Rhode Island Maternal Depression CQI Celebration Continuous Quality

Rhode Island Maternal Depression CQI Celebration Continuous Quality Improvement in the Rhode Island Maternal Infant Early Childhood Home Visiting Program (MIECHV) February 26, 2019 Crowne Plaza 9: 00 a. m. – 12: 30 p. m.

WELCOME!

What are the gaps in maternal depression? Many affected o 40 -60% of mothers in early childhood home visiting experience elevated symptoms of maternal depression; 10 -15% have major depression Many missed o Only 65% of mothers in home visiting are screened for depression Many unserved o Only 57% of mothers with elevated symptoms are referred for services

The Challenge! Our Collaborative AIM SMART Aim: 85% of women who screen positive for depression & access positiveservices for depression & access will report a 25% services will report a 1225% reduction in symptoms weeks (from 1 st service contact). reduction in symptoms 12 weeks (from 1 st service contact).

Collaborative Accomplishments ü 5 participating teams ü Support from local and national experts ü 16 front line staff trained in mothers and babies by national faculty ü ü ü 30 PDSAs submitted electronically 81 data submissions 13 monthly webinars 20 Improvement Advisor office hours 3 in person Learning Sessions ü ü ü Agency-specific meetings to review the work National webinar presentations with other states to share best practices Meeting and exceeding national averages Mentors at RI FHV model meetings Presentation at national FHV model conference

Benefits and Outcomes “ “ By paying attention to the data, we have been more effective in responding to moms with maternal depression. ” – Children’s Friend Healthy Families America (CF HFA) The combination of Professional development in Maternal Depression in conjunction with Infant Mental Health consultation has increased staff awareness of potential issues with moms. ” –– Federal Hill House Parents as Teachers (FHH PAT) HV Co. IIN 2. 0 Virtual Series Part 1: Breakthrough Change 6

Benefits and Outcomes “ Having a mom come to speak to the team about her experiences was so helpful and made such an impact with the nurses. Hearing her story about post partum depression, obstacles she faced, and what she has overcome was inspiring and reinforced to the nurses that the work they are doing makes a difference and is valuable. She has provided a great insight to the work we do and also how we do it. ” – Children’s Friend Nurse Family Partnership “ Participating in the HV Co. IIN Maternal Depression collaborative helped us to use the data to improve our practice and how we document the work we are doing. It has also made us think about how to share what we’ve learned and the new processes with new staff as they come on board so it remains part of our ongoing work. ” 7 – Children’s Friend Healthy Families America (CF HFA)

What is HV Co. IIN 2. 0? Home Visiting Collaborative Improvement and Innovation Network First ever national initiative using the Breakthrough Series approach to accelerate improvements in select process and outcome measures that reflect positive health and well-being for children and families within Maternal, Infant and Early Childhood Home Visiting (MIECHV). HV Co. IIN 2. 0 brings together Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Program awardees and local home visiting service agencies to engage in: • Collaborative learning • Rapid testing for improvement • Sharing of best practices • Scaling of tested interventions • Building of QI capacity

Continuous Quality Improvement in the Maternal Infant and Early Childhood Home Visiting Program (MIECHV) 2010 2013 - 2016 2018 - 2022 MIECHV created HV Co. IIN 1. 0 HV Co. IIN 2. 0 We are here 2022 -

Continuous Quality Improvement in the Maternal Infant and Early Childhood Home Visiting Program (MIECHV) 2010 2013 - 2016 2018 - 2022 MIECHV created HV Co. IIN 1. 0 12 states 36 LIAs HV Co. IIN 2. 0 25 states 250 LIAs

Continuous Quality Improvement in the Maternal Infant and Early Childhood Home Visiting Program (MIECHV) 2010 2013 - 2016 2018 - 2022 MIECHV created HV Co. IIN 1. 0 HV Co. IIN 2. 0 By 2022 25 states 250 agencies 2022 -

Scale Using Tested Change Packages Closing the gap between what works and implementation on the ground Charter Key Driver Diagram Measurement System

Gold Standard Change Packages PDSAs Ramps Tools

The Breakthrough Series as the HV Co. IIN Framework Shared Aims, Shared Measures www. IHI. org

Our Collaborative AIM 85% of women who screen positive forfordepression & access positive depression & access services will report a 25% services will a 25% reduction in symptoms 12 reduction symptoms weeks (fromin 1 st service contact). 12 weeks (from 1 st service contact).

HV Co. IIN 2. 0 in Rhode Island West Virginia Alabama Rhode Island New Jersey Louisiana Children’s Friend HFA Network for peer-to-peer learning, teaching, and sharing to enhance scale efforts. Children’s Friend NFP Community Care Alliance HFA Federal Hill House PAT Connecting for Children and Families PAT

RIDOH Team Kristy Whitcomb Collaborative Coordinator Sarah Bowman Improvement Advisor (CCF, CCA) Jenna Maloney Project Director Sara Remington Improvement Advisor (CF, FHH) Jamie Comella Senior Sponsor Rhode Island Expert Faculty Luisa De. Pina Expert Faculty Christine M. Low Expert Faculty Rebecca Silver Expert Faculty Susan Dickstein Expert Faculty

Our Collaborative AIM 85% of women who screen positive forfordepression & access positive depression & access services will report a 25% services will a 25% reduction in symptoms 12 reduction symptoms weeks (fromin 1 st service contact). 12 weeks (from 1 st service contact).

Maternal Depression Process Measures Map Step 1 Step 2 Step 3 Step 4 Step 5 Women screened Women with a positive appropriately screen for MD offered referral to evidence-based services Women with a positive screen accept referral to evidencebased services Women access evidence-based services Women who receive services experience reduction in symptoms (PD 1) % of women screened for MD within 3 months of enrollment (PD 3) % of women who screened positive for MD not in EB services that verbally accepted a referral to EB services (PD 3) % of women who screened positive for MD and verbally accepted a referral that had at least one EB service contact (SMART AIM) 85% of women who screen positive for maternal depression and access services will report a 25% reduction in symptoms in 12 weeks (from first service contact) (PD 1) % of women screened for MD within 3 months of giving birth (PD 3) % of women who screened positive for MD not in EB services that were offered a referral to EB services (PD 3) % of women who screened positive for MD and did not access EB services that received a home visitor ‘check-in’ within 30 days

RESULTS TO DATE HV Co. IIN 2. 0 Maternal Depression AIM: 85% of women who screen positive for depression and access services will report a 25% reduction in symptoms in 12 weeks. PD 1: Standardized and reliable processes for maternal depression screening and response Reminder system for rescreens Policy/protocol for HV response to screening results and referral Use of reliable and valid tools Policy/protocol for screening to include periodicity Policy, protocol and talking points for explaining MD screening process to families

RESULTS TO DATE HV Co. IIN 2. 0 Maternal Depression AIM: 85% of women who screen positive for depression and access services will report a 25% reduction in symptoms in 12 weeks. PD 1: Standardized and reliable processes for maternal depression screening and response

RESULTS TO DATE HV Co. IIN 2. 0 Maternal Depression AIM: 85% of women who screen positive for depression and access services will report a 25% reduction in symptoms in 12 weeks. PD 2: Capacity of and support for PD 1: Standardized and reliable home visitors to address maternal processes for maternal depression in the target population screening and response Support for HVs on protocol responses Training of HVs on MD symptoms, impact, and treatment Reflective supervision that encourages HVs to discuss MD Enhance the skill development of HVs for connecting with families on MD

RESULTS TO DATE HV Co. IIN 2. 0 Maternal Depression AIM: 85% of women who screen positive for depression and access services will report a 25% reduction in symptoms in 12 weeks. PD 3: Standardize processes for referral, treatment and follow-up In-house, evidence-based preventative support Crisis-response protocol Protocol for referral and linkage to service for mothers who screen +

RESULTS TO DATE HV Co. IIN 2. 0 Maternal Depression AIM: 85% of women who screen positive for depression and access services will report a 25% reduction in symptoms in 12 weeks. PD 3: Standardize processes for referral, treatment and follow-up

RESULTS TO DATE HV Co. IIN 2. 0 Maternal Depression AIM: 85% of women who screen positive for depression and access services will report a 25% reduction in symptoms in 12 weeks. PD 4: Data system for tracking all PD 3: Standardize processes for clients' maternal depression screening referral, treatment and follow-up periodicity and results, referral, acceptance of referral and receipt of service Tracking system for team to review improvement data and its use for guiding program effectiveness Tracking system for MD screening periodicity and results, referral, acceptance of referral, and follow-up to treatment

Our Collaborative AIM 85% of women who screen positive forfordepression & access positive depression & access services will report a 25% services will a 25% reduction in symptoms 12 reduction symptoms weeks (fromin 1 st service contact). 12 weeks (from 1 st service contact).

RESULTS TO DATE HV Co. IIN 2. 0 Maternal Depression AIM: 85% of women who screen positive for depression and access services will report a 25% reduction in symptoms in 12 weeks. Rhode Island Collaborative-wide

Rhode Island Maternal Depression Learning Collaborative RIDOH + Co. IIN Connecting for Children & Families February 26, 2019

Connecting for Children & Families Parents As Teachers

Team Reflections Team Success • We found creative ways to offer Mothers & Babies to moms. • We were able to share information to all mothers and fathers about Maternal Depression in unique ways. • We able to assist families with understanding the importance of Maternal Depression and the impact it has on mothers. • Team collaboration. Challenges • Not knowing if we could offer the curriculum to dads. • How to present M&B’s to mom’s that don’t have custody of their child but have weekly visits. • When translating the information to mom’s , trying not sound to clinical when describing the curriculum. • Undocumented families/ Uninsured families refusing M&B’s. • Can we offer the curriculum prenatally? Lessons Learned • Data is not meant to be punitive but to be help and used as a guide for improvement. • Woonsocket only has one MD that works in the field specific to Maternal Depression. • We need to create a referral process within our program/organization to support families dealing with Maternal Depression.

Process Measures: Where We Started vs Where We Are

Improvements through the collaborative Area of improvement: Offering Mothers and Babies as an evidence based support by our team. What we did: Our team members completed the Mothers and Babies training in June 2019. Since then we have offered Mothers and Babies to parents with elevated depression screens including many who had other supports in place. Families and staff had a positive response to Mothers and Babies.

Primary Driver: 2 Change Idea: Standardized and Reliable Process for Maternal Depression Screening and Response Name of Test: Offering Mothers and Babies All Parent Educators offered the Mothers and Babies Curriculum to moms who have been in the program long-term, still ensuring the offer is less clinical The second family offered mothers and babies agreed to participate and completed the first module. The parent educator reported comfort with module. Another Parent Educator offered the Mother’s and Babies Curriculum to another mom who have been in the program long-term, trying to make the offer less clinical and more comfortable The first family offered mothers and babies declined to participate. The team discussed how to offer the curriculum and agreed to try a less “clinical” approach One Parent Educator offered the Mothers and Babies Curriculum to a mom that has been in the program longterm Staff reported they were comfortable and ready to start working with families Parent educators were trained on Mothers and Babies and reported on self-confidence to implement the curriculum with families

One test we abandoned: The PDSA abandoned was Reminder Systems for Follow up screens. We found that the Outlook reminders were more effective as a reminder and tickler system.

Implementing Outlook Reminders A test that we are implementing: Outlook reminders/ticklers to ensure that Parent Educators screen and complete re-screens Our implementation approach: Sequential implementation. Started with the Parent Educators who were part of the testing, will continue testing with other staff. Only applicable when additional Parent Educators have people who will need to be screened postpartum or re-screened. Our implementation strategy approaches to increase readiness for the change: The following communication strategies will be used when additional Parent Educators have their first opportunity to use the Outlook reminder for scheduling a rescreening. The Parent Educator will provide information on why changes are being made and provide specific information on how the change will affect families.

Sustaining and Spreading Outlook Reminders • Our Program Manager is the process owner. • She will be updating a check list that each Parent Educator will keep for each family. Adding elevated scores and follow-up window to check list. • Program Manager currently maintains tracking spreadsheet to support supervision. Will update spread sheet with more steps for families with elevated score – adding reminder to ensure the Outlook reminder is in place during supervision, and to follow up on the completion of re-screens. • We will continue to monitor the data

From our staffs perspective: “I can now see the importance of this work! Without this CQI experience I don’t think I could have helped and many mom’s I have during this past year. ” From our families perspective: “My Parent Educator has given me so much support. Mother’s and Babies has helped me to be a better mom even when I don’t feel good. I know I have to stay strong for me and my son. Thank you for always being there when I need you. ”

Rhode Island Maternal Depression Learning Collaborative RIDOH + Co. IIN Children’s Friend NFP February 26, 2020

Team Success • Continue to have 100% screening for clients prenatally and postpartum and increased rescreening • Increase in PRN screenings • Continue to have parent involvement • 30 day check in clarification has helped – 54% of clients who have not accessed services have had a check in visit Reflectio ns From the. Challenges Work • The 30 day “check in” can be a challenge when there are missed/cancelled visits • Staff turnover on the CQI team Lessons Learned • Increase screening/rescreening and follow up due to looking more closely and refining our process

Process Measures: Where We Started vs Where We Are

Improvements Through the Collaborative • Clarification of home visitor check-in vs Rescreen with PHQ-9 • Charts were reviewed on all clients being tracked for elevated PHQ-9 • Submission of December data showed that 54. 2% of clients had a home visitor check-in within 30 days • Many clients who did not have a checkin were due to missed/cancelled visits

Improvements Through the Collaborative • 25% improvement in depressive symptoms for women with one of more evidence based service contact went from 50% (beginning of collaborative) to 75%!! • Increase in screenings (both follow up and prn) • More attention is being put on depressive symptoms by staff and nurse home visitors continue to support clients

Primary Driver: 1 Change Idea: 5 Name of Test: Reminder for Rescreens The entire NFP team created reminders to rescreen clients with elevated PHQ 9 scores for all of the clients we are tracking for the COIIN project within the next 3 months. This test ended July 31 st and all scheduled rescreens were completed. Two NHVs created a reminder to rescreen with the PHQ-9 on one client each day for two weeks utilizing the reminder function in the ETO system. Two Nurse Home Visitors (NHV) created a reminder utilizing their Outlook calendar every day for one week to test a reminder system for follow up PHQ-9 screenings.

What is a change that you are going to implement? PD: 3 Change Idea: 1 Crisis Response Protocol Our approach and plan that works best to implement this change: “Just do it” – We already had all of the processes in place and just needed to educate/remind staff of the processes and tools to use Our implementation strategy approaches to increase readiness for the change: “Provide information on why the change is being made” – There wasn’t a real “change” implemented, it was more to re-educate staff of the process and tools already in place. We provided information on the importance of the process for both staff and clients and showed the link between the change and outcomes for clients

Sustainability: How our team is going to sustain implementation and able to be spread to the whole team • We will make sure our system and processes are independent of the people involved • We will make this training part of our new hire onboarding process • We will continue to use existing tools • PHQ-9 screening tools • NFP tools for Depression Screening, Crisis Intervention Aid, Suicide Risk Assessment, and Safety Planning facilitators

The Nurse Home Visitor Difference…. • We have seen an increase to 75% of clients who have had at least a 25% improvement in depression symptoms after having at least one evidence based service contact • However, it seems from our tracking spreadsheet that many clients report a reduction in depression symptoms even if they have not had an evidence based service contact (36/42 clients = 85%) • Does having the support of a Nurse Home Visitor improve depressive symptoms despite not engaging in mental health treatment services?

Staff Feedback • Having a mom come to speak to the team about her experience was so helpful and made such an impact with the nurses. Hearing her story about post partum depression, obstacles she faced and what she has overcome was inspiring and reinforced to the nurses that the work they are doing makes a difference and is valuable. She has provided a great insight to the work we do and also how we do it.

Rhode Island Expert Faculty for the Rhode Island Maternal Depression HV Co. IIN 2. 0 CQI Collaborative Susan Dickstein, Ph. D. 53

Rhode Island Maternal Depression Learning Collaborative RIDOH + Co. IIN February 26, 2019

Seven Generations ounetos, D Estrella, Sue m le y a M , s ia e Belinda Ro Tina Laprad & t, s ir H e ll e Mich

Team Success • PD 1 -We were able to clarify re-screenings protocols which increased our percent of rescreens. As of October 4 th, 100% of our mothers with a positive PHQ 9 were rescreened in 90 days. • PD 2 - The team completed the Mothers and Babies training and reported an increase in confidence levels in using the curriculum. • PD 3 -The team was trained on crisis response protocols and reported and increase in confidence levels in responding to future crises. • PD 4 -Staff was trained to administer the PHQ-9 using both word and number scale. Staff reports this made answering easier for clients. Reflectio ns from the work Challenges • Getting clarification on “check ins” and rescreen timeframes. • Understanding where the data is pulling from in order to train staff. Lessons Learned • Staff members need a reminder system in order to consistently rescreen. • We learned that by paying attention to the data, we have been more effective in responding to mom’s with maternal depression.

PHQ-9 Scoring Cards—borrowed from Federal Hill House (Thank you!) • We adapted Federal Hill House’s Scoring Cards to include Portuguese and to have all the languages on one card. Not difficult at all 0 1 Somewhat difficult No es nada difícil Algo dificil Não é nada difícil Um pouco difícil (0 Days/dias) (1 -2 Days/dias) Very difficult 2 3 Extremely difficult Muy dificil Extremadamente difícil Muito difícil (3 -4 Days/dias) Extremamente difícil (5 -7 Days/dias)

Process Measures: Where We Started vs Where We Are

Improvements through the collaborative We saw in increase in acceptance of evidence-based services possibly due to offering Mothers and Babies more and staff feeling more confident delivering the curriculum as well as improved data collection.

Primary Driver: 2 Change Idea: Training/education of home visitors on maternal depression symptoms, impact, and treatment • Trained the HFA team to score the PHQ-9 using both Name of Test: Increase the numbers and words (English, Spanish, & Portuguese). knowledge & skills of Family • Staff began doing screens and re-screens using the combination number/word scoring system. Support Specialists to address perinatal mood • We adopted this training for all future staff to complete. disorders. • Trained staff began using Mothers and Babies with families with elevated screens. • Nine HFA staff will attend a Mothers and Babies training. • After completing the training they will receive a certificate of completion. • The HFA CQI team will deliver a training to the HFA team on Maternal Depression Rescreening Best Practice Guidelines. • CQI team will pick two families that have upcoming re-screens due and monitor to see if re-screens are completed. 4 th PDSA Cycle

What is a change that you are going to implement? We decided to “Just Do It” Screening using the PHQ-9 with both numbers/words (English/Spanish/ Portuguese). • Team Lead trained by Federal Hill House PAT staff • Team Lead trained rest of HFA team • Made cards with words and corresponding number for each team member to use. • Team began using with families Our implementation strategy approaches to increase readiness for the change: • Provided information on the change being made and why it was being considered. • Sought team’s input before implementing change. • Provided options for how the scoring cards to use with families would look.

Sustainability: How our team is going to sustain implementation and able to be spread to the whole team • Including new screening process in orientation for any new staff. • Supervisory check-ins and support. • Continue to periodically check data for progress and areas needing improvement. • Ask our IS team to help us create graphs of the data to make it easier to visually analyze. • Celebrate our successes with the whole team.

Quotes and Anecdote • The numbering system with the PHQ-9, “was lots easier to use with a mom who needs an interpreter”. The worker felt she got more accurate results with the new system. -HFA worker • “Mothers and babies is a good tool to bring to families who can’t access other resources”. –HFA worker • A mother and infant that Joycy is working with scored very high on the PHQ-9. She was actively suicidal and had a history of previous of attempts. Because Mom was Spanish speaking, there were limited resources for treatment. Joycy implemented Mother’s and Babies and over the course of the curriculum, Mom’s depressive symptoms drastically decreased. The parent /infant relationship has strengthened greatly. Mom is much less isolated and is actively seeking out friends. -Family

Rhode Island Maternal Depression Learning Collaborative RIDOH + Co. IIN Community Care Alliance February 26, 2019

CCA Connecting for Moms Team

Team Success • • • Increased attention to and tracking of elevated screens, referrals and follow-up Emergency protocol related to elevated PHQ-9 screens reviewed & revised Trained in Mothers & Babies curriculum Family Focus Group Enhanced team understand of measures and definitions Reflectio ns from Challenges COIIN • Data reports difficult to interpret d/t misunderstood definitions and shifting work: population • Missed visits and other priorities for families • Finding time to dedicate to COIIN work Lessons Learned • Meeting families where they’re at – e. g. , language used when presenting PHQ-9 • Value of Family feedback on practice • Earlier focus on shared understanding of measures at practice level

Process Measures: Where We Started vs Where We Are

Improvements through the collaborative Since our team began capturing referrals more accurately in July 2019, our data improved!

A change we’re implementing…. Increased attention to PHQ-9 elevated scores & utilization of tracking form for all process measures Our plan that works best to implement this change: Our implementation strategy approaches to increase readiness for the change: • Distribute monthly tracking sheets to Family Visitors and discuss in individual supervision • Provide information on how this change impacts our responses and supports for families • Document findings in electronic record • Utilizing a team champion who has adopted this change to inspire other team members • Supervisor will circle back to review data on families with elevated screen • Show appreciation for the energies of people implementing the change

How our team is going to sustain implementation and able to be spread to the whole team • We’ve identified a process owner to monitor our tracking fidelity • Supervisor will keep program manager and team members in the know about this process by inclusion on team agenda and in supervision • Team members will track their screens and complete the necessary follow-up • PHQ-9 screening procedure will be updated to reflect any procedural changes • New staff will be oriented by Supervisor to these procedures as part of regular practice

Family & Staff Reflections on PHQ -9 from Focus Group: • Participants felt timing was important. They recommended that it was best to not complete the questionnaire right after the birth of the baby when the parent is tired and overwhelmed. • Families stated it was important to feel safe when talking about this topic. They thought it best to wait until they got to know the home visitor rather than completing the screening on the first visit. • While our families felt it was an important and valuable tool, there is still fear around how it will be used, e. g. , would it be reported to DCYF. • Staff learned that the PHQ-9 is a way to support open discussion and conversations about what parents are feeling and how to identify resources in order to improve well-being.

A family story/staff anecdote • HFA Family Visitor - This has been good to learn from families and their experiences. There’s no standard way to help families understand why this screening is important. The best practice is to begin where families are at. • Mother in our focus group – It’s good to talk about this and know that maternal depression is more common that you think. I’m glad this topic is being discussed and makes the screening more than just another piece of paper to be put in a file.

Parent leadership is successfully achieved when parents and professionals build effective partnerships that combine professional knowledge and expertise with lived experience and expertise Mariel Mastrostefano Sara Remington

Rhode Island Maternal Depression Learning Collaborative RIDOH + Co. IIN Federal Hill House February 26, 2020

Catherine D. Pamela R. Yuberka J.

Team Success We made improvement in the following areas: • Women screened for maternal depression within three months of enrolment. • Women screened for maternal depression within three months of giving birth. • Women in referral for evidence based services. • Women with a positive screen for maternal depression that verbally accepted a referral. • Women with positive maternal depression that received a home visitor check in within 30 days. • Using Infant mental health and safe sleep in combination with Mothers and Babies to address support to mothers with maternal depression. • Adapting the PHQ-9 for clearer understanding by participants of the questions. • More efficient data tracking system. Reflectio ns from the work Challenges • Families overcoming the perception of maternal depression. • One staff is not trained in motivational interview. What we have learned • If we address maternal depression appropriately, more women will be able to benefit from in house evidence based support

Supporting women with maternal depression at home and during group connection

“I Feel Free” Feeling depressed is overwhelming. I was always feeling sick, angry, and full of worries. Without this help I wouldn’t be able to make it, you have helped me a lot. ; Without you, I would never be able to get out. I’m feeling well and ready to enjoy every day. I feel free. I’m leaving without stress. Now, I see everything differently. I’m free and willing to be happy; I realize nothing is possible without the help and support of others. I have been blessed with this program. I’m very thankful for this opportunity. (Statement taken from participant reflection P. L. )

Supporting pregnant women with maternal depression

Support for pregnant women with maternal depression

Engaging other family members. “You have done so much for my family” (MS).

Process Measures: Where We Started vs Where We Are

Improvements through the collaborative Our data has improved since our team began using comprehensive data tracking system for MD.

Optional slide: Improvements through the collaborative Since our team became confident using Mothers and Babies for in house evidence based support, our data improved!

Primary Driver: 2 Change Idea: 2 Reflective supervision that encourages home visitors to discuss maternal depression Name of Test: Incorporating maternal depression in reflective supervision. Standardized check in process using motivational interview and other strategies Standardized process for referral and treatment: create a goal plan with family to modify amount of support including other family members Review level of competency of parent educator addressing maternal depression during reflective supervision , this include observing families in natural environment , groups connection, and home visits. In house evident based support : Team increased level of comfort using Mothers and Babies to reduce stress related symptoms. 1 st PDSA Cycle

What is something that you tried and abandoned? To date we have not abandoned any strategies. We successfully adapted PHQ-9 and adopted Mother and Babies Curriculum.

What is a change that you are going to implement? PD 4 C: 1 • Comprehensive data tracking system for maternal depression. • Continue addressing maternal depression during reflective supervision • Review check in process with participant with positive maternal depression

Sustainability: How our team going to sustain implementation and able to be spread to the whole team • Continue addressing maternal depression during reflective supervision. • Keep track of data • Use the MOM PRN LINE • Develop an individual support plan for mothers with positive screen. • Continue implementing Mothers and Babies curriculum. • Make appropriate referral when required • Update protocol for crisis response. • Communicate with program director and agency executive director about improvement.

Following the HV Co. IIN 2. 0 Collaborative Continuous Quality Improvement (CQI) in the Rhode Island MIECHV Programs q MOMS PRN Line open to all FHV teams q Motivational Interview training q Integrating CQI into all FHV programs q Continuing to tests PDSAs and monitor data collection q Spreading the Maternal Depression CQI work to all FHV teams q Ongoing work with HV Co. IIN 2. 0 to continuously improve benchmark areas 2019 - 2020 - 2021 Maternal Depression Spread Well Child Visits Completion WCV Smart Aim: By March 2021, 85% of all children enrolled in home visiting will receive their last expected well child visit (WCV), based on the American Academy of Pediatrics (AAP) schedule.

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Office of Family Visiting Division of Community Health and Equity Rhode Island Department of Health

DO WE NEED TO BRING ANY OF THIS INTO THE FIRST SECTION? !

What is CQI? QI in public health “refers to a continuous and ongoing effort to achieve measurable improvements in the efficiency, effectiveness, performance, accountability, outcomes, and other indicators of quality in services or processes which achieve equity and improve the health of the community. ” Accreditation Coalition Workgroup, June 2009

Key Features of CQI • Focus on systems, not individuals • Ideas/changes from customers & front line staff • Focus on small tests of change • Frequent, ongoing measurement and data-driven decision making • QI is a never-ending process…it’s continuous • It should help staff, not hinder *

Approaches to System Changes PROBLEM SOLUTION ASSESS CURRENT CONDITION “FINAL” PLAN DEFINE POSSIBLE SOLUTIONS IMPLEMENT CONDUCT SYSTEM BARRIERS Plan-Do-Study-Act cycles FAIL SUCCESS Adapted from: Jean Vukoson’s Bright Futures Presentation