1. Michigan MIECHV CQI Learning Collaboratives January 14, 2014 Michigan MIECHV Grantee Meeting 1

2. Why CQI CQI methods and tools are used to ensure: – models are delivered with fidelity, providing the best services possible to families – the home visiting system meets performance Benchmarks, demonstrating positive outcomes for families Funding expectation: – In 3 years, Michigan will demonstrate improvement in 4 out of 6 benchmark areas by making improvements in over half the constructs in each benchmark area 2

3. MIECHV Benchmarks: A Reminder 1.Improved maternal and newborn health 2.Prevention of child injuries, child abuse, neglect, or maltreatment, and reduction of ER visits 3.Improvements in school readiness and achievements 4.Reduction in crime or domestic violence 5.Improvements in family economic self-sufficiency 6.Improvements in the coordination and referral for other community resources and supports 3

4. MIECHV Constructs: A Reminder 1. Improving maternal and newborn health – Prenatal care – Parental use of alcohol, tobacco, or illicit drugs – Preconception care – Inter-birth intervals – Screening for maternal depressive symptoms – Breastfeeding – Well-child visits – Maternal and child health insurance status 4

5. Strategy Local & State CQI projects: – Review data on a quarterly basis – Identify opportunities for improvement in Benchmark areas – Use QI methods to make improvements System-wide CQI projects: – QI Learning Collaborative model 5

6. QI Learning Collaborative What is it? Used widely in health care settings to translate what is known about ‘what works’ into practice – Use in public health and home visiting settings is on the rise Brings practitioners together to share insight into a common challenge, to study gaps, and test ideas for improvement 6

7. Benefits of Participating Increase staff knowledge and competency in using QI Awareness of resources Hear what others have tried; what worked; what didn’t; what challenges and solutions were experienced Ask questions, share stories, get feedback Get tools you can tailor to your home visiting program Network with other home visiting programs and models Greater awareness and visibility in the state of issues affecting the quality of home visiting services received by families Help Michigan work toward making improvements on the MIECHV Benchmarks and Constructs 7

8. QI Learning Collaborative Components 3 in-person Meetings at Grantee Meetings – January 14, 2014 – May 13, 2014 – September 18, 2014 2 Action Periods – Implement tests of improvement Completion of a QI Project – Use QI tools – Creation of a QI Team Charter and Story Board Ongoing Data Collection – MIECHV Data Collection Form – Data reports provided at each meeting 8

9. In-person QI Learning Collaborative Meetings Initial Meeting (January 14, 2014) – Work together to: Write an aim statement Examine the current approach (process & identify root causes to the problem) Identify potential solutions Develop an improvement theory 2 nd Meeting (May 13, 2014) – Work together to: Review data Discuss what has worked and what has not worked Modify improvement theories as necessary 3 rd Meeting (September 18, 2014) – Work together to: Review data Study the results of the test Act on the results Celebrate! 9

10. Learning Collaborative Topic Areas Selected based on baseline data: – Where can we improve as a system? Potential Topics: – Breastfeeding – ER Utilization – Social & Concrete Support – Service Referrals Site preferences & site data 10

11. Baseline Data on Selected Topic Areas ER UtilizationNumeratorDenominatorX02 Cohort 1 Value D89 Cohort 1 Value 2. Target children visiting a ER for any reason # of target children who visited the ER in the past 6 months as measured at 12 months post enrollment # of target children whose family has been enrolled in the program for 12 months 16/78 = 21% Missing =5 Data point not available for most Cohort 1 families 3. Female caregivers visiting the ER for any reason # of female caregivers who visited the ER in the past 6 months as measured at 12 months post enrollment # of female caregivers who have been enrolled in the program for 12 months 8/77 = 10% Missing =4 29/99 = 29% Missing=3 4. Children who require medical care for an injury or ingestion # of target children who have had an injury or ingestion requiring medical treatment within the past 6 months as measured at 12 months post enrollment # of target children whose family has been enrolled in the program for 12 months 0/81 = 0% Missing =2 2/102 = 2% Missing=0 11

12. Baseline Data on Selected Topic Areas 12 Service Referrals NumeratorDenominatorX02 Cohort 1 Value D89 Cohort 1 Value 5. Female caregivers are screened for substance use # of female caregivers screened for substance use # of female caregivers enrolled for 12 months 56/81 = 69% Missing=0 80/102 =78% 6. Female caregivers who are using substances are identified # of female caregivers who screen positive for substance use # of female caregivers screened for substance use 2/56 = 4% Missing=0 5/80=6% Missing=0 7. Female caregivers who screen positive for substance use are referred to services # of female caregivers who are referred to substance use services # of female caregivers who screen positive for substance use 1/2 = 50% Missing=0 4/4 = 100% Missing=1 8. Female caregivers are screened for depression # of female caregivers screened for depression # of female caregivers enrolled for 12 months 46/81 = 57% Missing=0 89/102=87% 9. Female caregivers who are experiencing depression are identified # of female caregivers who screen positive for depression # of female caregivers screened for depression 4/46 = 9% Missing=0 16/89 = 18% Missing=0 10. Female caregivers who screen positive for depression are referred to services # of female caregivers who are referred to depression services # of female caregivers who screen positive for depression 2/2 = 100% Missing=2 5/15 = 30% Missing=1

13. Baseline Data on Selected Topic Areas 13 Service Referrals NumeratorDenominatorX02 Cohort 1 Value D89 Cohort 1 Value 11. Female caregivers are screened for domestic violence # of female caregivers screened for domestic violence # of female caregivers enrolled for 12 months 55/81 = 68% Missing=0 77/102 = 75% 12. Female caregivers who are experiencing domestic violence are identified # of female caregivers who screen positive for domestic violence # of female caregivers screened for domestic violence 2/54 = 4% Missing=1 4/77 = 5% 13. Female caregivers who screen positive for domestic violence are referred to services # of female caregivers who are referred to domestic violence services # of female caregivers who screen positive for domestic violence 1/2 = 50% Missing=0 3/4 = 75%

14. Baseline Data on Selected Topic Areas 14 Service Referrals NumeratorDenominatorX02 Cohort 1 Value D89 Cohort 1 Value 14. Children are screened for developmental delays using the ASQ # of target children screened for developmental delays using the ASQ # of eligible target children whose caregivers are enrolled for 12 months 79/83=95%96/102=94% 15. Children who are experiencing developmental delays are identified using the ASQ # of target children who screen positive for developmental delays using the ASQ # of eligible target children screened for developmental delays using the ASQ 1/79=1%9/96 = 9% 16. Children who are experiencing developmental delays using the ASQ are referred to services # of target children who are referred to services for developmental delays # of eligible target children who screen positive for developmental delays using the ASQ 1/1=100% 0/9 = 0% 17. Children are screened for developmental delays using the ASQ-SE # of target children screened for developmental delays using the ASQ-SE # of eligible target children whose caregivers are enrolled for 12 months 67/82=82% 101/102 = 99% 18. Children who are experiencing developmental delays are identified using the ASQ-SE # of target children who screen positive for developmental delays using the ASQ-SE # of eligible target children screened for developmental delays using the ASQ-SE 0/82=0%3/101 =3% 19. Children who are experiencing developmental delays using the ASQ-SE are referred to services # of target children who are referred to services for developmental delays # of eligible target children who screen positive for developmental delays using the ASQ-SE NA0/3 = 0%

15. Baseline Data on Selected Topic Areas 15 Service Referrals NumeratorDenominatorX02 Cohort 1 Value D89 Cohort 1 Value 20. Families with service needs are identified # of families with an identified service need # of families enrolled for 6 months 103/143 = 72%83/135 = 61% 21. Families with service needs are referred to services # of families who are referred to services for an identified service need # of families with an identified service need 45/103 = 44%72/83 = 13%

16. QI Learning Collaboratives 16 ER Utilization Berrien NFP Calhoun NFP Ingham NFP Ingham EHS Kalamazoo NFP Kent HFA Muskegon HFA St. Clair EHS Service Referrals Genesee EHS Genesee NFP Kent NFP Oakland NFP Saginaw EHS Saginaw NFP Wayne County Babies HFA Wayne NFP Wayne Spaulding HFA

17. Questions 17