Public Health Notice
description
Transcript of Public Health Notice
Public Health Notice
Contagious Disease
Hazard
City and County of San Francisco
Oversight, PerformanceAnd
Focus Groups
Using Focus Groups in State
Oversight of County
Medicaid Managed Care
Specialty Mental Health
Services
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
Obtain direct input from consumers and families
Employ consumers and families as reviewers and moderators
DMH Policy
California Counties run their own mental health programs (MHP’s)
State DMH provides oversight and some direct services
And…
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
Oversight = (C+QI+TAT)
Compliance +
QI +Tech. Assistance &Training
Or,
A Quality Improvement MantraFor Our Times:
“Good news is no news”
“No news is bad news”
“Bad news is good news”
Who Said That?
Free Lunch to the Person Who Can Tell Us!
•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?
And, by golly,
People LIKE them!
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
How many?
About 150 each year!
What’s the Question?
Access and Availability
Beneficiary Protection
Coordination with other Services
Who leads them?
• 1 Family Member (of adult or youth)
• 1 Adult Client
• 1 DMH Technical Assistance and
Training Staff
How are moderators selected?
• DMH “Expert Pool”
• Individual Contracts
• Stipend and Expenses Paid
• Not in your own county!
How are moderators trained?
• Two-day paid workshop
• Faculty = Clients and Family
Members and DMH Staff
• Training is mostly experiential -
role playing
Focus Group Training - Spring, 2002
Focus Group Training - Spring, 2002
Moderator Responsibilities
• Group Leader
• Note Taker
• Report writer
ConductFocus Groups
ConductFocus Groups
WrittenReports
to County
WrittenReports
to County
Verbal ReportVerbal Report
How Information Flows
Three Years of Focus GroupsThree Years of Focus Groups
Evaluation Teams
1 - Family Member of Children/Youth1 - Family Member of Adult Client1 - Adult Consumer1 - DMH Staff
4
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
A consistent, collaborative process:
• Team members generate “Theme Lists” independently
• Collaborative ranking of themes
• Report written using final rankings
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:
Overview of 3 years
Who we saw - Groups
Year 1 Year 2 Year 3
118 157 163
Who we saw - People
Year 1 Year 2 Year 3
776 1195 1161
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%
What we have learned
Access Themes
•Staff turnover remains a problem
•Most know how to gain access
•But - it can be complex, difficult
Access Themes - 2
•Once you’re “in,” it’s better
•but long delays persist •They’d like more staff, money, services
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.”
Themes - BeneficiaryProtection
•B/P system is a fuzzy concept to most
•>50% recall seeing printed material
•BUT - content is not easily recalled
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
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.”
Coordination Themes
•>50% say it’s good, O.K.
•but A significant minority (up to 50%) say improvement is needed
Coordination Themes - 2•Problems: Communication;
Rx & pharmacy - TARS, Dental & Housing services
•Some Staff are exceptional at linking clients to services
Coordination Themes -3
•Most Frequently mentioned problem:
“My doctor and my psychiatrist don’t communicate!”
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.”
New in year 2
Involvement in Quality Improvement
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
The QI Experience (2)
•More education, training needed
•When it’s good, it’s very, very good…
•And when it’s bad…
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.
Room for Improvement
• Close the loop - feedback from county MHPs
• Recruit for specific participant types
• Integrate data from Compliance & Outcomes
The EndThe End
FinallyFinally!!