Step 4: Develop an Action Plan to Improve the Service System & Monitor Progress
Activity 3: Identify the Steps to Improve Measurement Capabilities
Action Plans are invaluable tools in clarifying goals and maintaining focus. The Team decides on enhanced measurement strategies that could include child or family impact, cost, time to implement, and human resources available. Below is a list of questions the leadership team can use to scrutinize and guide measurement improvements:
- Is the full scope of indicator captured in the data source?
- Are the data considered to be reliable and valid?
- Is the frequency of data collection sufficient to allow monitoring over time?
- Does the data source capture the broad population of CSHCN?
An example of one state's review of their data is provided below. Note that potential strategies for improving measurement are also recorded on this table.
| Indicators for Outcome #2: All children with special health care needs will receive coordinated ongoing comprehensive care within a medical home. | Current Data Sources | For Whom & how often reported? |
Adequacy of Data: 1. Full scope of indicator captured? 2. Data set reliable / valid? 3. Frequency of data collection? 4. Broad pop. Of CSHCN? |
Status |
|---|---|---|---|---|
|
1. % of CSHCN with a regular source of primary medical care through a primary care provider. |
a. Title V PM #3: Children with SHCN (i.e. CSHCN program family survey) or b. Utah Child Health Survey, 2000 (Title V Needs Assessment) c. CAHPS |
a. Children enrolled in some of CSHCN programs (clinics); usually collected every 5 years. b. Randomized household survey identifying broader pop. of CSHCN; ; there are no plans to continue in light of SLAITS c. Medicaid children with disabilities acc. To SSI definition; collected every 2 yrs. |
1. yes 2. yes 3. yes 4. Medicaid mgd. Care only |
1. Nt'l survey of CSHCN (will replace UT child health survey) 2. Collect data across multiple CSHCN programs 3. AAP survey of physicians, (if Utah sample is broad enough). |
Strategies Learned from M&M Partner States to Improve Measurement Capabilities
The M&M State teams developed ways to enhance their measurement capabilities to better gauge their progress in achieving the 6 core measures and the M&M indicators. It is important to note that states did not receive any funding from the M&M project to develop these enhanced measurement strategies. Rather, these approaches were created based on the partnership opportunities that developed within the State teams to join forces in their shared vision. These measurement strategies are described below.
The following examples illustrate several states' measuring and monitoring strategies.
South Carolina's Interagency Family Survey
As part of its ongoing measurement process, Children's Rehabilitative Services (CRS) redesigned its records review tool to evaluate the extent to which their CSHCN program services are implementing practices that support all six CSHCN outcomes. Part of the self-assessment process, conducted annually by regional CRS program staff, involves reviewing in-house records to ascertain the quality of services being provided. For example, a sample of client treatment plans is reviewed to ensure that the child's medical home is documented and that a copy of the treatment plan is sent to the medical home provider. Information regarding insurance status, documentation of appropriate referrals based on screening activities, and documentation of a needs assessment are reviewed. This process guides the regional offices in the improvement of services for children and families within their community.
The summarized data for the entire measurement process is used to guide planning for CRS. South Carolina also redesigned its Family Satisfaction Survey to include questions on the CSHCN outcomes and indicators to obtain family input regarding medical home, adequacy of insurance, well child checks, coordination of services, and supports for transition to adult life. This information is useful in guiding the priorities of the CRS program to ensure that it meets their customer's needs.
Oregon's Medical Home Surveys
Oregon's Medical Home Project, administered by Shriners Hospital and Oregon's Child Development and Rehabilitation Center, created two parallel surveys to measure the extent to which children served by Oregon's CSHCN program have a medical home. Family surveys measure accessibility, coordination, and the extent to which families partner with their medical home in decision-making. A companion survey is then administered to the primary care providers identified by the families surveyed through the CSHCN program. Together these surveys are used to assist in designing a training and support system for physicians to help them meet the needs of children and families.
Vermont's Parent to Parent Focus Groups
Parent to Parent of Vermont is a key partner with Vermont's CSHCN program in ensuring that services are family centered, accessible, and coordinated. Parent focus groups conducted by Parent to Parent staff provided valuable information related to Outcome #5: community-based services are organized so families can use them easily. For example, focus groups revealed the extent to which families were struggling with obtaining supports, such as respite and child care, as well as supported living options as children approached adulthood. Vermont used this information in setting state CSHCN program priorities, which are reflected in block grant and SSDI reports. Planning is now underway to develop activities for CSHCN clinics that support youth in their transition to adulthood.
Arizona and Utah Telephone and Household Surveys
As described in the insert entitled "Use of National and State-wide Surveys to Measure and Monitor Achievements for CSHCN Outcomes," both Arizona and Utah conducted randomized telephone household surveys to measure the extent to which the six CSHCN outcomes have been achieved for the broader population of children with special health care needs. These surveys offer potential for serving to guide system improvement when the results are used to drive the policies, practices, and activities of state CSHCN programs. For example, Utah's statewide Child Health Survey results identified the need to focus on transition to adulthood, which is reflected in the Utah's priority planning.
Ohio's Primary Health Care Survey
The Ohio Bureau for Children with Medical Handicaps (BCMH) conducted a survey to examine the quality of primary health care for children and families who receive their services. This mailed survey gathered information via parent report that pertained to the medical home, e.g., the percent of children who had a regular primary care provider, the percent of children whose provider communicates in a way that is clear and understandable, and the percent of providers who coordinate with other agencies serving their child. This information is being used to guide improvements in BCMH's program to ensure that children served in their program have a medical home. Additionally, Ohio used the results of this survey to help them identify and recruit families who might be interested in partnering in various advisory activities.