1. Change Package Ingham County Nurse Family Partnership
Topic Area: Maternal Depression
Name of the Intervention: If nurse HV’ers have a larger list of mental health providers to refer clients to; they will become more confident with referrals and clients will be better served.
Primary Driver: Standardize processes for referral, treatment and follow-up.

2. Definition of the Intervention
Include: What is the intervention? Include a short definition of the intervention. The intervention the team worked on was developing a more comprehensive list of mental health providers to refer to, in the treatment of Maternal Depression. By seeking out potential providers in the service area, and learning about their programs staff would feel confident when making referrals.

3. Can the team develop a more comprehensive list of current  providers, to help treat Maternal Depression.
The team brain stormed and developed a list of mental health providers that would possibly be good resources for nurses to use with clients .
This list of 21 providers was divided up by the 5 team members, to begin phone contact and briefly assess for services available.
Team members were to ask a) Did they accept medicaid for payment b) what was their current address c) were they accepting new patients.
The final list of 18 providers were sent an invitation to a ‘Lunch and Learn’, to be held at the Health Department. This was to serve as a time for agencies to introduce themselves and their services, and as a time for networking.
A total of 10 agencies attended. Wonderful information was shared, pamphlets given, and future planning sessions were arranged amongst the agencies.
The team will now begin to develop a referral sheet, with all the agencies listed. The plan is to laminate this as a single sheet for staff to carry in their bags and have available during HV’s.

4. How is the intervention carried out?
Model for improvements three fundamental questions;
What are we trying to accomplish: Increase the nurse's knowledge about referral sources that can be used in the treatment of Maternal Depression. Become familiar with what resources are currently taking medicaid clients.  Where are these resources located and how will our families access them?
How will we know a change is an improvement? Nurse Home visitors will have >2 referral sources on their list of EBS, that can be used in treating Maternal Depression.  Nurses (and nurse supervisor), will meet the providers of mental health services in the area, thus increasing their ability to engage clients in these services.
What changes can we make that will result in an improvement? The team will develop a more comprehensive list of current  providers, to help treat Maternal Depression.
The team ran 4 consecutive Plan-Do-Study-Act (PDSA) Cycles, each one incorporated the learning from the previous cycles to make an adjustment to the intervention

5. Cycle 1-Plan and Do Plan Who NFP home visitors and nursing supervisor.
When 
June 11th and June 18th team meetings.
What 
Development of a comprehensive list or available providers.
Where 
During team meetings- at the agency. (Later to go into the home environment)
Tasks or tools required to set up 
Data will be collected during team meetings.   Supervisor will divide up the list of potential referral sources, so that everyone on the list will get a call from someone on the team to : a. verify if the provider is currently taking new clients b. verify current address, phone#, and insurance information  

6. Cycle one (cont) Plan for collection of data Who
Nurse home visitors and supervisor
When 
June11-18th, 2015
What 
Collection of data
Where 
In the office, or field whichever is conducive to phone calling.
Predictions 
If a larger list of providers can be developed, nurses will feel more confident in resources they can use with clients.
Do 
Team Meeting 6/11/15- The team began to brain storm together for a more comprehensive list of potential providers.  A list of 21 potential providers were identified.  This list was divided up equally by the 5 team members.  Objective; to contact the providers on your list, verify demographic information  (address, phone #'s), and whether they are still taking new clients., as well as insurances accepted.

7. Study 
6/25/15- Team meeting, reviewed data that had been collected from staff so far.  Some agencys/resource assessments have not been completed yet, due to not being able to connect with them or the nurse not having time.      It was agreed the due date would be July 3rd, and that all information would be listed in the agencies ‘S' drive for all to see.  At the next team meeting, (July 7th), the list would be finalized and a target date for the 'Lunch and Learn' would be set.

8. Cycle two: What question(s) do we want to answer on this PDSA cycle?
Can the team develop a more comprehensive list of current  providers, to help treat Maternal Depression. 7/6/15- 1) Will we be able to organize a successful 'Lunch and Learn', that is helpful for the NFP team to learn more about Maternal Depression and the resources in the area.  Note: this will most likely be opened up to other HV teams within the Health Dept.  2) Is the Health Dept. an appropriate location for this activity.
Plan
Who 
NFP home visitors and nursing supervisor.
When 
July 15th team meeting
What   (7/6/15)-  Begin planning of the 'Lunch and Learn', settling on the date, and assignment of tasks.
Where 
During team meetings- at the agency.
Tasks or tools required to set up 
Data will be collected during team meetings.   Supervisor and staff will decide on the date for the 'Lunch and Learn'. Tasks for this event  will be identified and assigned to appropriate staff . 
Plan for collection of data
Who: Nurse home visitors and supervisor
July 15th-July 30th.
What 
Begin planning for a resource and data gathering luncheon (Lunch and Learn).
Team meeting for NFP staff (luncheon may or may not be held at the agency).
Predictions 
If a larger list of providers can be developed, nurses will feel more confident in resources they can use with clients. 7/6/15-By gathering representatives together, from multiple agencies that serve clients with Maternal Depression, staff will feel more confident in the referral process.

9. Cycle two- Do, Study, Act Do
Team Meeting 6/11/15- The team began to brain storm together for a more comprehensive list of potential providers.  A list of 21 potential providers were identified.  This list was divided up equally by the 5 team members.  Objective; to contact the providers on your list, verify demographic information  (address, phone #'s), and whether they are still taking new clients., as well as insurances accepted. 7/6/15-  With an updated list of providers, and a face-to-face meeting of these providers; there will be an increase in clients using these resources.
Study 
6/25/15- Team meeting, reviewed data that had been collected from staff so far.  Some agencys/resource assessments have not been completed yet, due to not being able to connect with them or the nurse not having time.      It was agreed the due date would be July 3rd, and that all information would be listed in the 's' drive for all to see.  At the next team meeting, (July 15th), the list would be finalized and a target date for the 'Lunch and Learn' would be set. 7/6/15 It has been surprising to see how many available resources there are for clients, and that sliding scale to no fee is often available.
Act 
We have not been able to compile results yet.

10. Cycle 3 What question(s) do we want to answer on this PDSA cycle
Cycle 3 What question(s) do we want to answer on this PDSA cycle?  Can the team develop a more comprehensive list of current  providers, to help treat Maternal Depression. 7/24/15-The " Lunch and Learn", date and time  has been established- August 26th, 12-1pm.  Will we have a successful turnout?  Will the information shared be helpful in gathering resources for future referrals to mental health providers?  Can this format be helpful in the future?
Plan
Who 
NFP home visitors, nursing supervisor., providers invited to the Lunch and Learn.
When 
August 26th, 2015
What   Lunch and learn event to be held on August 26th  This event is providing an opportunity for networking amongst  the NFP staff and mental health providers in the area.
Where 
Ingham Co. Health Department, Conference room C
Tasks or tools required to set up 
Invitations will be sent out to the identified providers by July 30th, with an RSVP back to Nola. Menu for luncheon will be agreed upon and ordered by 8/24/15.
Plan for collection of data
Nurse home visitors and supervisor
July 25th- Aug. 30th
What 
Compiling of data gathered at the 'Lunch and Learn'.
August team meetings for NFP staff.

11. Cycle 3- Predictions/Do
At the end of the luncheon, the NFP staff will have a larger list of providers to begin to pull together as resources for their clients suffering from Maternal Depression. If a larger list of providers can be developed, nurses will feel more confident in resources they can use with clients, and in getting the proper care for their clients.    
Do 
Nurses will feel better equipped to offer EB'ed services to their clients.

12. Cycle 4- Plan
What question(s) do we want to answer on this PDSA cycle? 
Can the team develop a more comprehensive list of current  providers, to help treat Maternal Depression. 7/24/15-The " Lunch and Learn", date and time  has been established- August 26th, 12-1pm.  Will we have a successful turnout?  Will the information shared be helpful in gathering resources for future referrals to mental health providers?  Can this format be helpful in the future?
Plan
Who 
NFP home visitors, nursing supervisor., providers invited to the Lunch and Learn.
When 
August 26th, 2015
What   Lunch and learn event to be held on August 26th  This event is providing an opportunity for networking amongst  the NFP staff and mental health providers in the area.
Where 
Ingham Co. Health Department, Conference room C
Tasks or tools required to set up 
Invitations will be sent out to the identified providers by July 30th, with an RSVP back to Nola Schramm. Menu for luncheon will be agreed upon and ordered by 8/24/15.

13. Cycle 4 (cont)
Study 
On August 26th, the 'Lunch and Learn', took place as scheduled.  Seventeen invitations were sent out and 10 providers attended.  A great round table discussion ensued.  Providers shared; 1)How long they have been in the community  2)Population they serve  3) Medicaid provider or not  4)How do we make referrals  5)Where are they located? There was also opportunity for agencies to do some networking amongst themselves. NFP nursing staff took great notes. 4/4 nurses saw this as a successful luncheon. We hope to compile a laminated referral sheet that can be taken, with the nurse, into the home as a reference when the 'maternal depression' resources are needed.
Act 
The plan was to have >2 referral sources for their  clients with maternal depression.  There are now 7-9 new resources that can be added to this list.  The nurses were excited to learn about these local resources and what they can offer clients.  Some of these resources can be used immediately.  In designing our referral list we want it to be easily referenced.   This indeed, was a successful way to learn about more resources. The next cycle will include making the referral sheet. The team has also begun the Mother baby course and we will develop PDSA cycles around that.

14. Pre-requisites for the intervention
What is needed in order to have success with this intervention?
The team is still working with this intervention as of Sept We will get our resources list finalized and laminated. Feedback in the future will include looking at, how well the new resources are being used by clients.

15. Advice Barriers / Challenges Key advice to overcome barriers
1) Gathering the best resources
1)Start with the most frequently used resources. Consider the document a changing, evolving resource list.
2)Getting good response for the Lunch& Learn, when professionals are busy.
2) Provide food as an incentive!
Choose the day of the week wisely, we
chose Wednesday, hoping more
employees would be in town.
3) Finding a good place to meet.
3) Find a central location as much as possible, and an expandable room.
4) Making it valuable for all.
4) Pre-work should include identifying what the project is about when doing initial contacts. (Get invitees excited)

16. Adaptations (if applicable)
Are there adaptations of this information?
The idea of a ‘Lunch and Learn’, was taken from a previous LIA, that presented at a Learning session. We found it a good option with the problem we were facing.

17. N

18. References
NFP TEAM Liz Amos- Nurse Homevisitor Celeste Davison- Nurse Homevisitor Teresa Spears- Nurse Homevisitor Shajuana Tyson- Nurse Homevisitor Nola Schramm-Nursing ( )