Florida Maternal, Infant and Early Childhood Home Visiting (MIECHV) Initiative

State Continuous Quality Improvement (CQI) Team Web Conference

August 21, 2014

Meeting Summary

Participants: Stacy Morgan, AlachuaParents as Teachers (PAT); Allison LaMont, PAT National Office; Anna Simmons, Florida Department of Health-Maternal and Child Health (FDOH-MCH); Dr. Joan Meek, Florida State University (FSU) College of Medicine; Janie Register, Florida Department of Education (FDOE); Sara Eldridge, Nurse Family Partnership (NFP) National Service Office; Diana Strawbridge, Hillsborough NFP; Dr. Jennifer Marshall, University of South Florida (USF)-MIECHV Evaluator; Dr. Maurine Jones, Director Emeritus, Center for Health Equity, and Anna Cismesia, Manatee PAT

FL MIECHV Staff: Allison Parish, Virginia Holland and Carol Brady

Participants were welcomed and participated in an introductory icebreaker on super heroes and super powers. Allison reviewed the meeting agenda and objectives.

Feedback of Draft State MIECHV CQI Plan

Allison reported 12 people provided feedback on the Draft State MIECHV CQI Plan. Five of the 12 recommended no changes, while seven suggested revisions and fine-tuning. Members were urged to provide additional input during the meeting as they reviewed the submitted comments.

Key recommendations included:

  • Adding a “Background” section to provide information on the federal MIECHV program and expectations around CQI activities as context for the plan.
  • Including a more detailed description of the three evidence-based models being implemented with MIECHV funding in Florida.
  • Providing hyperlinks and expanding the discussion of the relationship of CQI activities to the state MIECHV Benchmark and Data Plans.
  • Expanding state CQI Team responsibilities to include development of driver diagrams on specific areas (A driver diagram developed as part of the HRSA HV CoIIN was shown as an example).
  • Discussion focused on the need to engage implementing sites, as well as content area experts in developing the driver diagrams.
  • Diagrams should balance research with practical experience.
  • Adding “Learning Collaboratives” as a strategy for CQI implementation.
  • Continued emphasis on the importance of partnerships and collaboration in state and local activities.
  • Revising the description of “Implementation of CQI Activities” to include three specific stages:
  • Building a Culture of Quality (team building, professional development)
  • Ensuring Data Quality & Completeness
  • Implementing PDSA cycles
  • Utilizing baseline data on benchmarks (reported to HRSA in October) to identify potential topics for CQI.
  • Developing a CQI Implementation Manual for MIECHV sites that provides specific information and operationalizes CQI concepts for frontline staff and supervisors.
  • Need to emphasize why CQI is important for home visitors and its potential to impact families.
  • Guide should include specific examples of CQI activities, PDSA cycles, etc.
  • Consideralternative graphic for Figure 3. This graphic may be more appropriate for the Implementation Manual.
  • Add a quarterly deliverable in site contracts to facilitate updates on CQI activities by site.
  • Utah’s form was presented; could be modified to reflect status of sites in Florida.
  • Add form development to role of state CQI team.
  • Expand discussion of roles of model developers and state MIECHV initiative in ensuring model fidelity.
  • Model adherence is key to delivery of quality services. High quality data is needed to ensure fidelity.
  • Is there any potential to align required reporting and model fidelity assessments conducted by models with state MIECHV CQI activities?
  • Implementation of MIECHV CQI activities will support efforts by model developers around quality improvement.

Allison will make changes to the draft plan to incorporate comments and discussion. Revised plan will be sent to group for additional review prior to its submission to HRSA.

CQI in Action

Stacy Morgan, Director of the PAT program in Alachua County, shared the site’s experience in using the “Seven Wastes” concept. She presented the concept at a weekly staff meeting after learning about it on the June introductory CQI webinar. Staff each took one of the seven wastes, found examples in current operations, identified potential solutions and shared their findings at a subsequent staff meeting. Stacy reported the exercise increased understanding of the concept by frontline staff and resulted in some tangible improvements to program operations.

Anna Cismesia, Program Manager of PAT in Manatee County, noted project forms had been reorganizedby due date in a special folder to facilitate benchmark and other reporting to MIECHV and local funders as a result of CQI activities.

HV CoIIN Update

Allison provided an update on recent HV CoIIN activities:

  • Skill building around the creation and use of “run charts” was featured on a recent webinar.
  • Paul Dworkin, of the Help Me Grow national office, presented information on developmental surveillance and screening. He outlined research showing that how home visitors and others ask questions about development impacts the accuracy of responses. Questions about child development should be included in every home visit, even if there is a crisis. Inquiries can be tailored to reflect circumstances.
  • The Boston Infant Feeding Toolkit was highlighted in a webinar for the sites working on increasing breastfeeding duration. The toolkit identifies critical points in time when breastfeeding support is needed.

Meeting Options

Participants considered options for scheduling a face-to-face meeting for the group. January, 2015 was selected as a possible date. This will allow us to have baseline data compiled from required HRSA reports. Allison will poll members on specific dates and preferred location.

Professional Development Resources for CQI

The state MIECHV office would like to build a training resource list for CQI. Allison asked members to send her training resources they were aware of in Florida.

Next Steps

  1. Allison will revise draft CQI plan based on input and discussion during the meeting.
  2. A Doodle Poll will be emailed to the group on options for the next state CQI Team Conference Call.
  3. The date and location of the in-person meeting in January, 2015 will be finalized with input from members.

Participants were thanked for their support and comments. The meeting was adjourned at 11:30 a.m.

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