Dr. Rosa West, Clinical Assistant Professor University of Florida Susan Woodford, Executive Director NACDAC Angie Maldonado, Program Director Aspire Health Partners This product is supported by Florida Department of Children and Families Substance Abuse and Mental Health Program Office funding.
Block Grant Requirements Evidence-Based Practice Fidelity Site Visit Overview Case Studies Timelines
SAPT Block Grants Overview Block grants are noncompetitive, formula grants appropriated by Congress. This provides the foundation for safety net services in Florida. 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 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 HIV/TB Individuals in Treatment Injecting Drug Users Primary medical care Pediatric care Gender-specific treatment Preference in admissions Waiting list Interim services within 48 hours Risk assessment On-site HIV testing Pre/post-test counseling 14-120 days for admission Interim services within 48 hours
Block Grant requirements 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)
Peer Review Process mandated by DCF 5-days long 2 Peer Mentors Audit feel to the process DCF attended open/exit meetings
Florida won STAR-SI Grant 2006 NIATx process improvement model Created an open process Providers/ DCF/Peer Mentors New EBP Initiative FY 08-09 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
Assist DCF in meeting Block Grant Requirements by: Achieving the 5% mandated sample of substance abuse, mental health and prevention providers peer review provider visits across the state Capturing mandated block grant client level data for reporting Expanding use of NIATx Process Improvement Model across all providers Assisting providers in implementing EBP s with high fidelity (connecting EBP documentation from initial planning stages to implementation)
Evolution Continues Providers randomly selected New block grant priorities checklist added 1 peer mentor conducts site visits ME invited to attend Entrance/Exit meeting Follow-up call and technical assistance available
Fifteen (15) Florida providers will be 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 12 client record reviews Review the (4) Priority Population checklists for interview with FADAA Identify areas in the agency that need improvement or technical assistance (TA)
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 & Priority Population Checklists Identify best/promising practices used by provider Conduct the site visit exit interview and provide positive feedback Offer technical assistance as needed
To ensure a successful site visit agencies are asked to: Have materials and source documents accessible for peer mentor team (i.e. P&P, client handbooks, EBP manuals, EBP fidelity/supervision, EBP training plan) 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 managing entity representative to entrance and/or exit meetings only
Peer Mentor o o o o o o o Confirm contact person Confirm location of site visit Review BPP checklists are completed Ensure 12 client file review forms were completed Ask if provider has EHR (plan for this) Assist provider with any questions Engage and create positive expectations Provider o Contact information form o Select Staff to attend visit o Complete on-line survey o Complete self-assessment summary o Prepare brief presentation of EBP o Conduct interview with FADAA for BPP checklist o Complete 12 client record reviews using fidelity form o Provide FADAA local resources for PM
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 Clinical Staff Director/Manager Others?
Many agencies have electronic health records (EHRs). It s helpful to have the agency EHR staff available during the site visit. How will the site visit process be different for PM and Providers who are on an EHR?
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.
Develop Discrepancy Motivation for change is enhanced when people 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).
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?
Consider: o Who is key in identifying which BPPs are being implemented at your agency? o Should they attend the site visit? o Are BPP s included in your Policies and Procedures o How is the agency notifying staff about priority populations? Clients? o What documentation should be the clinical file?
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?
Your Agency has been randomly selected for an EBP site visit. As you are tasked to identify an EBP to be reviewed, you find that your Agency wants to implement a new one instead. How do you prepare for the site visit?
PEER MENTORS!
When Choosing an EBP o New EBP Vs Full/Partial implementation o What to consider? o Who should be involved? o What documentation is needed/required? o Fidelity/Supervision o Training o Clinical file o How do you show the process? o Policies and Procedures o Client handbooks o Share results/data
EBP Fidelity Site Visits o October 2016 through June 2017 Peer Mentor documentation o Due within 3-days after visit/follow-up call Provider documentation o Due within 3-days after visit Peer Mentor Stipend o $500 per visit +expenses
http://nrepp.samhsa.gov/ www.fadaa.org www.niatx.net http://www.hhs.gov/