Transcript Mental Health QAI in School

Mental Health Planning and Evaluation Template
-- ONLINE
TJ Cosgrove, LICSW
Public Health – Seattle & King County
Laura Hurwitz, LCSW
Director, School Mental Health Programs
Objectives of Webinar
Participant will be able to…
 assess whether the on-line Mental Health
Planning and Evaluation Template is an
appropriate tool for your setting.
 learn the steps for using the on-line Mental
Health Planning and Evaluation Template.
 learn how the on-line Mental Health
Planning and Evaluation Template can be
used in a quality improvement process.
MHPET Purpose
 Enhance
the evaluation of mental
health services in the SBHC and/or in
any school setting
 Improve mental health practices in the
SBHC and/or in any school setting
 Collect data for school mental health
advocacy and technical assistance
efforts at NASBHC
SBHC Staffing Models
(N=1235)
Primary Care
Mental Health
Plus
31%
Unknown
4%
Primary CareMental Health
34%
Primary Care
Only
31%
Mental Health Services in SBHCs With (n=655)
and Without (n=277) Mental Health Providers
*Other
*Conflict Resolution/Mediation
*Tobacco Use Counseling
*Substance Use Counseling
*Referrals
*Skill-Building
*Case Management
*Medication Management/Administration
*Long Term Therapy
*Brief Therapy
*Mental Health Diagnosis
*Screening
*Assessment
*Psycho-education
*Grief and Loss Therapy
* P<.01
*Crisis Intervention
0
10
20
30
40
With Me ntal He alth Provide r
50
60
70
80
Without Me ntal He alth Provide r
90
100
Mental Health Services in SBHCs
Fastest growing component of SBHC.
 In ten years, the percentage of SBHCs with
mental health staff went from 30% to over
65%.
 Survey of SBHC providers in 2004/2005
found that expansion of mental health
services was the first priority for program
funding.

Need for Quality Improvement in
Mental Health in SBHCs
Increased recognition that objective
measures were needed for SBHC quality
of care, especially in mental health
 Such a measure would need to recognize:

– Many disciplines
– Wide range of interventions
– Limited translational research around best
practice in schools
Continuous Quality
Improvement (CQI)
at NASBHC




Seeks to improve all performance not just areas
of unacceptable care.
Focuses on the processes of health care delivery
and use of research-based approaches to reduce
variations in those processes.
Need to understand and revise process in order to
improve quality
2001 - NASBHC developed CQI tool to assess
clinically based sentinel conditions, including
MH
MHPET
Development





January 2004 NASBHC convened a workgroup to
develop an evaluation tool
Based on School Mental Health Quality
Assessment Questionnaire (MH-QAQ) developed
by Mark Weist et al. at the Center for School
Mental Health
Broadened questions from clinician to program
level
Expanded questions to be more inclusive of school
staff and non-mental health providers
Shortened, fewer dimensions and indicators
MH-QAQ



School Mental Health Quality Assessment
Questionnaire (MH-QAQ)
Developed by Mark Weist et al. at the Center
for School Mental Health (CSMH)
http://csmha.umaryland.edu/research.html/qua
lity_assessment.html
Part of first ever systematic study “Enhancing
quality in expanded school mental health” of
school mental health quality assessment and
improvement (QAI)
This study was supported by the National
Institute of Mental Health
MHPET Beta-test

41 individuals completed the MHPET tool
–
–
–
–

20 mental health providers
11 medical providers
6 support staff members
4 administrators
21 unique SBHC sites were represented
(Talbot - 9, Illinois - 5, Seattle - 3, Montefiore - 4)
MHPET Beta-test
Responded to interview questions
 Revised and finalized tool accordingly:

–
–
–
–
generalized to school mental health
changed name (“program” to “planning”)
simplified dimensions and language
included substance abuse
Beta-test on-line MHPET

Beta-test with 29 participants in 6 schools
(3 SBHCs) in Baltimore, Pittsburgh, Little Rock,
and Worchester
Teams completed both sets of MHPET and
were given follow-up interview questions
 Team leads participated in conference calls
 Based on feedback, adjusted web links and
revised instructions (e.g. clarified role of
participants and team leads)

MHPET web-based tool
Now online www.nasbhc.org under
“mental health” section
 Set up to be completed by teams
 Teams complete tool and go back 3-6
months later to complete a second time
 Computer generates scores

Using the Web-Based
MHPET
Principles for SBHCs







Supports the school
Responds to the community
Focuses on the student
Delivers comprehensive care
Advances health promotion activities
Implements effective systems
Provides leadership in adolescent and child
health
http://www.nasbhc.org/site/c.jsJPKWPFJrH/b.2743459/k.9519/NAS
BHC_Principles_and_Goals_for_SBHCs.htm
Laura Hurwitz
Laura Hurwitz
Laura Hurwitz
James A Davis Middle School
1224 Clarendon Ave.
Bessamer, AL
2
3
James A Davis Middle School
1224 Clarendon Ave.
Bessamer, AL
3
Set Two Survey will be
available after…
Set Two Survey will be available after July 25, 2008
3
0
Quality
Improvement/Planning





Indicators with scores of 3 or less are
automatically flagged as potential areas for
improvement
Raters select targeted areas for improvement
(dimensions and/or indicators with averages that
are low relative to others)
Identify resources for improving target areas
Develop and implement improvement plan
Compare scores 3-6 months later and assess
progress
Using MHPET to identify
improvement targets

Examine the lowest rated indicators first.
– Which of these can you impact in the next 6
months?

Parallel to goal setting with a
student/client:
–
–
–
–
What are the strengths?
What areas are in need of improvement?
Realistic?
Obtainable?
Using MHPET to identify
improvement targets (cont.)

“Halo effect”
– By focusing on 2-3 indicators is there
potential to positively impact others?
If “don’t know” is prevalent in your
responses, can you select targets that will
result in informing these key people?
 Place the MHPET results in the context of
other data.

3
3
Qualifiers and Caveats
Quality Improvement for mental health
services in schools is new and unfamiliar
territory
 Consider where your program is
developmentally
 This is not about judgment i.e. good or
bad, right or wrong
 Should not be tied to staff performance
appraisal or funding

MHPET Next Steps
Develop compendium of quality
improvement resources for each indicator
 MHPET will have on-line link to resource
for each indicator
 Develop training module on quality
improvement (School Mental Health
Capacity Building Partnership)
 Collect and analyze national data from
MHPET

NASBHC Resources for Quality
Improvement: www.nasbhc.org

Paper version currently available
http://www.nasbhc.org/atf/cf/{CD9949F2-276142FB-BC7A-CEE165C701D9}/MHPET.pdf

General mental health resources
http://www.nasbhc.org/site/c.jsJPKWPFJrH/b.2642
293/k.85AC/mental_health.htm
Resource for Quality Improvement:
The School Mental Health Connection
www.schoolmentalhealth.org
In association with University of Maryland
Center for School Mental Health
(CSMH) www.csmh.umaryland.edu
 40 indicators of quality in school mental
health services
 PowerPoints provide background
information, a menu of suggested
activities, helpful hints, web resources, and
references

Other Resources for Quality
Improvement




Center for Health & Health Care in Schools
www.healthinschools.org
UCLA Center for Mental Health in Schools
www.smhp.psych.ucla.edu
National Technical Assistance Center for Children's
Mental Health at Georgetown University Center for
Child and Human Development
www.gucchd.georgetown.edu
IDEA Partnership www.sharedwork.org
Contact Information
TJ Cosgrove, LICSW
Public Health – Seattle & King County
[email protected]
206.263.8352
Laura Hurwitz, LCSW
Director, School Mental Health Programs
[email protected]
www.nasbhc.org
202.638.5872 x205