chronic disease self management education … · chronic pain self-management program (cpsmp) 12...
TRANSCRIPT
C H R O N I C D I S E A S E S E L F - M A N A G E M E N T E D U C AT I O N
I N T E G R AT E D S E R V I C E S D E L I V E R Y S Y S T E M
A S S E S S M E N T TO O L
RESULTS FROM THE 2014 ASSESSMENT
BACKGROUND INFORMATION
Twenty-two states responded to the 2014 Chronic Disease Self-Management Education Integrated Services Delivery System Assessment Tool. These states
were funded by the 2012 Prevention and Public Health Funds: Empowering Older Adults and Adults with Disabilities through Chronic Disease Self-Management
Education Programs grant to significantly increase the number of older and/or disabled adults who complete evidence-based CDSME programs to maintain or
improve their health status and to strengthen and expand integrated, sustainable service systems within states to provide evidence-based CDSME programs.
This assessment provides an overview of the states’ current progress towards sustainable and integrated systems. The assessment covers six key elements of
an integrated services delivery system: 1) leadership, 2) delivery infrastructure, 3) partnerships, 4) centralized and coordinated logistical processes, 5) business
planning and financial sustainability, and 6) quality assurance and fidelity.
The states offer the following CDSME programs:
TYPE OF CDSME PROGRAMS OFFERED
Chronic Disease Self-Management Program (CDSMP) 22
Diabetes Self-Management Program (DSMP) 21
Tomando Control de su Salud (Spanish CDSMP) 18
Programa de Manejo Personal de la Diabetes (Spanish DSMP) 13
Chronic Pain Self-Management Program (CPSMP) 12
Better Choices, Better Health® (Online CDSMP) 6
Positive Self-Management Program for HIV (PSMP) 5
Arthritis Self-Management Program (ASMP) 2
Better Choices, Better Health® - Diabetes (Online DSMP) 2
Better Choices, Better Health® - Arthritis (Online ASMP) 2
ELEMENT 1: LEADERSHIP
Effective leadership and project management includes a strong state unit on aging and state health department partnership, an integrated state vision,
documented plan and mutually agreed upon goals.
0
5
10
15
20
25
Our state unit onaging and state
health departmenthave workedtogether to
identify and targetunderserved
geographic areas.
Our state healthdepartment and
state unit on aginghave an integratedand documented
vision forevidence- basedprogramming.
Strategies tosupport CDSME or
other evidence-based
programming areincluded in our
state unit on agingstate plan.
Strategies tosupport CDSME or
other evidence-based
programming areincluded in our
state healthdepartment state
plan.
Strategies tosupport CDSME or
other evidence-based
programming areincluded in in
anothermanagement
body's state plan.
There is amanagementstructure (e.g.steering group,
coalition, partnerteam etc.)
including the stateunit on aging and
state healthdepartment thatprovides overall
direction andleadership forCDSME in the
state.
Our state unit onaging and state
health departmenthave a signed
agreementdocumenting
responsibilitiesrelated to CDSME.
20
13
19
16
7
20
14
Do you have any existing organizational charts or other graphics that describe your
state's structure for managing and delivering the CDSME program(s)?
Thirteen of the states indicated they have existing organizational charts or other graphics that describe the state's structure for managing and delivering the
CDSME. Nine states currently do not have this documentation in place.
59%
Yes
41% No
THE KEY BODIES THAT ARE INVOLVED IN MANAGING OR DIRECTING
CDSME ACTIVITIES AT THE STATE LEVEL:
State unit on aging 22
State health department 20
State advisory council or other management team 10
State coalition 6
Foundation/other oversight agency 0
Other management body* 10
*Other management bodies included the Arizona Living Well Institute, Wisconsin Institute for Healthy Aging, Missouri Arthritis Porgram, New
York State Quality and Technical Assistance Center (University at Albany), USC College of Social Work, statewide PRE-AIM team, Department of
Libraries, Department of Corrections, and T-Trainers and Master Trainers.
How often do your state unit on aging and state health department meet?
Sixty-eight percent of state units on aging and health departments meet at least monthly, with approximately one-third meeting on a weekly
basis.
Other responses indicated that the state unit on aging and state health department meet bi-weekly, quarterly, and as often as necessary.
Weekly 32%
Monthly
36%
Other 32%
WHICH AGENCIES ARE RESPONSIBLE FOR THE FOLLOWING KEY FUNCTIONS?
State Unit on Aging
State Health Department
Local Agencies Other
Management Body
Develops plan for expanding CDSME 20 18 16 6
Convenes state advisory council/other management
structure
14 14 0 7
Holds CDSME license 11 9 10 6
Coordinates master trainings 12 10 4 6
Develops and/or coordinates marketing/promotional
activities
18 16 17 9
Manages website 9 10 6 6
Coordinates workshop calendar 5 7 13 8
Responsible for NCOA data entry 9 7 5 7
Conducts fidelity and performance monitoring activities 16 10 16 10
Coordinates evaluation studies 11 11 4 8
Recruits major partners/ host sites 17 19 16 9
Seeks funding support 17 19 16 8
Provides technical support to trainers, leaders, sites 17 15 13 10
Designates agency staff to work on CDSME 18 19 15 10
Recruits and trains T-trainers/MTs/Lay Leaders 12 13 17 8
Our state currently has a strong leadership and project management team including public health and aging that will continue to
lead CDSME efforts after AoA funding ends.
Ninety-five percent of states indicated either to a large extent or moderate extent they felt that their state currently has a strong leadership and project
management team including public health and aging that will continue to lead CDSME efforts after AoA funding ends. This number is up from 94% of states
indicating this in the 2013 assessment and just 80% of states in the 2012 assessment.
That said, there was an 18% decrease with regard to states indicating to a large extent that they have a strong leadership and project management team to
lead CDSME efforts after AoA funding ends.
To a large extent
54%
To a moderate extent
41%
To a small extent 5%
ELEMENT 2: DELIVERY INFRASTRUCTURE
To make certain that evidence-based programs are as “accessible as prescription medications” requires ensuring a delivery infrastructure with an adequate
workforce that can support the number of workshops needed to ensure that programs can be delivered statewide to the targeted populations.
WHICH OF THE FOLLOWING ELEMENTS ARE CURRENTLY PART OF YOUR CDSME DELIVERY SYSTEM?
An appropriate number of active CDSME master trainers to meet the needs for leader training. 20
An adequate number of lay leaders to provide CDSME workshops across the state. 11
A mechanism or system to track CDSME master trainers or leaders statewide. 20
Ongoing communications, support, and other retention strategies for CDSME master trainers or leaders
that are implemented across the state.
19
Appropriate Stanford licensing to cover all implementation sites and planned number of workshops and
trainings.
22
A delivery structure in place that is capable of delivering CDSME programs throughout the state. 18
How many active CDSME T-trainers do you have in your state?
Most of the states had two or fewer T-trainers, with only Massachusetts,
New Mexico (both with four T-trainers), Michigan (with three T-trainers),
and New York (with six T-trainers) having more. Two states had more than
one hundred active master trainers—Michigan with 202 and New York
with 102. The majority of states (64%) had fifty or fewer active master
trainers in the state.
All of the states reporting had at least 50 active lay leaders and the
majority of states (64%) had between 50-200 lay leaders. An additional
three states had between 201-300 lay leaders and four states had between
301-500 lay leaders. Arizona and South Carolina were outliers with 533 and
800 lay leaders respectively.
How many active CDSME master trainers do you
have in your state?
3
8
3
5
1 2
10 or less
11-20
21-50
51-75
75-100
100+
0
1
2
3
4
5
6
7
Zero One Two Three Four Five Six
7
5
6
1
2
0
1
Forty-five percent of states estimate that 75%-99% of their counties have enough sites and leaders to offer CDSME workshops at least twice a year. That
number is up from only 14% of states in the previous self-assessment. Eighteen states (82%) estimated that at least 50% of their state’s population is included
in the counties where they are able to offer CDSME workshops at least twice a year.
What approximate percentage of your state’s population is included in the counties where you are able to offer CDSME workshops at least twice a year?
100% 1 state 4.55%
75-99% 11 states 50.00%
50-74% 6 states 27.27%
25-49% 1 state 4.55%
Less that 24% 1 states 4.55%
Don’t know/unsure 2 states 9.09%
0 1 2 3 4 5 6 7 8 9 10
100%
75-99%
50-74%
25-49%
Less than 24%
10
6
5
What percentage of your state's counties would you estimate currently have enough sites and leaders to provide CDSME
workshops at least twice a year?
ELEMENT 3: PARTNERSHIPS
To ensure that programs are as available as possible and are sustained over time requires establishing effective partnerships with agencies that have effectively
embedded CDSME and/or other evidence-based programs within their systems, have multiple implementation sites throughout the state, and/or can reach the
targeted audiences.
0
5
10
15
20
25
We collaborate withagencies already
reaching targetedunderservedpopulations.
Our partnershipsinclude agencies
with host sites withmultiple
implementationsites and/or
capacity to scalingup statewide.
We are effectivelycoordinating andintegrating with
existing CDSME andother community-based evidence-
based preventionprograms.
We arecoordinating with
chronic caremanagementprograms and
demonstrationsbeing sponsored by
physician groupsand hospitals.
We have signedagreements
documentingresponsibilities with
all of our majorpartners.
22 21 21
15 14
What percentage of your Area Agencies on Aging (AAAs) are part of your CDSME delivery system?
Thirty-two percent of states had 100% of Area Agencies on Aging (AAAs) as part of their CDSME delivery system. An additional 27% had less than
50% of AAAs as part of their delivery system (a 5% decrease from last year). Nine states covered the remaining 41% with a range from 54% to
90% of AAAs as part of the delivery system.
Under 50% 50%-74% 75%-99% 100%
6 6
3
7
How do you interact with the Aging and Disability Resource Centers (ADRCs) in your state?
(Select all that apply)
Seventy-seven percent of states have Aging and Disability Resource Centers (ADRCs) that serve as CDSME referral sites in their system. Forty-five
percent of states have ADRCs that serve as CDSME host sites (an increase of 9% from last year’s assessment). Of the 41% of states that indicated
“Other” in regards to their interactions with ADRCs, explanations include projects in process (referral protocols, integration within Options
Counseling), ADRCs not yet fully functional, and transitions within the ADRC system.
0 2 4 6 8 10 12 14 16 18
They serve as CDSME host sites.
They serve as CDSME referral sites.
They serve as CDSME implementation sites.
They have integrated CDSME into their OptionsCounseling program.
They have integrated CDSME into their CareTransitions program.
We do not have ADRCs in our state.
Other, please describe:
10
17
8
5
6
9
Besides the AAAs/ADRCs, who are your other major partners who have embedded CDSMEs into their ongoing activities or who have played other significant roles in helping you expand CDSMEs statewide?
Embedded program
Provides statewide delivery system
Referral source
Funding source
License holder
Advocacy/support groups 7 0 13 3 0
Agencies that reach rural populations 14 6 15 5 8
Area health education centers (AHECs) 6 2 13 2 4
Assisted Living Facilities/Continuing Care Retirement Communities (CCRCs) 5 0 12 1 0
Centers for Independent Living 5 3 13 1 1
Civic groups (e.g. Rotary Club, women’s group, Kiwanis, etc.) 1 1 7 0 0
Cooperative extension centers 3 3 11 1 0
Corporations/for-profit groups 2 0 5 2 1
Department of corrections 6 2 6 2 1
Ethnic/minority agencies 10 2 14 2 4
Embedded program
Provides statewide delivery system
Referral source
Funding source
License holder
Faith-based organizations 9 1 17 2 1
Federally Qualified Health Centers 14 4 12 4 3
Foundations 2 0 4 10 1
Groups working with people with disabilities 6 3 16 2 1
Health insurers/health plans 5 2 15 8 4
Hospitals/health care systems 14 1 18 7 6
Mental/behavioral health care providers/clinics 7 3 13 2 2
Native American tribal organizations 6 2 9 1 2
Primary care practice/local health organizations 8 2 18 3 4
Quality Improvement Organizations 1 0 9 1 0
Retiree groups/ groups for adults 55+ 2 1 11 1 0
Embedded program
Provides statewide delivery system
Referral source
Funding source
License holder
Senior Community Service Employment Program (SCSEP) 1 0 8 0 0
Senior housing 4 1 18 2 0
Substance abuse prevention/treatment facilities 2 0 8 2 0
University/academic institutions 6 0 15 3 0
Veteran’s Administration 10 3 12 2 3
Worksite programs/employee benefits programs 4 0 14 3 0
YMCA’s and recreation centers 8 2 15 2 1
Organization Count of Partner Roles
Agencies that reach rural populations 48
Hospitals/ health care systems 46
Federally Qualified Health Centers 37
Primary care practice/local health organizations 35
Health insurers/health plans 34
Ethnic/minority agencies 32
Faith-based organizations 30
Veteran’s Administration 30
YMCA’s and Recreation Centers 28
Groups working with people with disabilities 28
Mental/behavioral health care providers/clinics 27
Area Health Education Centers (AHECs) 27
Senior housing 25
University/academic institutions 24
Centers for Independent Living (CILs) 23
Advocacy/support groups 21
Worksite programs/employee benefits programs 21
Native American tribal organizations 20
Assisted Living Facilities/Continuing Care Retirement Communities 18
Cooperative Extension 18
Foundations 17
Department of Corrections 17
Retiree groups/groups for adults 55+ 15
Substance Abuse Prevention/Treatment facilities 12
Quality Improvement Organizations 11
Corporations/for-profit groups 10
Senior Community Service Employment Program (SCSEP) 9
Civic groups (e.g. Rotary Club, women’s group, Kiwanis, etc.) 9
Agencies that reach rural populations
had the highest count of partner roles
across the sites. Civic groups and SCSEP
had the lowest count. Referral source
was the highest recurring role across
potential partner organizations.
Are there other organizations in your state that hold a CDSME license who were not funded through your current AoA grant?
Eighteen states indicated other organizations held CDSME licenses in their states. Other organizations included senior centers, AAAs, councils on aging,
hospitals, universities, Veterans Affairs, YMCA, OASIS, Kaiser Permanente, Group Health Cooperative, Johns Hopkins Healthcare, Boston Public Health
Commission, and Commonwealth Care Alliance. These organizations collaborated with the grantees through sharing of data, membership in coalitions, co-
sponsoring workshops, sharing resources, assisting in marketing and referral efforts, and participating in training efforts.
Yes
82%
No 18%
Which of the following sources provide referrals to your evidence-based health program system?
Cross-referrals from other evidence-based programs were cited by twenty-one of the states as being a provider of referrals. The second highest source of
referrals was ADRCs and health care systems. Local public health agencies rounded out the top three referral sources. Other sources included employee and
retiree benefit programs, Older Americans Act programs, SCSEP, caregiver programs, coordinated care organizations, federally qualified health centers, and 2-
1-1.
0 5 10 15 20 25
Aging and Disability Resource Centers (ADRCs)
Cross-referrals from other evidence-based programs
Health care systems (including physicians, HMOs and…
Local public health agencies
Medicaid
Medicaid Dual Eligible Plans
Medicaid Managed Care
Medicaid Waiver
Other, please specify:
State Health Insurance Assistance Program (SHIP)
State Health Insurance Exchange
Tobacco cessation programs/quit lines
19
21
19
18
6
1
3
4
11
12
1
9
We have at least two major partners/ host organizations (outside of AAAs/ADRCs) that have embedded CDSME into their delivery
system and are offering the workshops in multiple implementation sites throughout the state.
States indicated a number of regional partnerships, as well as multiple partners that were in various stages of implementing and embedding CDSME programs.
To a large extent
54% To a moderate extent
23%
To a small extent 14%
To a very small
extent 9%
ELEMENT 4: CENTRALIZED AND COORDINATED PROCESSES
Centralized and coordinated logistical processes need to be in place for optimal efficiency, to decrease costs, and to ensure that potential participants hear about and enroll in the program as easily as possible and receive consistent service.
Do you track the number of T-trainers, master trainers and leaders
and their training and workshop activity?
Ninety-one percent of states track T-trainers, master trainers, and leaders and their training and workshop activity. This tracking is done mainly through workshop registration and survey packets, semi-annual reports, databases at the state level, annual partner surveys, and figures that are reported to Stanford University annually.
WHICH OF THE FOLLOWING ARE CURRENTLY IN PLACE IN YOUR STATE?
# OF STATES
A statewide brand name for your evidence-based initiatives. 13
A statewide brand name for your CDSME programs. 18
An ongoing public relations plan with multiple promotional strategies. 8
Standardized CDSME marketing materials. 18
A formal process for using former participants or other ambassadors to promote the program. 4
A statewide website for CDSME. 19
A statewide workshop calendar for CDSME. 16
A statewide toll-free number for CDSME. 14
A single or coordinated referral mechanism. 5
Online registration for CDSME. 7
A statewide mechanism for tracking wait time or a waitlist. 2
A consistent or coordinated intake, enrollment and registration process. 7
Ongoing activities to educate potential advocates and decision makers about CDSME in your state. 18
Agency bulletin boards for CDSME. 3
Mass mailings for CDSME. 5
Bulk or coordinated ordering of CDSME materials for the state. 12
Regular in-service or update training around CDSME. 20
A listserv or other information sharing tool for CDSME personnel and stakeholders. 17
Coordinated data reporting and entry procedures. 21
Yes
91%
No 9%
In addition to CDSME, do you cross-promote or use your CDSME distribution system to deliver any other evidence-based health promotion and disease prevention programs?
The majority of states cross-promoted A Matter of Balance (59%), with the Arthritis Foundation programs and EnhanceFitness not far behind. Other programs included Tai Ji Quan: Moving for Better Balance, Stepping On, National Diabetes Prevention Program, Healthy Eating, Powerful Tools for Caregivers, Savvy Caregiver, Home Meds, and Project Healthy Bones.
EVIDENCE-BASED HEALTH PROMOTION AND DISEASE PREVENTION PROGRAMS # OF STATES
A Matter of Balance 13
Active Living Every Day 2
Fit and Strong! 1
EnhanceWellness 1
EnhanceFitness 7
Program to Encourage Active Rewarding Lives (PEARLS) 1
Healthy IDEAS 3
Arthritis Foundation Walk with Ease Program 11
Arthritis Foundation Exercise Program 13
Arthritis Foundation Tai Chi Program 8
Other: 16
We have a coordinated, state-wide process for program marketing, referral, and recruitment, including a plan for using multiple, ongoing, promotional activities.
The percentage of states indicating to a large extent that they have a coordinated, statewide process for program marketing, referral, and recruitment, including a plan for using multiple, ongoing promotion activities increased by 9% from last year (18% vs. 9%).
To a large extent 18%
To a moderate
extent
41%
To a small extent 32%
To a very small extent
4%
Not at all 5%
ELEMENT 5: BUSINESS PLANNING AND FINANCIAL SUSTAINABILITY
To maintain their evidence-based programs, states must have a business infrastructure including an accounting/ financial system to document program
expenses and have a demonstrated capacity to fund programs after the grant period.
Partnerships with health care organizations to provide CDSME, sustainability plans, and an established per participant cost were the most popular options among states. Only New Jersey had a requirement that community partners complete a business plan for sustaining CDSME. Georgia and Kentucky were the only states that did not indicate having any of the business planning and financial sustainability elements in place yet.
WHICH OF THE FOLLOWING ARE CURRENTLY IN PLACE IN YOUR STATE? # OF STATES
A business plan for sustaining CDSME. 6
A sustainability plan for sustaining CDSME. 10
A requirement that community partners complete a business plan for sustaining CDSME. 1
A requirement that community partners complete a sustainability plan for sustaining CDSME. 4
A statewide distribution system. 5
Calculated and accurate operating costs for CDSME. 6
An established per participant cost for CDSME. 10
An established rate for programs using costs and local market information. 2
An established annual operating budget for CDSME. 6
Break-even analysis (calculation of how many workshops and participants you need to break even with income and expenses).
0
Cash flow management system established (includes accounts receivable and payable systems to track and manage revenue and payment of expenses).
5
Regularly monitored operational performance through monthly financial statements and accounts receivable reports.
7
Partnerships with health care organizations to provide CDSME. 18
Use of a consumer survey or needs assessment in business planning. 2
None of the above. 2
Are any of your sites currently charging a fee for participation in a CDSME program? Participation fees are being charged in ten of the states and range from $5-$120.
States with established per participant costs for CDSME:
Arizona ($375)
Colorado ($300)
Connecticut ($200)
Massachusetts ($100/completer)
Michigan ($100)
New Jersey ($150- $200)
New York ($325)
Oregon ($455 per participant, $692 per completer, $5,971 per workshop)
Virginia ($368)
Washington ($50.00/person/session)
States with an established annual operating
budget for CDSME:
Alabama ($280,000)
Arizona ($441,000)
Missouri ($800,000)
Oklahoma ($348,000)
Rhode Island ($579,00)
Washington (cost not cited)
No
55%
Yes 45%
OTHER SOURCES OF FUNDING BEING USED TO SUPPORT THE EVIDENCE-BASED PROGRAM SYSTEM
Older Americans Act, Title IIID. 22
Other, please specify:* 12
Foundation support or other non-ACL grants. 11
CDC – Arthritis. 10
CDC – Diabetes. 7
Older Americans Act – Other.** 6
Fee for service. 5
Health plan. 5
CDC – Coordinated Chronic Disease. 4
Accountable Care Organization. 3
Care Transitions 3
CDC – Heart Disease. 3
Medicare - DSMT. 3
National Association of Chronic Disease Directors (NACDD). 3
Affordable Care Act Initiatives. 2
CDC – Communities Putting Prevention to Work. 2
CDC- Other. 2
Medicaid Waiver. 2
CDC – Injury Prevention. 1
Medicaid Managed Care. 1
CMS Innovation Funds. 0
Medicaid Dual Eligible Plan. 0
Medicaid State Plan (Long-term Services and Supports). 0
Medicare. 0
*Other funders included state formula grant, Money Follows the Person, Office of Minority and Multicultural Health grant, National Association
of County and City Health Officials grant, Prevention and Wellness Trust Fund, and hospital system grant.
**Other Older Americans Act funding was through Titles IIIB, IIIC (and IIIC-1), and IIIE.
In which ways has your state been able to collaborate with Medicaid for evidence-based programs?
States partnering on Affordable Care Act Initiatives related to evidence-based programs were 1) working on the development of Health Homes and Duals Integration Projects and 2) working to ensure Coordinated Care Organizations are familiar with evidence-based program.
We arepartnering on
Affordable CareAct Initiatives
related toevidence-based
programs.
We havereimbursement
for programparticipation
through aMedicaid
waiver plan.
We havereimbursement
for programparticipationthrough the
state Medicaidplan.
We are workingon
reimbursementbut have notyet received
reimbursementfor program
participation.
We have a goodworking
knowledgeabout how ourstate Medicaidsystem works.
None of theabove.
Other, pleasespecify:
4 3
0
8
14
1
9
We have an effective business plan and processes in place to fund CDSMP after the grant period.
Forty-six percent of states indicated to a small extent or less that they have an effective business plan and processes in place to fund CDSME after the grant
period. There was a 14% increase in the states indicating that this is true to a moderate extent when compared with last year (50% vs. 36%).
To a large extent 4%
To a moderate
extent
50%
To a small extent 23%
To a very small extent 18%
Not at all 5%
ELEMENT 6: QUALITY ASSURANCE AND FIDELITY TO INTERVENTIONS
To ensure effective, quality programs and efficient delivery and distribution systems, states should develop quality assurance (QA) plans and have ongoing data
systems and procedures in place that address: 1) Continuous Quality Improvement (CQI) and 2) Program Fidelity. CQI is a cyclical process that includes setting
performance objectives, monitoring, evaluating what is or is not working and problem-solving, and making corrective changes as needed. Program Fidelity is
one aspect of quality assurance that focuses on monitoring the extent to which an evidence-based program is delivered consistently by all personnel across
sites, according to program developers’ intent and design.
How would you describe your state’s current approach to fidelity?
Our stateprogram has
implemented itsfidelity
monitoring plan.
Our stateprogram has a
fidelitymonitoring plan,which we have
not yetimplemented.
Fidelitymonitoring
activities aretaking place in
some sites,without state-
widecoordination or
leadership.
We have begun developing a state-wide
fidelity monitoring plan,
but we don’t currently have
one.
We do not have afidelity
monitoring plan,state-wide nor
site-specific.
17
2 2 2
0
WHICH OF THE FOLLOWING ARE PART OF YOUR STATE’S FIDELITY SYSTEM AND PROCESSES? # OF STATES
Fidelity standards are disseminated throughout the state. 20
New leaders are paired with experienced leaders to increase program fidelity. 20
Workshop data is tracked to monitor potential fidelity issues. 20
Fidelity checks are conducted for new leaders during their first workshop. 19
The Stanford Implementation/Fidelity Manual is used throughout the state. 18
Leaders sign an MOU agreeing to follow fidelity manual/fidelity protocols. 17
A system of regional mentors is in place to facilitate fidelity monitoring, coaching, and technical assistance. 14
New leaders are required to conduct a workshop within 4-6 months of training. 14
On-site technical assistance visits are conducted with leaders. 14
Leader evaluation forms are used to monitor fidelity. 12
Enhanced leader training on fidelity process and tools is provided. 11
Leaders are observed once per year. 11
Fidelity monitoring tools are posted on the statewide CDSME website. 9
Standard fidelity check list forms have been developed for each week and are used for all fidelity checks. 9
An online database is used to monitor quality, reach and effectiveness. 8
Monthly, quarterly, or semi-annual reports on fidelity monitoring process and outcomes are collected. 8
Training webinars are held for fidelity monitors. 8
A fidelity group meets regularly to address fidelity issues. 7
Annual master trainer reviews are held. 5
Quarterly observation is conducted from a Master Trainer or trained fidelity monitor. 3
Fidelity reporting is collected by an outside contractor. 2
WHICH OF THE FOLLOWING ARE PART OF YOUR STATE’S QUALITY ASSURANCE/QUALITY IMPROVEMENT SYSTEM AND PROCESSES?
# OF STATES
SPECIFICATION OF DESIGNATED ROLES, RESPONSIBILITIES AND TIMELINES FOR FIDELITY MONITORING AND OTHER QUALITY ASSURANCE ACTIVITIES. 14
ORIENTATION OF THE TEAM (PROGRAM COORDINATORS, HOST SITES AND PARTNERS) ABOUT THE QUALITY ASSURANCE PLAN AND SYSTEM. 13
A SYSTEM FOR FEEDBACK TO INVOLVED PERSONNEL AND STAKEHOLDERS. 12
A WRITTEN QUALITY ASSURANCE PLAN THAT ADDRESSES BOTH CQI AND FIDELITY MONITORING. 12
ONGOING PROCESSES FOR LEADERSHIP TO REVIEW FIDELITY MONITORING AND PERFORMANCE INDICATORS. 12
A SYSTEM FOR USING METRICS AND DATA TO CONTINUOUSLY IMPROVE QUALITY AND SYSTEM PERFORMANCE. 11
A SYSTEM FOR MAKING CORRECTIVE CHANGES AS NEEDED WITH THE AIM OF IMPROVING OVERALL PERFORMANCE AND ENHANCING PARTICIPANT SATISFACTION. 10
IDENTIFICATION OF PERFORMANCE INDICATORS DEVELOPED WITH INPUT FROM KEY PARTNERS AND OTHER STAKEHOLDERS. 8
NONE OF THE ABOVE. 1
We have a quality assurance plan and ongoing mechanisms in place to monitor fidelity and to ensure continuous quality improvement.
Sixteen states indicated they either agreed to a large extent (five states) or to a moderate extent (eleven states) with the statement “We have a quality assurance plan and ongoing mechanisms in place to monitor fidelity and to ensure continuous quality improvement.” Five states (California, Connecticut, New Mexico, Oregon, and Utah) agreed with this statement to a small extent. No states indicated to a very small extent or not at all.
To a large extent 23%
To a moderate extent
50%
To a small extent 27%
Are you conducting evaluation work or planning to do so?
Eighteen states are conducting evaluation work (or planning to do so). Evaluation efforts include a focus on continuous quality improvement, patient activation, patient outcomes, and impact of Session Zero.
Yes
82%
No 18%