• Change Package
• Ingham County Nurse Family Partnership
• Topic Area: Maternal Depression
• Name of the Intervention: If nurse HV’ers have a
larger list of mental health providers to refer clients
to; they will become more confident with referrals
and clients will be better served.
• Primary Driver: Standardize processes for referral,
treatment and follow-up.
Definition of the Intervention
Include: What is the intervention? Include a short
definition of the intervention.
The intervention the team worked on was developing a
more comprehensive list of mental health providers to
refer to, in the treatment of Maternal Depression. By
seeking out potential providers in the service area, and
learning about their programs staff would feel
confident when making referrals.
Can the team develop a more comprehensive list of
current providers, to help treat Maternal Depression.
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The team brain stormed and developed a list of mental health providers that
would possibly be good resources for nurses to use with clients .
This list of 21 providers was divided up by the 5 team members, to begin phone
contact and briefly assess for services available.
Team members were to ask a) Did they accept medicaid for payment b) what was
their current address c) were they accepting new patients.
The final list of 18 providers were sent an invitation to a ‘Lunch and Learn’, to be
held at the Health Department. This was to serve as a time for agencies to
introduce themselves and their services, and as a time for networking.
A total of 10 agencies attended. Wonderful information was shared, pamphlets
given, and future planning sessions were arranged amongst the agencies.
The team will now begin to develop a referral sheet, with all the agencies listed.
The plan is to laminate this as a single sheet for staff to carry in their bags and
have available during HV’s.
How is the intervention carried out?
• Model for improvements three fundamental questions;
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What are we trying to accomplish: Increase the nurse's knowledge about referral
sources that can be used in the treatment of Maternal Depression. Become
familiar with what resources are currently taking medicaid clients. Where are
these resources located and how will our families access them?
How will we know a change is an improvement? Nurse Home visitors will have >2
referral sources on their list of EBS, that can be used in treating Maternal
Depression. Nurses (and nurse supervisor), will meet the providers of mental
health services in the area, thus increasing their ability to engage clients in these
services.
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What changes can we make that will result in an improvement? The team will
develop a more comprehensive list of current providers, to help treat
Maternal Depression.
• The team ran 4 consecutive Plan-Do-Study-Act (PDSA) Cycles, each one
incorporated the learning from the previous cycles to make an
adjustment to the intervention
Cycle 1-Plan and Do
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Plan
Who
NFP home visitors and nursing supervisor.
When
June 11th and June 18th team meetings.
What
Development of a comprehensive list or available providers.
Where
During team meetings- at the agency. (Later to go into the home
environment)
• Tasks or tools required to set up
• Data will be collected during team meetings.
Supervisor will divide up the list of potential referral sources, so that
everyone on the list will get a call from someone on the team to :
a. verify if the provider is currently taking new clients
b. verify current address, phone#, and insurance information
Cycle one (cont)
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Plan for collection of data
Who
Nurse home visitors and supervisor
When
June11-18th, 2015
What
Collection of data
Where
In the office, or field whichever is conducive to phone calling.
Predictions
If a larger list of providers can be developed, nurses will feel more confident in
resources they can use with clients.
Do
Team Meeting 6/11/15- The team began to brain storm together for a more
comprehensive list of potential providers. A list of 21 potential providers were
identified. This list was divided up equally by the 5 team members. Objective; to
contact the providers on your list, verify demographic information (address,
phone #'s), and whether they are still taking new clients., as well as insurances
accepted.
Study
6/25/15- Team meeting, reviewed data that had been collected from
staff so far. Some agencys/resource assessments have not been
completed yet, due to not being able to connect with them or the
nurse not having time.
It was agreed the due date would be July 3rd, and that all
information would be listed in the agencies ‘S' drive for all to see. At
the next team meeting, (July 7th), the list would be finalized and a
target date for the 'Lunch and Learn' would be set.
Cycle two:
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What question(s) do we want to answer on this PDSA cycle?
Can the team develop a more comprehensive list of current providers, to help treat Maternal Depression.
7/6/15- 1) Will we be able to organize a successful 'Lunch and Learn', that is helpful for the NFP team to learn more about Maternal
Depression and the resources in the area. Note: this will most likely be opened up to other HV teams within the Health Dept. 2) Is the
Health Dept. an appropriate location for this activity.
Plan
Who
NFP home visitors and nursing supervisor.
When
July 15th team meeting
What
(7/6/15)- Begin planning of the 'Lunch and Learn', settling on the date, and assignment of tasks.
Where
During team meetings- at the agency.
Tasks or tools required to set up
Data will be collected during team meetings.
Supervisor and staff will decide on the date for the 'Lunch and Learn'.
Tasks for this event will be identified and assigned to appropriate staff .
Plan for collection of data
Who: Nurse home visitors and supervisor
When
July 15th-July 30th.
What
Begin planning for a resource and data gathering luncheon (Lunch and Learn).
Where
Team meeting for NFP staff (luncheon may or may not be held at the agency).
Predictions
If a larger list of providers can be developed, nurses will feel more confident in resources they can use with clients.
7/6/15-By gathering representatives together, from multiple agencies that serve clients with Maternal Depression, staff will feel more
confident in the referral process.
Cycle two- Do, Study, Act
• Do
• Team Meeting 6/11/15- The team began to brain storm together for a
more comprehensive list of potential providers. A list of 21 potential
providers were identified. This list was divided up equally by the 5 team
members. Objective; to contact the providers on your list, verify
demographic information (address, phone #'s), and whether they are still
taking new clients., as well as insurances accepted.
7/6/15- With an updated list of providers, and a face-to-face meeting of
these providers; there will be an increase in clients using these resources.
• Study
• 6/25/15- Team meeting, reviewed data that had been collected from staff
so far. Some agencys/resource assessments have not been completed yet,
due to not being able to connect with them or the nurse not having time.
It was agreed the due date would be July 3rd, and that all information
would be listed in the 's' drive for all to see. At the next team meeting,
(July 15th), the list would be finalized and a target date for the 'Lunch and
Learn' would be set.
7/6/15 It has been surprising to see how many available resources there
are for clients, and that sliding scale to no fee is often available.
• Act
• We have not been able to compile results yet.
Cycle 3
What question(s) do we want to answer on this PDSA cycle?
Can the team develop a more comprehensive list of current providers, to help treat Maternal Depression.
7/24/15-The " Lunch and Learn", date and time has been established- August 26th, 12-1pm. Will we have a
successful turnout? Will the information shared be helpful in gathering resources for future referrals to mental
health providers? Can this format be helpful in the future?
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Plan
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NFP home visitors, nursing supervisor., providers invited to the Lunch and Learn.
When
August 26th, 2015
What
Lunch and learn event to be held on August 26th 2015. This event is providing an opportunity for networking amongst the
NFP staff and mental health providers in the area.
Where
Ingham Co. Health Department, Conference room C
Tasks or tools required to set up
Invitations will be sent out to the identified providers by July 30th, with an RSVP back to Nola.
Menu for luncheon will be agreed upon and ordered by 8/24/15.
Plan for collection of data
Who
Nurse home visitors and supervisor
When
July 25th- Aug. 30th
What
Compiling of data gathered at the 'Lunch and Learn'.
Where
August team meetings for NFP staff.
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Cycle 3- Predictions/Do
• Predictions
• At the end of the luncheon, the NFP staff will have a larger
list of providers to begin to pull together as resources for
their clients suffering from Maternal Depression.
If a larger list of providers can be developed, nurses will feel
more confident in resources they can use with clients, and
in getting the proper care for their clients.
• Do
• Nurses will feel better equipped to offer EB'ed services to
their clients.
Cycle 4- Plan
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What question(s) do we want to answer on this PDSA cycle?
Can the team develop a more comprehensive list of current providers, to help treat Maternal
Depression.
7/24/15-The " Lunch and Learn", date and time has been established- August 26th, 121pm. Will we have a successful turnout? Will the information shared be helpful in gathering
resources for future referrals to mental health providers? Can this format be helpful in the
future?
Plan
Who
NFP home visitors, nursing supervisor., providers invited to the Lunch and Learn.
When
August 26th, 2015
What
Lunch and learn event to be held on August 26th 2015. This event is providing an
opportunity for networking amongst the NFP staff and mental health providers in the area.
Where
Ingham Co. Health Department, Conference room C
Tasks or tools required to set up
Invitations will be sent out to the identified providers by July 30th, with an RSVP back to Nola
Schramm. Menu for luncheon will be agreed upon and ordered by 8/24/15.
Cycle 4 (cont)
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Study
On August 26th, the 'Lunch and Learn', took place as scheduled. Seventeen
invitations were sent out and 10 providers attended. A great round table
discussion ensued. Providers shared; 1)How long they have been in the
community 2)Population they serve 3) Medicaid provider or not 4)How do we
make referrals 5)Where are they located?
There was also opportunity for agencies to do some networking amongst
themselves.
NFP nursing staff took great notes. 4/4 nurses saw this as a successful luncheon.
We hope to compile a laminated referral sheet that can be taken, with the nurse,
into the home as a reference when the 'maternal depression' resources are
needed.
Act
The plan was to have >2 referral sources for their clients with maternal
depression. There are now 7-9 new resources that can be added to this list. The
nurses were excited to learn about these local resources and what they can offer
clients. Some of these resources can be used immediately. In designing our
referral list we want it to be easily referenced. This indeed, was a successful way
to learn about more resources.
The next cycle will include making the referral sheet.
The team has also begun the Mother baby course and we will develop PDSA cycles
around that.
Pre-requisites for the intervention
• What is needed in order to have success with
this intervention?
• The team is still working with this intervention
as of Sept. 2015. We will get our resources list
finalized and laminated. Feedback in the
future will include looking at, how well the
new resources are being used by clients.
Advice
Barriers / Challenges
Key advice to overcome barriers
1) Gathering the best resources
1)Start with the most frequently used
resources. Consider the document a
changing, evolving resource list.
2)Getting good response for the Lunch&
Learn, when professionals are busy.
2) Provide food as an incentive!
Choose the day of the week wisely, we
chose Wednesday, hoping more
employees would be in town.
3) Finding a good place to meet.
3) Find a central location as much as
possible, and an expandable room.
4) Making it valuable for all.
4) Pre-work should include identifying
what the project is about when doing
initial contacts. (Get invitees excited)
Adaptations (if applicable)
• Are there adaptations of this information?
The idea of a ‘Lunch and Learn’, was taken from
a previous LIA, that presented at a Learning
session. We found it a good option with the
problem we were facing.
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References
NFP TEAM
Liz Amos- Nurse Homevisitor
Celeste Davison- Nurse Homevisitor
Teresa Spears- Nurse Homevisitor
Shajuana Tyson- Nurse Homevisitor
Nola Schramm-Nursing Supervisor
@nschramm.ingham.org (517-887-4324)