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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 . Objectives.

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continuous quality improvement within a system of care context

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

objectives
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.

what is continuous quality improvement cqi
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
cqi key principles
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
data driven tools to support cqi
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
systems of care cqi framework
Systems of Care CQI Framework

Continuous Quality Improvement

logic model as the framework for cqi
Logic Model as the Framework for CQI
  • Start with a logic model
  • Identify desired outcomes
  • Desired outcomes provide guidance for developing performance measures
slide8

Comprehensive Community Mental Health Services for Children & Their Families

>> Accountability >>

>> Adaptation >>

Logic Model

Population

System of Care Strategy

Outcomes

Guiding Principles

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.

  • Local Service Delivery Process:

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.

System entry, service planning, service provision, and review/monitoring of the care of individual children and families

Individualized & flexible services/supports

Community memberpartners

Family & child partners

>> Quality Improvement >>

Core Values are Family-drivenCulture-based

Evaluation and feedback to support improved service delivery

Local agency & organization partners

State & Federal agency partners

  • 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.

Community ownership and planning

  • Local Infrastructure Development:

Governance, management, quality monitoring and array of services/supports

<< Using Best/Current Research <<

<< Internal Evaluation <<

questions

Questions??

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Please press *6 to re-mute your line after your question has been answered.

cuyahoga tapestry system of care cleveland ohio

Cuyahoga Tapestry System of Care(Cleveland, Ohio)

The CQI Process and Collaboration

Using the CQI Progress Report

community collaboration our experience
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
cqi collaboration with local and national partners
CQI Collaboration with Local and National Partners
  • 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
providing information to the community about the cqi data seeing the big picture
Providing Information to the Community about the CQI data : Seeing the Big Picture

√++

Total site score and domain score

next steps
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
next steps16
Next Steps
  • 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
questions17

Questions??

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resources from the national evaluation to support cqi

Resources from the National Evaluation to Support CQI

The CMHS CQI Benchmarking Initiative

cqi benchmarking initiative purpose
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
cqi progress report primary objectives
CQI Progress ReportPrimary 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
cqi benchmarking initiative process
CQI Benchmarking InitiativeProcess
  • 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
slide22

CQI Progress ReportKey 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
questions and comments

Questions and Comments

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contact information
Contact Information
  • Brigitte Manteuffel (Macro International, Inc): Brigitte.A.Manteuffel@orcmacro.com
  • Beth Dague, Project Director, (Cuyahoga Tapestry): dague@cccmhb.org
  • Chris Stormann, Evaluator, (Cuyahoga Tapestry): cstorman@kent.edu
  • Teresa King, Family Lead, (Cuyahoga Tapestry): king@cccmhb.org