regular assessments of community health assets and needs and use the results to plan and implement services that respond to the cultural and linguistic diversity of populations in the service area. Page 16 Peer Review 2015

17. Enhanced National CLAS Standards 2013 Engagement, Continuous Improvement, and Accountability (cont’d): 13. Partner with the community to design, implement, and evaluate policies, practices, and services to ensure cultural and linguistic appropriateness. 14. Create conflict and grievance resolution processes that are culturally and linguistically appropriate to identify, prevent and resolve conflicts or complaints. 15. Communicate the organization’s progress in implementing and sustaining CLAS to all stakeholders, constituents, and the general public. Source: http://www.mass.gov/eohhs/docs/dph/health-equity/clas-intro.pdf Page 17 Peer Review 2015

18. Language in MA Page 18 Peer Review 2015 Massachusetts Census Most Frequently Encountered by MA Acute Care Hospitals Reported in the First Language Not English report** Spanish Portuguese FrenchRussianChinese ItalianChineseHaitian Creole ChineseHaitian CreoleVietnamese French CreoleCape Verdean CreoleKhmer RussianVietnameseCape Verdean Creole VietnameseArabicRussian GreekAmerican Sign LanguageArabic PolishAlbanianKorean Seventeen Languages appear on relevant Top Ten Languages lists: *http://www.mass.gov/eohhs/docs/dph/health-equity/language-access-plan.pdf **MA Dept of Elementary and Secondary Education, School and District Profiles 14% of the state’s population are foreign-born residents # of Massachusetts residents who are Limited English Proficient continues to increase: –>20% of the Commonwealth’s residents 5 years or older speak a language other than English at home; of this population, 44% spoke English less than "very well“*

19. Culture and Language Resources MA CLAS initiative: http://www.mass.gov/eohhs/gov/departments/dph/programs/admin/health-equity/clas/ MA Office of Health Equity http://www.mass.gov/eohhs/gov/departments/dph/programs/admin/health-equity/clas/ Language Access Plan: http://www.mass.gov/eohhs/docs/dph/health-equity/language-access-plan.pdf Interpreter Services: http://www.mass.gov/eohhs/gov/departments/dph/programs/admin/health- equity/interpreter-services.html MASSTAPP – MA Technical Assistance Partnership for Prevention http://masstapp.edc.org/prevention-planning/cultural-and-linguistic-competence Federal Office of Minority Health: http://minorityhealth.hhs.gov/omh/browse.aspx?lvl=2&lvlid=34 https://www.thinkculturalhealth.hhs.gov/Content/clas.asp#clas_standards Page 19 Peer Review 2015

20. Page 20 Peer Review 2015 NIATx Change Projects 1.Gather a team 2.Pick something that matters 3.Select a small change, with measurable effects 4.Collect baseline data 5.Try it out! Briefly 6.Look at your data 7.If it worked, spread it further; if it didn’t, either modify or just go back to what you were doing. For more info see www.niatx.netwww.niatx.net or talk with Mike Ellis of BSAS

21. Optional Tools Walk-through – Experience your program through the eyes, ears, smells, touches, tastes, and social experiences of your clients (NIATx) Nominal Group Technique – Ensure participation and idea generation (NIATx) DPH CLAS Initiative Self-Assessment (if you haven’t already done it) Page 21 Peer Review 2015

22. Online Workspace – Everyone must join www.careersofsubstance.org All forms, including Expense Form Announcements Online discussions Email notifications of new discussions Page 22 Peer Review 2015

23. Next Steps Contact your partner to schedule the Chart Review visits –Your review of their charts –Their review of your charts Begin your own Self-Study Add "info@careersofsubstance.org" to your address book so emails from the online group don't get filtered as spam. Track mileage and parking Join the online group if you have not already! www.careersofsubstance.org www.careersofsubstance.org Page 23 Peer Review 2015

24. Thank you! This Annual Independent Peer Review is an important obligation for the Federal Substance Abuse Block Grant, and your participation helps the Commonwealth continue to receive these critical funds. Page 24 Peer Review 2015

25. Page 25 Peer Review 2015 Contact If you have questions, contact Deborah Strod DMA Health Strategies 339-970-0302 deborahs@dmahealth.com Michael A. Ellis Bureau of Substance Abuse Services 617-624-5097 Michael.Ellis@state.ma.us