Public Health Notice

Contagious Disease

Hazard

City and County of San Francisco

Oversight, PerformanceAnd

Focus Groups

Using Focus Groups in State

Oversight of County

Medicaid Managed Care

Specialty Mental Health

Services

A Little Background...•California implements Managed Care for Medi-Cal Mental Health Specialty Services in FY 97-98

•CMS Freedom-of-choice waivers

•State oversight plan - review 56 county MHPs

Obtain direct input from consumers and families

Employ consumers and families as reviewers and moderators

DMH Policy

California Counties run their own mental health programs (MHP’s)

State DMH provides oversight and some direct services

And…

Combine Two Approaches

COMPLIANCE• 49 Page Protocol• In/Out of Compliance• Look at Policies &

Procedures• Interview Admin Staff• Make Calls to Access

Line• Write Plan of

Correction

QI/TAT• Hold 1 - 6 Focus

Groups(10 - 60 Participants)

• Prepare draft reports to County

• Hold exit discussion• Prepare final reports to

County - 30 days• TAT makes follow-up

visits

Oversight = (C+QI+TAT)

Compliance +

QI +Tech. Assistance &Training

Or,

A Quality Improvement MantraFor Our Times:

“Good news is no news”

“No news is bad news”

“Bad news is good news”

Who Said That?

Free Lunch to the Person Who Can Tell Us!

•Cheaper & faster than other methods

• Interaction generates additional information

• Questions can be changed rapidly, if needed

• Consumers like interaction with others

But why use focus groups?

And, by golly,

People LIKE them!

What Kind of Groups?• Adult Clients

• Youth Clients

• Family Members of Adult Clients

• Family Members of Children/Youth

Clients

• Clients/Family on QI Committees

• Monolingual/Non-English Speaking

How many?

About 150 each year!

What’s the Question?

Access and Availability

Beneficiary Protection

Coordination with other Services

Who leads them?

• 1 Family Member (of adult or youth)

• 1 Adult Client

• 1 DMH Technical Assistance and

Training Staff

How are moderators selected?

• DMH “Expert Pool”

• Individual Contracts

• Stipend and Expenses Paid

• Not in your own county!

How are moderators trained?

• Two-day paid workshop

• Faculty = Clients and Family

Members and DMH Staff

• Training is mostly experiential -

role playing

Focus Group Training - Spring, 2002

Focus Group Training - Spring, 2002

Moderator Responsibilities

• Group Leader

• Note Taker

• Report writer

ConductFocus Groups

ConductFocus Groups

WrittenReports

to County

WrittenReports

to County

Verbal ReportVerbal Report

How Information Flows

Three Years of Focus GroupsThree Years of Focus Groups

Evaluation Teams

1 - Family Member of Children/Youth1 - Family Member of Adult Client1 - Adult Consumer1 - DMH Staff

4

Draft State-wide

Report

SelectEvaluation

Teams

TrainEvaluators

Teams ConductEvaluation

DMH Approves and Disseminates

County Directors

Client Orgs.

Family Orgs.

The Evaluation Process

Family Orgs.SQIC

A consistent, collaborative process:

• Team members generate “Theme Lists” independently

• Collaborative ranking of themes

• Report written using final rankings

Analysis by DMH Staff

• Enter demographic data (Excel)• Tally recorded comments• Reconcile results with theme lists• Check with evaluation teams• Draft narrative• Send to Client/Family Member T/F

More Evaluation Process:

Overview of 3 years

Who we saw - Groups

Year 1 Year 2 Year 3

118 157 163

Who we saw - People

Year 1 Year 2 Year 3

776 1195 1161

Who we saw : Types

Type Year 1 Year 2 Year 3Adults 53% 33% 37%

F/Youth 26% 17% 16%

F/Adults 21% 15% 14%

QI 0% 12% 8%

Language N/A 19% 23%

Mixed N/A 4% N/A

Youth 0% 0% 2%

Total 100% 100% 100%

What we have learned

Access Themes

•Staff turnover remains a problem

•Most know how to gain access

•But - it can be complex, difficult

Access Themes - 2

•Once you’re “in,” it’s better

•but long delays persist •They’d like more staff, money, services

Access Quotes

• “Family involvement has worked very well…”

• “Call 1-800-GOOD LUCK.”

• It takes a mental health crisis to get mental health services.”

• We need more clinical staff.”

Themes - BeneficiaryProtection

•B/P system is a fuzzy concept to most

•>50% recall seeing printed material

•BUT - content is not easily recalled

Beneficiary Protection 2

•Process is seen as too complex for clients to navigate without help

•Some fear retaliation if they complain

•BUT- There are few reports of actual retaliation

Beneficiary ProtectionQuotes

• “I’ve seen the yellow brochure and forms but I didn’t read it.”

• “When you’re going thru a crisis situation, you don’t think about any booklet.”

• “I didn’t complain because I didn’t understand the process.”

Coordination Themes

•>50% say it’s good, O.K.

•but A significant minority (up to 50%) say improvement is needed

Coordination Themes - 2•Problems: Communication;

Rx & pharmacy - TARS, Dental & Housing services

•Some Staff are exceptional at linking clients to services

Coordination Themes -3

•Most Frequently mentioned problem:

“My doctor and my psychiatrist don’t communicate!”

Coordination - Quotes

• “Yes, they’ll help with anything.”

• “Mental Health works closely

with my physical care doctor.”

• “I didn’t know they could do that for you.”

New in year 2

Involvement in Quality Improvement

The QI Experience

•Client/Family input has been used in a meaningful way

•Some impact on services is noted

•They’d like more feedback on results

The QI Experience (2)

•More education, training needed

•When it’s good, it’s very, very good…

•And when it’s bad…

QI - Quotes• “The local Mental Health Board is

behind us 100%.”• “Absolutely. We are not considered

part of the problem - we’re part of the solution

• “They talk the talk but they don’t walk the walk.”

• “I’d like to be more than a rubber stamp. They do all the work first, then run it by us.

Room for Improvement

• Close the loop - feedback from county MHPs

• Recruit for specific participant types

• Integrate data from Compliance & Outcomes

The EndThe End

FinallyFinally!!