Biennial Service Review Training

1. Biennial Service Review Training Putting it All Together

2. Biennial Service Review Quality improvement through focused analysis and planning

3. Pulling together six HFA required analyses/reviews • Analysis of access to the population • Analysis of Assessment & Program Acceptance • Analysis of Participant Retention • Analysis of Home Visit Completion • Cultural Review • Analysis of Staff Retention and Satisfaction ~~~

4. Where to Start? • Review the 2014-2015 BSR • Analyze improvement plans for each category • Did you do what you planned? • If so, what was the impact? • If not, why not? • Did you do anything you hadn’t planned? • If so, what was the impact?

5. Analysis of Access to the Population • Description of Target Population Basic demographics of the target population such as race, ethnicity, age, language, general description of the area • Easidemographics.com • Edr.state.fl.us • Floridacharts.com • Zipwho.com • Factfinder.census.gov

6. Analysis of Access to the Population Continued • Description of Target Population • Basic demographics of the target population such as race, ethnicity, age, language, general description of the area • How target population was determined • Agreements in place to access population • Memoranda of agreement (MOAs) • Process for accessing target population • Community outreach activities • Percent of births screened (use Birth Rata Analysis)

7. Analysis of Access to the Population Continued • To improve the screening rate, explore: • Are you getting all the screens from Healthy Start? • Does Healthy Start have a low screening rate, too? • Are there other service providers/places that might provide access to the population? • Has there been an increase or decrease in Record Referral Screens? If so, why? • Has there been an increase or decrease in Prenatal Risk Screens? If so, why? • Develop a plan to expand methods of access. ~~~

8. Analysis of Assessment Acceptance • Include formal and informal data and identify sources • Formal data=hard data or numerically recorded data • Informal data=soft data or anecdotal data, gathered by discussion with staff, families, stakeholders, Advisory Committee members • Include a description that explains the data • What happened to families that screened positive, but were never assessed.

9. Analysis of Assessment Acceptance • Use the Screening Analysis Report • One year of data minimally required, two years optional • Determine factors impacting positive screens not resulting in assessment • By FAW (Unable to locate, Refusals) • Exploration of high “unable to locate”(how long between screen to offer, outreach techniques, etc.) • Root causes of “unable to process-limited resources” • Analysis of “other” • Develop a plan to increase percentage of positive screens resulting in an assessment

10. HEALTHY FAMILIES SOMEWHERE Screening Analysis Report(07/01/2016 – 06/30/2017)

11. Analysis of Program Acceptance • Include formal and informal data and identify sources • Formal data=hard data or numerically recorded data • Informal data=soft data or anecdotal data, gathered by discussion with staff, families, stakeholders, Advisory Committee members • Include a description that explains the data • What happened to families that assessed positive, but never enrolled.

12. HEALTHY FAMILIES SOMEWHERE Aggregate Report for Assessment Result (Assessed From 07/01/2016 Through 06/30/2017)

13. Analysis of Program Acceptance continued • Report the program acceptance rate for the reporting period. This is the percent of families accepting services out of all those offered services. • One year of data minimally required. • Consider including a performance trend line for at least three years.

14. HEALTHY FAMILIES SOMEWHERE Aggregate Report for Assessment Result (Assessed From 07/01/2016 Through 06/30/2017)

15. The program acceptance rate is determined by dividing the number that consented to participate by the total number offered an assessment (consented to participate + refused @ assessment + refused @ outreach) . Consented to Participate (102) . 129 Consented to Participate (102) + Refused@assessment (10) + Refused@Outreach (17) 102/129 = 79% Program Acceptance Rate

16. Analysis of Program Acceptance continued • Analysis of those that refused services • Must include a comparison to those that accepted services • HFA requires the analysis include the following factors: • Demographic • Programmatic • Social

17. Analysis of Program Acceptance continued • Demographic factors (use the Assessment Demographic Report) • gender: • age: • race & ethnicity; • marital status; • education; • language; • employment; and • city, zip code, community, etc.

18. Analysis of Program Acceptance continued • Programmatic Factors • referral sources* • staffing issues (patterns & trends among assessment staff or assigned FSW; use the Assessment Demographic Report) • timeframe between screen and assessment* • timeframe between assessment and initial contact* • number and/or type of attempted contacts* * These data would require local tracking mechanisms.

19. Analysis of Program Acceptance continued • Assessment Demographic Report • Result: Consented To Participate • Result: Refused Program @Assessment • Result: Refused Program During Creative Outreach(Assessed between 7/1/2016 and 6/30/2017)

20. Assessment of Program Acceptance continued • Social Factors • assessment score (use Participant Assessment by Results Report) • working or in school* • economic factors* • teen parent(s) living with parents* • cognitively delayed parents* • the big three – substance abuse, mental health or domestic violence* * This would require informal data since this data is not collected for those who do not enroll and is not easily accessed for those enrolled.

21. Participant Assessments by Result(Result: All Results) (Assessed During 7/1/2016 Thru 6/30/2017) • Run by: • Result: Consented To Participate • Result: Refused Program @Assessment • Result: Refused Program During Creative Outreach

22. Analysis of Program Acceptance continued • Analysis of those that refused the program • HFA requires that the analysis be based on the following factors • Demographic • Programmatic • Social • Findings (including comparison to those that accepted services) • Plan (based on findings) to increase program acceptance ~~~

23. Analysis of Retention Rates • Definition of Retention Rate The percent of families enrolled in a given fiscal year that remain in the program for a specified period of time after the initial home visit. • Retention Rate 12 Months 6 Months 24 Months OR 12 Months 36 Months 24 Months • Minimally use 1-year cohort • Consider using 3 1-year cohorts for trend analysis

24. HEALTHY FAMILIES SOMEWHERE Participant 12 Month Retention Rate

25. HEALTHY FAMILIES SOMEWHERE Participant 24 Month Retention Rate

26. HEALTHY FAMILIES SOMEWHERE Participant 36 Month Retention Rate

27. Analysis of Retention • Analysis is based on those families leaving the program in the reporting period • HFA requires that the analysis be based on the following factors • Demographic • Programmatic • Social

28. Analysis of Retention HEALTHY FAMILIES SOMEWHERE Aggregate Report for Closure Reasons (Closed During 07/01/2016 Thru 06/30/2017)

29. Analysis of Retention continued • Demographic factors (use the Participant Demographic Report-Closed Cases Only, All) • gender • age • race & ethnicity • marital status • education • language • employment • city/zip code, etc.

30. Analysis of Retention continued • Programmatic Factors • closure reasons • assessment scores* • timeframe from assessment to first home visit* • Prenatal versus postnatal enrollment* • staffing issues (by FSW, by team) • current service level at time of closure (from QPR) • length of time in program (from QPR) * This would require informal data or checking individual records since it is not aggregately reported for those enrolled.

31. Analysis of Retention continued • Social Factors • assessment score • working or in school* • economic factors* • teen parent(s) living with parents* • cognitively delayed parents* • the big three – substance abuse, mental health or domestic violence* *This would require informal data since this data is not collected or easily accessed for those enrolled.

32. Analysis of Retention continued • Analysis of those that left the program • HFA requires that the analysis be based on the following factors: • Demographic • Programmatic • Social • Findings (must include comparison to those that remained in the program) • Plan (based on findings) to increase family retention ~~~

33. Home Visit Completion • Describe monitoring system • Review home visit completion rates • By project • By team • By FSW • Include any findings from HFF QA monitoring • Develop plan to increase home visit completion based on findings of monitoring (not required if all FSWs achieve 90 percent or higher) ~~~

34. Cultural Review • Description of Service Population (those served in reporting period) • Include: • Ethnic/racial characteristics • Other demographic characteristics • Language • Other cultural characteristics • Compare to target population to determine any gaps • Compare to staff/home visitors • Discuss ability to serve the major cultures within the population including agreements with partners if needed

35. Cultural Review continued • Discuss cultural competence of the program regarding the Materials used by the FAWs and FSWs. • You must include input from both families and staff in the discussion of materials. Examples and survey results are great here. Item #5 and #6 of the Participant Satisfaction Survey provides family input. • Caution: Include how you got input from families and staff, but – don’t stop there! Include the actual input (survey results, what you learned from the focus group or staff meeting discussion, what you observed in shadowing, what you heard during QA calls, etc.)

36. Cultural Review continued Training on the Unique Characteristics of the Population • Often confused with training on cultural sensitivity • Describe what training was provided, when and who attended. • Compare the needs identified in the last BSR and whether you completed your plan to meet those needs. • Identify new training needs identified through the BSR process and plan to meet those needs.

37. Cultural Review continued Some tips on identifying the unique characteristics of the population: • Comparison of demographic reports • Comparison of Aggregate Report for Assessment Concerns • Areas that staff may have had difficulty in • Areas staff have requested training in Include how you determined the need in your BSR.

38. Cultural Competence in Service Delivery • Describe systems that ensure cultural competence in each service delivery area • Assessment • Home Visiting • Supervision • Management • Describe accommodations and adaptations to meet cultural needs in each of the service delivery areas • Discuss barriers and plans to address them

39. Cultural Review continued • Provide input from families on how they regard cultural competence of the program regarding: • Materials (may already have in materials section) • Communications/linguistics • Staff and family interventions

40. Cultural Competence continued Items from Participant Satisfaction Survey that provide input on these items: • Materials – “The materials my home visitor gives me are easy to understand” (#5), “The materials my home visitor gives me respect my culture” (#6) • Communications – “My home visitor talks with me in a language I understand or has an interpreter to help” (#12) • Staff/Family Interactions – “My home visitor treats me with courtesy and respect,” (#1) “My home visitor understands and respects my culture” (#13)

41. Cultural Review continued • Provide input from staff on how they view cultural competence of the program regarding: • Materials (if not already included in materials section) • Communications/linguistics • Staff and family interventions • Tell how you obtained the input from staff. Also, include the input. Discuss any barriers to communication or challenges with interventions that might need to be addressed.

42. Cultural Competence continued • Feedback from the advisory committee on last BSR (2014-2015) • Best practice is to review the whole BSR and get feedback • HFA Standards require feedback from the committee on the Cultural Review • Describe any actions taken on the feedback from the committee • Describe plan to present the current BSR to the committee ~~~

43. Staff Retention Analysis • Discuss how long current staff have been employed • Provide information on: • Any positions that became vacant in the reporting period • Reasons for leaving for each person that left • Demographics of staff that left compared to those that remained • Input from staff who are currently employed regarding satisfaction • Discuss any challenges to staff retention • Review the plan from the previous BSR • Discuss any changes made or planned to increase staff retention.

44. Staff Retention Analysis • Staff (by position title) who left during the timeframe (12 months for new sites, 24 months for all others) • their hire date • termination date • reason why they left • any other pertinent characteristics • Summary of staff satisfaction • Strategies developed based on what was learned from data • Strategies which have been implemented

45. Biennial Service Review • Involve others – make it a team effort • Cite your references • Be a detective – find out what’s working; why or why not • Include formal and informal data • Include a plan that is reasonably linked to the findings

46. Process after submission • BSRs are due November 15th for the reporting period of the previous fiscal year. • Once submitted, HFF staff will review the BSR and provide feedback, including requested revisions if the BSR does not cover everything required by the HFA Standards • Along with the feedback, projects will be given a deadline to submit revisions.

47. Any Questions If you have any questions at any time regarding what is required, what you are finding in your analyses, suggested activities to address your findings, or the process, etc…please feel free to contact your program specialist or me at Sgolden-mccord@ounce.org