magnolia place project

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Vision: All 35,000 children in the Magnolia catchment area will break all records of success in their education, health, and the quality of nurturing care and economic stability they receive from their families and community. Magnolia Community Initiative

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The Magnolia Place Initiative is a collaboration of faith-based and community groups within a 500-block portion of Los Angeles that crosses Pico Union, West Adams and the North Figueroa Corridor, west of downtown. This project used smartphones to help a group of Magnolia Place residents record images and information from their neighborhoods in ways that may contribute to meaningful change while building community capacity for research. We developed a "Holiday Campaign" around Halloween, which involved taking snapshots and mapping the observations, and created a rating scale for measuring holiday spirit. We also wrote a Spanish-language guide for the project.

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Page 1: Magnolia Place Project

Vision: All 35,000 children in the Magnolia catchment area will break all records of success in their education, health, and the quality of nurturing care and economic stability they receive from their families and community.

Magnolia Community Initiative

Page 2: Magnolia Place Project

About the Magnolia Community Initiative

• Voluntary network of 70 organizations

• Involves government and regional organizations – including Los Angeles County Chief Executive Office – to influence infrastructure that affects many residents, and to facilitate spread of what works beyond the catchment geography

• Emphasizes sustainable, scalable, evidence-based strategies: (1) increase access, use and quality of family-desired services, activities,

resources and support;

(2) strengthen social ties among residents; and

(3) improve economic opportunities and development.

• Connects diverse programs and providers (including physicians, child care and preschools, and mental health) to shared accountability and a common change process

Page 3: Magnolia Place Project

Achieving Population Outcomes

1. Work as a system to achieve population outcomes

2. Use design ideas that increase synergy/alignment of all sectors,

at all levels (policy, practice, families)

3. Increase expectations of, and accountability for, impact for a

population

4. Combine expertise on “what to try” with expertise on “how to

change”

5. Use tests and prototypes to implement

promising ideas that customize to work

consistently, across settings, and under all

conditions

6. Use networks to produce and accelerate

innovation, learning and spread

Page 4: Magnolia Place Project

MagnoliaCommunityDashboardJune2012

ParentExperiencesinMagnoliaPartner

Settings,andintheCommunityOverall

Current&PotentialReachtoChildren

%ParentsofChildren0-5WithProtectiveFactors %ParentsAchievingFamilyGoals

DevelopmentalProgressofChildrenEnteringKindergarten

27%

WhoAreProficientin

%of3rdGradeChildren

Reading

0% 100%

Health 7 31 9 35 24 15 15 22 19 31 9 5

Child care 20 - - - 33 39 40 40 - 40 - -

Family support 51 50 57 68 70 44 60 59 33 25 48 38

Linkage orgs - - - - - - - - - - - -

Community 127 - 106 - - - 96 - 97 - - 86

J A S O N D J F M A M J J

2011 2012

Number of questionnaires per month

0%

20%

40%

60%

80%

100%

JulAugSeptOctNovDecJanFebMarAprMayJun Jul

2011 2012

%ParentsReadingWithTheirChildDaily

Jul AugSeptOctNovDec Jan FebMarAprMayJun Jul

2011 2012

%ParentsRepor ngTiestoNeighbors

0%

20%

40%

60%

80%

100%

JulAugSeptOctNovDecJanFebMarAprMayJun Jul

2011 2012

%ParentsRepor ngPosi veRela onshipwithChild

Jul AugSeptOctNovDecJan FebMarAprMayJun Jul

2011 2012

%ParentsAskedAboutChildDevelopmentConcerns

Jul AugSeptOctNovDec Jan FebMarAprMayJun Jul

2011 2012

%ParentsAskedAboutFamilyStressors

0%

20%

40%

60%

80%

100%

JulAugSeptOctNovDecJanFebMarAprMayJun Jul

2011 2012

%ParentsDiscussingResourcesforFamilies

Jul AugSeptOctNovDec Jan FebMarAprMayJun Jul

2011 2012

%ParentsReceivingEmpathicCare

Jul AugSeptOctNovDecJan FebMarAprMayJun Jul

2011 2012

%ParentsHelpedwithFamilyIncome/Finances

0%

20%

40%

60%

80%

100%

JulAugSeptOctNovDecJanFebMarAprMayJun Jul

2011 2012

%ParentsDiscussingResourcesforSocialSupport

Jul AugSeptOctNovDec Jan FebMarAprMayJun Jul

2011 2012

%ParentsAskedAboutDepression

% receiving care in this system

% reached by network child care

% reached by network doctor

18%13% 13% 15% 13%

20%

9%

23%32% 29%

18%23%

Communica on Physical Language&cogni ve

Socialcompetence

Emo onalmaturity

Hasatleast2areasofvulnerability

HasIEP

Vulnerable Veryready

SocialConnec ons(%with2of2)

ConcreteSupports(%with

6of6)

Resilience(%with5of5)

0%

20%

40%

60%

80%

100%

At l

east

1 n

eigh

bor

with

who

m y

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onal

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blem

Can

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edic

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eded

Fle

xibl

e w

hen

life

does

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o as

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anne

d

0%

20%

40%

60%

80%

100%

SocialCondi ons

ParentHealth

EconomicStability

Paren ng

!"#$%&'

(&))&%

$

!"#$%&'"($)%#*+%

(,-'.+$/%0*%&'"1%

EDSI . EARLY

DEVELOPMENTAL

SCREENING

AND INTERVENTION

INITIATIVE

Early Developmental Screening

and Intervention InitiativeEDSI.

!"#$%&'$#()($$)

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In doctor offices

In child care

In the community overall

In family support programs

Goal

In linkage organizations

Developmental progress, by kindergarten

Protective factors for families

Family and community conditions

Reading proficiency, third grade

Potential and actual reach to children in the community

Parent activities and behaviors

Measures of real-time improvement in services and supports

Measuring Progress for the Population

Page 5: Magnolia Place Project

Network Reach to Residents

Magnolia Community Survey, October 2011 (790 residents; all ages)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0

50

100

150

200

250

300

350W

IC

St T

ho

mas

CB

SC

Ho

ove

r R

ec

Tob

erm

an

Mag

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lia E

l

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rman

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Red

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ield

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t St

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pe

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za

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irs

Pat

hw

ays

Pan

Am

eric

an

An

gelic

a

Pu

blic

Co

un

sel

Wel

com

e B

aby

CFR

C

SAJE

17

36

cen

ter

89% of survey respondents had contact with at least one partner in the past year

75% had contact with at least one of 5 most common network partners

Cu

mu

lati

ve %

Co

un

ts o

f re

sid

ents

in c

on

tact

wit

h p

artn

er

Page 6: Magnolia Place Project

Health Care Providers Seen by Children Ages 0-5 in Past 12 Months

PRELIMINARY DATA. Parents surveyed in WIC centers within Magnolia catchment, 2010-12. N=682 (of parent surveys completed on 632 children); cumulative percentages include some duplicate counts

Counts of children seeing the provider

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0

50

100

150

200

250

300

Eisner

StJohns

ClinicaSanJudas

ClinicaMacArthurPark

ClinicaSanMiguel

PicoClinica

KaiserPermanente

TeresaMedical

MsrOscarRomero

CaliforniaFamilyCare

SanMiguel

Children'sHospital

WomenandChildren'sW

ellness

CentroMedicaArthurPark

Queenscare

Altamed

ClinicadelaM

ujer

Dr.Ghalili

HoracioLopez

TeresaMedical

CenturyW

omen'sClinic

CasadeSalud

ClinicadeLosAngeles

Others

About 19% of children saw a health care provider in the network

Page 7: Magnolia Place Project

Known

Ideas

New

Ideas Little is known or published

Best science History of success Evidence based

Peter Margolis, EDSI Pacoima Collaborative Design Meeting, 3 November 2009

How to Generate Ideas That Will Achieve System Level Results

Test Prototype

Pilot Reliability (consistency)

Scale and spread

Page 8: Magnolia Place Project

A Recipe for Population Impact

Change Concepts

Evidence-Based Programs and Content

Model for Improvement

Network for Continual Learning

Select

Topic

Expert

Group

Change

Concepts

Participants

LS 1 LS 2 LS 3

P

S

A D

P

S

A D

Prework GLOBAL CQN AIM

We will build a sustainable quality

improvement infrastructure within our practice

to achieve measurable improvements in

asthma outcomes

Specific Aim

From fall 2009 to fall 2010, we will achieve

measurable improvements in asthma

outcomes by implementing the NHLBI

guidelines and making CQN’s key practice

changes

Measures/Goals

Outcome Measures:

>90% of patients well controlled

Process Measures

>90% of patients have “optimal” asthma care (all

of the following)

assessment of asthma control using a

validated instrument

stepwise approach to identify treatment

options and adjust therapy

written asthma action plan

patients >6 mos. Of age with flu shot

(or flu shot recommendation)

>90% of practice’s asthma patients have at least

an annual assessment using a structured encounter

form

Engaging Your QI Team and

Your Practice*The QI team and practice is active and

engaged in improving practice processes

and patient outcomes

Using a Registry to Manage

Your Asthma Population *Identify each asthma patient at every visit

*Identify needed services for each patient

*Recall patients for follow-up

Using a Planned Care

Approach to Ensure Reliable

Asthma Care in the Office * CQN Encounter Form

* Care team is aware of patient needs and

work together to ensure all needed

services are completed

Developing an Approach to

Employing Protocols * Standardize Care Processes

* Practice wide asthma guidelines

implemented

Providing Self management

Support * Realized patient and care team

relationship

Key Drivers

Interventions

Form a 3-5 person interdisciplinary QI Team

Formally communicate to entire practice the importance and goal of this

project

Meet regularly to work on improvement

All physicians and team members complete QI Basics on EQIPP

Collect and enter baseline data

Generate performance data monthly

Communicate with the state chapter and leaders within the organization

Turn in all necessary data and forms

Attend all necessary meetings and phone conferences

Select and install a registry tool

Determine staff workflow to support registry use

Populate registry with patient data

Routinely maintain registry data

Use registry to manage patient care & support population management

Select template tool from registry or create a flow sheet

Determine workflow to support use of encounter form at time of visit

Use encounter form with all asthma patients

Ensure registry updated each time encounter form used

Monitor use of encounter form

Select & customize evidence-based protocols for your office

Determine staff workflow to support protocol, including standing orders

Use protocols with all patients

Monitor use of protocols

Obtain patient education materials

Determine staff workflow to support SMS

Provide training to staff in SMS

Assess and set patient goals and degree of control collaboratively

Document & Monitor patient progress toward goals

Link with community resources

CQN Asthma Project Practice Key Driver Diagram Version 2.0

Peter Margolis, CCHMC; Ed Wagner, MD, MPH: MacColl Institute; Associates in Process Improvement; Institute for Healthcare Improvement

Whatarewetryingtoaccomplish?

Howwillweknowthatachangeisanimprovement?

Whatchangecanwemakethatwillresultinimprovement?

Act Plan

Study Do

Page 9: Magnolia Place Project

PDSA Example – Texting for Daily Reading

Can we increase the frequency of daily book-sharing by introducing texting, to prompt reading and to enable parents to share their successes with each other, in real time?

Drivers

Current outcomes:

Parent practice:

System practice:

% Reading daily

% Discussing importance of reading

Support parents to manage their child’s needs & promote development

% of third grade children proficient in reading: 27% % of children entering kindergarten with communication vulnerability: 18%

0%

20%

40%

60%

80%

100%

JulAugSeptOctNovDecJanFebMarAprMayJun Jul

2011 2012

0%

20%

40%

60%

80%

100%

JulAugSeptOctNovDecJanFebMarAprMayJunJul

2011 2012

Page 10: Magnolia Place Project

Collaboration with the CTSI – Year 2

Aim 1: Test the impact of several key functions of partnered infrastructure for translational research, to increase the volume and breadth of partnered research activities and funding, and to accelerate the timing of population impact

• Using MCI Research and Evaluation group to identify common priority topics, and link researchers and network partners

• CERP staff support of data visualization for community residents

• Biostatistics consulting to facilitate impact evaluation

Page 11: Magnolia Place Project

Collaboration with the CTSI – Year 2

Aim 2: Identify effective, scalable applications of mobile health technology that improve population health

•Feasibility pilot with Center for Embedded Networked Sensing (CENS) to identify effective uses of smartphones for helping residents describe their neighborhoods and daily lives in ways that contribute to meaningful action for neighborhood change

– Offer residents access to Ohmage, which is an open-source, mobile to web platform that records, analyzes, and visualizes data from prompted experience samples entered by residents

– “Holiday survey” to develop positive neighborhood asset measures

– Storytelling narratives about “a day in the life”

Page 12: Magnolia Place Project

HolidayMicro-CommunityParticipationSurveyChecklist TeamLeader________________________________Date:_12/________/2011 Start-Time:_____:_____ End-Time:_____:_____ TeamMembers:_____________________________

Howtonumberunitsifnumbernotlistedorvisible Page___of______

AddressesSINGLEORMULTIPLE

UNIT

IFMULTIPLE,HOWMANY

UNITS?

UNITNUMBER

HOLIDAYDÉCORRATING

WRITETYPEOFDECORATION&LOCATION

PHOTOTAKEN?

PHOTO#

Example:123414thStreet

Example2:123414thStreet

M

M

4

4

A

B

4

1

STRINGOFLIGHTAROUNDROOFLINE

WREATH

YES

YES

1

2

1. SORM

2.

3.

4.

5.

Key:Decorations-0=None,1=oneholidayitem,2=twoitems,3=3items,4=fourormoreitems

Neighborhood Observation