Upload
christal-stafford
View
214
Download
0
Tags:
Embed Size (px)
Citation preview
Measuring and Improving Measuring and Improving Practice and ResultsPractice and Results
2006 CSR Baseline Results2006 CSR Baseline Results
Measuring and Improving Measuring and Improving Practice and ResultsPractice and Results
2006 CSR Baseline Results2006 CSR Baseline Results
February 2007
Transformation Goals Transformation Goals Goal 1: Americans understand that mental health is
essential to overall health.
Goal 2: Mental health care is consumer and family driven.
Goal 3: Disparities in mental health services are eliminated.
Goal 4: Early mental health screening, assessment, and referral to services are common practice.
Goal 5: Excellent mental health care is delivered, and research is accelerated.
Goal 6: Technology is used to access mental health care and information.
Goal 1: Americans understand that mental health is essential to overall health.
Goal 2: Mental health care is consumer and family driven.
Goal 3: Disparities in mental health services are eliminated.
Goal 4: Early mental health screening, assessment, and referral to services are common practice.
Goal 5: Excellent mental health care is delivered, and research is accelerated.
Goal 6: Technology is used to access mental health care and information.
Measuring Performance Measuring Performance
What are the results achieved? Who are successes? Who do we fail? Are we achieving highly consistent, high
fidelity performance in Practice? Are we implementing evidence-based
practices with fidelity and wisdom. Are we intervening earlier?
What are the results achieved? Who are successes? Who do we fail? Are we achieving highly consistent, high
fidelity performance in Practice? Are we implementing evidence-based
practices with fidelity and wisdom. Are we intervening earlier?
Measuring Performance Measuring Performance
Are we working together more collaboratively?
Are we keeping more kids at home, in school? Adults independent & working?
Are we identifying the critical path to improved performance and outcomes?
What is our evidence of progress? How can we be more efficient?
Are we working together more collaboratively?
Are we keeping more kids at home, in school? Adults independent & working?
Are we identifying the critical path to improved performance and outcomes?
What is our evidence of progress? How can we be more efficient?
The Community Service The Community Service ReviewReview
The Community Service The Community Service ReviewReview
Is a CASE STUDYCASE STUDY technique that relies on a guided professional appraisal.
Uses various sampling strategies to “SPOT CHECKSPOT CHECK” daily front-line practice performance working conditions.
Shows WHAT’S WORKINGWHAT’S WORKING for adult service consumers (status indicators).
Is used for PRACTICE DEVELOPMENTPRACTICE DEVELOPMENT and refinements in PROGRAM DESIGN.
Is a CASE STUDYCASE STUDY technique that relies on a guided professional appraisal.
Uses various sampling strategies to “SPOT CHECKSPOT CHECK” daily front-line practice performance working conditions.
Shows WHAT’S WORKINGWHAT’S WORKING for adult service consumers (status indicators).
Is used for PRACTICE DEVELOPMENTPRACTICE DEVELOPMENT and refinements in PROGRAM DESIGN.
CSR:CSR:Person’s Status,Person’s Status,Daily Practice,Daily Practice,
Present ResultsPresent Results
A new LENS for A new LENS for Viewing OurViewing OurPractice & ResultsPractice & Results
CSR: Focus on Practice & ResultsCSR: Focus on Practice & ResultsCSR: Focus on Practice & ResultsCSR: Focus on Practice & Results
Status of Persons ServedStatus of Persons ServedAre adults receiving servicesAre adults receiving servicesdoing well now or showingdoing well now or showing
good progress in well-being, good progress in well-being, functioning, risk reduction,functioning, risk reduction,
safe & sustainable supports?safe & sustainable supports?
Status of Persons ServedStatus of Persons ServedAre adults receiving servicesAre adults receiving servicesdoing well now or showingdoing well now or showing
good progress in well-being, good progress in well-being, functioning, risk reduction,functioning, risk reduction,
safe & sustainable supports?safe & sustainable supports?
Practice & PerformancePractice & PerformanceAre our practices workingAre our practices working
well for those being served?well for those being served?
Practice & PerformancePractice & PerformanceAre our practices workingAre our practices working
well for those being served?well for those being served?
Front-Line ConditionsFront-Line ConditionsHow are front-line workingHow are front-line working
conditions affecting practice,conditions affecting practice,performance, and results?performance, and results?
Front-Line ConditionsFront-Line ConditionsHow are front-line workingHow are front-line working
conditions affecting practice,conditions affecting practice,performance, and results?performance, and results?
USING CSR FINDINGS FOR LEARNING & CHANGEUSING CSR FINDINGS FOR LEARNING & CHANGEFindings are used to decide Findings are used to decide WHAT TO DO NEXT!WHAT TO DO NEXT! NotNot just to say: just to say:
““good or bad” or “pass/fail.” A key purpose is Learning and Change.good or bad” or “pass/fail.” A key purpose is Learning and Change.
USING CSR FINDINGS FOR LEARNING & CHANGEUSING CSR FINDINGS FOR LEARNING & CHANGEFindings are used to decide Findings are used to decide WHAT TO DO NEXT!WHAT TO DO NEXT! NotNot just to say: just to say:
““good or bad” or “pass/fail.” A key purpose is Learning and Change.good or bad” or “pass/fail.” A key purpose is Learning and Change.
8
Coordinate and Coordinate and Deliver services while Deliver services while Advocating for those Advocating for those
not availablenot available
Core Functions in Child & Family PracticeCore Functions in Child & Family Practice
1
3
4 5
6
7 2
Engage Family Members/ Assemble Service Team
Engage Family Members/ Assemble Service Team
Assess & Understand Assess & Understand Current Situation, Current Situation,
Strengths, Needs, Wishes, Strengths, Needs, Wishes, Underlying FactorsUnderlying Factors
Assess & Understand Assess & Understand Current Situation, Current Situation,
Strengths, Needs, Wishes, Strengths, Needs, Wishes, Underlying FactorsUnderlying Factors
Plan Interventions, Plan Interventions, Supports, and Services Supports, and Services Following a Long-term Following a Long-term
Guiding ViewGuiding View
Plan Interventions, Plan Interventions, Supports, and Services Supports, and Services Following a Long-term Following a Long-term
Guiding ViewGuiding View
Access or Assemble Access or Assemble Necessary Resources in Necessary Resources in
Local CommunityLocal Community
Access or Assemble Access or Assemble Necessary Resources in Necessary Resources in
Local CommunityLocal Community
Implement Plan of Implement Plan of Interventions, Strategies, Interventions, Strategies,
SupportsSupports
Implement Plan of Implement Plan of Interventions, Strategies, Interventions, Strategies,
SupportsSupports
Monitor Progress, Monitor Progress, Evaluate Results, What’s Evaluate Results, What’s Working & Not WorkingWorking & Not Working
Monitor Progress, Monitor Progress, Evaluate Results, What’s Evaluate Results, What’s Working & Not WorkingWorking & Not Working
Adapt Delivered Services Adapt Delivered Services Through On-going Through On-going
AssessmentAssessment and Planningand Planning
Adapt Delivered Services Adapt Delivered Services Through On-going Through On-going
AssessmentAssessment and Planningand Planning
Key Functions in a Key Functions in a Basic Practice ModelBasic Practice Model: each function requires strategies & techniques: each function requires strategies & techniques
Find Child & Family in Find Child & Family in Need => Need => ENTRYENTRY
Find Child & Family in Find Child & Family in Need => Need => ENTRYENTRY
Make Transition & Make Transition & Safe Safe Case ClosureCase Closure => => EXITEXIT Make Transition & Make Transition & Safe Safe Case ClosureCase Closure => => EXITEXIT
9
CSR Tests theCSR Tests thePractice ModelPractice Model
© Human Systems & Outcomes, Inc. • 2003
6 = OPTIMAL PERFORMANCE . Excellent, consistent, effectivepractice for this person in this function area. This level of perfor-mance is indicative of exemplary practice and results for the person.["Optimum” does not imply “perfection.”]
5 = GOOD PERFORMANCE. At this level, the system function isworking dependably for this person, under changing conditions andover time. Effectiveness level is consistent with meeting long-termgoals for the person. [Keep this going for good results]
4 = FAIR PERFORMANCE. This level of performance is minimally ortemporarily sufficient for the person to meet short-term objectives.Performance may be time-limited or require adjustment soon due tochanging circumstances.[Some refinement is indicated]
3 = MARGINAL PERFORMANCE. Practice at this level may be un-der-powered, inconsistent, or not well-matched to need. Performanceis insufficient for the person to meet short-term objectives. [With re-finement, this could become acceptable in the near future.]
2 = POOR PERFORMANCE. Practice at this level is fragmented, in-consistent, lacking in intensity, or off-target. Elements of practicemay be noted, but it is incomplete/not operative on a consistent basis.
1 = ADVERSE PERFORMANCE. Practice may be absent or not oper-ative. Performance may be missing (not done). - OR - Practice strat-egies, if occurring in this area, may be contra-indicated or may beperformed inappropriately or harmfully.
AcceptableRange: 4-6
UnacceptableRange: 1-3
CSR Interpretative Guide for Practice Performance
MaintenanceZone: 5-6
Performance is effec-tive. Efforts should bemade to maintain andbuild upon a positivepractice situation.
RefinementZone: 3-4
Performance is minimalor marginal and maybechanging. Further effortsare necessary to refinethepractice situation.
ImprovementZone: 1-2
Performance is inade-quate. Quick actionshould be taken to im-prove practice now.
Indiana Adult DataIndiana Adult Data
18-29 years 30-49 years 50-69 years 70+ years0
10
20
30
40
14
11
30
36
24
36
2 3
Male
Female
Sample by Age and Gender
IN Adult CSR Combined Data 2006
1%
23% 23%
2%
15%
19%
9%
7%
Caucasian-American Indian
Latino-American
African-American
Euro-American
0 25 50 75 100 125 150
1
3
25
125
Number of Cases Reviewed
Race/Ethnicity Adult Review
6%
16%
81%
(2%)
(1%)
IN Adult CSR Combined Data 2006
n=154
10+ placements
6-9 placements
3-5 Placements
1-2 Placements
No placement changes
0 10 20 30 40 50 60 70 80 90 100
1
2
7
47
95
Number of Cases Reviewed
Placement Changes - Adult Review
61%
4%
30%
IN Adult CSR Combined Data 2006
(1%)
(1%)
37+ months
19-36 months
13-18 months
10-12 months
7-9 months
4-6 months
0-3 months
0 10 20 30 40 50 60 70
59
28
9
15
10
21
13
Number of Cases Reviewed
Length of Time in Current Living Arrangement
8%
13%
68%
IN Adult CSR Combined Data 2006
6%
10%
6%
18%
38%
Satisfaction: caregiver
Satisfaction: person
Social network: recovery
Social network: composition
Living arrangement
Income control
Income adequacy
Safety of others
Safety of the person
0% 20% 40% 60% 80% 100%
96%
92%
55%
62%
88%
79%
77%
94%
89%
Percent acceptable cases
Participant's StatusCommunity Living
IN Adult CSR Combined Data 2006
n=151
n=102
n=99
n=96
Person's Overall Status
Recovery activities
Work
Edu./career preparations
Voice & role in decisions
Mental health status
Substance use
Health/physical well-being
0% 20% 40% 60% 80% 100%
77%
51%
44%
39%
76%
65%
70%
81%
Percent acceptable cases
Participant's StatusWell-being/Life Activities
IN Adult CSR Combined Data 2006
n=155
n=56
n=69
n=79
n=144
Overall Progress
Meaningful personal relationships
Improved social integration
Successful life adjustments
Risk reduction
Progress to recovery goals
Education/work progress
Personal responsibilities
Substance use
Reduction psychiatric symptoms
0% 20% 40% 60% 80% 100%
65%
55%
50%
68%
63%
49%
42%
64%
70%
70%
Percent acceptable casesIN Adult CSR Combined Data 2006
Participant's Recent Progress
n=54
n=125
n=150
n=147
n=78
n=140
n=103
n=145
n=150
n=155
Transition/adjustments
Social integration
Sustainable supports
Income/benefits
Recovery/relapse
Symptom/SA reduction
Personal recovery goals
Assessment & understanding
Teamwork: functioning
Teamwork: formation
Engagement of the person
0% 20% 40% 60% 80% 100%
50%
44%
65%
76%
52%
79%
45%
73%
67%
72%
79%
Percent acceptable cases
Practice PerformancePlanning Treatment & Support
IN Adult CSR Combined Data
2006
n=145
n=154
n=143
n=139
n=140
n=144
n=155
n=124
Overall Practice Performance
Culturally appropriate
Recovery plan adjustments
Service coordination & continuity
Support for integration
Seclusion/restraint
Medication management
Urgent response
Intervention adequacy
Resources: use
Resources: availability
0% 20% 40% 60% 80% 100%
72%
96%
65%
78%
65%
89%
70%
65%
68%
76%
Percent acceptable cases
Practice PerformanceProviding and Managing Treatment
IN Adult CSR Combined Data
2006
n=100
n=70
n=0
n=129
n=149
n=155
n=45
Acceptability ofService SystemPerformance in
Individual Cases
Status of the Participant inIndividual Cases
Adult Case Review Outcome Categories
IN Adult CSR Combined Data 2006
n=156
Outcome 1:
Good status for the participant,ongoing services
acceptable.
65% (101 cases)
Outcome 3:
Good status for the participant, ongoing services mixed or
unacceptable.
12% (19 cases)
Outcome 2:
Poor status for the participant,ongoing services
minimally acceptable but limited inreach or efficacy.
8% (12 cases)
Outcome 4:
Poor status for the participant,ongoing services
unacceptable.
15% (24 cases)
AcceptableSystem
Performance73%
UnacceptableSystem
Performance27%
Favorable Person Status 77%Unfavorable Person Status 23%
Overall Practice Performance
Overall Progress
Person's Overall Status
0% 20% 40% 60% 80% 100%
70%
85%
61%
81%
74%
89%
Non-ACT Cases, n=129
ACT Cases, n=27
Participant's Overall Ratings
IN Adult CSR Combined Data 2006
Level 1 Level 2 Level 3 Level 4 Level 5 Level 60%
20%
40%
60%
80%
100%
0% 2% 4%10% 11%
18%
37%42%
48%
28%
0% 0%
Percent of ACT cases, n-27
Percent of Non-ACT cases, n=129
Adult Overall Practice Performance
ADVERSE POOR MARGINAL FAIR GOOD OPTIMAL
IMPROVEMENT REFINEMENT MAINTENANCE
UNACCEPTABLE ACCEPTABLE
IN Adult CSR Reviews 2006
Overall Adult CSR RatingsStatus and Perfromance
IN Adult CSR Regional Data 2006
South & Southwestern Regions
Eastern Region
Northeastern Region
Northwestern Region
Central Region
0% 20% 40% 60% 80% 100%
72%
76%
90%
93%
80%
80%
49%
63%
74%
74%
Percent Acceptable Perfromance
Percent Acceptable Status
Indiana Child GraphsIndiana Child Graphs
0-4 years 5-9 years 10-13 years 14+ years0
5
10
15
20
25
30
35
5
2
33
19
28
17
28
12
Boys
Girls
Sample by Age and Gender
IN Child CSR Combined Data 2006
n=144
12%
1%
3%
23%
19%
8%
13%
19%
Biracial
Latino-American
African-American
Euro-American
0 10 20 30 40 50 60 70 80 90 100 110
5
6
23
104
Number of Cases Reviewed
Race/Ethnicity Adult Review
IN Adult CSR Combined Data 2006
n=138
75%
17%
(4%)
(4%)
Diagnosis and Co-Occurring Conditions
Number Percent
Mood Disorder 45 31%
Anxiety Disorder 23 16%
PTSD/Adjustment to Trauma 19 13%
Thought Disorder/Psychosis 5 3%
ADD/ADHD 89 62%
Anger Control 30 21%
Substance Abuse/Dependence 7 5%
Learning Disorder 25 17%
Communication Disorder 8 6%
Autsim 8 6%
Disruptive Behavior Disorder (CD, ODD) 55 38%
Mental Retardation 24 17%
Medical Problem 33 23%
Level 8 - 10 Mild Impairment
Level 6 - 7 Moderate Impairment
Level 1 - 5 Serious Impairment
0 10 20 30 40 50 60 70
17
65
60
Number of Cases Reviewed
Child Level of Functioning (GAF)
42%
45%
12%
IN Child CSR Combined Data 2006
n=142
6-9 placements
3-5 Placements
1-2 Placements
No placement changes
0 10 20 30 40 50 60 70 80 90 100
2
14
36
90
Number of Cases Reviewed
Placement Changes - Child ReviewOver Past 12 Months
62%
10%
25%
IN Child CSR Combined Data 2006
n=142
(1%)
Educational Placement
Number Percent
Regular K-12 education 60 42%
Full inclusion 11 8%
Part-time special education 35 24%
Self-contained special education 22 15%
Alternative education 6 4%
Vocational education 1 1%
Adult basic/GED 1 1%
Day treatment program 6 4%
Completed/graduated 0 0%
Expelled/suspended 1 1%
Dropped out 1 1%
Special Education
Juvenile Justice
Child Welfare
0 10 20 30 40 50 60 70 80 90
80
16
35
Number of Cases Reviewed
Child Involvement with Other Agencies
24%
11%
IN Child CSR Combined Data 2006
56%
5+ psychotropic medications
4 psychotropic medications
3 psychotropic medications
2 psychotropic medications
1 psychotropic medication
No psychotropic medications
0 10 20 30 40
2
8
26
34
36
37
Number of Cases Reviewed
Number of Psychotropic Medications
26%
6%
24%
25%
IN Child CSR Combined Data 2006
18%
(1%)
37+ months
19-36 months
13-18 months
10-12 months
7-9 months
4-6 months
0-3 months
0 2 4 6 8 10 12
4
0
2
1
4
8
10
Number of Cases Reviewed
Length of Time in Current OOH Placement
34%
28%
IN Child CSR Combined Data 2006
14%
3%
7%
14%
n=29
Substance use: child/youth
Emotional well-being: school
Emotional well-being: home
Health/Physical well-being
Living arrangements
Permanency
Stability: school
Stability: home
Safety of others
Safety of the child
0% 20% 40% 60% 80% 100%
84%
71%
65%
94%
88%
85%
82%
81%
88%
92%
Percent acceptable cases
Child StatusSafety and Permanency
IN Child CSR Combined Data 2006
n=140
n=139
n=25
Overall Child Status
Lawful behavior: parent
Lawful behavior: child/youth
Social connection & support
Present performance
Instructional engagement
School attendance
Educational placement
0% 20% 40% 60% 80% 100%
78%
93%
83%
66%
61%
63%
87%
81%
Percent acceptable cases
Child StatusDeveloping Life Skills
IN Child CSR Combined
Data 2006
n=141
n=138
n=139
n=140
n=138
n=93
n=121
Overall Caregiver Status
Satisfaction:caregiver
Satisfaction: child/youth
Substance use: caregiver
Caregiver participation
Parenting capacities: reunify
Parenting capacities: present
Caregiver support of the child
0% 20% 40% 60% 80% 100%
88%
91%
91%
80%
86%
40%
80%
85%
Percent acceptable cases
Parent/Caregiver Status
IN Child CSR Combined Data 2006
n=114
n=44
n=15
n=139
n=136
Overall Progress
Progress toward transition
Meaningful relationships: adults
Meaningful relationships: peers
Meaningful relationships: family
Risk reduction
School/work progress
Improved coping/self-mgt.
Substance use reduction
Symptom reduction
0% 20% 40% 60% 80% 100%
75%
55%
81%
64%
85%
73%
64%
70%
71%
76%
Percent acceptable cases
Child Progress
IN Child CSR Combined Data
2006
n=138
n=14
n=60
n=138
n=113
n=134
n=139
n=135
n=131
Outcomes & ending requirements
Assessment: family
Assessment: child
Teamwork: functioning
Teamwork: formation
Engagement
0% 20% 40% 60% 80% 100%
56%
67%
77%
51%
54%
85%
Percent acceptable cases
Practice PerformanceEngagement
IN Child CSR Combined
Data 2006
n=140
Transition/independence
Recovery/relapse
Crisis response
Sustainable supports
Behavior changes
Symptom/SA reduction
0% 20% 40% 60% 80% 100%
44%
50%
55%
50%
74%
78%
Percent acceptable cases
Practice PerformanceIntervention Planning
IN Child CSR Combined Data
2006
n=82
n=40
n=75
n=132
n=141
n=135
Overall Practice
Tracking & adjustment
Adequacy of intervention
Resources: unit/placement-based
Resources: unique/flexible
Crisis response
Family support
0% 20% 40% 60% 80% 100%
60%
63%
67%
73%
58%
54%
65%
Percent acceptable cases
Practice PerformanceSupport & Resources
IN Child CSR Combined Data 2006
n=134
n=63
n=119
n=78
Acceptability ofService SystemPerformance in
Individual Cases
Status of Child/Family inIndividual Cases
Child Case Review Outcome Categories
Outcome 1:
Good status for child/family,ongoing services
acceptable.
56% (81 cases)
Outcome 3:
Good status for child/family,ongoing services mixed or
unacceptable.
22% (32 cases)
Outcome 2:
Poor status for child/family,ongoing services
minimally acceptable but limited inreach or efficacy.
4% (6 cases)
Outcome 4:
Poor status for child/family,ongoing services
unacceptable.
17% (25 cases)
AcceptableSystem
Performance60%
UnacceptableSystem
Performance39%
Favorable Child Status 78%Unfavorable Child Status 21%
IN Child CSR Combined Data 2006
n=144
Overall Practice Performance
Overall Child Progress
Overall Parent Caregiver Status
Overall Child Status
0% 20% 40% 60% 80% 100%
59%
73%
75%
73%
88%
82%
78%
82%
Non-SOC Cases, n=133
SOC Cases, n=11
Overall Child Ratings
IN Child CSR Combined Data
2006
Level 1 Level 2 Level 3 Level 4 Level 5 Level 60%
20%
40%
60%
80%
100%
0% 0%
9% 8%
18%
33%27%
33%
45%
25%
0% 1%
Percent of SOC cases, n-11
Percent of Non-SOC cases, n=133
Child Overall Practice Performance
ADVERSE POOR MARGINAL FAIR GOOD OPTIMAL
IMPROVEMENT REFINEMENT MAINTENANCE
UNACCEPTABLE ACCEPTABLE
IN Child CSR Reviews 2006
Overall Practice Performance
Overall Child Progress
Overall Parent Caregiver Status
Overall Child Status
0% 20% 40% 60% 80% 100%
60%
40%
75%
65%
62%
90%
85%
80%94%
75%
71%
85%
14+ years old, n=40
10-13 years old, n=45
5-9 years old, n=52
Overall Child Ratings by Age Groups
IN Child CSR Combined Data
2006
Overall Practice Performance
Overall Child Progress
Overall Parent Caregiver Status
Overall Child Status
0% 20% 40% 60% 80% 100%
76%
65%
52%
100%
83%
58%
100%
86%85%
94%
88%
63%
Level of Functioning 8-10, n=17
Level of Functioning 6-7, n=65
Level of Functioning 1-5, n=60
Overall Child Ratings by Functioning
IN Child CSR Combined Data
2006
Child Service Data
Child Service Data
Child Service Data
Overall Child CSR RatingsStatus and Perfromance
IN Child CSR Regional Data 2006
South & Southwestern Regions
Eastern Region
Northeastern Region
Northwestern Region
Central Region
0% 20% 40% 60% 80% 100%
62%
81%
48%
66%
69%
94%
64%
76%
56%
76%
Percent Acceptable Perfromance
Percent Acceptable Status
Key Elements for TransformationKey Elements for TransformationKey Elements for TransformationKey Elements for TransformationCLEAR EXPECTATIONSCLEAR EXPECTATIONS: common understandings (a shared vision by all levels of organization) of an integrated, collaborative, system of care based on accepted operating principles, a basic practice model, and measured results.
LEADERSHIPLEADERSHIP:: consistent focus, communications, problem solving, team work, reinforcement of directions and efforts within and across agencies.
TRAINING, MENTORING, & COACHINGTRAINING, MENTORING, & COACHING:: building and sustaining adequate and consistent, case-level practice support and supervision across all frontline units.
FRONTLINE CAPACITYFRONTLINE CAPACITY:: building an effective array of community-based services & finding better ways of conducting daily practice with the current workforce.
FLEXIBLE FUNDINGFLEXIBLE FUNDING:: creating better and more timely ways of accessing what’s needed, when need, and where needed by children and families.
PERFORMANCE MEASUREMENT WITH FEEDBACK LOOPS and ACTION STEPSPERFORMANCE MEASUREMENT WITH FEEDBACK LOOPS and ACTION STEPS:: providing feedback about frontline PERFORMANCE and RESULTS so that people can change from current performance levels to desired performance levels in improving practice and getting better results for children and families receiving services.
CLEAR EXPECTATIONSCLEAR EXPECTATIONS: common understandings (a shared vision by all levels of organization) of an integrated, collaborative, system of care based on accepted operating principles, a basic practice model, and measured results.
LEADERSHIPLEADERSHIP:: consistent focus, communications, problem solving, team work, reinforcement of directions and efforts within and across agencies.
TRAINING, MENTORING, & COACHINGTRAINING, MENTORING, & COACHING:: building and sustaining adequate and consistent, case-level practice support and supervision across all frontline units.
FRONTLINE CAPACITYFRONTLINE CAPACITY:: building an effective array of community-based services & finding better ways of conducting daily practice with the current workforce.
FLEXIBLE FUNDINGFLEXIBLE FUNDING:: creating better and more timely ways of accessing what’s needed, when need, and where needed by children and families.
PERFORMANCE MEASUREMENT WITH FEEDBACK LOOPS and ACTION STEPSPERFORMANCE MEASUREMENT WITH FEEDBACK LOOPS and ACTION STEPS:: providing feedback about frontline PERFORMANCE and RESULTS so that people can change from current performance levels to desired performance levels in improving practice and getting better results for children and families receiving services.
Next Steps Next Steps
improve the alignment of funding sources with program philosophy and goals.
Develop data on access, service array, outcome indicators and quality measures of results and consistency.
Conduct reviews using data profiles and CSR by provider.
Make the commitment!
improve the alignment of funding sources with program philosophy and goals.
Develop data on access, service array, outcome indicators and quality measures of results and consistency.
Conduct reviews using data profiles and CSR by provider.
Make the commitment!
Let’s Talk!Let’s Talk!
Quality Management Quality Management ConcernsConcerns
Service population: client characteristics, demog. profiles
System flow: flow through the system- access entry/exit points, Timeliness, paths, gaps, waitlists
Service utilization: which services people use and why
Resource utilization: fund/resource use patterns, adequacy
Practice: assessment,crafting interventions, timely and skillful delivery, judging results.
System dependability:Fidelity to program model, reliability of implementation, continuity of care
Service results: immediate effects/benefits of services
Stakeholder Satisfaction: perceptions of the service system
General System Concerns Front-line Performance Concerns
Innovation Curves: Spreading a New PracticeSee See Diffusion of InnovationDiffusion of Innovation; Everett Rogers, fifth edition, 2003; Everett Rogers, fifth edition, 2003
KnowledgeAttitudePractice
The Unfolding of Practice and Related Systems Change Over Time
Perc
ent o
f Pra
ctiti
oner
s
Understanding ofThe New Practice
Commitment toThe New Practice
Full Scale Use Of New Practice
Initial Awareness ofNew Practice
Beginning Acceptance of New Practice
Learning to PerformThe New Practice
Baseline 1 2 3 4 5 6
Confirmation & Integration of the Practice
Limited but Growing Implementation
© Human Systems & Outcomes, Inc., 2001
PracticeImprovementRequires:
n Knowledge of the Outcomes of Treatment
n Quick, continuous and Correct Feedback
n Continually improving Skill/ Craft knowledge of techniques andmethods of intervention
n Relationship of Process and Outcomes
n Ability to Contextualize knowledge to fit individuals
n Ability to Synthesize and Generalize Learning
Bickman, 1999