Tutorial 9 · Implementing and Evaluating ECMHC Services
Accountability and Continuous Quality Improvement
Accountability, or the degree to which the MHC and the program are implementing the specified number and type of ECMHC services, is a necessary component of quality improvement. However, a broad quality improvement strategy is needed to better determine if consultation services are meeting the needs of children, families, and staff, and if not, identify areas in need of strengthening. Most importantly, quality improvement strategies should take the approach that all individuals, practices, and services can benefit from ongoing review, feedback, and improvement efforts. Data collected as part of a quality improvement effort needs to be regularly reviewed, reflected upon, and used to inform practice.
Effective consultation programs need to have a clear plan for quality improvement that includes:
After developing the initial strategic plan for your program’s mental health approach, developing and monitoring a quality improvement plan is a key function for your program’s Mental Health Workgroup. The figure below shows a general model for sharing and using that feedback for improving practice.
Figure: A Feedback Loop Model for Continuous Quality Improvement
Strategies for Building Feedback Loops
Strategies for building feedback loops include administrative structures such as gathering contract-based service information, regular supervision, the role of the Mental Health Workgroup, feedback from those who utilize or receive consultation services, and a process of review, reflection, analysis, and discussion that leads to ideas and strategies to strengthen and improve services. You will need to determine the specific types of information that will be collected, how often and with whom it will be shared, and how the information will be used to drive practice that makes the most sense for your program.
One of the most important, but often overlooked, components of ongoing quality improvement efforts is establishing the appropriate mechanisms for sharing information between key individuals and groups, and ensuring that there are feedback loops in place for incorporating the information collected into ongoing program practices. There are a number of different ways that feedback loops might be established in your Head Start program.
As a program administrator, it is important for you to think about how to best put into place clear ways for information about the amounts, types, and outcomes of consultation to be shared and discussed with appropriate groups of people within the program, and to provide a forum for discussing how to continually improve the effectiveness of consultation. Remember, the figure above shows a general model for sharing feedback and using that feedback for improving practice. You will need to determine the specific types of information that will be collected, how often and with whom it will be shared, and how the information will be used to drive practice that makes the most sense for your program.
Addressing Concerns or Challenges
Ideally, if you have processes in place for regular one-on-one meetings between the consultant and a Head Start supervisor, as well as regular reporting to other formal groups such as the Mental Health Workgroup, the leadership team, policy council, board and other staff meetings, you will be able to identify any concerns or challenges in your program’s mental health approach and services quite early, before serious performance or other problems emerge.
One of the benefits of establishing these feedback loops and having clear communication that focuses both on activities and outcomes is that concerns and areas for improvement are identified early and more easily addressed. Continuous quality improvement is based on the premise that all practices can be improved, and takes the approach that all staff benefit from continuous feedback that leads to positive growth and improved practice. Your role as an administrator is to make sure that this feedback is regular, early, constructive and growth-oriented – and is not focused on finding fault or assigning blame.
However, it is possible that through the process of engaging in program-wide needs assessment and strategic planning focused on your consultative model, you will need to make fundamental changes in how consultation services are being delivered, or who is delivering them within your program. Having the “right” consultant – one who is a good fit for your program’s needs and who understands your consultative model and approach to mental health is essential. Ultimately, it is the responsibility of the administrator to determine when continuous quality improvement efforts have not led to the desired changes, and more fundamental programmatic changes are required.
This website was made possible by grant number 90YD0268 from the Office of Head Start, Administration for Children, Youth and Families, U.S. Department of Health and Human Services. The contents are solely the responsibility of the authors and do not represent the official views or policies of the funding agency nor does publication in any way constitute an endorsement by the funding agency.