Transcript Peer Mentor Evidence-Based Practice Fidelity Site Visit

January 23, 2015
This product is supported by Florida Department of Children and Families
Substance Abuse and Mental Health Program Office funding.
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Block Grant Requirements
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Evidence-Based Practice Fidelity Site Visit
Overview
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Discussion and Feedback
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Case Studies
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Upcoming Events
SAPT Block Grants Overview
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Block grants are noncompetitive, formula grants appropriated by
Congress.
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This provides the foundation for safety net services in Florida.
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Federal grants with federal legal requirements that apply to every
aspect of the process
- Department
 SAMH Program
 Contracts
 Licensing
 Revenue Management
 Budgeting
- Managing Entities
- Providers that receive federal dollars (all providers that receive
Department funding)
SAPT Block Grant Priority
Populations
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Pregnant and Parenting Women
Intravenous Drug Users
Individuals receiving services related to
communicable diseases (specifically
Tuberculosis and Human Immunodeficiency
Virus)
Individuals receiving prevention services
Substance Abuse 42 U.S.C. s. 300x-21
Priority Populations
Pregnant Women &
Women with
Dependent Children
• Primary medical care
• Pediatric care
• Gender-specific
treatment
• Preference in
admissions
• Waiting list
• Interim services
within 48 hours
HIV/TB
Individuals in
Treatment
• Risk assessment
• On-site HIV
testing
• Pre/post-test
counseling
Injecting Drug
Users
• 14-120 days for
admission
• Interim services
within 48 hours
Twenty Florida providers were randomly
selected to participate
Prior to the site visit, providers:
Conduct a self-review of a specific EBP
Use the fidelity monitoring tool protocol
Conduct client record reviews
Identify areas in the agency that need
improvement
• Identify areas that could benefit from technical
assistance (TA)
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Selected based on experience and knowledge of
process improvement and specific selected EBP
Conduct on-site visits
Complete EBP fidelity tool review reports
◦ Client records review
◦ Program review
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Identify best/promising practices used by
provider
Conduct the site visit exit interview and provide
positive feedback
Offer technical assistance as needed
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To ensure a successful site visit agencies
are asked to:
◦ Have materials and source documents accessible
for peer mentor team
◦ Designate a contact person
◦ Have staff team available to work with peer
mentors
◦ Provide a place for the peer mentor team to work
◦ Invite local SAMH supervisor, managing entity or
community coalition representative to entrance
and/or exit meetings only
Background of EBP Fidelity Site Visits
 Block Grant requirements
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Independent peer reviews are required by 45 C.F.R.
5% of contracted entities must be reviewed
Quality and appropriateness of services
Substance abuse and mental health systems
EPB implementation across all providers (FY 08-09)
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Peer Review Process mandated by DCF
5-days long
2 Peer Mentors
Audit “feel” to the process
DCF attended open/exit meetings
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Florida won STAR-SI Grant 2006
◦ NIATx process improvement model
◦ Created an open process
◦ Providers/ DCF/Peer Mentors
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New EBP Initiative FY 08-09
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Created a “True Peer Review Process”
Providers volunteered for visit
2 Peer Mentors
1 DCF staff present for the entire process
Technical assistance available for providers
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Evolution Continues
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Providers randomly selected
New block grant priorities checklist
2 peer mentors (for treatment providers)
DCF/ME invited to attend Exit meeting
No technical assistance available
Site Visit is Scheduled…Now What?
 Call provider one week before
 Ask…
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Confirm contact person
Confirm location of site visit
Review BPP checklists are completed
Ensure 6 client file reviews have been completed
Ask if provider has EHR (plan for this)
Assist provider with any questions
Engage and create positive expectations
Diversity in Staff
It is important to have good
representation of the agency during
the staff visit
There are multiple areas of review and
a diverse staff can provide more
comprehensive feedback (360 degree)
Consider who may be beneficial to
participate
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Clinical Staff
Director/Manager
Others?
Using Motivational Interviewing to
Solicit Information
Many agencies have electronic
health records (EHRs).
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It’s helpful to have the agency
EHR staff available during the
site visit.
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How should conversations
about the site visit be handled
with program staff present?
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Open-Ended Questions
◦ Asking open-ended questions
helps you understand your
clients' point of view and elicits
their feelings about a given topic
or situation.
◦ Helpful with facilitating dialog
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Listen Reflectively
◦ Reflective listening is a
way of checking rather
than assuming that you
know what is meant.
◦ Check for understanding
 Is there clarity to what
information is provided?
 If not, have staff walk you
through some of the
navigation of the EHR.
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Develop Discrepancy
◦ Motivation for change is enhanced
when clients perceive differences
between their current situation and
their hopes for the future.
◦ Work to raise awareness of
processes which do not align with
the desired outcome.
 For example, you would like to
demonstrate the clients are
benefiting from the EBP but the EBP
is not discussed in the clinical record
(progress note).
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Affirm
◦ Support the self-efficacy of
the agency by affirming the
work that is done.
◦ For example, you are doing a
good job with “X”. How can
we make sure to capture the
work you are doing?
On the best/promising practice (BPPs)
checklists, which questions are key in
identifying if BPPs are being implemented by an
agency?
You’re conducting an EBP
fidelity site visit and you’re
about to review the
best/promising practice
checklists. The provider
informs you that none of
the checklists apply to their
work. What do you do?
Upon arriving for the site
visit, you discover that the
provider has not adequately
briefed their staff. They are
unaware of the purpose of
the site visit and they have
not completed the client
reviews or the
best/promising practice
checklists. What do you do?
March TBD
June TBD