HV CoIIN 2.0 Virtual Series Part 2: How You Can Achieve Breakthrough Benefits § Heather Johnson , CQI Team Lead, Alabama MIECHV § Jessica Diedling , Data and Quality Manager, LA MIECHV § Mary Mackrain , Managing Project Director, EDC
Welcome and Technical Tips Please share your name and state § or territory in the chat Please share comments or questions actively! § We have time at the end to address All lines are muted § Click the four arrows at the top right of the slides § to enlarge your screen for easier viewing Slides for today’s session are in the file share pod § 2 HV CoIIN 2.0 Virtual Series Part 2: How You Can Achieve Breakthrough Benefits
Reminder: 2 Work Streams Cohort 1 of 3 (by 2022) is Underway (1) SCALE (2) NEW TOPIC COIINS 5 Awardees 6 Awardees Scaling HV CoIIN 1.0 12-18-month CoIIN with playbooks with 55 LIAs 18 LIAs to improve Intimate Partner Violence Outcomes 3 HV CoIIN 2.0 Virtual Series Part 2: How You Can Achieve Breakthrough Benefits
The What: Scaling Tested Playbooks from HV CoIIN 1.0 Charter, Key Driver Diagram and Gold HV COIIN 2.0 MATERNAL DEPRESSION CHARTER Standard Changes, and Computation of Key Measures SIU School of Medicine - General Internal Medicine A. WHAT ARE WE TRYING TO ACCOMPLISH? Call to Action: Studies show that 40-60% of families with young children enrolled in home Measurement System visiting programs experience elevated depressive symptoms, and 10-15% have major N women who gave depression. i ii Left undetected and untreated, maternal depression can have long-lasting N women who gave N women enrolled birth 90 or more days negative effects on the growth and development of infants and young children. Studies have N women enrolled birth 90 or more days ago ago screened for MD shown that mothers with depression are less positive, spontaneous, and responsive with Total N 90 of more days 90 or more days screened for MD within within 3 months of infants, iii compromising the critical relationship a young child needs to develop. Young children Month enrolled women ago ago 3 months of enrollment giving birth with compromised responsive caregiving are at an increased risk of exhibiting challenging Jan-19 Feb-19 behavior, developmental difficulties, poor social relationships, and cognitive impairment. ivv Mar-19 Apr-19 Identification and linkage of women with depressive symptoms to effective, evidence-based May-19 interventions can make a difference, vi vii viii reducing by half the percent of women exhibiting Jun-19 major depression or developing depression. ix x However, families challenged with maternal Jul-19 depression often struggle to access and engage with treatment: they have less frequent use of Aug-19 Sep-19 preventive health services and greater use of emergency departments and in-patient services Oct-19 for illness and injury. xixii Nov-19 Dec-19 Home visiting programs have a unique opportunity to reach vulnerable families and to Jan-20 incorporate evidence-based and practice-informed strategies — what we know works, and what Feb-20 Mar-20 we do on the ground, to decrease rates of maternal depression. In HV CoIIN 1.0, MIECHV Apr-20 awardees and their LIAs tested evidence and practice-informed-changes and improved rates of May-20 Jun-20 depression screening and engagement in evidence-based services, and decreased depressive Jul-20 symptoms among women accessing services. Aug-20 • 96% of women were screened for depression within 3 months of enrollment and birth Sep-20 Oct-20 • 66% of women with a positive screen had one or more evidence-based service contacts Nov-20 • 60% of women who accessed evidence-based services experienced a 25% reduction Dec-20 depressive symptoms within three months Jan-21 Feb-21 Mar-21 In [insert your state here], [insert a description of the status of maternal depression in home visiting Apr-21 in your state here. If you participated in HV CoIIN 1.0, you could begin by summarizing the May-21 accomplishments and learning from 1.0. Then describe the gap in practice that you plan to Jun-21 overcome.] Jul-21 Aug-21 Sep-21 Mission: Together, in HV CoIIN 2.0 , we will dramatically reduce depressive symptoms among Oct-21 mothers of young children receiving home visiting services [insert here the expected timeframe, Nov-21 based on the time between your launch date and December 31, 2019; for example “between Dec-21 January 20, 2019 and December 31, 2019” ] by developing and refining policy and practices that
Alabama MIECHV A Snapshot of Breakthrough Change Topic: Maternal Depression Scale Method: IHI’s Breakthrough Series
Alabama’s First Teacher CQI Team Pictured Right: Heather Johnson , § Alicia Thurmond CQI Team Lead Matt Fifolt, Lead Faculty, § Lead Improvement Advisor Beth Johns, Improvement § Advisor Maggie Enlow, CQI Coach § Alicia Thurmond, CQI Coach § Pictured Above (from left to right): Matt Fifolt, Maggie Enlow, Heather Johnson, Beth Johns 6 HV CoIIN 2.0 Virtual Series Part 2: How You Can Achieve Breakthrough Benefits
Why This, Why Now? In Alabama, Left undetected and We knew that HV CoIIN approximately 16% of untreated, maternal 2.0 would help us to primary caregivers depression can have address key questions screen positive for long-lasting negative about maternal maternal depression, effects on the growth depression screening, with some sites and development of access to treatment, and reported rates as high infants and young symptom reduction as 33% children 7 HV CoIIN 2.0 Virtual Series Part 2: How You Can Achieve Breakthrough Benefits
FY2018 Maternal Depression Screening and Referral Data Figure 1. Depression screening, referral, and referral follow-up. Screened Positive for Given a Referral for Completed or Received Program Name Depression (%) Services (%) Services (%) SAFE 17.6 66.7 100.0 PACT 30.3 100.0 100.0 Marshall County BOE 3.8 100.0 100.0 United Ability 33.3 100.0 37.5 TCR Child Care 5.7 100.0 75.0 Community Action Partnership of N. Alabama 12.5 100.0 70.0 Exchange Club Family Skills Center 25.0 100.0 33.3 Goodwill Easter Seals Gulf Coast 25.0 100.0 100.0 Easter Seals West Alabama – PAT 20.4 90.9 20.0 Family Guidance Center 14.3 95.5 38.1 Circle of Care 33.3 100.0 20.0 Eufaula – HIPPY 2.7 100.0 0.0 Eufaula – PAT 26.3 100.0 20.0 Easter Seals West Alabama – NFP 33.3 100.0 0.0 Statewide Totals 16.0 96.7 46.0 8 HV CoIIN 2.0 Virtual Series Part 2: How You Can Achieve Breakthrough Benefits
Participating LIAs 8 LIAs participating § (this is ½ of Alabama’s MIECHV-funded sites) We invited LIAs to participate based on § several considerations ⁃ Maternal depression screening rates ⁃ Mix of urban, suburban, rural ⁃ Mix of sites with various ranges of CQI knowledge and experience 9 HV CoIIN 2.0 Virtual Series Part 2: How You Can Achieve Breakthrough Benefits
Barriers Lack of Data —what really happens to moms § who screen positive? What happens after a referral? (The data registry) Lack of Services —how can we help mothers § access services? What happens if they do not want to seek help outside of the home? (Mothers and Babies) 10 HV CoIIN 2.0 Virtual Series Part 2: How You Can Achieve Breakthrough Benefits
Ideas Tested Across Sites PRIMARY DRIVER 1 PRIMARY DRIVERS 1 & 2 PRIMARY DRIVERS 1 & 2 Maternal depression Mothers Motivational screening script and babies interviewing PRIMARY DRIVER 4 PRIMARY DRIVER 4 In-depth data All teams using management tools CQI data in practice 11 HV CoIIN 2.0 Virtual Series Part 2: How You Can Achieve Breakthrough Benefits
Maternal Depression Change Prioritization Results Action Period 2 Action Period 3 PD PD PD PD PD PD PD PD PD PD PD PD PD PD PD PD PD PD PD PD PD PD PD PD PD PD PD PD SITE 1.1 1.2 1.3 1.4 1.5 2.1 2.2 2.3 2.4 3.1 3.2 3.3 4.1 4.2 SITE 1.1 1.2 1.3 1.4 1.5 2.1 2.2 2.3 2.4 3.1 3.2 3.3 4.1 4.2 United United Ability Ability Eufaula Eufaula City City Schools Schools Circle of Circle of Care Care ESWA- PAT ESWA- PAT CAPNA ESWA- CAPNA NFP East ESWA- NFP Alabama East Mental Alabama Health Mental Health NFP of NFP of Central Central Alabama Alabama 12
% of Women Who Had 1 or More EB Service Contact Who Had 25% Improvement in Depressive Symptoms % of Mothers With 25% Symptom Improvement 90 Goal 80 70 Median 60 50 40 30 20 10 0 4/1/201 5/1/201 6/1/201 7/1/201 8/1/201 9/1/201 10/1/20 11/1/20 12/1/20 19 19 19 9 9 9 9 9 9 CoIIN Begins Mothers Motivational Registry and Babies Interviewing Training Training 13 HV CoIIN 2.0 Virtual Series Part 2: How You Can Achieve Breakthrough Benefits
Biggest Surprises § Level of Support from HV CoIIN 2.0 ⎯ Playbook ⎯ Trainings ⎯ Peer Sharing § It Works!! ⎯ We are seeing results—this happened much faster than we thought possible ⎯ Not only are our screening and referral rates improving, but we are seeing symptom improvement! 14 HV CoIIN 2.0 Virtual Series Part 2: How You Can Achieve Breakthrough Benefits
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