1. Administration for Children and Families
Tribal Home Visiting: Building Capacity for Data-Driven Quality Improvement
Moushumi Beltangady
Administration for Children and Families
Julie R. Morales
James Bell Associates
2015

2. Tribal Maternal, Infant and Early Childhood Home Visiting Program
Administered by ACF in collaboration with HRSA
Funded through ACA, MIECHV includes 3% set aside for tribal program
25 cooperative agreements awarded to Tribes, Tribal consortia, Tribal organizations and urban Indian organizations
5-year grants that begin with a needs assessment and a planning year
3 cohorts: 13 in FY 2010, 6 awarded in FY 2011, 6 awarded in FY 2012
Grantees must report to ACF on performance measures, conduct rigorous evaluation and engage in continuous quality improvement activities
Port Gamble S’Klallam Tribe

3. TEI consists of: James Bell Associates, Inc.
Johns Hopkins Bloomberg School of Public Health, Center for American Indian Health
University of Colorado School of Public Health, Centers for American Indian and Alaska Native Health
MDRC

4. TEI Federal partners Office of Planning, Research and Evaluation
Administration for Children and Families, Office of the Assistant Secretary for Early Childhood Development
Office of Child Care

5. TEI provides guidance on:
Tracking and reporting on benchmarks (i.e., performance measures)
Rigorous evaluation
Data systems
Continuous Quality Improvement
Ethical dissemination and knowledge translation
Taos Pueblo

6. What is Continuous Quality Improvement?
“QI is the use of a deliberate and defined improvement process, such as Plan-Do-Study-Act, which is focused on activities that are responsive to community needs and improving population health. It refers to a continuous and ongoing effort to achieve measurable improvements in the efficiency, effectiveness, performance, accountability, outcomes, and other indicators of quality in services or processes which achieve equity and improve the health of the community.”
Bialek, R., Beitsch, L. M., Cofsky, A., Corso, L., Moran, J., Riley, W., & Russo, P. (2009). Proceedings from Accreditation Coalition Workgroup: Quality Improvement in Public Health.

7. CQI Capacity Building Approach
Drawing from adult learning principles & strategies
Self-directed learning
Active Learner participation
Solution centeredness
Tribal and local focus
Crafted around grantee’s own data and unique program needs
Inclusive
Resources and supports to engage entire home visiting team
Developmental
Start with fundamentals
Building on existing team based strengths and knowledge
Engaged peer-based learning

8. CQI Regional Workshops
Grantee preparation for workshop attendance
Select existing topic of focus
Create trend charts (tools and supports provided)
Grantees encouraged to bring entire home visiting team
Coordinator/Director
Home Visitors
Evaluators/Data Analysts

9. CQI Regional Workshops
Facilitated by Michigan Public Health Institute with TEI
Robin VanDerMoere
Angela Precht
Smaller group of grantees facilitates peer learning
Attended by only 6 grantee teams at one time
Establishing safe, non-punitive context for team learning
Models culture of learning

10. CQI Regional Workshops: 3 days
Content overview blended with interactive team exercises
Foundational CQI concepts and tools
Peer sharing to larger group following each exercise
Reflection on utility and learnings
Grantees engage in 9 step PDSA process
Each grantee team designs first CQI project
Develops fundamentals for first test of change

11. CQI Regional Workshops: 3 days
Hands-on and interactive introduction to CQI principles
CQI & PDSA cycles
Using Tools & Skill building
Defining problem & precise targets for tests of change
Using SMART Goals
Drilling down into data
Examining current data
Establishing baselines
Identifying possible causes
Targeting a solution
Using a team charter and CQI Meeting Agenda

12. Grantee’s Targeted CQI Topics
Cohort 1
Family Engagement (home visit completion; 5)
Domestic Violence Screening (4)
Developmental Screening (2)
Family Retention
Parenting Skills Assessment
Cohort 2:
Family Engagement (4)
Family Retention (2)

13. Communities of Learning (CoL)
Grantees provide updated CQI Team Charter
Two months following workshop
CQI PDSA Progress summarized for CoL
Grantees attend first CQI community of learning call
2 months after Regional Workshop and quarterly thereafter
Fellow CQI Regional Workshop grantees attending
Share CQI work to date
Updates to Aim Statements
Refinements to test of change
Share lessons learned from planning & tests of change

14. Advantages of Approach
Great compliment to benchmark data requirement
Grantees see how they can use all the data they collect
Grantees have most readily engaged with CQI
Less of a time commitment, more immediate learnings
Can address implementation challenges
Inclusive, team oriented approach
Grantees find it useful

15. CQI Capacity Building: What Works
Purposeful and strategic preparation for CQI training
Setting expectations for full team participation
Intensive tribal grantee centered CQI Workshops
Hands on applied learning
Focused and guided participation
Accommodating various levels of expertise
Recognizing team dynamics
Clearly defined follow up expectations

16. For more information on TEI contact: Nicole Denmark Kate Lyon
The Tribal Home Visiting Evaluation Institute (TEI) is funded by the Office of Planning, Research and Evaluation, Administration for Children and Families, Department of Health and Human Services under contract number HHSP WC.
TEI is funded to provide technical assistance to Tribal Home Visiting grantees on rigorous evaluation, performance measurement, continuous quality improvement, data systems, and ethical dissemination and translation of evaluation findings.
TEI1 was awarded to MDRC; James Bell Associates, Inc.; Johns Hopkins Bloomberg School of Public Health, Center for American Indian Health, and University of Colorado School of Public Health, Centers for American Indian and Alaska Native Health.
For more information on TEI contact:
Nicole Denmark Kate Lyon
Federal Project Officer Project Director
Office of Planning Research and Evaluation James Bell Associates, Inc.
The Tribal Evaluation Institute is funded by the Office of Planning, research and Evaluation within the Administration for Children and Families. TEI was awarded to James Bell Associates in partnership with the University of Colorado’s Centers for American Indian and Alaska Native Health and Michigan Public Health Institute. For more information, contact the individuals on this slide.