The goal of the Envision NM Quality Improvement Initiative (QII) is to improve healthcare provider practices through systems change. The Model for Improvement (Plan-Do-Study-Act Cycle) is utilized to implement effective treatment (e.g., best practices), and improve efficiency (e.g. office work flow processes).

There will be 5 components of the QII beginning in the fall of 2008. These are:

1. Pediatric Overweight Prevention, Identification, and Treatment (POW)
2. Improved Clinical Practices (ICP)
3. Behavioral Health: Student Depression Screening, Assessment and Treatment (BH)
4. Community Collaboration (CC)
5. Teen Lifestyle Change (TLC)

Site Visit

The site visit assessment will include use of a tool called “Content Area Specific Assessment”, or CASA. This is a site self-assessment tool developed by Envision NM that provides content specific indicators of the current status of operations for each site. It is based on the “Strengths/Weaknesses/Opportunities/Threats” (SWOT) analysis model frequently used by the National Assembly on School-based Healthcare (NASBHC).

During the 2007-2008 school year, Envision NM and the Office of School and Adolescent Health are working together to bring quality improvement to SBHCs. Thirty six SBHCs from all over New Mexico have been selected to be in one of the four Quality Improvement Initiative "Pods"*

1. Behavioral Health Integration and Suicide Prevention(10 SBHC sites)
2. Infrastructure (10 SBHC sites)
3. Obesity Prevention, Treatment, and Community Outreach(10 SBHC sites)
4. SBHC Teen Lifestyle Change Program (6 SBHC sites)

Envision NM’s School-based Healthcare Center (SBHC) Quality Improvement Initiatives/Pods are projects that will teach and support SBHCs in making changes in and evaluating if changes to the practice of healthcare are improvements. The four topics chosen for the QI Initiatives/Pods were identified by the Office of School and Adolescent Health (OSAH) as the most pressing healthcare concerns for children and adolescents in New Mexico’s schools. Envision NM is contracted by OSAH to provide trainings, technical support, and evaluation of the Quality Improvement Initiatives. Envision NM will not be monitoring the OSAH contracts.

*QUALITY IMPROVEMENT "PODS"

A "pod" is Envision's way of describing our “Quality Improvement Initiatives.” The Envision NM Pod leader(s) and the SBHC Improvement Teams will work together as to improve quality together.

School-Based Health Center Behavioral Health Integration and Suicide Prevention

This Quality Initiative/Pod will improve the skills of participating SBHC providers to identify student behavioral health problems. For primary care and behavioral health providers, this is an opportunity to improve their clinical skills in suicide prevention/crisis intervention and general behavioral health. Parts of this Quality Initiative include:

1. Best use of the Student Health Questionnaire (SHQ).
2. Formation/use of wrap-up team meetings to improve communication needed for effective care coordination.
   This promotes student learning.
3. Design a referral system for students with behavioral health problems, both for in-school and for community referrals.
4. Working knowledge of the SBHC Suicide/Crisis intervention plan.
5. Use of clinical case consultation to obtain technical assistance with the delivery of student behavioral health services.

QI Pod Leader Contact Information -
Dan Rifkin, drifkin@salud.unm.edu

School-Based Health Center Infrastructure

There are important parts of operations and delivery of quality school-based health care. The goal of this Initiative/Pod is to make sure that your SBHC provides high quality healthcare and that systems are in place to become a member of the SBHC Medicaid program. This initiative includes the following:

1. Understanding and meeting the Department of Health Standards and Benchmarks.
2. Ensuring certain clinical systems are in place and working well.
3. Developing key services such as care coordination, case management, referrals, and consultations.
4. Training to assess health insurance status and evaluation for Medicaid eligibility.
5. Assisting with correct coding of encounter data and billing.

QI Pod Leader Contact Information -
Paula LeSueur 247-2553, plesueur@salud.unm.edu

OSAH Standards and Benchmarks

New Mexico Alliance for School-Based Health Care

Medicaid Assistance Division: School Health

School-Based Health Center Obesity Prevention, Treatment, and Community Outreach

This QI Initiative/Pod will work to improve the skills and comfort level of providers so that they give the best quality care possible to students who are overweight or at risk for becoming overweight. The Quality Initiative/Pod will include the following parts:

1. Understand how to use the new Expert Committee Recommendations on Prevention and Treatment of Pediatric Overweight.
2. Learn how to use Motivational Interviewing with patients who want to change their eating and physical activity habits.
3. Understand how to use evidence-based information to help students change their eating and physical activity habits.
4. Use community outreach to connect SBHC providers with community resources that their patients can use to increase their physical activity and improve nutrition.
5. Assist the School Health Advisory Committee (SHAC) and SBHC staff with developing and putting in place the School Wellness Policy.

QI Pod Leaders Contact Information -
Obesity Prevention and Treatment: Suzanne Gagnon 247-3683, sgagnon@salud.unm.edu and
Community Outreach: Chenoa Bah Stilwell-Jensen 247-3691, cjensen@salud.unm.edu

School-Based Health Center Teen Lifestyle Change Program

The Teen Lifestyle Change (TLC) program encourages overweight teenagers to learn about eating healthy and being active in a small group, classroom-style setting. The TLC initiative will provide the following:

1. Group leaders from the SBHC (trained by Envision NM staff) will lead each group through the ten (10) week TLC program.
2. Training and support for group leaders is provided using telehealth.

QI POD Leader Contact Information -

Carole Conley, 247-1645, cconley@salud.unm.edu and
Kirsten Bennett, 247-1845, kdbennett@salud.unm.edu