Presentation is loading. Please wait.

Presentation is loading. Please wait.

PCCYFS 2012 Annual Spring Conference 02/2/12 Fidelity Management: Increasing Provider Negotiating Strength in the Environment of Evidence-based Programs.

Similar presentations


Presentation on theme: "PCCYFS 2012 Annual Spring Conference 02/2/12 Fidelity Management: Increasing Provider Negotiating Strength in the Environment of Evidence-based Programs."— Presentation transcript:

1 PCCYFS 2012 Annual Spring Conference 02/2/12 Fidelity Management: Increasing Provider Negotiating Strength in the Environment of Evidence-based Programs Presented By: Wesley Spectrum Services Doug Muetzel, Pamela Meadowcroft & Pamela Weaver For more information, please contact Doug Muetzel, CEO, , 1

2 PCCYFS 2012 Annual Spring Conference 2 Agenda Introductions and “setting the stage” for CEOs in the EBP environment Scenario Building: Experiences with EBP Case Study: WSIH – survived and thrived Workshop case: participant selection Summary lessons learned Wesley Spectrum Services (c) 2

3 PCCYFS 2012 Annual Spring Conference 3 Learning Objectives Benefits and limitations of evidence- based models Alternative to packaged models (comparable level of accountability for less cost) How to use in your organization / program How to use “Fidelity Management” to create funding case Wesley Spectrum Services (c) 3

4 PCCYFS 2012 Annual Spring Conference 4 1. Setting the stage Introductions CEO perspective – it starts with mission – must be sustainable – “mantra” to live by Blue Print Evidenced Based Models – create a dilemma for CEO’s Wesley Spectrum Services (c) 4

5 PCCYFS 2012 Annual Spring Conference 5 Wesley Spectrum Services (c) 5 Payor ROI Confidence Referrals a large“gap”emerged… payors had minimal data and lacked confidence in their ROI EBP a reasonable solution that filled the gap the realities have created a real dilemma for CEOs

6 PCCYFS 2012 Annual Spring Conference 6 Wesley Spectrum Services (c) 6 Volume Quality inherent in “fee for service” model is the requirement of maximizing volume to sustain the business mission advancement and sustainability driven by quality CEO charged with sustainability and mission advancement

7 PCCYFS 2012 Annual Spring Conference 7 Wesley Spectrum Services (c) 7 Costs Quality does quality ever cost too much? quality is related to cost Digress Unit costs and reducing cost for sustainability

8 PCCYFS 2012 Annual Spring Conference 8 Wesley Spectrum Services (c) 8 Quantity (census) Quality do we really know what payors will pay for? balancing quality and quantity

9 PCCYFS 2012 Annual Spring Conference 9 Stakeholder perspective helps us understand complexity of social services and our marketing context: Allegheny County Marc Cherna Marcia Sturdivant Pat Valentine Case managers Providers CEO Program Directors Direct care workers Commonwealth Legislators DPW Secretary Deputy Secretary Managed Care (CCBH) CEO/management Case managers Sellers of Evidenced Based Programs Researchers Consultants Context: Marketing Wesley Spectrum Services (c) 9

10 PCCYFS 2012 Annual Spring Conference 10 EBP Service Contracts In the future …. Standardized contracts to require agreed upon evidence-based performance measures and outcome data Adherence to the principles of the Standardized Program Evaluation Protocol (SPEP) –Dosage should be consistent with what research indicates is effective –Do providers have internal protocols for monitoring adherence to written policies? Fiscal policy supporting evidence-based programming [based on Pennsylvania’s Juvenile Justice System Enhancement Strategy (JJSES) 12/12/11) Wesley Spectrum Services (c) 10

11 PCCYFS 2012 Annual Spring Conference Scenario Building Wesley Spectrum Services (c) 11 What has been your experience with Evidence-based practices, programs, or models?

12 PCCYFS 2012 Annual Spring Conference 12 Evidence based practice environment Context: increased accountability in resource strained times; lack of consistent outcomes; program clutter; “fee for service” volume Benefits: increased confidence in outcomes, guaranteed results and efficiency for specific populations, funder commitment Limitations: cost, limited external validity, fidelity and scalability Wesley Spectrum Services (c) 12

13 PCCYFS 2012 Annual Spring Conference 13 Programs / interventions can be placed along a “proof of effectiveness” continuum How confident are we that a program will improve outcomes? Wesley Spectrum Services (c) 13 Not much confidence Best Practices “We’ve done it and we like it” Promising Practices “We really think this will work… but we need time to prove it” Research-based “This program is based on sound theory informed by research” Evidence-based “This program has been rigorously evaluated and shown to work” Very much confidence Bumbarger, B. K. (2009). Promoting the Use of Evidence-based Prevention: Application in the Real World. Available online at https://breeze.psu.edu/p https://breeze.psu.edu/p

14 PCCYFS 2012 Annual Spring Conference 14 Evidence-based Programming and Interventions The Evidence-based Prevention and Intervention Support Center (EPISCenter at Penn State University) 1.Big Brother Big Sisters 2.Functional Family Therapy 3.Life Skills Training Program 4.Multidimensional Treatment Foster Care 5.Multisystemic Therapy 6.Olweus Bullying Prevention Program 7.Project Toward No Drug Abuse 8.Promoting Alternative Thinking Strategies 9.Strengthening Families 10.The Incredible Years 11.Aggression Replacement Training Wesley Spectrum Services (c) 14 The EPISCenter supports the dissemination, quality implementation, sustainability, and impact assessment of proven-effective prevention and intervention programs, and conducts original research to advance the science and practice of evidence-based programs. Evidence-based Programs Supported [From Pennsylvania’s Juvenile Justice System Enhancement Strategy (JJSES) 12/12/11]

15 PCCYFS 2012 Annual Spring Conference 15 What is Value? 15 Wesley Spectrum Services (c) NUMBERS OF AND FAMES SERVED and AFFORDABILITY QUALITY Lower Quality/no outcomes Higher Quality/proven effectiveness Greater access, higher volume CURRENT SYSTEM THE FUTURE: Evidence-based locally-developed models within context of CQI Lower access, smaller volume THE PAST THE CATALYST: Evidence-based (RCT) brand-models

16 PCCYFS 2012 Annual Spring Conference Case Study: WSIH survived and thrived Wesley Spectrum Services (c) 16

17 PCCYFS 2012 Annual Spring Conference 17 Wesley Spectrum In Home: History of Tracking Outcomes Wesley Spectrum Services (c) 17

18 PCCYFS 2012 Annual Spring Conference 18 But… Why Good Outcomes? Easier population? OR Something we are DOING (our interventions/program model)? In other words: TRACKING OUTCOMES IS NOT ENOUGH 18

19 PCCYFS 2012 Annual Spring Conference 19 We Know a Lot About What Works! Meta-analyses on thousands of studies Many programs ARE using research- based practices They just have not MEASURED and TRACKED their work!!! Which lead WISH down a different path: Fidelity Management 19

20 PCCYFS 2012 Annual Spring Conference 20 Alternative to proprietary EBP Fidelity Management: Five Key Steps 1.Define program key ingredients that are research-supported 2.Develop Fidelity metrics for use during supervision 3.Develop/refine outcome measures and incorporate into tracking tools 4.Validate your model (relate Fidelity measures to Outcome measures) 5.Use in CQI Wesley Spectrum Services (c) 20

21 PCCYFS 2012 Annual Spring Conference 21 Step #1: Define the Program Logic Model Key program components –Specific population –Staff selection and training –What the staff does –How they are supervised –Expected outputs and outcomes –Suggested measures Example of Logic Model Developing from existing performance data Wesley Spectrum Services (c) 21

22 PCCYFS 2012 Annual Spring Conference 22 Verify Program Elements with Existing Research Literature review or “common elements” (Lipsey or Chorpita) Eliminate from tracking anything that doesn’t have existing research support Examples Wesley Spectrum Services (c) 22

23 PCCYFS 2012 Annual Spring Conference 23 Step #2 and #3: Develop and Track Model Fidelity and Outcomes Therapist and Supervisor Checklist (Intake, Monthly, Discharge) Scores: –Who we are serving (population assessments) –What are we doing (outputs related to key activities, intensity of services) –How did we do (client outcomes) Consumer Satisfaction Survey Scores –Items relate to key program activities; additional output measures Wesley Spectrum Services (c) 23

24 PCCYFS 2012 Annual Spring Conference 24 Step #4: Relate Fidelity and Outcomes High fidelity to the model leads to the best outcomes (ideal results and actual sample data) Wesley Spectrum Services (c) 24

25 PCCYFS 2012 Annual Spring Conference 25 Higher Model Fidelity Improved Child Well-Being: Strong Relationship between Model Fidelity and Outcomes Wesley Spectrum Services (c) 25

26 PCCYFS 2012 Annual Spring Conference 26 Step #5: Build in CQI: Model Fidelity Comparison of Two Sites Wesley Spectrum Services (c) 26

27 PCCYFS 2012 Annual Spring Conference Workshop Case Why your programs can and should do Fidelity Management –Marketing of what your program DOES THAT MATTERS (i.e., is supported by existing research) –Increased likelihood that you’ll produce positive outcomes –Efficiency (unit cost) and effectiveness (related to outcomes) Wesley Spectrum Services (c) 27

28 PCCYFS 2012 Annual Spring Conference 28 Workshop Case: participant program Try-out the five steps of Fidelity Management Wesley Spectrum Services (c) 28

29 PCCYFS 2012 Annual Spring Conference 29 More Reasons to Locally Develop EBP Wesley Spectrum Services (c) 29

30 PCCYFS 2012 Annual Spring Conference 30 Yet More Reasons... Mark Lipsey, “Evidence-based Practice More than One Approach.” MST and FFT (two brand-names) show positive results, the dark boxes, but even “generic” interventions showed better results. Wesley Spectrum Services (c) 30 From

31 PCCYFS 2012 Annual Spring Conference 31 Yet more reasons…cost-benefit Wesley Spectrum Services (c) 31

32 PCCYFS 2012 Annual Spring Conference 32 Cost Comparison MST vs. WSIH Based on Washington State Institute Public Policy work Main benefit of Youth Intervention programs is reduction in crime Compared Allegheny youth who completed either MST or WSIH treatment 32 Wesley Spectrum Services (c)

33 PCCYFS 2012 Annual Spring Conference 33 Wesley Spectrum Services (c) ProgramBenefitCompleted cases Average hrs/client Cost/unit service Cost per completed case Return on investment (per $1 invested) MST ( )$14,996 per participant 22 or 49% of all served (12 months 2010) 55.5 hrs/client $138.96/ hr $8, Wesley Spectrum In Home $14,996 per participant 69 or 78% of all served (six months 2011) hrs/client $51.94/hr$1,

34 PCCYFS 2012 Annual Spring Conference 34 Brand-name EBP vs. Local-developed EBP Proprietary EBP $millions for research and evaluation Many decades research/development Highly prescribed High level accountability High level marketability Low adaptability High effort Scalability (and ongoing cost) Community connections have to be built (and sometimes don’t happen) Wesley Spectrum Services (c) 34 Locally Developed EBP Low-cost research and evaluation in short-time Moderate level program requirements Lower program cost Very good level accountability Need to develop marketing zeitgeist Greater utility across populations Greater access for consumers Embedded in CQI Tools for incorporating new practices Staff commitment

35 PCCYFS 2012 Annual Spring Conference 35 Marketing Brand-name EBPs leg-up How-to for locally developed (using Workshop Case from participants) Wesley Spectrum Services (c) 35

36 PCCYFS 2012 Annual Spring Conference 36 Key Conclusions Evidence based models pose limitations that Fidelity Management does not Fidelity Management is replicable so other programs could do the same The process gives programs the supervision and monitoring tools for continuous improvement AND for making the case of value to stakeholders Gives CEOs a tool for aligning unit cost and outcomes -- sustainability Wesley Spectrum Services (c) 36

37 PCCYFS 2012 Annual Spring Conference 37 How’d We Do? Benefits and limitations of evidence-based models Alternative to packaged models (comparable level of accountability for less cost) How to use in your organization/program How to use “Fidelity Management” to create funding case Wesley Spectrum Services (c) 37

38 PCCYFS 2012 Annual Spring Conference 38 Don’t Forget… Wesley Spectrum Services (c) 38


Download ppt "PCCYFS 2012 Annual Spring Conference 02/2/12 Fidelity Management: Increasing Provider Negotiating Strength in the Environment of Evidence-based Programs."

Similar presentations


Ads by Google