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Public Health Notice

City and County of San Francisco. Public Health Notice. Contagious Disease Hazard. Oversight, Performance And Focus Groups. Using Focus Groups in State Oversight of County Medicaid Managed Care Specialty Mental Health Services. A Little Background.

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Public Health Notice

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  1. City and County of San Francisco Public Health Notice Contagious Disease Hazard

  2. Oversight, Performance And Focus Groups

  3. Using Focus Groups in State Oversight of County Medicaid Managed Care Specialty Mental Health Services

  4. 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

  5. DMH Policy Obtain direct input from consumers and families Employ consumers and families as reviewers and moderators

  6. And… California Counties run their own mental health programs (MHP’s) State DMH provides oversight and some direct services

  7. 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 Combine Two Approaches

  8. Oversight = (C+QI+TAT) Or, Compliance + QI +Tech. Assistance &Training

  9. A Quality Improvement MantraFor Our Times: • “Good news is no news” • “No news is bad news” • “Bad news is good news”

  10. Who Said That? Free Lunch to the Person Who Can Tell Us!

  11. But why use focus groups? • Cheaper & faster than other methods • Interaction generates additional information • Questions can be changed rapidly, if needed • Consumers like interaction with others

  12. And, by golly, People LIKE them!

  13. 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

  14. How many? About 150 each year!

  15. What’s the Question? Access and Availability Beneficiary Protection Coordination with other Services

  16. Who leads them? • 1 Family Member (of adult or youth) • 1 Adult Client • 1 DMH Technical Assistance and Training Staff

  17. How are moderators selected? • DMH “Expert Pool” • Individual Contracts • Stipend and Expenses Paid • Not in your own county!

  18. How are moderators trained? • Two-day paid workshop • Faculty = Clients and Family Members and DMH Staff • Training is mostly experiential - role playing

  19. Focus Group Training - Spring, 2002

  20. Focus Group Training - Spring, 2002

  21. Moderator Responsibilities • Group Leader • Note Taker • Report writer

  22. How Information Flows ConductFocus Groups WrittenReportsto County Verbal Report

  23. Three Years of Focus Groups

  24. Evaluation Teams 1 - Family Member of Children/Youth1 - Family Member of Adult Client1 - Adult Consumer1 - DMH Staff 4

  25. The Evaluation Process SelectEvaluationTeams TrainEvaluators Teams Conduct Evaluation County Directors Draft State-wide Report DMH Approves and Disseminates Client Orgs. Family Orgs. SQIC Family Orgs.

  26. A consistent, collaborative process: • Team members generate “Theme Lists” independently • Collaborative ranking of themes • Report written using final rankings

  27. More Evaluation Process: 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

  28. Overview of 3 years

  29. Who we saw - Groups

  30. Who we saw - People

  31. Who we saw : Types

  32. What we have learned

  33. Access Themes • Staff turnover remains a problem • Most know how to gain access • But - it can be complex, difficult

  34. Access Themes - 2 • Once you’re “in,” it’s better • but long delays persist • They’d like more staff, money, services

  35. 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.”

  36. Themes - BeneficiaryProtection • B/P system is a fuzzy concept to most • >50% recall seeing printed material • BUT - content is not easily recalled

  37. 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

  38. 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.”

  39. Coordination Themes • >50% say it’s good, O.K. • but A significant minority (up to 50%) say improvement is needed

  40. Coordination Themes - 2 • Problems: Communication; Rx & pharmacy - TARS, Dental & Housing services • Some Staff are exceptional at linking clients to services

  41. Coordination Themes -3 • Most Frequently mentioned problem:“My doctor and my psychiatrist don’t communicate!”

  42. 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.”

  43. New in year 2 Involvement in Quality Improvement

  44. 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

  45. The QI Experience (2) • More education, training needed • When it’s good, it’s very, very good… • And when it’s bad…

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