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...
•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
DMH Policy
Obtain direct input from
consumers and families
Employ consumers and families as
reviewers and moderators
And…
California Counties run their own
mental health programs (MHP’s)
State DMH provides oversight and
some direct services
Combine Two Approaches
•
•
•
•
•
•
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
Oversight = (C+QI+TAT)
Or,
Compliance
+
QI +Tech. Assistance &Training
A Quality Improvement Mantra
For Our Times:
“Good news is no news”
“No news is bad news”
“Bad news is good news”
Who Said That?
Free Lunch to the Person Who Can
Tell Us!
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
And, by golly,
People LIKE them!
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
How many?
About 150 each year!
What’s the Question?
Access and Availability
Beneficiary Protection
Coordination with other Services
Who leads them?
• 1 Family Member (of adult or youth)
• 1 Adult Client
• 1 DMH Technical Assistance and
Training Staff
How are moderators selected?
• DMH “Expert Pool”
• Individual Contracts
• Stipend and Expenses Paid
• Not in your own county!
How are moderators trained?
• Two-day paid workshop
• Faculty = Clients and Family
Members and DMH Staff
• Training is mostly experiential role playing
Focus Group Training - Spring,
2002
Focus Group Training - Spring,
2002
Moderator Responsibilities
• Group Leader
• Note Taker
• Report writer
How Information Flows
Conduct
Focus Groups
Verbal
Report
Written
Reports
to
County
Three Years of Focus Groups
Evaluation Teams
1 - Family Member of Children/Youth
1 - Family Member of Adult Client
1 - Adult Consumer
1 - DMH Staff
4
The Evaluation Process
Select
Evaluation
Teams
Train
Evaluators
Teams Conduct
Evaluation
County Directors
Draft Statewide
Report
DMH
Approves and
Disseminates
Client Orgs.
Family Orgs.
SQIC
Family
Orgs.
A consistent, collaborative
process:
• Team members generate “Theme
Lists” independently
• Collaborative ranking of themes
• Report written using final
rankings
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
Overview of 3 years
Who we saw - Groups
Year 1
Year 2
Year 3
118
157
163
Who we saw - People
Year 1
Year 2
Year 3
776
1195
1161
Who we saw : Types
Type
Year 1
Year 2
Year 3
Adults
53%
33%
37%
F/Youth
26%
17%
16%
F/Adults
21%
15%
14%
0%
12%
8%
Language
N/A
19%
23%
Mixed
N/A
4%
N/A
Youth
Total
0%
100%
0%
100%
2%
100%
QI
What we have
learned
Access Themes
•Staff turnover remains a
problem
•Most know how to gain
access
•But - it can be complex,
difficult
Access Themes - 2
•Once you’re “in,” it’s better
•but long delays persist
•They’d like more staff,
money, services
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.”
Themes - Beneficiary
Protection
•B/P system is a fuzzy
concept
to most
•>50% recall seeing printed
material
•BUT - content is not easily
recalled
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
Beneficiary Protection
Quotes
• “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.”
Coordination Themes
•>50% say it’s good, O.K.
•but A significant minority
(up to 50%) say improvement
is needed
Coordination Themes - 2
•Problems: Communication;
Rx & pharmacy - TARS, Dental
& Housing services
•Some Staff are exceptional
at linking clients to services
Coordination Themes -3
•Most Frequently
mentioned problem:
“My doctor and my
psychiatrist don’t
communicate!”
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.”
New in year 2
Involvement in Quality
Improvement
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
The QI Experience (2)
•More education, training
needed
•When it’s good, it’s very,
very good…
•And when it’s bad…
QI - Quotes
• “The
local Mental Health Board is
behind us 100%.”
• “Absolutely. We are not considered
part of the problem - we’re part of the
solution
• “They talk the talk but they don’t walk
the walk.”
• “I’d like to be more than a rubber
stamp. They do all the work first,
then run it by us.
Room for Improvement
•Close the loop - feedback
from county MHPs
•Recruit for specific
participant types
•Integrate data from
Compliance & Outcomes
The End
Finally!