1. Feedback for Quality Improvement
Addiction Research Institute
Kelly Alanis
Michelle Steinley-Bumgarner

2. FQI Project Overview
Funded by: The Texas Department of State Health Services
Objective: Develop a system to enhance quality improvement of a Behavioral Healthcare network (NorthSTAR) serving indigent and Medicaid clients in a seven-county service area in north Texas
Process: Obtain feedback from network enrollees and direct treatment staff to assess the quality of treatment processes as well as provider staffing and organization

3. Systems Infrastructure for Quality Improvement
Positive Outcomes
Treatment
Process
Program
Change
Structure, climate, & resources
How does this all fit together?
Program Structure
Organizational Climate
Program Resources

4. NorthSTAR Fast Facts
Service region includes 15% of the total population of Texas
Serves 22% of the State’s consumers of mental health services
Serves 32% of alcohol and chemical abuse clients in Texas
YTD monthly average number of persons receiving chemical dependency services: 1,273

5. NorthSTAR Treatment Modalities
Residential / Inpatient
Intensive Outpatient
Supportive Outpatient
Aftercare
Ambulatory Detox
Methadone
Adults
Adolescents

6. Instruments
Survey of Organizational Functioning (SOF): overview of organization from staff’s perspective
* Motivation * Resources
* Staff Attributes * Organizational Climate
Client Evaluation of Self and Treatment (CEST): overview of organization from clients’ perspective
* Treatment Motivation * Psychological Functioning
* Social Functioning * Treatment Process
Program Training Needs (PTN): overview of training needs from staff’s perspective
* Training Needs * Preferences
* Barriers

7. Typical Results
The next several slides illustrate the typical results format as reported to agencies.
For presentation purposes, only SOF results are provided for this example. CEST and PTN reporting is similar.

8. Mean SOF Responses for Agency X vs. NorthSTAR
5: Strongly Agree
4.5
4: Agree
3.5
3: Undecided
Concern?
Click bars.
2.5
Concern?
Click bars.
2: Disagree
1.5
1: Strongly Disagree
Typical results chart provided to agencies
Program Needs Guidance
Staff Needs Training
Pressure For Change
Offices Are Adequate
Staffing Is Adequate
Training Is Adequate
Computers Are Adequate
Internet / Available
Professional Growth Occurs
Staff Are Effective
Staff Have Influence
Staff Are Adaptable
Has Sense of Mission
Staff Work Together Well
Staff Have Autonomy
Communication Is Good
Stress Is High
Program Is Open To Change
Motivation
Resources
Staff Attributes
Organizational Climate

9. Mean SOF Responses: Agency X vs. NorthSTAR
Section
Scale
Agency Average
NorthSTAR Average
Motivation for Change
Program Needs Guidance
2.45
2.59
Staff Needs Training
2.49
2.54
Pressure For Change
2.60
2.85
Resources
Offices Are Adequate
3.86
3.75
Staffing Is Adequate
2.44
3.35
Training Is Adequate
4.04
3.52
Computers Are Adequate
4.08
3.40
Internet / Are Available
3.83
3.72
Staff Attributes
Professional Growth Occurs
3.90
3.77
Staff Are Effective
4.18
4.17
Staff Have Influence
3.96
3.82
Staff Are Adaptable
3.93
3.92
Climate
Has Sense Of Mission
3.66
Staff Work Together Well
3.84
Staff Have Autonomy
3.43
3.79
Communication Is Good
3.30
3.65
Stress Is High
2.91
Program Is Open To Changes
3.50
3.67
Same data as illustrated in previous graph

10. Percent Extreme SOF Responses: Agency X vs. NorthSTAR
Section
Scale
Agency Average
NorthSTAR Average
Resources
Offices Are Adequate 0% 4%
Staffing Is Adequate
38%
Training Is Adequate 3%
Computers Are Adequate 2%
Internet/ Available
Staff Attributes
Professional Growth Occurs
13%
Staff Are Effective
Staff Have Influence 1%
Staff Are Adaptable
Climate
Has Sense Of Mission
Staff Work Together Well
Staff Have Autonomy
Communication Is Good
Stress Is High
16%
Program Is Open To Changes
Extreme scores represent the percentage of individuals whose responses may indicate a reason for concern.
Extreme scores are scale averages of 2 or lower (disagree or strongly disagree) -- an exception is the Stress scale which is counted as extreme if individuals score a 4 or higher (agree or strongly agree).

11. Mean SOF Responses Across All Agencies: Staffing Is Adequate
5: Strongly Agree
4: Agree
3: Undecided
Scale specific response distribution across all agencies
2: Disagree
1: Strongly Disagree
Back

12. Mean SOF Responses Across All Agencies: Stress Is High
5: Strongly Agree
4: Agree
3: Undecided
2: Disagree
1: Strongly Disagree
Back

13. Staffing Is Adequate: Items
58. There are enough counselors here to meet current client needs.
92. A larger support staff is needed to help meet program needs. ®
110. Frequent staff turnover is a problem for this program. ®
111. Counselors here are able to spend enough time with clients.
112. Support staff here have the skills they need to do their jobs.
113. Clinical staff here are well-trained.
Back

14. Stress Is High: Items
50. You are under too many pressures to do your job effectively.
66. Staff members often show signs of stress and strain.
80. The heavy workload here reduces program effectiveness.
97. Staff frustration is common here.
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