Pacific Clinics CQI through TCOM

Abstract Pacific Clinics Purpose This proposal is to provide technical assistance and consultation to Pacific Clinics on continuous quality improvement (CQI) through a Transformational Collaborative Outcomes Management (TCOM) framework. The support provided by the Center for Innovation in Population Health (IPH Center) will include: technical assistance in the implementation of the California Child and Adolescent Needs and Strengths assessment tool (CANS); program evaluation through Facilitated Collaborative Inquiry (FCI); and implementation of the Safe Systems Improvement Tool (SSIT). Qualifications The CANS is a functional assessment tool that has been in use in child welfare, children’s behavioral health, educational and juvenile justice systems since the late 1990s. Developed by John S. Lyons, PhD while at Northwestern University, the CANS is now used across the United States, Canada and over 10 countries internationally. It is estimated that 80% of children served in public behavioral health and child welfare systems in the United States have had a [CANS]. Since the development of the CANS, other similar tools have been created including the Adult Needs and Strengths Assessment, Family Advocacy and Support Tool, Crisis Assessment Tool, and the Readiness Inventory for Successful Employment. During the last 30+ years Dr. Lyons’ work has received support from the organizations that he has worked in which contributed to the development of his team and the evolution of the Transformational Collaborative Outcomes Management (TCOM) approach: University of Ottawa, Chapin Hall at the University of Chicago, and most recently at the Center for Innovation in Population Health (IPH Center) at the University of Kentucky. Established in 2019, the IPH Center provides a platform for the TCOM approach to flourish in a research setting that can draw multi-sector collaborative relationships with key partners in the academy as well as throughout the human service sectors. Within the context of the IPH Center, TCOM and its tools, such as the CANS, broadens the strategy of personal transformation to addressing population health improvement. Methods 1. Program Evaluation: Dr. Stephen Shimshock will provide technical assistance and consultation on how to implement Facilitated Collaborative Inquiry (FCI). FCI is a framework for organizational learning through the use of data and small-tests-of-change feedback loops. It is collaborative in that the major learning activities (identifying a challenge to address, unpacking and understanding the challenge, selecting and development strategies to address the challenge, and measuring success) are primarily carried out by those in direct serving capacities. The process is facilitated by a trained researcher who ensures rigor and high fidelity to established research processes. It is well situated to help Pacific Clinics develop and sustain continuous quality improvement efforts. 2. CANS Training: Dr. Fernando will lead the Workforce Development team to support Pacific Clinics’ use of the CANS. a. Supervision Training: 1 (one) 4-hour training for up to 25 trainees b. Treatment Planning Training: 1 (one) 4-hour training for up to 25 trainees c. CANS Booster: 2 (two) 4-hour training sessions for up to 25 trainees each session d. CANS Implementation: Technical assistance and consultation to support Pacific Clinics’ on-going use of the CANS. e. Training event coordination. 3. Data Visualization, Feedback, and Reporting: Dr. Lyons will lead the Precision Analytics team to provide technical assistance on best practices for data visualization and reporting of data collected from the CANS. 4. Safety Culture: Dr. Cull will provide technical assistance and consultation on the implementation of the Safe Systems Improvement Tool. 5. Project Coordination: Nicholas Guerra will provide project coordination for the IPH Center team. Qualifications of Key Staff April D. Fernando, PhD Background and experience: Dr. Fernando the Associate Director for Workforce Development at the Center for Innovation in Population Health, and an Assistant Professor of Health, Behavior and Society at the College of Public Health, University of Kentucky. Dr. Fernando works with non-profit agencies as well as child welfare and behavioral health care systems across the United States in implementing Transformational Collaborative Outcomes Management (TCOM) and utilizing the TCOM tools such as the Child and Adolescent Needs and Strengths (CANS). She developed the CANS-Commercially Sexually Exploited version, which is used nationally. A licensed clinical psychologist, Dr. Fernando brings her years of experience as an educator, clinician, and mental health administrator to her work with TCOM and the CANS. Position Description: As Principle Investigator, Dr. Fernando will be the CANS implementation lead for this project. In this role she will consult across the team to support the use of the CANS as a foundation for trauma-informed care and a data source for continuous quality improvement (CQI) efforts. Michael J. Cull, PhD Background and Experience Dr. Cull is the Associate Director for Safe Systems at the IPH Center at UK, and an Associate Professor of Health Management and Policy in the College of Public Health. Dr. Cull is a licensed nurse practitioner with a specialty in child and adolescent psychiatry. He holds a Master of Science in Nursing degree from Vanderbilt University and received his Ph.D. from the Institute of Government at Tennessee State University. Dr. Cull served as Deputy Commissioner overseeing the Office of Child Health for Tennessee’s Department of Children’s Services. Prior to this appointment, he was an Assistant Professor in Health System Management at Vanderbilt University’s School of Nursing and over his 20 years at Vanderbilt served in a number of clinical and administrative roles including Director of Education and Dissemination in the office of Quality and Patient Safety. Dr. Cull has specific expertise in applying safety science to improve safety, reliability, and effectiveness in organizations. His approach leverages tools like organizational assessment and systems analysis of critical incidents, including deaths and near deaths, to build team culture and help systems learn and get better. Position Description: As Co-Investigator, Dr. Cull will be the Safe Systems lead for this project. John S. Lyons, PhD Background and experience: Dr. Lyons is the Director of the IPH Center and a Professor of Health Management and Policy in the College of Public Health. Across his 39-year career he has been an innovator and leader in outcome management and continuous quality improvement. He developed the theory of measurement—Communimetrics–behind the SSIT and the CANS. This year approximately 80% of all children and youth served in either child welfare or public behavioral health in the United States will receive a CANS assessment. Many implementations have sustained for nearly two decades evolving the approach consistent with the tenets of quality improvement. Dr. Lyons proposed the system management theory of TCOM which has been successfully used to foster positive change in systems across the United States and internationally. TCOM is the first person-centered theory of outcomes management and is intended to ‘engineer’ the implementation of person-centered thinking throughout a system of care. Dr. Lyons is a leader in research in residential treatment and psychiatric hospitalization and was Editor of the journal Residential Treatment for Children and Youth for seven years. Position Description: As Co-Investigator, Dr. Lyons will be the Precision Analytics lead for this project. Stephen M. Shimshock, PhD Background and Experience: Dr. Shimshock is an Assistant Professor of Biostatistics in the College of Public Health. Dr. Shimshock provides analytical and consultation services to a wide variety of private and government agencies looking to transform the lives of youth and families. Dr. Shimshock has over 25 years of experience working in the social services field and extensive experience in cultivating data-informed learning cultures, or what he calls “cultures of best-practitioners.” Dr. Shimshock has a passion for helping communities connect their stories to data and their data to stories all in an effort to ensure system-wide change is in direct response to the strengths and needs of those being served by the system of care. Precision Analytics uses advanced statistical techniques to optimize placement of children and youth across levels of care to improve outcomes. He is also leading a national effort to understand outcomes of residential treatment using data from all the states currently using the CANS in their congregate care system. Position Description: As Co-Investigator, Dr. Shimshock will be the FCI lead for this project.