Developing Quality Indicators for Family Support Services in Community Team-Based Mental Health Care

Abstract

Quality indicators for programs integrating parent-delivered family support services for children’s mental health have not been systematically developed. Increasing emphasis on accountability under the Affordable Care Act highlights the importance of quality-benchmarking efforts. Using a modified Delphi approach, quality indicators were developed for both program level and family support specialist level practices. These indicators were pilot tested with 21 community-based mental health programs. Psychometric properties of these indicators are reported; variations in program and family support specialist performance suggest the utility of these indicators as tools to guide policies and practices in organizations that integrate parent-delivered family support service components.

An ARC-Informed Family Centered Care Intervention for Children’s Community Based Mental Health Programs

“…Immersive training exercises were used to shift staff attitudes and beliefs about the parent role and the provider role in care. Based on previously identified counterproductive practices within these same programs such as using deficit-based language or being directive and making decisions for families (Olin et al 2014a, b), vignettes were developed that allowed teams to viscerally experience the impact of the counterproductive approaches. The exercises revealed biases and mismatches in provider stories and interpretations about parents and the range of normal, human explanations for parent behaviors and perspectives that become clearer when “walking in the shoes” of the parent.…”

“…At the time of study recruitment, there were 33 HCBS Waiver programs located within New York State, each embedded within a larger human service agency. HCBS Waiver program staff generally include at least: (a) Agency Administrators, usually the CEO or designee of a large mental health agency that oversees several programs including the HCBS Waiver program; (b) Program Director, usually a master’s level clinician who is responsible for the overall management of the program; (c) Individualized Care Coordinator, who conducts intake and screening, assessment of needs, service plan development, monitoring of goals, and consultation; (d) Parent Peer Specialists, who are peer providers of services with experience as a parent of a child with mental health needs and who provide advocacy and support for parents of children with mental health issues; (e) Skill Builders, who assist the child in acquiring, developing, and addressing functional skills and support, both social and environmental; (f) Respite Workers, who provide a break for the family and the child to ease stress at home and improve family harmony; (g) Crisis Response Workers, who implement activities to stabilize occurrences of child/family crisis, and who provide intensive interventions in the home when a crisis response service is not enough (Olin et al 2014a, b; Wisdom et al 2014). …”

“…Despite the rapid expansion of parent peer specialists nationally, the evidence for effectiveness of such services lag behind their rapid growth in mental health (Hoagwood et al 2010; Olin et al 2014a, b). In the current health care context, the viability of peer services depends on the ability to link quality components to outcomes (Obrochta et al 2011).…”

“…Moreover, if new practices such as family-centered care challenge currently held shared values and beliefs that underlie clinical practice, resistance can be doubly difficult to overcome. Recent studies document these challenges, which include variability in the roles and responsibilities of parent peer specialists vis a vis families and other providers on the team (Kutash et al 2014; Rodriguez et al 2011; Salzer et al 2010; Wisdom et al 2014), variability of service quality across programs (Olin et al 2014a, b), and the impact of social organization context in inhibiting or facilitating high quality parent peer services (Olin et al 2014a, b). Clearly, training of parent peer specialists alone is insufficient.…”

Quality Indicators for Multidisciplinary Team Functioning in Community-Based Children’s Mental Health Services

“…The quality indicators used in this study were developed using a modified Delphi technique (Boulkedid et al 2011) using an expert panel and is described in detail in Olin et al (2013a). To assess the performance on each quality indicator, PDs completed a modified MacArthur Survey that included questions on infrastructure, referrals, supervision and training, and staff roles.…”