Presentation on theme: "Public Health Notice Contagious Disease Hazard City and County of San Francisco."— Presentation transcript:
Public Health Notice Contagious Disease Hazard City and County of San Francisco
Oversight, Performance And 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 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 Focus Groups ( Participants) Prepare draft reports to County Hold exit discussion Prepare final reports to County - 30 days TAT makes follow-up visits
A Quality Improvement Mantra For 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
Moderator Responsibilities Group Leader Note Taker Report writer
Conduct Focus Groups Written Reports to County Verbal Report How Information Flows
Three Years of Focus Groups
Evaluation Teams 1 - Family Member of Children/Youth 1 - Family Member of Adult Client 1 - Adult Consumer 1 - DMH Staff 4
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
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 1Year 2Year
Who we saw - People Year 1Year 2Year
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%
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 GOOD LUCK.” It takes a mental health crisis to get mental health services.” We need more clinical staff.”
Themes - Beneficiary Protection 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 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.”
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