Hello, and welcome to the fourth installment in our “Approaches to Measuring Quality Improvement in Public Health” series! While quality improvement principles have traditionally been implemented in clinical settings, this series is focused on unpacking a measurement framework to apply a  Q.I model/ lens to public health, systems-level work. In our most recent post, we focused on the Augmenting MCH Capacity piece of the framework.  The post highlighted the Wisconsin Adolescent and Young Adult Behavioral Health (AYA BH) CoIIN team’s efforts to support improved primary care provider’s capacity for caring for their patient’s emotional well-being through promotion the state’s child psychiatry consultation program.

For today’s entry, we’ll be honing in on the Assessment, Measurement, and Monitoring piece of the QI framework.  This domain emphasizes the importance of assessing the current landscape of efforts across the state focused on AYA emotional well-being as well as creating a defined measurement plan to inform intervention and monitor outcomes.  Read on to learn how Vermont’s AYA BH CoIIN has operationalized this tenant of the framework.

Assessment, Measurement, and Monitoring of Adolescent and Young Adult Emotional Well-Being in Vermont
By: Sally Kerschner, RN, MSN–Coordinator of MCH Injury Prevention, Vermont Department of Health

Assessment

Vermont has spent much of its initial CoIIN efforts in the assessing the current landscape of existing mental health integration efforts across the state. In creating this inventory, the team realized that several projects and programs have been intentionally developed over recent years by many partners, all with a goal of achieving comprehensive and best practice screening processes in a variety of practice settings.

Below is a partial list of key projects or initiatives in Vermont:

• Vermont’s Children’s Health, Integration, Linkage, Detection Grant program, designed to promote full integration and collaboration in clinical practice between primary care and mental health providers and organizations.
• Project AWARE: Advancing Wellness and Resiliency in Education supports early identification and referral of youth experiencing mental illness
• The Screening, Treatment and Access for Mothers and Perinatal Partners Program provides support for pregnant women and new families by building upon successful quality improvement initiatives and piloting several novel approaches to increase psychosocial screening in pediatric, family medicine and obstetric practices through strategic collaborations. 
• Child Safety Learning Collaborative and Suicide/Self Harm QI initiative aims to increase screening for suicidality of youth entering crisis services in community mental health agencies.
• Zero Suicide via the VT Department of Mental Health, which is a framework for continuous quality improvement aimed at transforming suicide prevention in health and behavioral health care systems
  

This assessment of existing efforts and the resulting inventory has illuminated the need to partner with, or at the very least, coordinate with these varying programs in order to avoid duplication of efforts.  It is important to be intentional in avoiding duplication to avoid creating skepticism among front-line practitioners and inefficiencies in implementation. Moving forward, a key strategy is to assist our Department of Health and Department of Mental Health state agency leaders in coordinating these various efforts by developing better routine communications channels to be aware of the progress of each initiative.

Measurement and Monitoring

Vermont’s CoIIN is working to augment and complement several other programs and initiatives to address upstream youth mental health and wellness, including suicide prevention. Vermont does not have dedicated injury or suicide prevention funds, however, we work to integrate public health interventions into our existing capacity. In order to anchor the key public health issue of youth suicide prevention in our work, we incorporated key measures into our MCH Title V Grant planning. The following priority needs are reflected in Vermont’s current state action plan and will be revised after the Title V 2020 Needs Assessment process: 

Priority: Youth choose healthy behaviors and thrive

State Performance Measure: Percent of adolescents that feel they matter to people in their community

Supporting Objectives:

State Performance Measure: Percent of high school students who made a plan to attempt suicide in the past 12 months (measured using the Vermont’s Youth Risk Behavior Survey)

Supporting Objective: By 2023, increase the percentage of youth and adults screened for suicidality in the primary care setting by 25%.  

Strategies to Meet Objectives:

• In partnership with the Vermont Child Health Improvement Program, collect and report on quality improvement data from pediatric practices on depression screening. MCH Leadership supports the AYA CoIIN for systems improvement in screening youth for depression and other factors that may lead to suicidality.
  
• Support presence of Umatter Youth and Young Adults Mental Health Wellness Promotion and Community Action in 10 schools statewide.