Explore Innovative Invoice Ideas for Quality Assurance

Invoice ideas for Quality Assurance

foreign thank you all right I see we go ahead and get started um hopefully a few more folks will join but in the interest of time I say we go right ahead so welcome everyone to session six of our Medicaid Academy quality assurance and quality improvement next slide so as usual the views opinions and content expressed here and do not necessarily reflect the official position of the Department of Behavioral Health and Recovery or the Health Care Authority next slide your team today will be me you all know me and Terry Lee of Terry again which is very exciting next slide yep sorry we can skip over this slide we can skip over this slide sorry hold on we'll get all right all right so as I mentioned today is quality assurance and quality improvement and then this coming Thursday will be our second opportunity for Q a if anything is unclear on this session or any of the previous sessions if you want help or guidance on how to use some of the suggested tools any you know any questions or technical assistance you're hoping for you can join this coming Thursday and we will be here to help next slide great and Terry thank you all right everyone it's good to be here again with you all I hope your documentation session and billing session went well uh I do usually do the documentation session so throughout this if anyone has any questions about that I know it gets a little tricky sometimes once you've had some time to think about it you can ask some questions hopefully hopefully at the end we have some time so we're going to talk a little bit uh just a little bit about the dimensions of quality of CSH we're going to talk about quality improvement and understanding quality standards we're also going to talk about outcomes and measurements and collecting data I did the uh part of this session was internal monitoring and audit which as you remember we did a couple of weeks ago so I already covered that I will be referencing it just a just for a little bit but I won't be going over the auditing and the in the internal monitoring so again if you have any questions about any of that feel free to just put them in the chat Eva will be monitoring the chat as I'm uh doing the slides so a question for all of you and you can put it in the chat what's the first thing that comes to mind when you hear audit or Fidelity review accountability compliance it out documentation oh crap what have we missed that's pretty much what I uh what I think stress is what I think too that they are two different things okay both have to do with accountability and monitoring but they are very different in terms of what what people are looking for one of the things I said when I was talking about internal monitoring is that it's always best what to find your own mistakes so you don't want an outside person coming in finding the oh crap what have I missed you want yourselves to come in and find that so no one likes uh internal monitoring no one likes that compliance piece that we do and we go into programs and do that but again way better for us to find our mistakes and fix them than for someone else too anything else anyone thinks of when uh when you hear audit or Fidelity review okay so uh these are the two different approaches it sometimes sounds like the quality assurance piece is uh the you know the Bad and the quality improvement is the good but I you know I would say you need both to in order to have a really good quality improvement program or quality improvement plan it's important to have both the quality assurance piece is more of the uh compliance standards accountability it's more of that structure uh it's it may be focused on what the funder wants so all of the data that you are focused on would be about uh what what is it the funder wants what is it that we have to report on so it's very driven when it's externally driven it's very driven by what does the funder want or what is the Fidelity reviewer want what does the state want and and so and that's what you focus on and and with the quality assurance piece that is really all you focus on it doesn't necessarily have to be sanctioned or finding blame or punishing but a lot of times that's what happens because when you do when you do monitoring you are looking for things that are wrong so sometimes it might seem like it's it's um punishing and finding blame but really what you want to do is you want to correct you want to have and we talked about this at the at the two sessions ago when we talked about internal monitoring you want to make sure that you have that process down in your policies and procedures on how you're going to fix those problems that you find in your monitoring who does what where it goes uh who signs off on it how do you know that that the issues are fixed and uh and then you also want to look at what is a trend so do 60 of our client charts not have the right intake form or not show client choice or is it just one or two anomalies that was just a mistake so you don't want to make this big corrective action because everyone makes mistakes you want to have a big corrective action based on just a couple of mistakes but if it's a trend you need to look at it and you need to come up with processes around how to fix this how did it get this way and how did it fix how do we fix it so I would say the quality assurance piece does might might feel like it looks at blame finding blame but really what you want to do is you want to find the corrections the quality improvement so I would say quality assurance is part of quality improvement quality improvement is the bigger picture based on what will get move us forward what will get us to Quality on go on our ongoing journey to be the best that we can be to be the best quality program we can be in terms of Staff tenants buildings in terms of all of that so it's the bigger picture of how to we how do we continue to move forward in a positive way taking the quality assurance pieces so you have to take that accountability and compliance it's part of it but also taking uh what what what is their data showing us what how do we analyze what's happening with our programs and our staff so it's not just about compliance the funders and what the funder wants in terms of reporting but it's it's a bigger picture in terms of how do we build our program to to be a higher quality so analyzing looking at gaps looking at strength looking at weaknesses in developing a plan toward that and it is on an ongoing Journey we're we're never quite there with quality improvement we always want to be looking at something that we can do better or that we can improve upon or a gap in our services we're going to talk a little bit about that in a little bit so part of the quality improvement in quality uh outcomes is committing to evidence-based practices we didn't really do any Services here but I know the state does a lot of training on services so you want to make sure that you you and your staff so there's supervisors here and if there are directors and program managers you want to make sure your staff have this training housing first harm reduction which is the first part of housing first motivational interviewing person-centered planning is crucial with your benefit cultural humility and trauma-informed Care these are just suggestions if you have training on these doesn't mean that you don't have to have training on anything else uh there's also assertive and active engagement there's Crisis de-escalation crisis intervention safety planning there's a lot of training around working with our clients and also I I always say one training does not an expert make so we want to make sure that we have continued training you want to have a training plan and make sure that staff are learning and I think we did also talk about this in the last session I did so you want to make sure that staff are learning things and that you're helping them with their skills whether that means role playing or talking about it in a group or talking about how they're implementing these if we don't use our skills we'll we'll lose them and they'll get stale so part of training is that skill building team so samsa also have examples of uh psh in terms of quality Supportive Housing and this is when we do the Fidelity review which we will do in December that webinar we're going to pay more strict attention to this this is what the state will look for in terms of these principles of Supportive Housing so choice and we know the power of choice there's a lot of research Around The Power of Choice with our clients and our tenants separation of Housing and services so you want the property management on on one side having their role and responsibilities and services on the other that you as I say as we like to say we want to be driving in the same direction but we want to be in our lanes in our separate Lanes uh of course safe and affordable housing housing integration as much as we can making sure that our tenants are being integrated into the community we also know how important that is when when they feel part of the community that they live in their rights of tenancy it's important that they understand their rights and their responsibilities of the lease and as a leaseholder the quick access to housing and of course the flexible voluntary Services is really key and integral to housing first and that's also why the active engagement motivational interviewing and trauma-informed Care is so important that training because it helps us helps us with helping our clients be motivated to engage in Services because it is voluntary these are outcomes that we work with at CSH and the outcomes as you can see are in the middle we have a guide that I actually don't think we put in uh in that shared drive but it is in our website and if anyone's interested we can have you get access to it but these are the important outcomes and it's the house the length of stay uh when they leave do they leave to a independent housing or a positive outcome that they're satisfied with Services we're going to talk a little bit about that later increase their income and employment improve their health and they have important social and Community connections so we know that those are important outcomes when it comes to there when it comes to Supportive Housing and these outcomes are linked and connected to keeping people successfully housed and having people have a successful housing experience you don't want to measure outcomes if we don't believe and we don't feel it or know that they're connected to positive outcomes in successful being successful in housing so these outcomes have been shown to be successful with our clients and with housing so these you have with your benefit uh the the community FCS um you have pre-tenancy supports and then you have once people are housed so housing sustaining support these are the services that you can bill for and that are important to have as part of your services plan and have part of your service delivery option the functional needs assessment is where everything starts so you want to make sure that that is present and it's what the recommendations are to that remember the golden thread that I'm sure they talked about last week in terms of documentation you want to have that golden thread you want to make sure that the goals and recommendations from the assessment follow with the goals on the person-centered plan and the progress note so you want to be able that that thread should be seen throughout those documents that those documents you want to make sure that you are connecting people so the previous slide talked about the importance of those outcomes and Community integration and social connections is one of those that's very important and we know that people our tenants are much more successful and they feel part of the community and and just in our own lives we can see that so we want to make sure that we're assisting people with those social services and connecting them when we're helping them find housing we want to develop an individualized and Community integration plan so again based on the need from that needs assessment and part of the overall person-centered plan the person-centered plan is your individualized plan for that specific client not a cookie cutter plan but based on that person's functional assessment you want to have short and long-term goals and measuring measure measurable sorry measurable objectives to those goals that are that are reachable and that clients feel that they can actually reach and then the supports and interventions in terms of how you're going to get to those goals then you have tendency sustaining so once someone is actually housed these are the services also that you can provide it's again very important that you continue that golden thread so you're continuing those goals to measure those goals someone's goals may change from free tendency to tenancy they probably will it's okay to change those goals as long as they're still connected to what is it the client wants to achieve and what their needs are from that from that functional assessment so their goals will change from finding housing helping them access choice all of those to maintaining that housing so what do they need to do to maintain that housing what services do they need to be connected with and linked with what about in Social Security or employment or IDs or all of those things that we know that they need to be able to to to get and maintain housing also anything that is uh able to assist them with their daily living skills anything that will help them in the development of their living skills is services that you can provide during tenancy any services to help them with communicating with their landlord it's important a lot of times we know many times our clients will go from zero to sixty they won't say anything and then they may show a lot of anger and and not appropriate communication so role modeling for them how to communicate with landlords or how to communicate with the maintenance person how to communicate with social security so all of those things you're able to to build for all of those things are that are part of that tendency sustaining Services I may say this again but it's important that you know that cold calling landlords uh maybe advocating for your program educating landlords about the program in general are not considered Tennessee sustaining Services it needs to be connected to a specific tenant or a specific client so if it needs to be done landlord we do need to have that education and Outreach the landlords absolutely but it isn't something that is tenancy sustaining Services unless it is connected to a specific client so if anyone has any questions about that let me know and uh or any other comment all right I want to make sure I got everything yeah one of the things I also want to say is you know we are the connector the case manager to to our clients and we're not expected to provide all things or be all things that our clients that we're you know if the client needs AAA meetings if the client needs a specific life skills group if they need uh if they're all they're interested in uh attending counseling or attending group those are things that we should be connecting them with and so resources and having those resources available and accessible is really important so again part of our job is that collaboration with community uh and so it's important to have those resources available when our clients are interested even if client feels like they need inpatient treatment at some point we should have those resources available I know they're all part of Tennessee tendency sustaining so these are the outcomes that you want to track this would probably go more on the quality assurance piece but you it's important to gather data so you know ahead of time you know now these are the outcomes that you are to track so they want to track that number of days from intake to placement and housing how long did that take I mean understand with housing first that quick access to housing is really important we don't want to tell someone that they're going to get housing and then have them wait for three months so that quick access to housing is important so they want to measure that the state wants to measure that how long are they housed uh what's their tenure in the program have they been hospitalized so you can see these and you can create your spreadsheet now or create your process now for collecting that data yeah it is important and I we're going to show you the uh monthly report from uh forget the name of the company but we'll show you that monthly report and they want you to show these outcomes in that report so it's important that you set up your processes now and that you find a way to gather that data and you want to make sure that you check on that so once you set up your processes you want to make sure you're you're checking on and we're going to talk about this when we do the check back plan plan do check and act but you want to make sure that you set it up and that it's working so you don't want to set it up and then never look at it for six months or 12 months so you want to make sure it's working who's collecting the data uh is it what you thought it was and that's where the quality improvement piece comes in maybe we thought it took 10 days to house from someone from intake to placement but maybe in reality maybe it's a 30 day so you those are things that you want to look at so you're not just collecting data you're looking at the data we're going to talk a little bit more about the self-report in terms of tenant satisfaction their group was the name of the place I was thinking so this is I know it's a little hard to see this is the tool that was developed by Amerigroup for submission monthly it is due by the 10th of the month and I do believe you get reminders of this uh there's one for supported employment and there's one for supported Supportive Housing and you'll see the drop down boxes and you'll see what it is that they want you to report on even if you don't have any client currently they would still like you to submit this outcomes report and send it directly to Amerigroup they use this report for several things one of which is are you accepting external referrals and you'll see there's a there's a drop down box for that so even if you don't have current clients they would like you to complete this monthly if you are accepting external referrals they may send some your way if you're not that's important for them to know as well so it's important that you fill this out monthly and again it sends it goes directly to a merit group the tenant satisfaction uh we're going to talk a little bit later about feedback from Penance but kind of satisfaction is important uh and we want we we can measure that in many many different ways you versus first and foremost you can measure it by asking them so surveys and we do have some survey examples for you so self-report of their satisfaction in housing and you can't ask them to rate it on a one to five scale you can ask yes or no questions you can do a mixture of both you can ask specific focused questions about maybe activities or events or Community integration employment opportunities so you can be really specific about their satisfaction as well not just are you satisfied in the in the program the location and safety of housing are people feeling safe in their housing that's something else that you should be asking so satisfaction although self-report if you ask very focused questions uh you'll get a little bit more information about how the tenants are feeling and then the percent of tenants that are satisfied with Services maybe in in one year or more and participation in community activity so you may want to survey tenants maybe within the first three months especially with the satisfaction of their location and safety how they're feeling and maybe those who have been housed for one year and see what they're feeling questions are probably going to be different but these surveys are really important and you just don't want to hand out the surveys you want to also create process a policy and a process or what you're going to do with the data that you collect from the surveys we're going to talk a little bit about supported employment because this is part of the benefit we again the connection between employment and good health success and programming quality of life self-confidence self-efficacy has been found and the research is there so we understand and we know that employment is really part of a healthy outcome and success in in the program unemployment has been leaked linked to these uh core outcome so on the opposite side employment has been linked to healthier outcomes and unemployment has been linked to these unhealthier outcomes including not just uh Health in terms of physical health but also in terms of Behavioral Health we and we know that being employed really does increase someone's self-confidence and feeling of efficacy and their ability to to feel more confident and confident in that of course is always important so supported employment similar to housing first uh you are similar to Supportive Housing you have pre-employment services and employment services so similar to the pre-tenancy and the tenancy sustaining it's the same so you want to in this functional assessment so the golden thread that we talked about with the housing program you want that functional assessment those goals those needs you want to see that with the service plan and you want to see it in the documentation it's the same way with employment employment is a little less rigid so it's a little it's a little more flexible and more open to eligibility so a little easier to find someone eligible for the supported Employment Services so things that are job related if you're if you're helping with an assessment if you're helping with vocational training or a class or you're doing a inventory you're helping them with a resume so there's all kinds of ways that you can help someone in their job search similar to the landlord issue if you are a cold calling employers educating them about your program that would not be eligible to for these pre-employment Services it has to be a specific person or specific client helping them with their pre-employment services and then Employment sustaining so again similar to housing sustaining employment sustaining what does this person need to be able to maintain employment we know many times that our clients are pretty good at finding jobs there they need a little bit more help and support in maintaining jobs it's not something that they have a lot of experience in maintaining jobs so they need some support and guidance in how to do that so anything that you do around helping this person be sustained in their employment will will be billable or you you can bill for it and Implement those services you you know of course you you want to uh make sure that you have proper releases all the way around and releases of information and consent to make sure that people want are okay with you so in in your in a job it's a little bit different I would imagine not all of our clients want our case manager hanging around and like you know oh yeah here's there's my case manager but they may want access to you they may want to call you if they're in a bind or if they're upset and they need to calm down and they don't want to take it out on their co-workers or their boss so maybe not hanging around but also also making sure that they have access to you and the ability whatever it is that they may need to maintain that employment but I see Dawn says there's a study that shows people who are chronically unemployed die up to 25 years earlier than those of us who are typically employed mind-boggling very much health related thank you for for sharing that that is actually incredible wow you have the if you have that uh where that comes from let us know that's really incredible and then supported employment goes follows along the eight principles of of ips it is Fidelity so if you want to bill for that and follow along the IPS supported employment principles uh these are what they are and the important thing is that it's very again it's very similar to housing first you don't have to go through vocational training or classes you help someone get employment competitive employment as quickly as possible so you want to connect them with employment as quickly as possible and wrap services around them so if the employment we're not waiting for someone to be compliant with their medication or any of that if someone's interested in employment and they can work then we help find them work quickly and wrap services around them so it should sound very similar to to Supportive Housing you know it's non-linear again so we don't wait for someone to be employment ready like or like we don't wait for someone to be housing ready but we we work with them uh as you see there's zero exclusion that someone is willing and able to work and agreeing to work then that's what we do the other piece of supported employment is that they are connected to what's interesting to them many times the employment programs I've worked at many times is we found employers who are open to employing our clients when that's hard to do it's hard to find and then we match our clients up with those open positions they may have had absolutely no interest in doing that if a warehouse was accepting applications from our clients we had clients fill out those applications and work there whether they were interested in it or not so supported employment goes the opposite way they ask the clients what they're interested in and then you find employers that are have that training or or skill or work that they're interested in and then match so it's a little bit of the opposite and I and I know just like housing is difficult sometimes to find employers who are willing to take a chance and employ our clients but the client preferences is what comes first what is interesting to them what have they what have they done in the past that they may want to do in the future or the opposite what have they done in the past that they want to avoid and if they have very little experience just talking about what their skills are and interests are will help them to get a better idea of maybe where they do want to work so those those uh preferences are really really important and then benefit planning I want to say it's a lot of times that's the reason our clients don't want to work is because they think they're going to lose their benefits so you need to make sure that you're up to date on how much they can work depending on what kind of Social Security they have or other benefits that they have and make sure that you are educated on that you're giving proper and accurate information about if they were what will happen many times you can work and collect benefits uh I'm not I don't know I'm not an expert in that especially in your state but you definitely want to make sure that you are aware of that and that you give that accurate information to your clients that they are also aware of it also similar to housing first the support is non-time limited many times our clients won't want us you know around hanging around their jobs as I said before forever but if the access is important when if they're having a bad day if they don't want to as they say go off on someone and they want to be able to talk and de-escalate themselves that access is really important for them and and that is also time Unlimited one other thing about the job search the rapid job search uh just like housing when we ex when we thought people needed to be housing ready we thought they needed to uh be abstinent from drugs or being a drug and alcohol program we thought the same with employment we thought they should go through an eight-week vocational training class or a classroom eight-week classroom class and that that wasn't necessarily being successful our clients weren't sitting through those they got bored they got antsy and wanted to start working there are some I believe there are some programs that will pay to have you go through the vocational training and it's very short so that could be a possibility for success but the rapid job search is to get someone that job experience and that employment experience not necessarily have to go through the vocational training or the class great so similar to the housing outcomes these are the employment outcomes the supported employment outcomes you can take a minute to read these over they're very similar employment related you want to make sure you know what these outcomes are what the state is looking for and set up your processes and your data collection and once again that's the quality assurance the quality assurance piece is these are the requirements we need to set up something and collect this data the quality improvement piece of that is what are we going to do with that data how are we going to analyze it is it what we thought and if it isn't what we thought then is that good or bad and what changes do we need to make or if it's better than we thought what what do we need to keep doing that's the data analysis that's really important infidelity to supported employment is National and it's important that you are following that fidelity okay a word about Equity we should probably spend a lot more time on it but we want it to at least have a few slides on equity and the importance of equity in quality improvement so CSH has what we call the racial disparities and disproportionality index and it shows what the so what what it does do is shows what the general population is and what the target what the population is in all of these specific categories so for example chronic homeless you'll see black is 6.64 percent and white is 0.45 so in in general to the general population it is much higher uh the black and the American Indian group than it is with the white the Asian and native Hawaiian are probably underreported but this is important to do in your area so that you are aware of the disproportionalities in your system versus your general population it's really important to educate yourself and have that data available and use that data to help you help streamline your your programs and see where your gaps are in your program this is a scenario I'm going to read it and then you all can take a minute to think about it and whoever wants to respond in the chat please do if you have ideas uh in a recent quality certification site visit it was discovered that the experience of younger African-American men in one of the Supportive Housing projects was different than tenants in the building the other tenants of the building in a tenant focus group when asked about program rules so we were I was actually part of this certification site visit and so we did focus group of random tenants when asked about program rules and which rules led to eviction it was discovered that only the younger African-American men had been written up for specific rules like as you can see no flippers or tank tops in the common areas it was it was a lot about dress other tenants weren't aware of these rules or said that they saw the signs that regularly wore these items also without being approached by staff so the African-American men in the focus group had received verbal or written warnings related to this rule if we would have talked to staff they would have not even been aware of this so we're not saying these staff were bad people or that they were doing this on purpose we don't think they were but our unconscious bias and how we treat our Penance is really part of our quality improvement and should be part of our quality improvement and our outcome goals how we how we treat tenants in general and specifically our tenants of color uh and make and making sure that staff are treating everyone with equity so what in thinking about this and thinking about your policies and procedures and your quality improvement the values at your agency thinking about the Medicaid benefits uh what would you do to make amends to the residents or how would you look at your policies and procedures and make sure that this didn't happen again uh and what training or supervision do you feel like your staff would need you can certainly answer any or all of those questions but in terms of what would you do and how would you look at this if this occurred in a tenant Focus Group in your agency or your program what would you do great Carolyn thank you take all cultures and backgrounds into consideration what else maybe some cultural humility and cultural uh training for your staff and supervisors could be something that you would consider and and you know again I always say that you don't want outside people to come in and find the mistakes and find issues so here we are an outside person coming in and doing a tenant focus group and this comes out so in thinking about that even how do you think you would be able to do that monitoring yourself without an external entity or the state coming in and finding it equal enforcement of rules it could be a question that you ask the tenants in your surveys in terms of any any interest any discrimination that they feel they've gotten any treatment that's different that might be something that you want to ask right up front and uh and write up reflecting whether the rules themselves are problematic problematic thank you Eva yeah okay if people think of other things that they would do just put them in the chat I know these are tough questions Michael says that our my previous TSH job we reviewed all housing notice data by demographics to reveal blind spots and enforcement thank you for sharing that Michael because I think it's important that's sometimes what the data shows us so if you're not looking at your data by gender or race or culture then you may be missing things so having that data by demographics is really important thank and thank you so thanks Michael for that if you're not collecting it then you're not seeing it everyone should take a cultural basis class yes absolutely thank you so anything else go ahead and share and then another question for you to consider um and I think some of you have already spoken to that but in looking at quality improvement and your quality improvement plan and policies hot what have you done so any of you have already put training in place or collected data as Michael mentioned that has helped address the disparities please share so other people can see what you've done and maybe learn from you and if you haven't how do you think you can use your quality improvement program to address this and again I'll give you a minute to consider okay well anyone wants to share just go ahead and do it as we move forward hopefully it is something you're thinking about maybe just don't want to share but any anyone who has really great ideas it's nice to share with the group so they can learn thanks Eva set clear goals and stratify your data by demographics absolutely absolutely the the just a quick aside the program I run it's a Statewide program for individuals leaving State Prison and for many years we didn't collect information by by gender or race or offense even and so we started doing that and found out uh it wasn't certainly something we were doing but we did discover that more people of color were what they call violated so most of them more of them had a parole violation and went were reincarcerated for that or just had a parole violation then their white counterparts so we found out information from that so again if you're not collecting that data it's important to collect it so you can look at it and analyze it okay so commitment to qualities obviously ongoing uh hold on let me look at the chat here it would be beneficial to have so you can see where the needs are need to be made within the program absolutely and your hints stand the history of the land where you are consider land acknowledgments and engaged tribes in your work up front not at the tail end absolutely thank you for sharing that both Sherry and Jolie very important all of those things are important to consider and look at so these are the quality measures in in terms of Home and Community Based Services which is what the Medicaid waiver is based on the service plans have to be updated annually we talked about that person-centered plan uh it must address all those needs that start with that functional assessment there's that golden thread again you don't have to wait to update your service plan annually you can do it more often but it must be updated annually eligibility requirements are reviewed annually to make sure everything is still in place all the documentation is there that's needed they're still eligible providers must meet your required qualifications and training you uh it's important to follow that home and community-based Rule making sure that it's uh that things are the least restrictive and that clients are in the most integrated setting the state identifies and addresses and seeks to prevent incidents of abuse neglect and exploitation I think that the requirement of training requirements the mandated reporter training requirements DHS will be the ones responsible to review and Survey the performance measurements that these the CMS the federal government has given them and they'll create those systems for any program Improvement strategies so these are important quality measures again to look at to make sure that you are looking at them in terms of compliance and in terms of the ongoing quality improvement piece locally Elevate Heather's comment or question actually have any organizations created discussion problem-solving groups for program participants to give input into not only the problems but how best to resolve that's something we're considering in our organization and assessing how effective it could be interested in whether others have had success great thank you Heather and Eva so let's uh give people a chance to respond to that I know uh when we in the community where I live which is Columbus Ohio Franklin County we have had some input and involvement in New single site Supportive Housing buildings and we have led tennis focus groups in other single site buildings and used their input what would you have what would you like to have added to this building that you're missing or what's really good about this building that you would want to make sure that gets uh inputted in in this new building up coming up so that one was we used their input for the future buildings that were being built uh and we also have an Advisory Group in the Pro the Statewide program I run and we just discussed different processes in terms of things like intake or paperwork or peers and what would help them be more successful what have other people have done incorporate program participants another thing I will say is it is important to have when when you do have some tenant run groups or discussion groups it is important to focus on the positive and things that they would like to see and make sure that they understand where their input is going to be uh input and implemented and the importance of their input you don't want it to just be a bright session but you want it to be something that is productive and beneficial for everyone so if people want to respond to Heather please do response great okay okay so some just some questions uh sorry Sherry just responded we employ former clients as well as people with lived experience of homelessness and Recovery thank you Sherry for sharing that that is important so some just some questions to consider and to ask in terms of your Audits and we're going to go through this again in the Fidelity review webinar in December and in a little bit as well so you know who's going to do what when's it going to happen how are you going to prepare when do you start preparing uh are there any other standards Beyond those that we lit that we listed in terms of the outcomes that you want to measure for yourself for your program or are there other funders that require things that weren't listed on the previous slide so getting yourself organized and in terms of it could be a committee that you want to have around your policies and what needs to be revised or a committee around your quality improvement program or a committee around eligibility and collecting data that would help clients be eligible and you know so it's important to get yourself organized around all of these different things that you need to do in order to get the the benefit and get the most out of this benefit for you for you in terms of funding and for the clients as well we want this to be win-win all the way around okay we are having Nikki because we are having a hard time finding someone taking on new clients okay that's a certainly a staffing and training issue I would think so quickly just to review again we're going to review this in more detail in December but just the steps to the Fidelity review process you'll get your notification you need to start preparing right away uh you will review all the activities that's going to happen the state is upfront and very clear about everything they're going to look at and what they're going to do and then you will have that follow-up in terms of any recommendations that they have uh but this is the what you need to do to establish that and again we're going to talk what's much more about that in detail in December oh so during the review uh they will give you the letter of notification and you'll have the prep call again the agency would need to start preparing right away and everything that you need to do it does does need to be a agency-wide process and involvement it cannot be just a few people working on this it needs to be either your program or your agency whoever it is that's billing for this new benefit uh and you need to have everyone involved everyone educated everyone on board including your tenants staff and tenants will be interviewed and they'll do the record review as well yeah and and they're they're very clear with you on how they're doing all of that and what they're doing then they score you and then they have the final report and recommendation right now they are still incentivizing agencies for the review I want to point out it's quite a quite a good sum of money and ran if you're on I can't write down how much it was but it was quite a bit so they're still incentivizing agencies to participate they do have quite a few agencies and sites that are interested in being a reviewer but they still need sites to review for for people to volunteer to be reviewed and be audited uh and again this they're continuing to incentivize agencies who are interested in that um and Iran if you want to put it in the chat or here you go there you go 7 500 if it's a baseline or reviewer and 5 000 the follow-up Don Miller says so it's not I mean it's uh I believe did Don send that directly to you Terry if you did okay Don if you wouldn't mind putting that in the chat to everyone that would be great and ran says email her and she ran has her has her email right there and really anytime you're interested in I mentioned all those outcomes and I mentioned all the training that you need and the best practices bran is a wealth of information and she's very helpful I I think in terms she's been a provider she knows what it's like in terms of state employees and people that I have met and I've worked with she is super helpful and I I think he'll she'll she'll really be able to assist you in any way she can She's All That okay all right so quality improvement and compliance let me get up okay so it is important to have to talk about why quality improvement is important it you know of of course it is important because it will help you stay compliant and it's required in order for you to make sure that if you are reviewed that you are in compliant with all of those requirements and outcomes but there's many other reasons why you should embark on a quality improvement program it really really does improve the quality of all your programs and your staff training your you you look at when you when you do a quality improvement when you embark on a quality improvement plan you look at all aspects of your program and that's why it really helps the quality so you're looking at the service interventions with tenants you're looking at tenant satisfaction you're looking at the data you're looking at gaps in data so what aren't we collecting what would give us more information uh you are looking at all your grants and your funding and you're making sure that the funding is organized in such a way so I know I've been a provider too I know we Cobble together many different funding sources and grants and if you've got four grants you probably have four different requirements and four different outcome measures you need to measure in four different reports that you have to do so having that in one place organized will really help you stay compliant so again there's that compliance piece that's really an important part of quality improvement it will improve your outcomes why because you'll be looking at things you'll be looking at your data you'll be looking at your the gaps in the analysis of what you're collecting and making sure you're collecting the right the right things you'll it improves your policies and procedures because again you'll be looking at them from a compliance standpoint and from do we have a policy to address this and are we following it I think I mentioned when I did the policy and procedures session that I've worked with agencies whose fact didn't even know where the policy and procedure manual was how to access it they didn't know they had guidelines around client documentation or interventions or the Medicaid rules that were necessary to have so you don't definitely don't want that to be the answer when asked for your staff so you want to be looking at your policies and procedures making sure that you have the right one and making sure you have the procedures that are clear that follow the policies and making sure your staff understand them they know where to access them and they're following them and that takes follow-up it takes asking it takes observing make sure that those protocols and those procedures are being followed the way that they're meant to be followed uh and of course it does keep you in compliant I have to say when I worked at Volunteers of America at the time in Ohio in order to build Medicaid you had to be you had to be accredited by a national body and they don't require that anymore but they require that then and we chose carp and so it was it was about a two-year long process because we we had nothing we didn't even have a quality improvement manager a fast person we didn't have they didn't even do anything with quality improvement so we were starting from the from the beginning uh and all we needed to do is continue to build but uh it was it was a long process but at the end we we really had a higher quality program for our clients we had higher trained and um fast knowledgeable expertise who were in The Right positions uh and we we just had a better all-around all of our paperwork was better and more organized our training training that uh programs were better so really we just had a more quality higher quality program all the way around so it's worth the investment sorry check the chat great okay so thank you uh Dawn is saying this support employment side of the reviewer team is looking for agencies interested in participating in a baseline Fidelity review I cover the east side of the Washington of Washington state and I'm also in need of fidelity reviewers please let me know if you are interested thank you great and thank you for the studies thank you though okay so we've already talked about these this is uh just a slide to show you here are some options for you have been thinking about your quality improvement program so we talked about the why and we talked about the importance of it we talked about quality assurance piece and then the quality improvement piece so it's really the documentation the chart reviews preparing for your Audits and then that continuous quality improvement so it's the piece about the standardization and the guidelines the compliance and then of course the more continuous bigger picture okay some important information oh thank you John found some studies around unemployment mortality thank you looks like you probably have to copy and paste that and after the Sherry's question so here's a quality improvement plan so these are and I think you also have a handout on this in in your uh the shared Drive these are this is actually actual documents so when we talk about quality improvement program I'm talking about the program big picture General this is the actual plan so just like your policies and procedures you need a quality improvement plan that will help guide your pro your quality improvement program so when you are writing this plan these are some of the sections that you can have you don't have to have them but these are just some sections for you to consider I never like to reinvent the wheel if I don't have to so we developed some of these for you to look at and they're not necessarily in order in these boxes but just some things to consider so you may want to start out with actually your program Services Program and services overview and for those so with Volunteers of America we had lots of programs but we only had the one program that we were going to get carf accredited and build Medicaid for but when we wrote Our quality improvement plan we decided to include all of the programs so we had programs of just a very short description what the goal of that program was maybe and where it was located because we were all over the state so not not a big thing but a short description of the programs and services in terms of especially of the goals and outcomes uh the outcome measurements and funder requirements so you want to make sure that part of your quality improvement plan uh what each funder is required was requiring you to measure or to collect in each of those your staff training plan we've talked about in terms of Staff responsibilities it's really and I know we don't want program description or position descriptions just in terms of what it is how it's related to your Qi plan so is our program directors responsible to make sure that the client chart reviews happen or is that the quality improvement person or a program director is responsible for making sure that the corrections are done when there's chart reviews so those the staff responsibilities are really in relation to the quality improvement plan and your the monitoring that you're doing your policy and procedure review is is more about here's the policies that need to be reviewed and the timeline so do you have your safety policy do you have your incident review policy do you have what policies do you need to be that need to be approved by the board and what's the timeline for that client satisfaction surveys when do you do them uh do you only do them annually would you like to do them more often do you want to do them in the first 90 days and then annually you want to do them when someone leaves uh so that outlines your plan for client satisfaction surveys and with Carr we had to review our plan every year so we we may have changed that from year to year in terms of the client satisfaction surveys the focus review would be more uh more focused on a specific topic so do you want to talk to your clients about the intake process do you want to talk to them about uh your activities on Friday night if you have a single site so you could do a focused review that's very specific and you can meet for three or four times talk about this very specific thing and then you can just stand again make sure that you are using that feedback in in making sure that clients know how you're using that feedback and you you need to be asking for their opinions about a very specific topic for a focus review and then the all of the client charts that we talked about in the last session in terms of all the reviews that you do whatever billing is different than the documentation piece for the billing piece you want to make sure that if you build this much for this client that you have that documentation to satisfy that to justify that in terms of the other just the Medicaid compliance documentation you want to make sure that you have all of those triggers or all of those things that are necessary in a progress note that is needed in that the quality of the progress note is there too so those are two very different focuses in terms of billing and clients and Medicaid compliance and you could also have targeted reviews we again I keep harping on intake but we had some issues around intake and Volunteers of America so we did a targeted review on how long did it take us to house someone did we do the proper intake uh information where was the eligibility information there so you could do it that's what a targeted review means you could do a targeted review on that specific thing if you could do a targeted review on staff training you might want to take the last few people that were hired and look at their the first six months of their hire did they have all the training they were supposed to do so those are the more focused reviews you can do so Staffing and supervision considerations is important you need to make sure that the qualifications of your staff are compliant with this new benefit so you want to make sure that you want to look at your staff always whenever you're reviewing anything I didn't I didn't say this earlier but you always want to get your Baseline where are we now what staff do we have in place now what their supervision now what their training plan now and where do we want to be in order to be compliant with the benefit or in order to be compliant with our quality improvement plan uh or you know in order to make sure that we are compliant with all the regulations where do we where do we need to be and and what is that going to take so you always want to make sure that you're taking stock of where are we now so looking at your Staffing pattern your teams what the supervision look like it's important that you make sure that you have of the individual and the group supervision planned out that you document all of that so that you you know you have proof or documentation that supervision is happening you want to look at caseload size I think Mark Martella probably shared with you our Services budgeting tool and the Staffing the caseload sizes that we recommend in terms of either single site or scattered site and specific Target populations Families versus transition age youth versus chronic homeless or homeless so depending on that your caseload size is really important you want it I'm a licensed social or independent social worker the nasw says a kind of a broad way but the caseload sizes should be based on what your case managers can do in terms of quality work with clients time for documentation time for supervision and making sure all of that happens in a quality way that's kind of the broad non-general description but it really gives you a good idea of what you should be looking for in terms of pace mode size Terry I just want to highlight Sherry's question can we bill for supervision no you cannot as far as I know Ryan may want to slip in you cannot bill for supervision you can uh I believe you can build collaterally if you are talking to a collateral person landlord employer about a specific client but General supervision no and then tenant input is here also for you uh to just to ask yourself some questions all right yes the answer that's correct so when you think about billing and non-billing you want to think about the general rule is is it about a specific client for a specific goal so uh you know if you're talking to a landlord about a specific client and the goal is to help them understand the lease or get it get uh their maybe their behavior is bothering neighbors or something like that uh and same with employment employers but just kind of General discussions General supervision General Outreach is not so here's some questions for you to ask yourself in terms of your tenant input we've talked a lot about it it's very important to this Medicaid benefit and important to the state that you incorporate the tenant voice that you show them how you incorporate the tenant voice uh you know you can start out small and then Build It Up you can pilot things you don't have to start out right away with you know a big a big program but you know have it be maybe in pieces that you can work up toward having a regular advocacy or leadership group but it's important that you get that feedback and that you be able to demonstrate how you use that feedback and then one of the things I didn't mention about training is that it's important it's really two kinds of training with our staff so we've talked about the clinical pieces orientation having that plan but also it's important that they have that what I call the Technical Training that they understand what that golden thread is that you have someone who can read person-centered plans read progress notes so they can you can give them give staff some recommendations and ideas on yes this works nope this this needs a little bit more or you know you said you spent an hour and 15 minutes with this client and the note says that you you know talk to them about their aunt visiting uh and so it you know it wasn't anything the time wasn't justifiable so having someone read that and help staff with that so that's the more Technical Training that they'll probably need with this all right lost my mouth sorry so we talked a lot about tenant excuse me tenant input and I just want to say this is really about tenant input but but before we get into that I just want to say that all stakeholder input is important we have stakeholders we have community stakeholders we have collaborating stakeholders so people that we refer to for counseling that we referred to for uh behavioral health treatment that we refer to for Psychiatry for nursing for Primary Care those relationships are really important and we want to make sure that we gather and incorporate their input as well you love people that you refer to and there's probably people that refer to you uh maybe in terms of the Continuum of Care or those kinds but you want to make sure that you get their feedback both ways you know how how is it when you refer someone to us and when we refer someone to you are they appropriate is it working out so that stakeholder important is that stakeholder information is important as well and then um there's the community so how are you doing with the community in terms especially if it's a single site in terms of community members always have a worse impression of what's going to happen before your building is built and after so you want to make sure you gather that input as well so getting all stakeholders input is support but this here is about clients in our credits so you want to here's just some ways that you can get information we've talked a lot about them already the client rights officer is important if you if your client has a grievance or needs to appeal something it's important that they know who to go to that that is accessible to them so again if someone comes in and asks one of your tenants who would you go to if you had a grievance or wanted to appeal a decision that was being made they should know the answer to that question you could we talked about focus groups already you could have a mailbox or suggestion box I'm not the biggest proponent of those because I think sometimes we forget about them and then that's really the worst thing so if you have a suggestion box or a mailbox you need to have a process around that in terms of who's going to check it how often it's going to get checked who's going to get back with the people who put things in the in the suggestion box you know what that CL again closing that Loop so you need to have those processes in place make sure that people aren't putting things in the suggestion box and then they just never get read Community meetings and open houses I've worked with agencies that have done some picnics once they've been established in a neighborhood again this is a single site once they've been established in a neighborhood to have to just open it up to communities it's a great way to build relationships it's a great way for Community to trust with people who are living in your building and a great way for the people in the building to trust the community so it's a really great Rapport in relationship building uh way to do things and then we've already talked about satisfaction surveys and remember that it doesn't have to be General satisfaction it can be very specific questions about satisfaction and as we said incorporating safety and services and groups and activities neighbors all those things you can ask about and asking about it again in different at different time periods maybe again in the first three months annually at Exit maybe someone will be more honest with you when they're exiting than they are if they're continuing to be there and making sure that you have that I don't know if we have a slide on that or not but making sure that yeah we do okay um so this is a just example and I believe Eva put this in the share drive you don't have to use this specific specific survey but it's just an example for you so what do you do so uh in terms of input we want the state and you want it documented what you have done with the input did you were you able to revise any policies or procedures or house rules you know did something sound like a really good idea to you as fast and then as you were implementing it it was really in real life a terrible idea and you know clients are really good at pointing that out and saying you know this this is really a barrier for us or it's very difficult for us to abide by this does it make any sense so can yo