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Kate Whitaker, Tracie Lansing
HFA Peer Reviewer & TA/QA Training
June 18 - 20, 2012Fort Wayne, IN
What To Expect Out of the Training
Grounded in a CQI philosophy
Understand the Site Visit Process
Competent in activities required of peer reviewers
Ready to complete site visits or provide TA/QA in accordance to Accreditation
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The Essence of Quality
“Quality is never an accident; it is always a result of high intention, sincere effort, intelligent direction and skillful execution; it represents the wise choice of many alternatives.”
-William A. Foster
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THE HFA INITIATIVE TODAY
444 programs in 43 states, D.C., U.S. territories and Canada
Additional states and territories, plus expansion in existing states with federal MIECHV program
300+ leaders with expertise in QA, funding, PR, TA, training, etc.
385 or 95% of sites up-to-date and 95 sites currently in process
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HFA REGIONAL & NATIONAL OFFICES
Technical Assistance & Support Affiliation Accreditation
Pre-site Development of the self study Intent of the standards Evidence examplesPost-site Development of the response to
the Preliminary Credentialing Report
Deferral Celebrate!
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HFA Regions
Northeast Region, Region I: Connecticut, Delaware, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont, Virginia, Washington DC., West Virginia, Puerto Rico, and Us Virgin Islands.
Southeast Region, Region II: Alabama, Florida, Georgia, Hawaii, Kentucky, Mississippi, North Carolina, South Carolina, Tennessee, Canada, Commonwealth of the Northern Mariana Islands Guam, and American Samoa.
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HFA Regions (cont.)
Central Region: Region III: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, Ohio, Wisconsin
Western Region, Region IV: Alaska, Arizona, Arkansas, California, Colorado, Idaho, Louisiana, Montana, Nevada, New Mexico, North Dakota, Oklahoma, Oregon, South Dakota, Texas, Utah, Washington, Wyoming,
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Contact Information: Regional Staff Northeast Region, Region I: – 312.590.4889
Lynn [email protected]
Southeast Region-Region II 312.590.4797Kate Whitaker [email protected]
Central Region, Region III – 312.590.4537Tracie [email protected]
Western Region, Region IV – 541.521.7225 Satya Kline
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Contact Information: National Staff
HFA National Office – 312.663.3520
Lisa Sutter – Training – [email protected]
Cydney Wessel – [email protected]
Site Visit Scheduling & Expense ReimbursementsPhyllis Medrano – [email protected]
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DL Workbook & Analysis Activity
Pull-out Assignment Workbook Sign and pass to the front pages
4 & 5 (Confidentiality and Principles of Behavior)
Review Ratings – pages 6-10 Rating Standards that require
monitoring, measuring and analyzing
The distinction between these activities
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Monitoring-Measuring-AnalyzingStandards that Require Monitoring:
1-1.C, 1-1.E, 4-2.C, 6-4.B, 6-6.B, 7-4.B, 9-4, 10-1, GA-3, GA-9
Standards that Require Measuring: 1-1.D, 1-1.F, 1-2.A, 3-4.A, 4-1.B, 4-2.B, 7-1.B, 7-2, 11-1.B
Standards that Require Analysis:1-2.B/C and 3-4.B/C
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SIMPLIFYING THE COMPLEXITIES OF ANALYSES
Step 1: Measure utilize HFA methodology
Step 2: Analyze includes required components:
(comprehensive WDPS+F/I, comparative, correct timeframe)
Step 3: Plan and implement Addresses findings from Step 2
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ACTIVITY: Monitoring-Measuring-Analyzing
1) Review Sample 1-1 Data Tracking and assign ratings
2) Review Sample 1-2.A, B and C and assign ratings
3) Review Sample 3-4.A, B and C and assign ratings
4) Review Sample 9-4 and assign rating
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FAQ’s
What if the program defines enrollment date as date consent is signed vs. date of first home visit?
Do all categories need to be completed on the analysis grids?
Is the program out of adherence if the numbers don’t seem to jive on the worksheets?
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FAQ’s continued
Is the program out of adherence if the retention percentage says “invalid”?
Can programs enter all participants on the retention worksheet or just those from a particular year?
Do we need to see back-up information on-site to verify the data on worksheets?
Other Questions
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FOUNDATION OF SELF-ASSESSMENT TOOL
Based upon the critical elements & literature review Consensus and Research Based SAT forms minimum standards at
which a program must function
12 critical elements & a section on governance and administration
Elements 10 & 11 re: training are combined into standard 10 in SAT
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FOUNDATION OF SELF-ASSESSMENT TOOL
A series of inter-related standards Broadly organized by 1st order standards Similar to an outline
1. 1st Order Standard Initiate services prenatally or at birth. 1-1. 2nd Order Standard The program ensures it identifies families in the target population for services
either while mother is pregnant (prenatally) and/or at the birth of baby.
1-1.A. 3rd Order Standard The program has a description of the target population that
includes applicable demographic data and identifies places where the population is found (e.g., local hospitals, prenatal clinics, high schools, etc.).
1-1.B. 3rd Order Standard The program’s system of organizational relationships with
community entities (e.g. prenatal clinics, hospitals, etc.) allows families in the target population to be screened/identified to establish possible need for service.
Each is a critical element, except for governance & administration section
Form major components of 1st order standard
Building blocks of system & forms basis of program’s self-study
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Unsupported Second Orders
Are not broken down into two or more specific standards.
Examples: 3-1. Services are offered to families on a
voluntary basis.
4-3. The program offers home visitation services to families for a minimum of three years after the birth of the baby.
5-1. The program has a description of the cultural characteristics of its current service population, including ethnic, racial, linguistic, demographic and other characteristics.
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TOOLS FOR MEASURING A PROGRAM’S ADHERENCE
STANDARD 7-3. Home visitors provide information, referrals, and linkages to available health care resources for all participating family members.
INTENT: It is recommended that programs only provide information, referrals and linkages when necessary, (i.e., when a pregnant mother needs assistance connecting to prenatal care, or when parents or siblings have health concerns and are without a medical care provider). Therefore if a family is currently receiving necessary care, there may be no need for further provision of the above-mentioned services.
EVIDENCE TABLE: Found in your folder Identifies policy & procedure requirements, additional pre-site evidence & on-site activities
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TOOLS FOR MEASURING A PROGRAM’S ADHERENCE
RATING INDICATORS
3 = Program Exceeds the standard
2 = Program is meeting the standard
1 = Program is not adhering to the standard
NA = Not applicable
Tips: OPTIONAL!! Do not use Tips to determine adherence.
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Where peers gather their information
Program Self Study Participant File Review Other On-site Documentation
Supervision Logs Meeting Minutes Personnel Records Training Logs
Interviews Interviews – No this is not an
accidental repeat. Electronic Surveys
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UTILIZING THE ELECTRONIC SURVEYS
SCAVENGER HUNT
Using example survey summaries and SAT, work with partner
1st Task:In 5 minutes, identify as many standards as possible that are inquired about in the surveys
2nd Task:In 5 minutes, identify some areas of strength and some areas to further explore based on survey responses
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Site Visit Simulation
All materials presented are from Babyville, USA
In your peer team, you will complete a peer review site visit from beginning to end
All activities will build upon the previous activity
And will result in a completed Accreditation Site Visit Report (SVR)
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The Process
Review the self study, develop preliminary ratings and develop interview questions
Conduct a pre-site call w/co-peer Review & integrate the electronic
surveys Review Participant Files Conduct an entrance meeting Further develop interview questions Interview program staff
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The Process (cont.)
Rate the standards Develop rationales for areas of
non-adherence Conduct an exit meeting
After each section, you will receive feedback regarding strengths and areas of growth.
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PRE-SITE CALLS WITH FELLOW PEER
Confirm travel arrangements
Review each critical element
Review self study standards
Draft list of additional information needed
Develop Pre-site ratings of adherence only
Draft interview questions
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DURING THE TEAM COORDINATOR’S CALL WITH PROGRAM LEADERSHIP
Discuss travel arrangements Develop the interview schedule Identify formal and casual culture Discuss omissions in the Self
Study Review site visit activities &
sampling methods Ask for any updates
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PARTICIPANT RECORD REVIEW
Peers select records Use a participant “roster” to select
a representative sample Across home visitors Across levels of service Across length of time in the
program (age of child) Review a minimum of 3 records
per home visitor for programs with 1-7 staff
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REVIEWING ADDITIONAL RECORDS
Creative outreach - Closed As needed to determine rating,
when: there are inconsistencies new or changed policies or
practices peers’ judgment
Keep in mind you need only review documentation for selected standards
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PARTICIPANT FILE CHECKLIST
Identifies standards that require file review
Helps quantify record review Makes review more consistent & less
subjective
Peers should: Use dates where possible Include size of active caseload Create a key for PCA America staff Identify name at top of form & submit with
Preliminary Credentialing Report
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OTHER ON-SITE DOCUMENTATION
Training logs Supervision records (logs, notes, etc.) Personnel records (specific to standards) Minutes of organizing body meetings Any documentation that is evidence of
adherence to standards (use documentation checklist as guide), especially documentation not submitted with self-study & forms, policies, etc., that have been modified since completion of self-study
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ENTRANCE MEETING
Meet each other
30 minute agenda
Put program staff at ease
Discuss the activities for the next two days
Avoid disclosing the number of peer reviews you have completed
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ENTRANCE MEETING AGENDA
Thank attendees Make brief introductions Overview of HFA accreditation
process & purpose of accreditation Review what the site has already
accomplished Describe on-site activities Answer questions the site might have Review confidentiality/anonymity
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INTERVIEWING ESSENTIALS
Come prepared Create a welcoming
environment Ask effective questions Follow-up responses with
additional questions as necessary
Ask clarifying questions before assigning a “1” rating
Behavioral interviews
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COME PREPARED
Know what you want to achieve
Organize questions around the background of the interviewee
Review the standards that are interview paradigms
Use listener responses, files and standards as points of reference
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STARTING THE INTERVIEW
Typically 30 minutes for staff (15 for families)
Introduce self
Thank interviewee
Assure confidentiality
Ask permission to take notes
Acknowledge strengths
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WHAT IS AN INTERVIEW PARADIGM?
There are a number of standards are interview paradigms
Standards that focus on process versus documentation
Build follow- questions on interviewee’s responses
Ask interviewees to illustrate process using files
Example: trust building activities (standard 3-2.B)
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RATING INTERVIEW PARADIGMS
Documentation is sufficient for continuation of services
Interviews are consistent across multiple staff roles
Families concur that practice is occurring in the field (when appropriate)
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WRITING RATIONALES
What is the ultimate purpose of the rationale?
To prove lack of adherence or to motivate improvement?
Be detailed, specific, factual Reference:
Self-study File Review Interviews Other documentation
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WRITING RATIONALES
Provide link to intent of the standard
Keep tone objective
What we write is just as important, if not more important, than what we say
Put yourself in the program’s shoes - no surprises please
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WRITING RATIONALES
Who is the audience? The program HFA National staff The HFA Accreditation Panel
Importance of the details
Expect technical support & assistance
Writing strengths & recommendations
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EXIT MEETING
Commend program for hard work and congratulate on commitment to providing services consistent with HFA best practice standards
Overview meeting agenda Summarize team findings addressing
each critical element: Strengths Challenges
Recognize recent practice changes Cite positive comments from families
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EXIT MEETING (cont.)
Provide opportunity to clarify and emphasize that program can still provide evidence as appropriate
Review next steps and decision making process Receipt of SVR (4 weeks) Consultation with national/regional office Development of plan to complete the
credentialing process
Solicit questions & comments Thank site for hospitality and cooperation
during visit
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Correspondence with National
Request to sign up for a site visit Confirmation Letter Technical Assistance & Support Travel Arrangements & Hotel Reimbursements Feedback to fellow peer & process Submission of
paperwork/checklists
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CONGRATULATIONS!!!!!!!
TRAINING IS COMPLETE, WE NOW DEEM YOU
PROVISIONARY HFA PEER REVIEWERS!!
REMEMBER TO GET YOUSELF ON THE SITE VISIT CALENDAR.
Evaluations will be sent to you electronically!!!
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