Rhode Island Maternal Depression CQI Learning Collaborative Learning Session 2 Meeting June 12, 2019 9:00 a.m. – 4:15 p.m.

Rhode Island Maternal Depression CQI Learning Collaborative Learning Session 2 Meeting
June 12, 2019 9:00 a.m. – 4:15 p.m.

Today’s Agenda Break Review PD2 and PD3
Welcome and Overview Team Presentation Break Review PD2 and PD3 Training: Introduction to Motivational Interviewing Change Prioritization Assessment Lunch Parent Leadership PDSA Pointers Team Time: PDSA Development Peer PDSA Review Wrap Up Report Out Today’s Agenda In addition to the objectives listed we will save time for questions and answers. Welcome and Overview Team Presentation Review PD2 and PD3 Training Lunch Sharing Tools Primary Driver and Change Prioritization Assessment PDSA Pointers Team Time: PDSA Development Break Peer PDSA Review Report Out Wrap Up

Learning Session 2 Welcome and Overview Team Presentation Break Review PD2 and PD3 Training: Introduction to Motivational Interviewing Change Prioritization Assessment Lunch Parent Leadership PDSA Pointers Team Time: PDSA Development Break Peer PDSA Review Wrap Up Report Out

Our Collaborative AIM 85% of women who screen positive for depression & access services will report a 25% reduction in symptoms 12 weeks (from 1st service contact).

Why Maternal Depression?
Many affected 40-60% of mothers in early childhood home visiting experience elevated symptoms of maternal depression; 10-15% have major depression Many missed Only 65% of mothers in home visiting are screened for depression Many unserved Only 57% of mothers with elevated symptoms are referred for services Presenter: Kristy Notes: National data confirms the work we do is important

Regular Support to Teams to Teach QI and Theory
Coaching Monthly collaborative calls 1:1 and small group coaching QI training to enhance skills Learning Sessions SMART AIM review Learn QI Methods Get started> Get a stride> Sustain Action Periods (time between Learning Sessions) Test changes Collect and monitor data

Collaborative Overview for 2019
Where we are today @ LS 1 end of the day feedback asked for training on MI, excited to have Stephanie here today

Objectives for Learning Session 2
1. Review our shared vision: review importance of the work with our shared SMART Aim 2. Review tools, tips, and resources 3. Plan your next PDSA Tools and resources: Change Package/Key Driver Diagram, Storyboards, PDSA Development, PDSA Testing, Empathy, and Parent Involvement and Leadership

Your State Team Kristy Whitcomb Collaborative Coordinator Sarah Bowman
Improvement Advisor (CCF, CCA) Sara Remington Improvement Advisor (CF, FHH) Jamie Comella Senior Sponsor Jenna Maloney Project Director Luisa DePina Expert Faculty Jaime and Jim to introduce themselves and give a brief update on Moms PRN progress.

Content Experts for Advisement
Luisa DePina Expert Faculty Rebecca Silver Expert Faculty Christine M. Low Expert Faculty Susan Dickstein Expert Faculty

Introductions Children’s Friend (HFA) Federal Hill House (PAT)
Community Care Alliance (HFA) Children’s Friend (NFP) Connecting for Children and Families (PAT) Introductions

Handouts for this Session
PDSA Form PDSA Form – Guidance Driver Prioritization Resource Handouts for this Session Key Driver Diagram Change Prioritization Resource PD Feedback Form Although your state team will not complete any work on todays call as it is information only- Ive called out a few resources and areas that you might consider team time when introducing this theory to teams. We have our updated KDD on our website which has live links to what we refer to as the gold standard changes- meaning teams tested, faculty and teams had a high degree of belief in the change and data showed that testing the intervention was linked to improvement in the process measures and the eventual smart aim. Secondly we developed a Primary driver self assessment teams can use to prioritize their current status in the driver and the potential impact it could have in their community- this helps teams hone in on a potential starting point for testing. Lastly we developed a change assessment- so teams can identify what interventions they already have in place, where they could strengthen their processes a bit and where they have major gaps, again to help them narrow down their starting point within the change package.

Tools for Team Reflections
End of the presentation During Presentation Here we will have a self assessment teams can use to reflect on their own status within this driver- again this will help them identify a starting point for later testing.

Key Driver Diagram: Our Roadmap
How You Get There! What needs to be in place to reach SMART aim. Evidenced-based, necessary, and sufficient The Key Driver diagram serves as the roadmap that visually displays a shared theory of how things might get better within a system of care based on information gathered through research, observation and experience. by the end of the collaborative teams will have worked across the drivers and our hunch is that by doing so teams will meet the overall smart aim we will focus on the primary drivers- critical systems elements that are necessary and sufficient to achieve the aim and changes for putting those drivers into place

Key Driver Diagram: Our Roadmap
How You Get There! What needs to be in place to reach SMART aim. Evidenced-based, necessary, and sufficient

Seven Generations Children’s Friend HfA

Primary Driver: _1_ Change Idea: Policy and protocol for screening to include periodicity (e.g., prenatally, postnatally, rescreening as needed)Name of Test: Increase the number of mother’s rescreened at appropriate intervals. Insert here: What did you test on the 4th PDSA Cycle Insert here: What did you test on the 3rd PDSA Cycle RAMP: We will expand our test to include all anticipated PHQ9 rescreens in the month of May for all Family Support Specialist. We know that the first two individuals we were tracking for PHQ9 rescreen completion were completed in appropriate timeframe. We are still analyzing data re: PHQ9 completion in a timely manner for the entire team. Preliminary assessments indicate that rescreens are being completed in the correct timeframes. The HFA CQI team will deliver a training to the HFA team on Maternal Depression Rescreening Best Practice Guidelines. CQI team will pick two families that have upcoming re-screens due, and monitor to see if re-screens are completed. 1st PDSA Cycle

Primary Driver: _2_ Change Idea: Training/education of home visitors on maternal depression symptoms, impact, and treatment Name of Test: Increase the knowledge and skills of Family Support Specialists to address perinatal mood disorders. Insert here: What did you test on the 4th PDSA Cycle Insert here: What did you test on the 3rd PDSA Cycle Nine HFA staff will attend a two hour Mothers and Babies training. After completing the training, they will receive a certificate of completion. . Seven staff, as well as the Supervisor and Program Manager, were trained in the first training session of Mothers and Babies. The HFA CQI team will deliver a training to the HFA team on Maternal Depression Rescreening Best Practice Guidelines. CQI team will pick two families that have upcoming re-screens due, and monitor to see if re-screens are completed. 2nd PDSA Cycle

Insert here: What did you test on the 4th PDSA Cycle
Primary Driver: _2_ Change Idea: Introduce M&B as part of the usual HV curriculum, refer to it as a 'stress reducing' practice, and complete Session 1 including worksheets.Name of Test: To learn how to comfortably and effectively introduce M&B curriculum with 2-3 clients. Insert here: What did you test on the 4th PDSA Cycle To learn how to comfortably and effectively introduce M&B curriculum with 2-3 clients Nine HFA staff will attend a two hour training Mothers and Babies. After completing the training, they will receive a certificate of completion. . Each of the seven staff who attended the M&B training were asked to complete a questionnaire regarding their comfort level. The questionnaire included questions regarding how much time the worker prepped, their comfort level before and after introducing the curriculum, as well as the clients response. The HFA CQI team will deliver a training to the HFA team on Maternal Depression Rescreening Best Practice Guidelines. CQI team will pick two families that have upcoming re-screens due, and monitor to see if re-screens are completed. 3rd PDSA Cycle

Reflections from Action Period 1:
Team Success The entire team has received training on the appropriate timeframe guidelines for re-screening the PHQ9. As a result of this training, we have seen an increase in the number of families that are receiving re-screens within the correct timeframes. 7 of 9 of our direct service staff, as well as the Supervisor and Program Manager, have received Mothers and Babies, and the team is not doing the curriculum with families, which means our families are receiving an EB service to address stress management! The CQI team has been able to commit to the weekly meetings and have all been active participants. Challenges Different work styles can lead to complications. For example, sometimes certain team members want to continue talking things through, and others feel ready to move forward. Choosing when something is a test or a task continues to be a struggle. When team members are absent is can be challenging to catch them up on what they missed. In addition, when we have had to miss meetings we have been unable to reschedule. Lessons Learned Though different work styles can add challenges, we also recognize that it makes our work together more rich. We needed to have longer meetings so the data uploading was not up to only one team member. In reviewing our data, we learned we need to be more clear about what our baseline data is. Reflections from Action Period 1:

Family Participation We had one mom actively involved with weekly team meeting since the beginning of our work as a CQI team. Due to recent changes within her family circumstances, she felt she needed to make the decision to no longer participate on our team. At this time we are assessing the practicality of introducing a new family participant to our CQI team.

CCA Connecting for Moms Please insert your team photo here

Primary Driver: 1 Change Idea: Standardize Introduction/framing PHQ-9 Name of Test: Talking Points
Insert here: What did you test on the 4th PDSA Cycle Insert here: What did you test on the 3rd PDSA Cycle Same talking points expand to all HFA team – 2 additional HV with at least one client Team report out on PD1: Review of Tested PDSAs since Learning Session 1 CFM Team (3) using talking points & rating responsiveness/authenticity with a least one client 1st PDSA Cycle

Team Success Cycle 1 completed 100% and Cycle 2 is 50% complete Challenges Waiting time for intakes/opportunities to test Staff adaptation to adjust to new talking points For repeat screenings, helping client to see screening as helpful due to earlier client experience when it was presented differently Lessons Learned One family responded positively to reframing screening as a helpful process rather than a labeling tool Staff members viewed this approach more positively Reflections from Action Period 1:

Primary Driver: 1 Change Idea: Establish a reminder system for rescreening Name of Test: Tickler
Insert here: What did you test on the 4th PDSA Cycle Insert here: What did you test on the 3rd PDSA Cycle Two of three staff choose to incorporate spreadsheet reminder due dates into ETO “to-do” list Team report out on PD1: Review of Tested PDSAs since Learning Session 1 MFM team determined option for staff reminders is spreadsheet updated by supervisor monthly and distributed to staff 1st PDSA Cycle

Team Success HFA Team identified need and began implementing reminder system and re-screens are being completed Challenges Team members identified different methods to remind themselves and some team members added the feature of the ETO to-do list Lessons Learned Team work makes the dream work! Supervisor is spreadsheet queen! Reflections from Action Period 1:

Parent Leadership CCA HFA recently completed family satisfaction surveys to learn more about their program experiences –29 % of the families responded. Families told us ways that their lives have improved since joining HFA like ability to solve problems, understanding their child’s development, more patience with their child, improved relationships with family members and/or partner, appreciation of their child, etc. Our team is exploring & wondering how to best engage families authentically with program improvement efforts –e.g., what are we asking, concretely of families, to do and what are expectations for families who do participate

Nurse Family Partnership
Children’s Friend Nurse Family Partnership

Insert here: What did you test on the 4th PDSA Cycle
Primary Driver: 1 Change Idea: 5 Name of Test: Reminder system for rescreens Insert here: What did you test on the 4th PDSA Cycle The entire NFP team created reminders to rescreen clients with elevated PHQ9 scores for all of the clients we are tracking for the COIIN project within the next 3 months. This test will end July 31st due to clients needing rescreening after a 90 day period. Two NHVs created a reminder to rescreen with the PHQ-9 on one client each day for two weeks utilizing the reminder function in the ETO system. 3rd PDSA Cycle Team report out on PD1: Review of Tested PDSAs since Learning Session 1 Two Nurse Home Visitors (NHV) created a reminder utilizing their Outlook calendar every day for one week to test a reminder system for follow up PHQ-9 screenings. 1st PDSA Cycle

Team Name: Children’s Friend Nurse Family Partnership
Primary Driver 1: Standardized and reliable processes for maternal depression screening and response Change Idea 5: Reminder system for rescreens Cycle #1 Cycle #2 Cycle #3 What: a reminder system will be created for following up on women who have a positive PHQ9 screening •To test a reminder system within a short time period (i.e. not wait 30 days for test), the NFP nurse will set a reminder notification on their outlook calendar every day for one week. Who (population): 2 Nurse Home Visitors (Katie and Lauren) When: 3/25/19 – 4/1/19 Prediction: If we… create and implement a tickler/tracking system for PHQ9 rescreening It will result in…. NFP staff will be more consistent about following up with positive PHQ9 scores and rescreening procedures. Results: The test was carried out as planned. Each nurse home visitor set reminders on their outlook calendar using their phones. One Nurse Home Visitor states the alert did not go off and needed to reset notifications on her phone. The other Nurse Home Visitor states she received the alert as set each day. Act: X Adapt: The Nurse Home Visitors realized that there is a function in ETO (the data collection system) where you can set a reminder that a follow up assessment is due. For instance, when completing the PHQ9 assessment in ETO, you can set a reminder to complete a follow up PHQ9 assessment in 30 days (or another timeframe if needed). The nurses requested to test this procedure in order to eliminate using a second system (outlook calendar) for a reminder. Abandon Adopt test the reminder function in ETO daily times 2 weeks to check the ease of using the system, the mechanism for the alert and functionality of using this vs two systems. When: 4/2/19 – 4/15/19 If we…create and implement a tickler/tracking system for PHQ9 rescreening It will result in…. NFP staff will be more consistent about following up with positive PHQ9 scores, referrals to mental health services, and rescreening procedures. The test was carried out as planned. Each nurse home visitor set reminder alerts in ETO daily times two weeks. The nurses did have to check their “To Do List” in order to see the alert as there is no direct pop up reminder on the dashboard/home page. The 2 NHV stated that this reminder system was more efficient as they did not have to use a separate system (Outlook). X Adapt: Will have the entire NFP team trial the ETO reminder system through July on those clients we are tracking for COIIN. test the reminder function in ETO for those clients who are being tracked for the COIIN project with elevated PHQ9 screenings. Who (population): NFP Nurse Home Visitors (entire team) When: 4/23/19 – 7/31/19 Adapt: This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number UF4MC26525, Home Visiting Cllaborative Improvement and Innovation Network (HV CoIIN). This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.

Team Success Two NHV on CQI team tested each method first The entire NFP team is willing to try the third ramp cycle and provide feedback Challenges Need to wait 90 days to fully test the change due to time period for re-screenings. Lessons Learned It was helpful to use small tests of change first (i.e. only two NHV, short time period) Reflections from Action Period 1:

Parent Leadership Family participant was identified by one of our NHV on the CQI team NHV explained the CQI project and invited client to participate CQI meeting held on 5/28/19 to meet client, familiarize her with the project and allow her to provide her background information and feedback on mental health screening, resources, etc. Client is participating in today’s learning session……Welcome Mariel!

Federal Hill House Yuberka Jimenez Pamela Romero Catherine Dugan

Primary Driver: _1_ Change Idea: Create talking points ___________________ Name of Test: PHQ9
Insert here: What did you test on the 4th PDSA Cycle Insert here: What did you test on the 3rd PDSA Cycle Families rescreened using the numbering system. Along with the numbering system examples were provided to client to clarify the question. Team report out on PD1: Review of Tested PDSAs since Learning Session 1 Home visitor creation of numbering system to reflect more accurate response from client. New system used with 11 families chosen by parent educator. 1st PDSA Cycle

Team Success By adapting the numbering system we received more accurate responses from client. Challenges Lack of education and/or cultural beliefs effect participants response. Lessons Learned Working as a team has lead to support of staff as we make changes to our processes. Reflections from Action Period 1:

Parent Leadership Update
FHH – ask team plans for parent leadership and progress to date

Please be back in 5 minutes
Break Please be back in 5 minutes

Learning Session 2 Welcome and Overview Team Presentation Break Review PD2 and PD3 Training: Introduction to Motivational Interviewing Change Prioritization Assessment Lunch Parent Leadership PDSA Pointers Team Time: PDSA Development Break Peer PDSA Review Wrap Up Report Out Presenter: Sarah Notes: Remind teams to use the Driver Prioritization form DURING the presentation – to later submit to RIDOH

The “What” That Needs to Be in Place
Training of HVs on MD symptoms, impact, and treatment Enhance the skill development of HVs for connecting with families on MD Reflective supervision that encourages HVs to discuss MD Support for HVs on protocol responses Primary Driver 1. Standardized and reliable processes for maternal depression screening and response Primary Driver 2. Competent and skilled workforce to address maternal depression Primary Driver 3. Standardized processes for referral, treatment and follow-up Primary Driver 4. Comprehensive data-tracking system for maternal depression JENNA

Why a Focus on a Competent and Skilled Workforce?
Training of HVs on MD symptoms, impact, and treatment Enhance the skill development of HVs for connecting with families on MD Reflective supervision that encourages HVs to discuss MD Support for HVs on protocol responses Why a Focus on a Competent and Skilled Workforce? Share some rationale- can use personal examples or research to emphasize the importance of these elements

How the “What” gets put into place:
Gold Standard Changes For driver 2 which support a competent and skilled workforce we chose to highlight change 2 , Training and education to enhance the skill of HVs for connecting with families We heard early on from HVs that they sometimes didn’t want to screen or ask about MD as they didn’t know how to talk about it in a comfortable way

Sample PDSAs for Each Module of the Intervention
In this PDSA example, the team incrementally tested the use of MI techniques by starting with non MD topic use and then moving to using MI for MD conversations about referral The prediction was, If we… Support home visitors to become more comfortable with utilizing MI techniques by a) starting small (e.g. 1 MI technique in 50% of visits) and initially on topics other than maternal depression, b) increasing incrementally the number of techniques they use and the percentage of visits in which they use them, c) reviewing their MI practice in reflective supervision and d) applying MI to maternal depression only after they are practiced and comfortable with the techniques It will result in… An increase of referrals and acceptance of evidence-based services by 25%

Changes that result in Improvement
Cycle 6-9: 1/5-1/30 Weekly cycles, M-F, Apply MI to MD DATA Cycle 3-5: 12/1-12/19 Weekly cycles, Monday through Friday, add 1 MI technique each time Cycle 2: 11/20-11/26 - All HVs will add another MI technique and use 1 of the 2 MI techniques in 60% of visits (still not focused on MD). Still daily text reminders During Week 1, home visitors utilized 1 MI techniques in 50% of visits (they were very successful!) 93% of visits. Home visitors were able to practice utilizing MI techniques in more visits than anticipated. They themselves were very surprised how easy it was to incorporate techniques throughout their visits. They felt that more information was obtained using these techniques. During Week 1, one parent asked the HV if she (the mom) was doing anything wrong because the approach the HV was using during the vist was different than prior visits. Cycle 1: 11/12-11/19 -All HVs will use 1 MI technique (open-ended questions) in 50% of visits (ideally not on MD) w/ daily text reminders Hunches & Ideas

MI Techniques Used in Home Visits
MI techniques focused on MD Sustained these gains of using MI techniques to talk about depression at 100% for all 9 months- this is remarkable!

Training of HVs on MD symptoms, impact, and treatment
Enhance the skill development of HVs for connecting with families on MD Reflective supervision that encourages HVs to discuss MD Support for HVs on protocol responses Team Time Competent and skilled workforce to address maternal depression Which of the four critical changes might your team prioritize and test? Share some rationale- can use personal examples or research to emphasize the importance of these elements

The “What” That Needs to Be in Place
Crisis-response protocol Protocol for referral and linkage to service for mothers who screen + In-house, evidence-based preventative support Primary Driver 1. Standardized and reliable processes for maternal depression screening and response Primary Driver 2. Competent and skilled workforce to address maternal depression Primary Driver 3. Standardized processes for referral, treatment and follow-up Primary Driver 4. Comprehensive data-tracking system for maternal depression SARAH. Policy and protocol for home visitors’ response to screening results (e.g., decision tree) Reliable and effective systems for referral and follow-up

Why Standardized Processes for Referral, Treatment and Follow-up?
Crisis-response protocol Protocol for referral and linkage to service for mothers who screen + In-house, evidence-based preventative support Why Standardized Processes for Referral, Treatment and Follow-up? Share some rationale- can use personal examples or research to emphasize the importance of these elements

How the “What” gets put into place:
Gold Standard Changes

Sample PDSAs for Each Module of the Intervention
Aim: By August 31, 2015, the Carolina Health Center will increase, by xx, the mean comfort level of home visitors introducing the Mothers and Babies Curriculum to clients. Prediction: If we…train home visitors in the Mothers and Babies curriculum and specifically have them frame the program as ‘stress reducing , It will result in…home visitors having the comfort, skills and knowledge to introduce the Mothers and Babies curriculum to clients. If we collect information from this test from both home visitors and clients, then key lessons learned will be identified and we will be able to better introduce the program to subsequent clients. Getting started: Two home visitors will be trained on introduction of the curriculum to clients. • Each home visitor will select two to three clients that are a good fit for the Mothers and Babies program and utilize the new training/script with those clients as an invitation to participate in the program. Type of data collected: Number of clients offered Mothers and Babies program • Number of clients accepted starting Mothers and Babies program • Clients’ responses and questions regarding the Mothers and Babies program • Home visitor’s comfort introducing (1-10, 1 = extremely uncomfortable; 10 = perfectly comfortable) Plan

Each ramp was a module of the program

Toolkit Available Working on a TOT for a cadre of MD supervisors or faculty

Standardize processes for referral, treatment and follow-up

Crisis-response protocol
Protocol for referral and linkage to service for mothers who screen + In-house, evidence-based preventative support Team Time Standardized processes for referral, treatment and follow-up Which of the three critical changes might your team prioritize and test? Share some rationale- can use personal examples or research to emphasize the importance of these elements

Prioritization Worksheet for Maternal Depression
Change Prioritization Worksheet for Maternal Depression Please return to the RIDOH team! Take 15 minutes to complete with your team!

Learning Session 2 Welcome and Overview Team Presentation Review PD2 and PD3 Training Lunch Parent Leadership Primary Driver and Change Prioritization Assessment PDSA Pointers Team Time: PDSA Development Break Peer PDSA Review Report Out Wrap Up Facilitator: Jenna Notes: Please pull out half sheet to rate the teams’ presentation

1/5 teams reported a parent contributed to the development, testing, or adaptation of the tested PDSAs. Presenter: Sara Notes: Parent contribution could involve suggesting the change idea, helping to plan or execute the PDSA, studying the results or planning next steps in HV CoIIN 2.0.

Working with parents to collaboratively set goals helps CQI teams prioritize work that provides direct value to participants; reducing efforts that do not add value may reduce costs. Transparent data-sharing with participants may build trust and increase their ownership of results. New innovations that stem from lived experience may be developed and tested. Expanding the team’s capacity can help frontline home visitors, who often feel overstretched. Participants provide a constant reminder of why home visiting is important, which may motivate teams to sustain their CQI work. Parent leadership is successfully achieved when parents and professionals build effective partnerships that combine professional knowledge and expertise with lived experience and expertise

Parent leaders can work with agencies to Keep in mind for meetings
Engage in interviews Engage in focus groups Attend meetings Participate in workgroup or subcommittee meetings Respond to requested surveys Provide feedback, share perspective as a parent or family member Serve as an active voice in CQI meetings Serve as a community liaison by providing insight and information and disseminating group information to personal networks Ensure confidentiality of all CQI information Present at local and state meetings, conferences, and presentations Communicate with agency regarding barriers to active participation arise; work together to overcome said barriers, and provide feedback on the experience Keep in mind for meetings Translation needs Meeting time Transportation Childcare Stipends We have added the Parent Toolkit to your packet to reference as agencies’ ability to utilize these tools are specific to each agency’s contract and funding abilities. However, LIA’s approaches to Parent Leadership are unique depending on their organizational readiness, capacity, and training needs- and that’s okay.

Team Time and Report Out:
Complete the Readiness Assessment OR Review and discuss your agency’s completed Readiness Assessment Team Report Out: How has the assessment guided your teams in Parent Leadership? Presenter: Sara Notes: Complete the Readiness Assessment Review and discuss your agency’s Readiness Assessment Team Report Out: How has the assessment guided your teams in Parent Leadership? Note: the assessment asks questions related to the state – think about your agency instead

Tool Kit Resources: Ongoing work with Parent Leaders
Page 52 Page 51 Page 54 Reminder of resources as you progress in your CQI work and are involving families: Parent Assessment Tool: Do you own CQI on Parent Leadership – checking in to see if your LIA teams’ plans for parent leadership aligns with the parents’ input through a brief survey. Can use this with your one on one meeting with parent leaders. (page 52 of your Parent Leadership Toolkit) Shared agreement: Same page for the day to day work, take it more seriously, structure, design how to incorporate CQI work Level of Engagement Tool: Discussion: CCA – survey developed – ask more information on this tool that was presented on earlier today

Learning Session 2 Welcome and Overview Review PD2 and PD3 Training Lunch Sharing Tools Primary Driver and Change Prioritization Assessment PDSA Pointers Team Time: PDSA Development Break Peer PDSA Review Report Out Wrap Up

Change Package – Gold Standard Changes
You are NOT starting from scratch! PD2.C1

RIDOH to present the “Gold Standards” of PD2. C2 and PD3
RIDOH to present the “Gold Standards” of PD2.C2 and PD3.C3 – links of PDSAs and Ramps from KDD (helps prepare for MB testing and 6/20 webinar) This is Primary Driver 3, Change Idea 3 – Training home visitors in Mothers and Babies Curriculum Here the Carolina Health Centers, Inc decided to test increasing the comfort level of utilizing the mothers and babies curriculum The CHC indicated they would know a change is an improvement if home visitors indicate an 1) increased level of comfort in utilizing the MB curriculum against the baseline 2) and also seeing clients agreeing to participate Assessing home visitor comfort level will be assessed through implementing 1) a survey after each interaction with clients using the MB curriculum while also 2) tracking percentage of clients who agree to participate in the mothers and babies program Changes make to result in an improvement: train two home visitors in MB curriculum as a part of the HV curcumin as “stress reducing” practice with the prediction that doing this will result in increased home visitors’ comfort, skills, and knowledge to introduce the MB curriculum to clients. Information collection from both HVs and clients to better introduce to the program to other clients moving forward. Plan: Began with 2 home visitors – selected 2-3 clients each based on fit for MB curriculum for one whole week in initial PDSA testing Data collection: indicating number of clients offered MB program, Number of clients accepting to begin MB program, clients’ responses and questions regarding the MB program, Home visitor’s comfort introducing the program (1-10 scale) Do HV trained Clients selected – appropriateness for the program Data collection – HV record questions from families for qualitative data and HVs completed the interview regarding the experience and lessons learned. Study Found face to face was more effective than over the phone Found 100% clients were interested in the program HV Confidence in the program was 70% Act Lessons learned and expand training to more home visitors

Ramp developed Cycle 2: What – still focusing on the comfortability of MB session Who – focusing on clients participating in the MB curriculum When – the following month for 2 weeks Predictions – participants will understand the MB curriculum, more enthusiasm, and progress in the program Results – Findings from each HV session Data findings – what did the data tell you? – Indicate mood after MB activities, indicate if and how successful sessions are in regards to HV knowledge and mood, participant engagement in the session, understand the benefit in MB course, willingness to open up and share What did you learn? – the information is important to participants that are eligible / appropriate participants (HV knowledge), Utilization of MI to get participant to open up about the stressor in her life, understanding and utilization of the mood scale for participants, reflect on realities, Act: Adapting – based on all findings from each HV testing in the Cycle 2 with new questions to answer and further actions to take.

Change Package – Gold Standard Changes
You are NOT starting from scratch! PD2.C1 Add: List of MI techniques included Notes: Teams are working on MI training for them to take in the near future

Ask teams: what would a ramp look like going from this form – what might you test next?
What might have they tried if this test did not go well?

Questions? Presenter: Notes:
We would like to pause and see if there are any outstanding questions that individuals have regarding PDSAs, Ramps, etc before we progress on to PDSA development time. Questions?

Team Time: PDSA Development

Source: This instrument was developed by Karen Zeribi (karen@zeribi
Source: This instrument was developed by Karen Susana Toledo MaryCatherine Arbour

Wrap-up and Plans for Learning Session 3 November 6, 2019
Jenna Maloney 4:00 – 4:15 p.m.

Upcoming Dates Data and PDSA submissions through CoIIN site second Friday or to Jenna by Thursday COB THIS THURSDAY/FRIDAY Team Specific Office Hour Calls Sarah Bowman: July 16, 2019 (11:00 a.m. – 12:00 p.m.) Sara Remington: July 9, 2019 (2:30 PM – 3:30 PM) CQI Monthly Webinar July 12, 2019 (11:00 a.m. – 12:00 p.m.) We have determined a due date for data submissions to be sent from your agency to RIDOH. Please have your data leads submit your agency’s monthly data to RIDOH by the second Friday of each month. This will allow us to review the data, discuss findings with our national partners, and provide feedback at our monthly coaching calls with all of the agencies in our collaborative. We will be including these deadlines/due dates in Outlook and in the CQI calendars that we share with you as well. MB on the 20th – have PDSA ready In your PDSA development, be prepared to develop tools by LS3. Please upload these tools with the PDSAs you are testing and be prepared to share either in our monthly webinars or for sure by Learning Session 3.

Model Specific Monthly Office Hour Calls
July 2019 Monthly Call Dates & Time Sarah Bowman Sara Remington July 16, :00 a.m. – 12:00 p.m. July 9, 2019 2:30 PM – 3:30 PM Improvement Advisor Sarah Bowman Sara Remington CCF CF CCA FFH MB template for those doing it – deadline from HV CoIIN August 2019 Monthly Call Dates & Time Sarah Bowman Sara Remington August 27, :00 a.m. – 12:00 p.m. August 5, 2019 3:00 PM – 4:00 PM Check out CQI Calendar for all scheduled dates in the collaborative!

Team Planning: What will you do by next Friday?
Presenter: Kristy Notes: Round robin – what are teams going to test

Changing systems is not easy work but it can be done and together we can make small impactful changes that can change the trajectory for many families- lets get started, …

What Reflections Do You Have On Our Meeting Today?
Please Complete 3 Post Its and Post on the Charts on Your Way Out: What is one thing that worked well for you today What is one thing you would improve? What is a content area your team would like more support in?

Thank you!

Rhode Island Maternal Depression CQI Learning Collaborative Learning Session 2 Meeting June 12, 2019 9:00 a.m. – 4:15 p.m.

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Rhode Island Maternal Depression CQI Learning Collaborative Learning Session 2 Meeting June 12, 2019 9:00 a.m. – 4:15 p.m.

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Presentation on theme: "Rhode Island Maternal Depression CQI Learning Collaborative Learning Session 2 Meeting June 12, 2019 9:00 a.m. – 4:15 p.m."— Presentation transcript:

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