Innovations in Design and Utilization of Measurement Systems to Promote Children's Cognitive, Affective, and Behavioral Health Workshop Summary (2015) / Chapter Skim
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4 Using Quality Measures to Facilitate System Change
4 Using Quality Measures to Facilitate System Change
Pages 37-50
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From page 37... ...
. More recently, the Race to the Top Early Learning Challenge encouraged states to integrate quality-monitoring systems across funding streams, and the Improving Head Start for School Readiness Act of 2007 required lower-quality Head Start grantees to recompete for funding (though none were actually required to do so until 2011)
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From page 38... ...
For example, the Race to the Top Early Learning Challenge required states to use "valid and reliable" indicators of the overall quality of the early learning environment and of the quality of adult–child interactions.2 Such use of the terms reliable and valid suggest that these are static properties of a measure for all time, all purposes, and all populations, Gordon observed, but noting "This isn't consistent with our contemporary thinking about measurement." Instead, the developers and users of measures need to consider the intents of each research and policy use and weigh the body of reliability and validity evidence against each use, she said, which is consistent with the latest Standards for Educational and Psychological Testing (AERA/APA/NCME, 2014)
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From page 39... ...
The ECERS-R emerged in the 1970s from a checklist to help child care practitioners improve the quality of their settings. It reflects developmentally appropriate practices, including a predominance of child-initiated activities selected from a wide array of options and a "whole child" approach that integrates physical, emotional, social, and cognitive components.
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From page 40... ...
Its short-term goals are improved program delivery, better matching of youth to services, system improvements, and reinvestment of cost savings to the front end of youth services in the community rather than in confinement. Its long-term goals are decreased recidivism rates and improved outcomes for youth, improved cost effectiveness of juvenile justice services, and a reduction in public cost and reinvestment in community services.
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From page 41... ...
. Developed by Mark Lipsey at Vanderbilt University's Peabody Research Institute based on a meta-analysis of more than 600 intervention studies, SPEP assesses how well current program practice matches the profile of programs with research evidence for effectiveness.
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From page 42... ...
"We think it is one of the next best things in terms of helping us meet our mission, which is to have the juvenile justice system be rare, fair, and beneficial." Evidence All Youth 12-Month Recidivism by Matrix Adherence Level 53.5% 34.0% 18.9% 21.3% Below Optimum Appropriate Above Guidelines Placement Placement Guidelines FIGURE 4-2 All youth 12-month recidivism by matrix adherence level. Optimum placement in the least restrictive environment reduces recidivism.
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From page 43... ...
CAN CHILD MENTAL HEALTH CROSS THE QUALITY CHASM? As with the educational system and juvenile justice system, the health care system is in the process of building an infrastructure of structural measures with associated process and outcome measures.
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Pincus called attention to several key features of these quality measurement systems. First, measures can improve performance by teaching people how to improve.
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From page 45... ...
Developing indicators in turn involves a series of steps: • Establishing an evidence base • Translating evidence to guidelines • Translating guidelines to measure concepts • Operationalizing concepts to measure specifications (which includes determining a numerator and denominator) • Testing for reliability, validity, feasibility • Aligning measures across multiple programs • Stewardship, including updating measures over time
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From page 46... ...
and credible (valid) results about the quality of care when implemented • Usability -- Extent to which potential audiences are using or could use performance results for both accountability and performance improvement to achieve the goal of high-quality, efficient health care for individuals or populations • Feasibility -- Extent to which the required data are readily available or could be captured without undue burden and can be imple mented for performance evaluation Finally, Pincus noted that indicators can be used to improve quality at the clinical level, the organizational level, and the policy level.
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From page 47... ...
QUALITY MEASURES AND IMPROVEMENT IN HEALTH CARE As part of its accreditation process for health plans, NCQA looks at performance-based measures of health care quality. For example, a measure it has been using in recent years is the percentage of children who receive appropriate follow-up care when they are prescribed medications for attention deficit hyperactivity disorder (ADHD)
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From page 48... ...
The logic model for quality measurement starts with structure, said Scholle, including training and ongoing supervision in evidence-based therapy, an infrastructure for collection of patient-reported data, and systems for sharing information across care teams (Lewandowski et al., 2013)
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From page 49... ...
It is helping to create joint accountability through models like shared savings programs, health homes, patient-centered medical homes, and incentives for states and health plans, so improving mental health and substance use outcomes becomes a community responsibility. However, existing quality measures for mental health and substance use show only limited improvement, and measures assessing psychosocial inter ventions are lacking.
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From page 50... ...
Children's behavioral health, healthcare reform, and the "quality measurement industrial complex." Presented at Institute of Medicine and National Research Council Workshop on Innovations in Design and Utilization of Measurement Systems to Promote Children's Cognitive, Affec tive, and Behavioral Health, Washington, DC.
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