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ANNUAL PERFORMANCE AND QUALITY
IMPROVEMENT REPORT FOR FY 2010/2011
FY 10/11 Performance and Quality Improvement Report Page 2
Executive Summary Rebekah Children's Services (RCS) has been helping kids find homes, get treatment, and overcome
obstacles for 115 years. Our goal is to deliver services to families and children across California in the
most effective and efficient manner. To fulfill this goal, RCS has embarked on creating several processes
to evaluate different quality indicators. This report outlines the efforts made by RCS to improve the lives
of people, maintain accountability and improve where areas needed. Founded on strong principles and
consistent to best practices outlined in the Council on Accreditation, RCS presents you the FY 10-11 Performance and Quality Improvement Report.
Contents Executive Summary ...................................................................................................................................... 2
Introduction ................................................................................................................................................... 3
Mission Statement ......................................................................................................................................... 3
Vision ............................................................................................................................................................ 3
Core Values ................................................................................................................................................... 3
RCS Client Demographics ............................................................................................................................ 4
Consumer Outcomes ..................................................................................................................................... 5
Fidelity to Values ...................................................................................................................................... 5
Consumer Satisfaction .............................................................................................................................. 5
Measure of Clinical Effectiveness ............................................................................................................ 6
Academic Achievements .......................................................................................................................... 6
Prevention Services ................................................................................................................................... 6
Incident Reports ............................................................................................................................................ 7
Complaint and Grievances ............................................................................................................................ 8
Internal Case Record Review ........................................................................................................................ 8
Conclusion .................................................................................................................................................... 8
FY 10/11 Performance and Quality Improvement Report Page 3
Introduction The Performance and Quality Improvement ("PQI") Program at RCS is a comprehensive approach to the
improvement process that is based on cooperative efforts encompassing the entire agency, including
consumers and their families. The following PQI Annual Report provides significant positive
developments, challenges and/or obstacles faced by RCS over the last year with regard to performance
and quality improvement.
The PQI process is consumer-responsive and prevention-oriented. It is continually developing and
transforming based on information from ongoing reviews, outcome monitoring, consumer feedback and
satisfaction, organizational strategic planning, industry and professional information, and federal, state and local regulations. The RCS PQI Plan provides details of the current process.
Mission Statement We are dedicated to promoting the social, emotional and physical well being of children and families.
Vision
To be the national leader in creating, shaping, teaching and providing services that achieve positive,
permanent outcomes for children and families
Core Values We are a family centered organization, connecting children, parents, caregivers and all we serve to
healthy, enduring relationships that offer them trust, safety and permanency. We hear and respond to
the voice and culture of the family.
We operate with integrity and accountability demonstrating responsible stewardship of the funding,
resources and donations placed in our trust.
We strengthen and mold our services and supports around the needs expressed by the child and
family using effective models of service. Our innovative work advances theory, policy and practice
while producing positive, measurable changes.
We value and consult our stakeholders in our commitment to being a fully integrated organization
working together toward our vision.
We believe staff is our greatest asset. Together we are committed to create an environment of
fulfillment, stimulation and opportunity for professional growth, founded on truth, transparency and
respect. We demonstrate consistent, supportive and effective leadership, promoting teamwork and
individual excellence. We invite and honor the contribution of all staff and challenge each other to
assume ownership for achieving the mission, vision and goals of RCS.
We value the physical environment where we work and strive to keep it clean, safe, functional and
attractive.
FY 10/11 Performance and Quality Improvement Report Page 4
RCS Client Demographics RCS served children and families, primarily from Santa Clara County, but also had strong relationships
with 12 other Counties. Consumers who receive services at RCS range from newborn to 17-year-olds.
Service models are Community and Campus-Based Services. In fiscal year FY10-11, RCS averaged 260
unduplicated active clients daily and 658 (20% duplicated) clients were served during the fiscal year. The
following client demographic information best describes the population served. Our geographic profile
during the fiscal year reached as far south to Riverside, and north to Mendocino. In addition, RCS serves
an average of 1,000 (not shown in the tables below) consumers through the Prevention and Education
Program.
Sex Count Total %
F 252 35.84%
M 406 64.16%
Total 658 100.00%
Ethnicity Count %
Hispanic/Mex Ame 465 70.67%
Caucasian/White 140 21.28%
Black 26 3.95%
Other 12 1.82%
American Native 4 0.61%
Filipino 3 0.46%
Vietnamese 2 0.30%
Chinese 2 0.30%
Amer. Asian 1 0.15%
Samoan 1 0.15%
Asian Indian 1 0.15%
Cambodian 1 0.15%
Grand Total 658 100.00%
Age Count %
0 2 0.30%
2 5 0.76%
3 16 2.43%
4 18 2.74%
5 27 4.10%
6 28 4.26%
7 31 4.71%
8 29 4.41%
9 36 5.47%
10 37 5.62%
11 32 4.86%
12 46 6.99%
13 50 7.60%
14 55 8.36%
15 82 12.46%
16 92 13.98%
17 64 9.73%
18 7 1.06%
19 1 0.15%
Grand Total 658 100.00%
County % Total %
Contra Costa 1 0.22%
Madera 4 0.88%
Mendocino 1 0.22%
Monterey 63 10.62%
Riverside 3 0.66%
Sacramento 1 0.22%
San Benito 1 0.22%
San Joaquin 3 0.66%
San Luis Obispo 4 0.88%
San Mateo 4 0.44%
Santa Clara 571 84.51%
Santa Cruz 2 0.44%
Grand Total 658 100.00%
FY 10/11 Performance and Quality Improvement Report Page 5
4.39
3.98
4.15
4.24
4.25
4.17
4.2
4.26
4.21
4.19
4.15
4.46
4.44
4.5
4.34
3 3.5 4 4.5 5
1: I am satisfied with services I …
2: I helped choose my services
3: I helped to choose my …
4: The people helping me stuck …
5: I felt I had someone to talk to …
6: I participated in my own …
7: I received services that were …
8: The location of services were …
9: Services were available at the …
10: I got the help I wanted
11: I got as much help as I needed
12: Staff treated me with respect
13: Staff respected my family's …
14: Staff spoke with me in a way …
15: Staff were sensitive to my …
Consumer Satisfaction =107
Consumer Outcomes To ensure consumers at RCS are receiving high quality and effective services, we have adopted a variety
of consumer driven and informed measures. This section of the report provides a brief overview of the
Fidelity Measures we use to evaluate that our values are being honored and embraced in care, that
consumers are satisfied with the services they receive and to assess that our service is effective in
promoting consumer’s well being.
Fidelity to Values In fiscal year 10/11, RCS
consumers rated RCS
above the national average
in having fidelity to the 10
wraparound principles.
RCS uses these fidelity
measures to work on
improving services that are
delivered to our consumers
in addition to compare
against the national
average for performance
improvement opportunities.
Consumer Satisfaction Consumer Satisfaction
Measures were
administered in April 2011.
All mental health
consumers who received
services during the survey
collection time were
invited to participate. Of
the 107 consumers who
participated, collectively,
they rated RCS above the
satisfaction baseline of 3.5
across 15 quality
indicators.
91
83
69
97
72
98
80 80 84
72
92
82
74
96
78
98
81
93
83 82
83
72
64
85
71
91
69
83 82
67
40
50
60
70
80
90
100
110
Fidelity to Wraparound n=77
Monterey Wraparound Santa Clara Wraparound
National Mean
FY 10/11 Performance and Quality Improvement Report Page 6
43.79
47.54 47.97
51.12
40.00
42.00
44.00
46.00
48.00
50.00
52.00
Intake 6 months 12 months Discharge
Clin
ical
Ran
ge is
be
low
50
Increased Functioning n=704
Functioning Level Clinical Range
25.66
22.02 20.47 19.62
0.00
5.00
10.00
15.00
20.00
25.00
30.00
Intake 6 months 12 months Discharge
Clin
ical
ran
ge is
ab
ove
20
Decreased Problem Severity n=704
Problem Severity Level Clinical Range
Measure of Clinical Effectiveness RCS used the Ohio Scales, developed by the University of Ohio State to measure effectiveness of clinical
gains. Among other areas the Ohio Scales measure, two are the Increased Functioning and Reduced
Problem Severity Scales.
Consumers who participate in
Mental Health Services are rated
at six- month intervals to evaluate
progress in services. In fiscal
year 10/11, 704 surveys were
entered and rated. The evaluation
is a three part evaluation that
involves the caretaker of the
client, the client, and the
clinician. RCS outcomes showed
that consumers who receive
services from RCS increase their
functioning from low functioning
to a healthy one, from the time
they enter services to when they
depart.
In addition, RCS shows that
consumers who participate in
services at RCS decrease
problems from an acute state to a
suitable range that improves their
ability to function well in a
community setting.
Academic Achievements Students who attend the RCS
Non Public School (NPS)
maintain a positive attendance
rate of 90%.
After three months of instruction
at the NPS, students average an
increased performance of one
grade level (.94) across subjects
of reading, math, and spelling, as
measured by the Wide Range
Achievement Test pre and post-
tests. Students average 9 months
of school attendance.
Prevention Services In the fall of 2010, The Prevention and Education Department conducted a total of 29 session
Life Skills Training classes to 814 students at Brownell, Ascension Solorsano, and South Valley
Middle Schools in Gilroy. Botvin’s Skill Training curriculum is considered a model program
proven to be effective in helping children and youth develop drug resistance skills, personal
management skills and general social skills. To evaluate the program, Prevention & Education
give students a test on the first day of class (a pre-test) and the same test on the last day of class
(a post-test) and compares the results for changes. Research has shown that changing negative
FY 10/11 Performance and Quality Improvement Report Page 7
behaviors requires alignment of knowledge, attitude, and skills. Young people need to know a
behavior is harmful, realize that they don’t want to suffer the consequences of the behavior, and
have a set of alternatives to the behavior available to them. Based on the 814 students who
participated, 100% indicated they improved knowledge to make more informed decisions. The
degree of positive knowledge increased 14.8% of key indicators, and 8.6% in applying skills to
help them in the community from when participants started the course to when they ended.
Incident Reports One method RCS improves quality
is by tracking and analyzing
incident reports. In fiscal year
10/11, 549 incident reports were
recorded. A qualifying incident
report at RCS is based on the
situations our external guarantors,
such as Community Care
Licensing, Department of Mental
Health or other partners that
mandate us to report. They range
from physical interventions to
allegations of mistreatment or
select acting out behaviors. One
critical area that RCS pays special
attention to is physical
intervention. Of the 549 incidents
15% were physical interventions.
A physical restraint is only applied
in our Campus Services when a client is a danger to themselves or others.
85
62
26 18
2
48
8 4 5 1 7
27
2
25 29
9 5
127
10 14
39
25 18
6
94
43
136
5
77
0
20
40
60
80
100
120
140
160
Incident Reports n=549 Each Incident Report can contain more than one incident type. Total incident reports will not match the total incident types
10 11 15
31
66
33 23
33
52 38 39
29 7
25 21
20
14
14 19
7
12
10 12
8
0
10
20
30
40
50
60
70
80
90
Incident Report Trend n=549
Campus Community
FY 10/11 Performance and Quality Improvement Report Page 8
Complaint and Grievances Consistent to our values, we honor the voice of the consumer and their family, therefore providing us
another opportunity to improve services. In this fiscal year, RCS had 7 consumer complaints. Two of
which were sustained (the acts were validated), one was exonerated (the acts were validated but
consistent to our policies), and two were unsubstantiated (there was no evidence to validated the acts). Of
the 7 complaints, five were voiced from the wraparound program and two were voiced from the
outpatient mental health program. All complaints were handled within RCS policy and addressed in a
timely manner. Consumers who voice complaints are engaged within one workday from when they made
their report.
Internal Case Record
Review RCS’s uses Federal, State and County
guidelines to assess that clinical
documents are completed accurately,
timely, and consistent to best practices
and the regulations. This process is
another area for opportunity to improve
quality on how we record services, and
defeat system or programmatic
challenges. Consistent to our values, we
feel that accurate recording of services
increases credibility and integrity. In the
course of this year, RCS evaluated 1,075
assessments and treatments plans,
comparing the 1st quarter’s performance
score to the last two quarters; we show a
performance increase of 10%.
Conclusion The goal and objective of our PQI process during this fiscal year was to improve the consumer experience
in receiving services and overcome access barriers resulting from system limitations or structures. RCS
evolved in this initiative and the following performance metrics were applied:
Maintain a fidelity score equivalent or higher to the National Means as reported by the National
Wraparound Evaluation and Research Team.
Maintain consumer satisfaction above a 3.5 baseline on a 5-point likert scale on 20 quality
indicators.
Show evidence of cost reduction by 5% on consumers who receive concurrent services as a result
of integrating care coordination, by implementing a unified assessment and outcomes process.
Maintain quality of care, by measuring effective service outcomes through the Ohio Scales
Outcomes tool. Show evidence of increased functioning and decrease problems for those who
receive our services.
Improved care coordination by reducing 100% parallel assessments for consumers who enter
RCS.
Eliminated 100% redundant or competing data collection tools for outcome tracking and apply a
more uniformed and consumer driven practice.
RCS learned methods in which to become more consumer-driven, increase efficiency and manage
cost that will positively impact the consumer experience, RCS operations, County and State Systems.
The performance and quality improvement goals of RCS were met this fiscal year.
72%
84%
80%
66%
68%
70%
72%
74%
76%
78%
80%
82%
84%
86%
Ist Quarter 2nd Quarter 3rd & 4th Quarter
Internal Case Record Compliance