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CSNI has a long history of participating in quality improvement activities. In 1996, in partnership with the Bureau of Developmental Services and the Institute on Disability at UNH, CSNI developed the Quality Outcomes Partnership which established a comprehensive set of quality indicators for the entire system. More recently, CSNI was represented on the Quality Committee established under SB 138 which resulted in the establishment of the NH Quality Council. In addition, CSNI was instrumental in the decision to join the National Core Indicators project.
Quality improvement activities are coordinated by one of CSNI’s standing committees, the QI committee. This group is made up of the quality assurance directors of each area agency. This group meets quarterly and reviews quality data generated for the entire area agency system. They review trends and make recommendations for system-wide improvement. Their efforts have resulted in the publication of the 2009/2010 Annual Report of quality improvement.
We began by narrowing the scope of our work to these forms: incident reports, budget submissions, daily CPS notes, monthly progress notes, attendance, and the service agreement. After reviewing some of the existing forms in use for each category, we made the decision that daily CPS notes and monthly progress notes do not currently have a required format. As such, we agreed that creating required forms would place an undue burden on provider agencies, who may already have appropriate forms in place. The monthly progress note and daily CPS note that we developed are being offered as best practice examples, but we are not recommending that they be adopted as required forms.
We developed forms for incident reports, budget submissions, attendance, and service agreements for the area agency executive directors to review and adopt. The draft forms were shared with stakeholders from the area agencies and provider agencies. Some of their feedback was incorporated into the final documents, wherever we felt that the change improved the effectiveness of the form.
During the process, it became clear that our various organizations are at different stages with regard to utilizing electronic forms and on-line electronic records. To ensure that our new forms increase efficiency, rather than adding another burden to the system, we propose that we permit provider agencies to re-create the standard form in whatever electronic format they currently use. The expectation is that all the required information would appear on the final product in the same order and format, but the form could be generated in whatever system or manner the agency uses. For example, a vendor that uses an electronic record system would be free to re-create the standard form with its own software. This point is critical to ensuring that the standard forms don’t create duplicate work.
Prior to completing the process, the committee was notified that the Bureau of Developmental Services was developing new required forms for both budget submissions and service agreements. Our work on these was placed on hold. Thus, the final required forms that we are proposing are the incident report and the attendance form.
The CSNI IT Committee meets regularly to identify and explore areas for improving the accuracy, timeliness and security of data. This Committee provides valuable input to the Board of Directors on matters pertaining to the use of technology and data systems.
The Statewide Risk Management Committee is comprised of skilled clinicians and other professionals from each of the 10 area agencies, along with administrators from the Bureau of Developmental Services and representatives from CSNI. This meeting is facilitated monthly by CSNI. The purpose of this committee is to endorse and/or provide feedback to agencies who present a Risk Management Plan for review. Risk Management Plans are written utilizing assessments from independent assessors, and addresses what the agency’s expectations are of service providers for providing safe, clinically appropriate supports.
The Community of Practice is a monthly statewide group, facilitated by CSNI. Participation on the CoP includes representatives from each of the 10 Area Agencies, representatives from each of the agencies who operate Intensive Treatment Services (ITS) programs, administrators from the Bureau of Developmental Services and representatives from CSNI. The purpose of the CoP is to oversee the movement in and out of Intensive Treatment Programs. ITS program capacity is a scarce resource, and the committee’s goal is to ensure that individuals are progressing through treatment and residing in the least restrictive setting for their needs. Additionally, the CoP approves or disapproves of placements in ITS residences. This serves as an additional way to manage the scarcity of ITS placement availability. The CoP is also available for consultation when agencies are struggling to identify placements for individuals who have challenging needs.
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