0. HFA Peer Reviewer & TA/QA Training June 18 - 20, 2012 Fort Wayne, IN
Kate Whitaker, Tracie Lansing

1. What To Expect Out of the Training
Grounded in a CQI philosophy
Understand the Site Visit Process
Competent in activities required of peer reviewers
Ready to complete site visits or provide TA/QA in accordance to Accreditation

2. -William A. Foster The Essence of Quality
“Quality is never an accident; it is always a result of high intention, sincere effort, intelligent direction and skillful execution; it represents the wise choice of many alternatives.”
-William A. Foster

3. THE HFA INITIATIVE TODAY
444 programs in 43 states, D.C., U.S. territories and Canada
Additional states and territories, plus expansion in existing states with federal MIECHV program
300+ leaders with expertise in QA, funding, PR, TA, training, etc.
385 or 95% of sites up-to-date and 95 sites currently in process

4. HFA REGIONAL & NATIONAL OFFICES
Technical Assistance & Support
Affiliation
Accreditation
Pre-site
Development of the self study
Intent of the standards
Evidence examples
Post-site
Development of the response to the Preliminary Credentialing Report
Deferral
Celebrate!

5. HFA Regions
Northeast Region, Region I: Connecticut, Delaware, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont, Virginia, Washington DC., West Virginia, Puerto Rico, and Us Virgin Islands.
Southeast Region, Region II: Alabama, Florida, Georgia, Hawaii, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee, Canada, Commonwealth of the Northern Mariana Islands Guam, and American Samoa.

6. HFA Regions (cont.)
Central Region: Region III: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, Ohio, Wisconsin
Western Region, Region IV: Alaska, Arizona, Arkansas, California, Colorado, Idaho, Louisiana, Montana, Nevada, New Mexico, North Dakota, Oklahoma, Oregon, South Dakota, Texas, Utah, Washington, Wyoming,

7. Contact Information: Regional Staff
Northeast Region, Region I: –
Lynn Kosanovich
Southeast Region-Region II
Kate Whitaker
Central Region, Region III –
Tracie Lansing
Western Region, Region IV –
Satya Kline

8. Contact Information: National Staff
HFA National Office –
Lisa Sutter – Training –
Cydney Wessel –
Site Visit Scheduling & Expense Reimbursements
Phyllis Medrano –

9. DL Workbook & Analysis Activity
Pull-out Assignment Workbook
Sign and pass to the front pages 4 & 5 (Confidentiality and Principles of Behavior)
Review Ratings – pages 6-10
Rating Standards that require monitoring, measuring and analyzing
The distinction between these activities

10. Monitoring-Measuring-Analyzing
Standards that Require Monitoring: 1-1.C, 1-1.E, 4-2.C, 6-4.B, 6-6.B, 7-4.B, 9-4, 10-1, GA-3, GA-9 Standards that Require Measuring: 1-1.D, 1-1.F, 1-2.A, 3-4.A, 4-1.B, 4-2.B, 7-1.B, 7-2, 11-1.B Standards that Require Analysis: 1-2.B/C and 3-4.B/C

11. SIMPLIFYING THE COMPLEXITIES OF ANALYSES
Step 1: Measure
utilize HFA methodology
Step 2: Analyze
includes required components: (comprehensive WDPS+F/I, comparative, correct timeframe)
Step 3: Plan and implement
Addresses findings from Step 2

12. ACTIVITY: Monitoring-Measuring-Analyzing
Review Sample 1-1 Data Tracking and assign ratings
Review Sample 1-2.A, B and C and assign ratings
Review Sample 3-4.A, B and C and assign ratings
Review Sample 9-4 and assign rating

13. FAQ’s
What if the program defines enrollment date as date consent is signed vs. date of first home visit?
Do all categories need to be completed on the analysis grids?
Is the program out of adherence if the numbers don’t seem to jive on the worksheets?

14. FAQ’s continued
Is the program out of adherence if the retention percentage says “invalid”?
Can programs enter all participants on the retention worksheet or just those from a particular year?
Do we need to see back-up information on-site to verify the data on worksheets?
Other Questions

15. FOUNDATION OF SELF-ASSESSMENT TOOL
Based upon the critical elements & literature review
Consensus and Research Based
SAT forms minimum standards at which a program must function
12 critical elements & a section on governance and administration
Elements 10 & 11 re: training are combined into standard 10 in SAT

16. FOUNDATION OF SELF-ASSESSMENT TOOL
A series of inter-related standards
Broadly organized by 1st order standards
Similar to an outline
1. 1st Order Standard
Initiate services prenatally or at birth.
nd Order Standard
The program ensures it identifies families in the target population for services either while mother is pregnant (prenatally) and/or at the birth of baby.
1-1.A. 3rd Order Standard
The program has a description of the target population that includes applicable demographic data and identifies places where the population is found (e.g., local hospitals, prenatal clinics, high schools, etc.).
1-1.B. 3rd Order Standard
The program’s system of organizational relationships with community entities (e.g. prenatal clinics, hospitals, etc.) allows families in the target population to be screened/identified to establish possible need for service.
Each is a critical element, except for governance & administration section
Form major components of 1st order standard
Building blocks of system & forms basis of program’s self-study

17. Unsupported Second Orders
Are not broken down into two or more specific standards.
Examples:
3-1. Services are offered to families on a voluntary basis.
4-3. The program offers home visitation services to families for a minimum of three years after the birth of the baby.
5-1. The program has a description of the cultural characteristics of its current service population, including ethnic, racial, linguistic, demographic and other characteristics.

18. TOOLS FOR MEASURING A PROGRAM’S ADHERENCE
STANDARD Home visitors provide information, referrals, and linkages to available health care resources for all participating family members.
INTENT: It is recommended that programs only provide information, referrals and linkages when necessary, (i.e., when a pregnant mother needs assistance connecting to prenatal care, or when parents or siblings have health concerns and are without a medical care provider). Therefore if a family is currently receiving necessary care, there may be no need for further provision of the above-mentioned services.
EVIDENCE TABLE: Found in your folder Identifies policy & procedure requirements, additional pre-site evidence & on-site activities

19. TOOLS FOR MEASURING A PROGRAM’S ADHERENCE
RATING INDICATORS
3 = Program Exceeds the standard
2 = Program is meeting the standard
1 = Program is not adhering to the standard
NA = Not applicable
Tips: OPTIONAL!! Do not use Tips to determine adherence.

20. Where peers gather their information
Program Self Study
Participant File Review
Other On-site Documentation
Supervision Logs
Meeting Minutes
Personnel Records
Training Logs
Interviews
Interviews – No this is not an accidental repeat. 
Electronic Surveys

21. UTILIZING THE ELECTRONIC SURVEYS
SCAVENGER HUNT
Using example survey summaries and SAT, work with partner
1st Task:
In 5 minutes, identify as many standards as possible that are inquired about in the surveys
2nd Task:
In 5 minutes, identify some areas of strength and some areas to further explore based on survey responses

22. Site Visit Simulation All materials presented are from Babyville, USA
In your peer team, you will complete a peer review site visit from beginning to end
All activities will build upon the previous activity
And will result in a completed Accreditation Site Visit Report (SVR)

23. The Process
Review the self study, develop preliminary ratings and develop interview questions
Conduct a pre-site call w/co-peer
Review & integrate the electronic surveys
Review Participant Files
Conduct an entrance meeting
Further develop interview questions
Interview program staff

24. The Process (cont.) Rate the standards
Develop rationales for areas of non-adherence
Conduct an exit meeting
After each section, you will receive feedback regarding strengths and areas of growth.

25. PRE-SITE CALLS WITH FELLOW PEER
Confirm travel arrangements
Review each critical element
Review self study standards
Draft list of additional information needed
Develop Pre-site ratings of adherence only
Draft interview questions

26. DURING THE TEAM COORDINATOR’S CALL WITH PROGRAM LEADERSHIP
Discuss travel arrangements
Develop the interview schedule
Identify formal and casual culture
Discuss omissions in the Self Study
Review site visit activities & sampling methods
Ask for any updates

27. PARTICIPANT RECORD REVIEW
Peers select records
Use a participant “roster” to select a representative sample
Across home visitors
Across levels of service
Across length of time in the program (age of child)
Review a minimum of 3 records per home visitor for programs with 1-7 staff

28. REVIEWING ADDITIONAL RECORDS
Creative outreach - Closed
As needed to determine rating, when:
there are inconsistencies
new or changed policies or practices
peers’ judgment
Keep in mind you need only review documentation for selected standards

29. PARTICIPANT FILE CHECKLIST
Identifies standards that require file review
Helps quantify record review
Makes review more consistent & less subjective
Peers should:
Use dates where possible
Include size of active caseload
Create a key for PCA America staff
Identify name at top of form & submit with Preliminary Credentialing Report

30. OTHER ON-SITE DOCUMENTATION
Training logs
Supervision records (logs, notes, etc.)
Personnel records (specific to standards)
Minutes of organizing body meetings
Any documentation that is evidence of adherence to standards (use documentation checklist as guide), especially documentation not submitted with self-study & forms, policies, etc., that have been modified since completion of self-study

31. ENTRANCE MEETING Meet each other 30 minute agenda
Put program staff at ease
Discuss the activities for the next two days
Avoid disclosing the number of peer reviews you have completed

32. ENTRANCE MEETING AGENDA
Thank attendees
Make brief introductions
Overview of HFA accreditation process & purpose of accreditation
Review what the site has already accomplished
Describe on-site activities
Answer questions the site might have
Review confidentiality/anonymity

33. INTERVIEWING ESSENTIALS
Come prepared
Create a welcoming environment
Ask effective questions
Follow-up responses with additional questions as necessary
Ask clarifying questions before assigning a “1” rating
Behavioral interviews

34. COME PREPARED Know what you want to achieve
Organize questions around the background of the interviewee
Review the standards that are interview paradigms
Use listener responses, files and standards as points of reference

35. STARTING THE INTERVIEW
Typically 30 minutes for staff (15 for families)
Introduce self
Thank interviewee
Assure confidentiality
Ask permission to take notes
Acknowledge strengths
This applies to interviewees who were not present at the Entrance meeting.

36. WHAT IS AN INTERVIEW PARADIGM?
There are a number of standards are interview paradigms
Standards that focus on process versus documentation
Build follow- questions on interviewee’s responses
Ask interviewees to illustrate process using files
Example: trust building activities (standard 3-2.B)

37. RATING INTERVIEW PARADIGMS
Documentation is sufficient for continuation of services
Interviews are consistent across multiple staff roles
Families concur that practice is occurring in the field (when appropriate)

38. WRITING RATIONALES What is the ultimate purpose of the rationale?
To prove lack of adherence or to motivate improvement?
Be detailed, specific, factual
Reference:
Self-study
File Review
Interviews
Other documentation

39. WRITING RATIONALES Provide link to intent of the standard
Keep tone objective
What we write is just as important, if not more important, than what we say
Put yourself in the program’s shoes - no surprises please

40. WRITING RATIONALES Who is the audience? The program HFA National staff
The HFA Accreditation Panel
Importance of the details
Expect technical support & assistance
Writing strengths & recommendations

41. EXIT MEETING
Commend program for hard work and congratulate on commitment to providing services consistent with HFA best practice standards
Overview meeting agenda
Summarize team findings addressing each critical element:
Strengths
Challenges
Recognize recent practice changes
Cite positive comments from families

42. EXIT MEETING (cont.)
Provide opportunity to clarify and emphasize that program can still provide evidence as appropriate
Review next steps and decision making process
Receipt of SVR (4 weeks)
Consultation with national/regional office
Development of plan to complete the credentialing process
Solicit questions & comments
Thank site for hospitality and cooperation during visit

43. Correspondence with National
Request to sign up for a site visit
Confirmation Letter
Technical Assistance & Support
Travel Arrangements & Hotel
Reimbursements
Feedback to fellow peer & process
Submission of paperwork/checklists

44. CONGRATULATIONS!!!!!!!
TRAINING IS COMPLETE, WE NOW DEEM YOU PROVISIONARY HFA PEER REVIEWERS!!
REMEMBER TO GET YOUSELF ON THE SITE VISIT CALENDAR.
Evaluations will be sent to you electronically!!!