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Public Health Notice Contagious Disease Hazard City and County of San Francisco.

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Presentation on theme: "Public Health Notice Contagious Disease Hazard City and County of San Francisco."— Presentation transcript:


2 Public Health Notice Contagious Disease Hazard City and County of San Francisco




6 Oversight, Performance And Focus Groups

7 Using Focus Groups in State Oversight of County Medicaid Managed Care Specialty Mental Health Services

8 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

9 Obtain direct input from consumers and families Employ consumers and families as reviewers and moderators DMH Policy


11 California Counties run their own mental health programs (MHP’s) State DMH provides oversight and some direct services And…

12 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

13 Oversight = (C+QI+TAT) Compliance + QI +Tech. Assistance &Training Or,

14 A Quality Improvement Mantra For Our Times: “Good news is no news” “No news is bad news” “Bad news is good news ”

15 Who Said That? Free Lunch to the Person Who Can Tell Us!

16 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?

17 And, by golly, People LIKE them!

18 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

19 How many? About 150 each year!

20 What’s the Question? Access and Availability Beneficiary Protection Coordination with other Services

21 Who leads them? 1 Family Member (of adult or youth) 1 Adult Client 1 DMH Technical Assistance and Training Staff

22 How are moderators selected? DMH “Expert Pool” Individual Contracts Stipend and Expenses Paid Not in your own county!

23 How are moderators trained? Two-day paid workshop Faculty = Clients and Family Members and DMH Staff Training is mostly experiential - role playing

24 Focus Group Training - Spring, 2002


26 Moderator Responsibilities Group Leader Note Taker Report writer

27 Conduct Focus Groups Written Reports to County Verbal Report How Information Flows

28 Three Years of Focus Groups

29 Evaluation Teams 1 - Family Member of Children/Youth 1 - Family Member of Adult Client 1 - Adult Consumer 1 - DMH Staff 4

30 Draft State- wide Report Select Evaluation Teams Train Evaluators Teams Conduct Evaluation DMH Approves and Disseminates County Directors Client Orgs. Family Orgs. The Evaluation Process Family Orgs. SQIC

31 A consistent, collaborative process: Team members generate “Theme Lists” independently Collaborative ranking of themes Report written using final rankings

32 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:

33 Overview of 3 years

34 Who we saw - Groups Year 1Year 2Year 3 118157163

35 Who we saw - People Year 1Year 2Year 3 7761195 1161

36 Who we saw : Types TypeYear 1Year 2Year 3 Adults53%33%37% F/Youth26%17%16% F/Adults21%15%14% QI0%12%8% LanguageN/A19%23% MixedN/A4%N/A Youth0% 2% Total100%


38 What we have learned

39 Access Themes Staff turnover remains a problem Most know how to gain access But - it can be complex, difficult

40 Access Themes - 2 Once you’re “in,” it’s better but long delays persist They’d like more staff, money, services

41 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.”

42 Themes - Beneficiary Protection B/P system is a fuzzy concept to most >50% recall seeing printed material BUT - content is not easily recalled

43 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

44 Beneficiary Protection Quotes “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.”

45 Coordination Themes >50% say it’s good, O.K. but A significant minority (up to 50%) say improvement is needed

46 Coordination Themes - 2 Problems: Communication; Rx & pharmacy - TARS, Dental & Housing services Some Staff are exceptional at linking clients to services

47 Coordination Themes -3 Most Frequently mentioned problem: “My doctor and my psychiatrist don’t communicate!”

48 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.”

49 New in year 2 Involvement in Quality Improvement

50 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

51 The QI Experience (2) More education, training needed When it’s good, it’s very, very good… And when it’s bad…

52 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.

53 Room for Improvement Close the loop - feedback from county MHPs Recruit for specific participant types Integrate data from Compliance & Outcomes

54 The End Finally !

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