Ohio

Consumer Quality Review Teams

Pulling It All Together

Vision
CQRT data is used to promote continuous
quality improvement of mental health services for all Ohio citizens with mental illness and
behavioral disorders.

Mission
CQRT is a statewide consumer-run initiative that
independently collects, analyzes and disseminates objective information about behavioral health care services and quality of life¹ issues that promote recovery and resiliency.

Quality of life refers to non-clinical or personal support network, which may be augmented, but not dominated, by formal mental health services. These may include, but are not limited to, housing, employment, education, diversion programs, and cultural differences.

Values

Respect        We treat all people with respect and dignity. We are respectful of individual, community and we support individual choice and encourage the strengths of adults, children, youth and communities.

Integrity        We are honest and ethical in all our dealings. We keep our promises, confidences and are accountable for our actions.

Dedication        We are committed to helping every Ohioan with mental health needs.

Quality        We strive to promote the highest quality of services to the people of Ohio. We evaluate the acceptability, accessibility, availability, appropriateness, and adequacy of services provided by the mental health system.

Teamwork        We promote innovative thinking and active partnerships that reach across system and organizational boundaries.

Promoting Recovery & Resiliency
Recovery in Action

     CQRT promotes recovery in many ways. Most of its employees are consumers or significant others for whom recovery is a reality. Employees relate, “Getting this job gave me back my self-esteem,” and that the job “…helped me to stabilize my depression.” Other employees feel that they are “part of a team” and can “interact with fellow workers to achieve common goals.” Another employee says that, “Employment, for the most part, has been my recovery” while another relates, “I am doing what I love and have been on the job for six years.”

CQRT data, as well as the ODMH Employment Initiative, show the importance of meaningful work in the recovery process. CQRT is ‘Recovery in Action’.

Connecting
Strategic Themes

     1. ODMH: Increase access to care while decreasing disparities in access for diverse populations.
CQRT: Data collected by CQRT can assist administrators in planning, financing and the triage of services based on feedback from consumers themselves. Providing those services that consumers identify as most important to recovery and eliminating or reducing those identified as not helpful will increase access for all. Allocation of increasingly scarce resources based on consumer choice is a necessity, not an option.

2. ODMH: Improve Clinical Quality and System Performance.
CQRT: CQRT provides up to date feedback on what ‘customers’ say about the service they receive. The development of ‘real-time’ web-based CQRT data offers accessible and timely information with which decision makers can make sound and knowledgeable decisions for CQI. CQRT’s Performance Action Teams (PATeams) focus on utilization of data and promote systems improvements at both local and statewide levels.

3. ODMH: Enable every child to succeed by emphasizing school success, especially better outcomes for children with serious emotional disorders.
CQRT: CQRT empowers children by providing them with an opportunity to talk about their illness and what matters to them in their care, their school and their families. CQRT offers children a ‘place at the table’ when decisions are made about their services and promotes a sense of control in situations where they often feel they have no control. Such empowerment leads to improved outcomes and better chances for recovery.

4. ODMH: Reduce disability, and disability costs due to mental illness, while increasing employment and economic independence of people recovering from serious mental illness.
CQRT: CQRT is the single largest employer of consumers in Ohio. CQRT consumer employees enjoy the satisfaction of being paid for work that is meaningful and requires a high degree of professionalism. Our employees enjoy the rights and responsibilities of all hard-working Ohioans, supporting themselves and their families, being able to afford cars or live independently for the first time, even groan about paying taxes – in other words, a chance to be just like everybody else. Important too is the fact that CQRT employees provide role models to those they interview and offer hope that recovery is a reality, thereby encouraging others to take those first steps toward employment and ultimately, a way out of the dependency that poverty imposes.

5. ODMH: Reduce criminalization of persons with mental illness while promoting public safety via improved forensic services and monitoring.
CQRT: CQRT has conducted evaluations of Ohio jail diversion programs to provide the important perspective of those within the criminal justice system who know what has been effective or ineffective in the past and to reduce recidivism through more effective use of resources and treatment for offenders with mental illnesses.

Future  Opportunities

Real-Time Data

Unlike other alternatives in the data collection and analysis marketplace, the CQRT Statewide Aggregate Data Toolset allows instantaneous, live viewing and analysis of collected data. Data can be queried and graphed the instant it is entered into the database. This real-time access is achieved by having data entry staff enter data into a mySQL database, which serves as the backbone to the web-based data analysis project.

By July 1, 2003, ODMH, participating boards, and providers will be able to access FY 04 CQRT aggregate data via the internet. Participating boards will be able to utilize CQRT data for systems improvement and ODMH stakeholders will be able to utilize aggregate data for other ODMH initiatives.

ODMH Data Needs

     CQR Teams will be working with ODMH stakeholders to determine the data needs of ODMH not currently reflected in CQRT data. ODMH specific data will be available ’live’ via the CQRT Website in Fiscal Year 2004.

Using CQRT and CQI Data 
For Systems Improvement

The CQR Teams are creating Performance Action Teams (PATeams) for each board participating in the CQRT initiative. In collaboration with the participating boards, PATeams consist of up to 8 members from each board area and include: consumers, providers (both administrative and clinical), significant others, board members and a CQRT facilitator.

Utilizing the board area’s CQRT Key Findings, each PATeam will develop a CQI Action Plan for systems improvement customized to its specific board area. Once the action plan is implemented, the CQR Teams will conduct interviews with consumers, significant others and providers to gather data to determine continuous quality improvement (CQI) changes made by the PATeams. In addition, NAMI Ohio will develop regional and statewide aggregate CQI key findings reports for systems improvement.

Statewide CQRT Web Page

     In collaboration with CQRT, NAMI Ohio will develop and maintain a CQRT web page, containing up-to-date information about the CQRT initiative, findings and resources.

How Far We
Have Come

· 1994: Members of Ohio Community Support Program Advisory Committee (now the Ohio Community Support Planning Council) visit the Philadelphia and Georgia Consumer Satisfaction Teams (CST) to observe a new concept of hiring consumers and family members to survey recipients about their satisfaction with public mental health services
· 1995: Ohio Community Support Planning Council recommends to ODMH that CSTs be established in Ohio 
Rationale: ▫ Research indicated a strong link between CSTs and outcomes
▫ Ohio’s mental health system was moving toward a ’recovery’ model
▫ Quality assurance model was replacing ‘regulatory’ model 
· 1996 - 2000: ODMH, in collaboration with NAMI Ohio and Ohio Advocates for Mental Health, establishes Consumer Quality Review Teams in 22 counties 
· 2000: ODMH releases grant funds to ADAMHS/CMH Boards served by CQRTs for systems improvement/enhancement projects based on CQRT findings. With this funding, Boards purchased computers for agency waiting rooms and consumer clubhouses and funding to develop ADAMHS Board websites 
· 2001: ODMH releases a Request for Proposal (RFP) for grant funds for CQRT expansion. The number of counties served by CQRT increases from 22 to 43
· 2001: CQRTs began using Mobile Office Units (MOUs) to reach more consumers in rural areas
· CQRTs employ over 50 persons, the vast majority of whom are consumers, making it the single largest employer of mental health consumers in the state of Ohio
· Key Findings based on collected data are presented to stakeholders, including ODMH, NAMI, OAMH, ADAMHS/CMH Boards, provider agencies, family members, and consumers
· Key findings for consumers and family members are presented in user-friendly booklet form
· July, 2003: CQRT statewide aggregate data will be readily accessible to stakeholders through a password protected website and presented interactively in ‘real-time’. The aggregate database allows boards and provider agencies to view current data, to compare data within a given timeframe, and to see if changes implemented over time are having the desired effect on the system. This built-in mechanism for measuring outcomes is an important tool for continuously improving Ohio’s mental health system
· CQRTs have been collecting other types of mental health data, recently expanding into statewide housing data collection for ODMH
· 2002/2003: Performance Action Teams (PATeams) are established to determine which key 
findings have practical applications to benefit Board areas where the data were collected.

Where We are Going:
Performance Action Teams

To address quality improvement issues associated with the CQRT data and to make a positive difference in the public mental health system, QRS, Inc. developed and initiated the Performance Action Team (PATeam) Model for systems improvement. As a result, now both CQR Teams have adopted this PATeam Model for systems improvement.

The PATeam model is an innovative approach that uses a Performance Action Team to develop individualized Continuous Quality Improvement (CQI) Action Plans for systems improvement for each participating board area. Boards who participate in the PATeam model are asked to commit to the process and the product as part of their agreement to use CQRT data for systems improvement.

PATeam membership is developed in partnership with participating boards. Each participating site selects eight (8) individuals to comprise the PAT Team representing consumers, board members, administrative and clinical providers, significant others, and a CQRT facilitator.

Persons eligible for PATeam membership must fall into one of the following categories:
· A consumer currently receiving mental health services in the local Board area
· A family member who has a consumer currently receiving mental health services in the local Board area
· A clinical staff person, therapist or case manager in a Board provider agency in the local Board area
· An ADAMHS or CMH Board member or administrative staff in the local Board area

Eligible applicants must commit to attending regularly scheduled meetings to formulate a CQI Action Plan to implement positive change in the local mental health system. Once the local PATeam is formed, it uses the participating board’s CQRT data and key findings to identify what changes, enhancements, or additions should be implemented to address issues presented by that area’s CQRT data. The local PATeam develops a customized CQI Action Plan for implementation of the systems improvement activities identified in the data review. The CQI Action Plan should reflect both the consumer perspective evidenced by the CQRT findings, as well as the board’s input regarding the feasibility of implementing the recommended CQI Action Plan. The participating Board is then asked to adopt and implement the customized CQI Action Plan in part or to the extent possible.

Following the implementation of the CQI Action Plan, the CQR Teams will conduct a second round of interviews with consumers, significant others and providers with specific emphasis on the quality improvement activities. The collected data is then analyzed to evaluate the impact of the CQI changes made in response to the PATeams’ recommended CQI Action Plans. NAMI Ohio will then develop a regional and statewide aggregate Continuous Quality Improvement Key Findings Report for systems improvement.

Participating organizations, such as local clubhouses, drop-in centers, and local NAMI organizations, are able to receive a stipend for consumer and family participation in each PATeam area.

Consumer Quality Review Teams (CQRT) Initiative and Quilt of a Different Color document is funded through a grant from the Ohio Department of Mental Health, Michael F. Hogan, PH.D., Director.