Accountability and Continuous Quality Improvement

Accountability and Continuous Quality Improvement

Accountability, or the degree to which the MHC and the program are implementing the specified number and type of ECMHC services, is a necessary component of quality improvement. However, a broad quality improvement strategy is needed to better determine if consultation services are meeting the needs of children, families, and staff, and if not, identify areas in need of strengthening. Most importantly, quality improvement strategies should take the approach that all individuals, practices, and services can benefit from ongoing review, feedback, and improvement efforts. Data collected as part of a quality improvement effort needs to be regularly reviewed, reflected upon, and used to inform practice.

Effective consultation programs need to have a clear plan for quality improvement that includes:

  • the kinds of information to be collected,
  • who is responsible for collecting it, and
  • how the information will be shared and used for ongoing improvement.

After developing the initial strategic plan for your program’s mental health approach, developing and monitoring a quality improvement plan is a key function for your program’s Mental Health Workgroup. The figure below shows a general model for sharing and using that feedback for improving practice.

Figure: A Feedback Loop Model for Continuous Quality Improvement

Strategies for Building Feedback Loops

Strategies for building feedback loops include administrative structures such as gathering contract-based service information, regular supervision, the role of the Mental Health Workgroup, feedback from those who utilize or receive consultation services, and a process of review, reflection, analysis, and discussion that leads to ideas and strategies to strengthen and improve services. You will need to determine the specific types of information that will be collected, how often and with whom it will be shared, and how the information will be used to drive practice that makes the most sense for your program.

Sharing Information

One of the most important, but often overlooked, components of ongoing quality improvement efforts is establishing the appropriate mechanisms for sharing information between key individuals and groups, and ensuring that there are feedback loops in place for incorporating the information collected into ongoing program practices. There are a number of different ways that feedback loops might be established in your Head Start program.

As a program administrator, it is important for you to think about how to best put into place clear ways for information about the amounts, types, and outcomes of consultation to be shared and discussed with appropriate groups of people within the program, and to provide a forum for discussing how to continually improve the effectiveness of consultation. Remember, the figure above shows a general model for sharing feedback and using that feedback for improving practice. You will need to determine the specific types of information that will be collected, how often and with whom it will be shared, and how the information will be used to drive practice that makes the most sense for your program.

  • Consultant Supervision: As described above, regular administrative supervision meetings between the designated Head Start staff and the mental health consultant provide one avenue for sharing information about what consultants are doing, how the program can support their work, and what outcomes are being achieved through the program’s mental health services and approach [see more information on supervision of the mental health consultant]. Supervision also provides opportunities to address concerns that are inter-personal nature (e.g., A teacher reporting that the consultant was rude to them) or the characteristics of the consultant him/herself.
  • Consultant Annual Review: Another mechanism for formal feedback is the annual review, which we recommend for both employed (staff) consultants as well as contracted consultants, as a formal opportunity to assess the quality and effectiveness of consultation. Monitoring that the consultant is doing what s/he is expected to do is a key role for the administrative supervisor, and generally not an appropriate role for teaching staff, parents, or others. However, these others, especially in the role of the Mental Health Work Group can play an important role in shaping and guiding the consultants’ work to ensure that the consultation best meets the needs of children, families, and staff.
  • Mental Health Workgroup Meetings: If you have established a Mental Health Workgroup that is overseeing your program’s mental-health specific strategic plan, this group provides a logical forum for discussing the type of information that is needed to determine whether the program is achieving short and long term goals related to improving mental health consultation, services, and supports. This group could be responsible either for regularly reviewing information collected by the HS program and consultant, for periodically soliciting feedback from teachers or parents about their experiences with the MHC—(link to tool,) and for discussing this information with consultants and other program staff to determine if there are areas in need of strengthening.

    The Mental Health Workgroup discussions of quality improvement should focus on the effectiveness of the consultation activities, program approach, and success of services. It is also important to remember that consultation is an interactive process and that staff and families play an important role in the effectiveness of consultation services. The Mental Health Workgroup should make sure to understand how the context and other stakeholders involved in the consultation services influence effectiveness as well, and include recommendations about the entire consultative process (not just the consultant) in any recommended practice changes.

  • Written Reports: In addition to the Mental Health Workgroup, it is important to share information about what the consultants are doing and related outcomes with other stakeholders, such as the program’s leadership team, staff meetings, parent meetings and policy council on a regular basis. A brief written report may suffice, although ideally such a report would be presented by the consultant or consultants to allow face-to- face discussion of the results.

Addressing Concerns or Challenges

Ideally, if you have processes in place for regular one-on-one meetings between the consultant and a Head Start supervisor, as well as regular reporting to other formal groups such as the Mental Health Workgroup, the leadership team, policy council, board and other staff meetings, you will be able to identify any concerns or challenges in your program’s mental health approach and services quite early, before serious performance or other problems emerge.

One of the benefits of establishing these feedback loops and having clear communication that focuses both on activities and outcomes is that concerns and areas for improvement are identified early and more easily addressed. Continuous quality improvement is based on the premise that all practices can be improved, and takes the approach that all staff benefit from continuous feedback that leads to positive growth and improved practice. Your role as an administrator is to make sure that this feedback is regular, early, constructive and growth-oriented – and is not focused on finding fault or assigning blame.

However, it is possible that through the process of engaging in program-wide needs assessment and strategic planning focused on your consultative model, you will need to make fundamental changes in how consultation services are being delivered, or who is delivering them within your program. Having the “right” consultant – one who is a good fit for your program’s needs and who understands your consultative model and approach to mental health is essential. Ultimately, it is the responsibility of the administrator to determine when continuous quality improvement efforts have not led to the desired changes, and more fundamental programmatic changes are required.

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This product was developed [in part] under grant number 1H79SM082070-01 from the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS). The views, policies and opinions expressed are those of the authors and do not necessarily reflect those of SAMHSA or HHS.