Download - Public Health Notice
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Public Health Notice
Contagious Disease
Hazard
City and County of San Francisco
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Oversight, PerformanceAnd
Focus Groups
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Using Focus Groups in State
Oversight of County
Medicaid Managed Care
Specialty Mental Health
Services
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A Little Background...•California implements Managed Care for Medi-Cal Mental Health Specialty Services in FY 97-98
•CMS Freedom-of-choice waivers
•State oversight plan - review 56 county MHPs
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Obtain direct input from consumers and families
Employ consumers and families as reviewers and moderators
DMH Policy
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California Counties run their own mental health programs (MHP’s)
State DMH provides oversight and some direct services
And…
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Combine Two Approaches
COMPLIANCE• 49 Page Protocol• In/Out of Compliance• Look at Policies &
Procedures• Interview Admin Staff• Make Calls to Access
Line• Write Plan of
Correction
QI/TAT• Hold 1 - 6 Focus
Groups(10 - 60 Participants)
• Prepare draft reports to County
• Hold exit discussion• Prepare final reports to
County - 30 days• TAT makes follow-up
visits
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Oversight = (C+QI+TAT)
Compliance +
QI +Tech. Assistance &Training
Or,
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A Quality Improvement MantraFor Our Times:
“Good news is no news”
“No news is bad news”
“Bad news is good news”
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Who Said That?
Free Lunch to the Person Who Can Tell Us!
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•Cheaper & faster than other methods
• Interaction generates additional information
• Questions can be changed rapidly, if needed
• Consumers like interaction with others
But why use focus groups?
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And, by golly,
People LIKE them!
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What Kind of Groups?• Adult Clients
• Youth Clients
• Family Members of Adult Clients
• Family Members of Children/Youth
Clients
• Clients/Family on QI Committees
• Monolingual/Non-English Speaking
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How many?
About 150 each year!
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What’s the Question?
Access and Availability
Beneficiary Protection
Coordination with other Services
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Who leads them?
• 1 Family Member (of adult or youth)
• 1 Adult Client
• 1 DMH Technical Assistance and
Training Staff
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How are moderators selected?
• DMH “Expert Pool”
• Individual Contracts
• Stipend and Expenses Paid
• Not in your own county!
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How are moderators trained?
• Two-day paid workshop
• Faculty = Clients and Family
Members and DMH Staff
• Training is mostly experiential -
role playing
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Focus Group Training - Spring, 2002
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Focus Group Training - Spring, 2002
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Moderator Responsibilities
• Group Leader
• Note Taker
• Report writer
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ConductFocus Groups
ConductFocus Groups
WrittenReports
to County
WrittenReports
to County
Verbal ReportVerbal Report
How Information Flows
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Three Years of Focus GroupsThree Years of Focus Groups
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Evaluation Teams
1 - Family Member of Children/Youth1 - Family Member of Adult Client1 - Adult Consumer1 - DMH Staff
4
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Draft State-wide
Report
SelectEvaluation
Teams
TrainEvaluators
Teams ConductEvaluation
DMH Approves and Disseminates
County Directors
Client Orgs.
Family Orgs.
The Evaluation Process
Family Orgs.SQIC
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A consistent, collaborative process:
• Team members generate “Theme Lists” independently
• Collaborative ranking of themes
• Report written using final rankings
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Analysis by DMH Staff
• Enter demographic data (Excel)• Tally recorded comments• Reconcile results with theme lists• Check with evaluation teams• Draft narrative• Send to Client/Family Member T/F
More Evaluation Process:
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Overview of 3 years
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Who we saw - Groups
Year 1 Year 2 Year 3
118 157 163
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Who we saw - People
Year 1 Year 2 Year 3
776 1195 1161
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Who we saw : Types
Type Year 1 Year 2 Year 3Adults 53% 33% 37%
F/Youth 26% 17% 16%
F/Adults 21% 15% 14%
QI 0% 12% 8%
Language N/A 19% 23%
Mixed N/A 4% N/A
Youth 0% 0% 2%
Total 100% 100% 100%
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What we have learned
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Access Themes
•Staff turnover remains a problem
•Most know how to gain access
•But - it can be complex, difficult
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Access Themes - 2
•Once you’re “in,” it’s better
•but long delays persist •They’d like more staff, money, services
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Access Quotes
• “Family involvement has worked very well…”
• “Call 1-800-GOOD LUCK.”
• It takes a mental health crisis to get mental health services.”
• We need more clinical staff.”
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Themes - BeneficiaryProtection
•B/P system is a fuzzy concept to most
•>50% recall seeing printed material
•BUT - content is not easily recalled
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Beneficiary Protection 2
•Process is seen as too complex for clients to navigate without help
•Some fear retaliation if they complain
•BUT- There are few reports of actual retaliation
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Beneficiary ProtectionQuotes
• “I’ve seen the yellow brochure and forms but I didn’t read it.”
• “When you’re going thru a crisis situation, you don’t think about any booklet.”
• “I didn’t complain because I didn’t understand the process.”
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Coordination Themes
•>50% say it’s good, O.K.
•but A significant minority (up to 50%) say improvement is needed
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Coordination Themes - 2•Problems: Communication;
Rx & pharmacy - TARS, Dental & Housing services
•Some Staff are exceptional at linking clients to services
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Coordination Themes -3
•Most Frequently mentioned problem:
“My doctor and my psychiatrist don’t communicate!”
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Coordination - Quotes
• “Yes, they’ll help with anything.”
• “Mental Health works closely
with my physical care doctor.”
• “I didn’t know they could do that for you.”
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New in year 2
Involvement in Quality Improvement
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The QI Experience
•Client/Family input has been used in a meaningful way
•Some impact on services is noted
•They’d like more feedback on results
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The QI Experience (2)
•More education, training needed
•When it’s good, it’s very, very good…
•And when it’s bad…
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QI - Quotes• “The local Mental Health Board is
behind us 100%.”• “Absolutely. We are not considered
part of the problem - we’re part of the solution
• “They talk the talk but they don’t walk the walk.”
• “I’d like to be more than a rubber stamp. They do all the work first, then run it by us.
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Room for Improvement
• Close the loop - feedback from county MHPs
• Recruit for specific participant types
• Integrate data from Compliance & Outcomes
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The EndThe End
FinallyFinally!!