HV CoIIN 2.0 Virtual SeriesPart 2: How You Can Achieve Breakthrough Benefits§ Heather Johnson, CQI Team Lead, Alabama MIECHV

§ Jessica Diedling, Data and Quality Manager, LA MIECHV

§ Mary Mackrain, Managing Project Director, EDC

Welcome and Technical Tips

§ Please share your name and state or territory in the chat

§ Please share comments or questions actively! We have time at the end to address

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§ Slides for today’s session are in the file share pod

2HV CoIIN 2.0 Virtual Series Part 2: How You Can Achieve Breakthrough Benefits

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Reminder: 2 Work StreamsCohort 1 of 3 (by 2022) is Underway

HV CoIIN 2.0 Virtual Series Part 2: How You Can Achieve Breakthrough Benefits

(1) SCALE

5 Awardees(2) NEW TOPIC COIINS

6 Awardees

Scaling HV CoIIN 1.0 playbooks with 55 LIAs

12-18-month CoIIN with 18 LIAs to improve Intimate Partner Violence Outcomes

HV COIIN 2.0 MATERNAL DEPRESSION CHARTER

A. WHAT ARE WE TRYING TO ACCOMPLISH? Call to Action: Studies show that 40-60% of families with young children enrolled in home visiting programs experience elevated depressive symptoms, and 10-15% have major depression.i ii Left undetected and untreated, maternal depression can have long-lasting negative effects on the growth and development of infants and young children. Studies have shown that mothers with depression are less positive, spontaneous, and responsive with infants, iii compromising the critical relationship a young child needs to develop. Young children with compromised responsive caregiving are at an increased risk of exhibiting challenging behavior, developmental difficulties, poor social relationships, and cognitive impairment.ivv Identification and linkage of women with depressive symptoms to effective, evidence-based interventions can make a difference,vi vii viii reducing by half the percent of women exhibiting major depression or developing depression. ix x However, families challenged with maternal depression often struggle to access and engage with treatment: they have less frequent use of preventive health services and greater use of emergency departments and in-patient services for illness and injury.xixii Home visiting programs have a unique opportunity to reach vulnerable families and to incorporate evidence-based and practice-informed strategies —what we know works, and what we do on the ground, to decrease rates of maternal depression. In HV CoIIN 1.0, MIECHV awardees and their LIAs tested evidence and practice-informed-changes and improved rates of depression screening and engagement in evidence-based services, and decreased depressive symptoms among women accessing services.

• 96% of women were screened for depression within 3 months of enrollment and birth • 66% of women with a positive screen had one or more evidence-based service contacts • 60% of women who accessed evidence-based services experienced a 25% reduction

depressive symptoms within three months In [insert your state here], [insert a description of the status of maternal depression in home visiting in your state here. If you participated in HV CoIIN 1.0, you could begin by summarizing the accomplishments and learning from 1.0. Then describe the gap in practice that you plan to overcome.] Mission: Together, in HV CoIIN 2.0 , we will dramatically reduce depressive symptoms among mothers of young children receiving home visiting services [insert here the expected timeframe, based on the time between your launch date and December 31, 2019; for example “between January 20, 2019 and December 31, 2019”] by developing and refining policy and practices that lead to; (1) Standardized and reliable processes for maternal depression screening and response, (2) Competent and skilled workforce to address maternal depression, (3) Standardized processes for referral, treatment and follow-up and (4) Comprehensive data-tracking system for maternal

Computation of Key Measures SIU School of Medicine - General Internal Medicine

2/7/20 Page 1 of 37

MonthTotal N

enrolled women

N women enrolled 90 of more days

ago

N women who gave birth

90 or more days ago

N women enrolled 90 or more days ago

screened for MD within 3 months of enrollment

N women who gave birth 90 or more days ago screened for MD

within 3 months of giving birth

Jan-19Feb-19Mar-19Apr-19

May-19Jun-19Jul-19

Aug-19Sep-19Oct-19Nov-19Dec-19Jan-20Feb-20Mar-20Apr-20

May-20Jun-20Jul-20

Aug-20Sep-20Oct-20Nov-20Dec-20Jan-21Feb-21Mar-21Apr-21

May-21Jun-21Jul-21

Aug-21Sep-21Oct-21Nov-21Dec-21

The What: Scaling Tested Playbooks from HV CoIIN 1.0

Charter, Key Driver Diagram and Gold Standard Changes, and Measurement System

Alabama MIECHVA Snapshot of Breakthrough Change

Topic: Maternal DepressionScale Method: IHI’s Breakthrough Series

§ Heather Johnson, CQI Team Lead

§ Matt Fifolt, Lead Faculty, Lead Improvement Advisor

§ Beth Johns, Improvement Advisor

§ Maggie Enlow, CQI Coach§ Alicia Thurmond, CQI Coach

Alabama’s First Teacher CQI Team

Pictured Above (from left to right): Matt Fifolt, Maggie Enlow, Heather Johnson, Beth Johns

6HV CoIIN 2.0 Virtual Series Part 2: How You Can Achieve Breakthrough Benefits

Pictured Right: Alicia Thurmond

Why This, Why Now?

In Alabama, approximately 16% of primary caregivers screen positive for maternal depression, with some sites reported rates as high as 33%

Left undetected and untreated, maternal depression can have long-lasting negative effects on the growth and development of infants and young children

We knew that HV CoIIN 2.0 would help us to address key questions about maternal depression screening, access to treatment, and symptom reduction

7HV CoIIN 2.0 Virtual Series Part 2: How You Can Achieve Breakthrough Benefits

Program Name Screened Positive for Depression (%)

Given a Referral for Services (%)

Completed or Received Services (%)

SAFE 17.6 66.7 100.0PACT 30.3 100.0 100.0Marshall County BOE 3.8 100.0 100.0United Ability 33.3 100.0 37.5TCR Child Care 5.7 100.0 75.0Community Action Partnership of N. Alabama 12.5 100.0 70.0Exchange Club Family Skills Center 25.0 100.0 33.3Goodwill Easter Seals Gulf Coast 25.0 100.0 100.0Easter Seals West Alabama – PAT 20.4 90.9 20.0Family Guidance Center 14.3 95.5 38.1Circle of Care 33.3 100.0 20.0Eufaula – HIPPY 2.7 100.0 0.0Eufaula – PAT 26.3 100.0 20.0Easter Seals West Alabama – NFP 33.3 100.0 0.0

Statewide Totals 16.0 96.7 46.0

Figure 1. Depression screening, referral, and referral follow-up.

FY2018 Maternal Depression Screening and Referral Data

8HV CoIIN 2.0 Virtual Series Part 2: How You Can Achieve Breakthrough Benefits

Participating LIAs

§ 8 LIAs participating (this is ½ of Alabama’s MIECHV-funded sites)

§ We invited LIAs to participate based on several considerations⁃ Maternal depression screening rates⁃ Mix of urban, suburban, rural⁃ Mix of sites with various ranges of CQI

knowledge and experience

9HV CoIIN 2.0 Virtual Series Part 2: How You Can Achieve Breakthrough Benefits

Barriers

§ Lack of Data—what really happens to moms who screen positive? What happens after a referral? (The data registry)

§ Lack of Services—how can we help mothers access services? What happens if they do not want to seek help outside of the home? (Mothers and Babies)

10HV CoIIN 2.0 Virtual Series Part 2: How You Can Achieve Breakthrough Benefits

PRIMARY DRIVERS 1 & 2 Mothers

and babies

PRIMARY DRIVERS 1 & 2Motivational interviewing

PRIMARY DRIVER 4 In-depth data

management tools

PRIMARY DRIVER 1Maternal depression

screening script

PRIMARY DRIVER 4All teams using

CQI data in practice

11HV CoIIN 2.0 Virtual Series Part 2: How You Can Achieve Breakthrough Benefits

Ideas Tested Across Sites

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Maternal Depression Change Prioritization Results

SITE PD1.1

PD1.2

PD1.3

PD1.4

PD1.5

PD2.1

PD2.2

PD2.3

PD2.4

PD3.1

PD3.2

PD3.3

PD4.1

PD4.2

United AbilityEufaula

City SchoolsCircle of

Care

ESWA- PAT

CAPNAESWA-

NFP

East Alabama Mental Health

NFP of Central

Alabama

Action Period 2SITE

PD1.1

PD1.2

PD1.3

PD1.4

PD1.5

PD2.1

PD2.2

PD2.3

PD2.4

PD3.1

PD3.2

PD3.3

PD4.1

PD4.2

United AbilityEufaula City SchoolsCircle of Care

ESWA- PAT

CAPNA

ESWA- NFPEast Alabama Mental HealthNFP of Central Alabama

Action Period 3

CoIIN Begins Mothers and Babies Training

Motivational Interviewing Training

Registry

13HV CoIIN 2.0 Virtual Series Part 2: How You Can Achieve Breakthrough Benefits

% of Women Who Had 1 or More EB Service Contact Who Had 25% Improvement in Depressive Symptoms

Median

Goal

0

10

20

30

40

50

60

70

80

90

4/1/2019

5/1/2019

6/1/2019

7/1/2019

8/1/2019

9/1/2019

10/1/2019

11/1/2019

12/1/2019

% of Mothers With 25% Symptom Improvement

Biggest Surprises

§ Level of Support from HV CoIIN 2.0⎯ Playbook⎯ Trainings⎯ Peer Sharing

§ It Works!!⎯ We are seeing results—this happened much

faster than we thought possible⎯ Not only are our screening and referral rates improving,

but we are seeing symptom improvement!

14HV CoIIN 2.0 Virtual Series Part 2: How You Can Achieve Breakthrough Benefits

What Do Our Home Visitors Say?

We have a rich Mental Health component in the model, but the HV COIIN has helped to solidify the referral process as well as assist with the ability to offer evidence-based services initially to our clients when they score positive for depression.

15HV CoIIN 2.0 Virtual Series Part 2: How You Can Achieve Breakthrough Benefits

This HV CoIIN has given us the tools to provide more meaningful and evidence-based services to caregivers in the home through Mothers and Babies and motivational interviewing. We have also implemented strategies to achieve a higher level of efficiency through the registry and PHQ-9 script. We have learned more valuable, useful, and practical information this time around than ever before.

““

“Participation in the CoIIN has provided me with an opportunity to see making small, but consistent changes can make long term impacts.

Examples of Success Stories from First Teacher Families

Better able to deal with anxiety

Self Care

Assisting and encouraging me to be a better parent

Helpful tips shared regarding coping, parenting, sleep, communication

Parenting tips for young children

Reassurance about taking care of myself

Connecting to community resources and counseling

Assisted with stopping smoking

Laughing together with my parent educator

Listening and encouraging

Success Stories from First Teacher Families about their interactions with their home visitor in better managing stress and improving mood.

What Do Our Parents Say?

16HV CoIIN 2.0 Virtual Series Part 2: How You Can Achieve Breakthrough Benefits

Louisiana MIECHVA Snapshot of Breakthrough ChangeTopic: Maternal DepressionScale Method: IHI’s Breakthrough Series

Why We Joined HV CoIIN 2.0

⎯ Build CQI capacity for LIAs and Statewide team

⎯ Enhance existing Mental Health Consultation services

⎯ Structure and resources offered by HV CoIIN

⎯ Recommended by coach after CQI Practicum

HV CoIIN 2.0 Virtual Series Part 2: How You Can Achieve Breakthrough Benefits

Generating LIA Participation

§ 10 LIAs participating

§ Collective is new to Louisiana. Previously we had tried all LIAs picking a topic or trying to select topics regionally.

§ Focusing on one aim was a way to unify our efforts. Easier to make gains and organize on a state level and increases buy in from LIAs when we can see our progress quickly.

§ This is a way to see real movement in outcomes and less spinning your wheels

HV CoIIN 2.0 Virtual Series Part 2: How You Can Achieve Breakthrough Benefits 19

Overcoming Early Obstacles

20HV CoIIN 2.0 Virtual Series Part 2: How You Can Achieve Breakthrough Benefits

• Invested in initial in-person meeting

• Replaced other in-person meetings that could be held virtually/ regionally

• HV CoIIN is helping build capacity.

• Time investment up front, but seeing payoff on the backend

• Selected a topic of interest to LIAs. Once they started seeing gains, they were even more committed

• Going through the key driver diagram, we realized there were still many areas for improvement.

• Ability to develop mental health consultation to be even more effective

Travel StaffCapacity

StaffBuy-In

Aren’t we already doing

this?

Bright Spots and Benefits

§ LIAs felt they had exhausted all resources connecting moms with maternal depression to services, but through this process realize there were changes they could make that had a big impact

§ Learning Sessions and monthly calls have really expanded CQI knowledge and skills

§ Effectiveness of BTS Model § HV CoIIN website and database is a huge resource- post PDSA’s and

data, provide TA to LIAs, share resources with peer states§ Coaching and peer support from HV CoIIN and other states

21HV CoIIN 2.0 Virtual Series Part 2: How You Can Achieve Breakthrough Benefits

§ Major Outcomes⎯ Ability for home visitors to make a difference through

Mothers and Babies⎯ Training for home visitors on how to talk about

maternal depression and mental health, especially with women who do not want to receive services

⎯ 30-day check-in with clients who do not accept referrals using motivational interviewing techniques has led to more women accepting services

§ The playbook alone is not enough!⎯ Coaching from HV CoIIN and support from peer states⎯ The playbook provides changes, but it requires so

much support outside the change ideas to truly test and implement

22HV CoIIN 2.0 Virtual Series Part 2: How You Can Achieve Breakthrough Benefits

Lessons Learned

Lessons Learned (cont’d.)

§ Proven results

§ Data shows your progress, effectiveness, and where to improve

§ HV CoIIN website does it all for you

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Ending Reflections

⎯ HV CoIIN will work within your existing structure; it’s adaptable/flexible to meet your state’s structure

⎯ If you can commit the time, you can make it work ⎯ Once you start, you’ll be amazed by what is possible

24HV CoIIN 2.0 Virtual Series Part 2: How You Can Achieve Breakthrough Benefits

What are you wondering about?

HV CoIIN 2.0 Virtual Series Part 2: How You Can Achieve Breakthrough Benefits 25

26HV CoIIN 2.0 Virtual Series Part 2: How You Can Achieve Breakthrough Benefits

Important Dates and Next Steps

Virtual Series: Register HereCOMING UP NEXT§ Part 3. Innovations in Parent Leadership:

March 25, 2020 from 1:30-2:00 ET§ Part 4. What is Next? Cohort 2 Application

April 22, 2020 from 1:30-2:00 ET

COHORT 2 APPLICATION Open Now Through May 2, 2020 Available http://hv-coiin.edc.org/

How Did This 30-Minute Webinar Work for You?

Please Let Us Know:https://edc.co1.qualtrics.com/jfe/form/SV_5AyAYx6PJcZK0OF

FOR MORE INFORMATION:• Contact Mary Mackrain at mmackrain@edc.org• Visit our website at www.hv-coiin.edc.org• Check out our HV CoIIN 2.0 New Fact Sheets