LESSON 1:X – CONTINUOUS QUALITY IMPROVEMENT IS OUR GUIDING FRAMEWORK
CQI and the overall initiative
Every aspect of the initiative is guided by the four-step, data-driven process of Continuous Quality Improvement (CQI). You can see how CQI guides the broader development of the county initiative following a process of assessing, planning, acting and evaluation.
CQI and the action team projects
Below, we show how this four-step CQI process also guides the design and implementation of each project developed by an action team.
In this first phase, we use data to identify the challenges facing children, youth and families—focused on your particular innovation area. For example, the parent and youth survey may have revealed that 50% of residents lack access to behavioral health care.
We then assess the current capacity of programs and services, like behavioral health care, to address the challenges.
- Identify the challenges to be addressed (For example, lack of behavioral health care that is easy to access for students and their parents)
- Use data to better understand the problems and solutions. (For example, where does behavioral health care exist in the schools, community and health care settings? How affordable is it?
- Use data to determine priorities.(For example, would more access be provided if the action team focused on working to create a school-based behavioral health care center at the middle school that served both students and parents?)
- Use data to drill down to root causes of the challenges. (For example, might the root cause of lack of access to behavioral health care be that most leaders in the school, community and elected bodies believe that people should be able to fix themselves without professional help?)
In this second phase, we research evidence-based solutions to the problems you seek to solve. We also focus on how to develop partnerships, effective communication and countywide collaboration.
- Research evidence-informed solutions to the challenges.(For example, how have some schools been able to become full-services community schools with school-based behavioral health care centers serving students and families?)
- Identify a timeline, roles and responsibilities, costs and other elements related to the overall implementation of the problem-solving process. (In the example case, solving the problem of lack of access to behavioral health care required funding and recruiting staff for a school-based behavioral health care center)
- Develop a hypothesis and logic model that outlines the theory of change and how progress will be measured.(For example, a hypothesis could be: If we provide easy-to-access behavioral health care at schools, where youth are already present, we can increase the use of counseling for youth and their families to address challenges associated with ACEs, trauma and social adversity)
- Articulate a plan consistent with the logic model. (Here is where the action team turns data into action, by making the plan to begin community dialogue about the need for a school-based behavioral health care center. This leads to a series of actions over the next year to build support and then literally build the center, assuming buy-in is achieved. All the steps are written in the one page logic model.
In this third phase, we follow the plan to implement strategies shown to reduce and treat problems. This process requires short and long term work, using data to monitor progress.
- Secure buy-in from key stakeholders and those who may be impacted by the process of problem-solving.(For example, to build a school-based behavioral health care centers will mean buy-in from school district, school site staff, educators, parents and youth. For funding, it might require buy in from city, county and state elected leaders. A local hospital may also be a potential partner to secure buy in and funding from.
- Begin implementation of solutions.(Here is where your logic model can evolve into a broader strategic plan to guide the short, intermediate and long term work.
- Monitor activity in the plan and make adjustments as needed. (The action team guiding this work will need to be vigilant to ensure the project stays on track, on budget and meets expectations of the entire school community.)
- Ensure data are collected throughout the action phase. (Surveys on school community member’s beliefs about behavioral health care might be useful)
In this fourth phase, we use data to measure the effectiveness of our actions, how agencies are being supported and how our children, youth and families are being served.
Analyze all relevant data gathered during the action phase. (For example, surveys and informational interviews as buy-in evolves and funding is secured will be useful. This information can guide future action teams if they choose to tackle a similar challenge at another school.
- Identify the strengths and weaknesses of the problem-solving process.
- Assess the impact of the problem-solving process on the challenge (this would be a good time to re-deploy the Resilient Community Experience Survey).
- Communicate the results of the problem-solving process with all stakeholders.