ACF - Administration for Children and Families

20/11/2024 | Press release | Distributed by Public on 20/11/2024 13:22

Using a Continuous Quality Improvement Collaborative Approach in Indigenous Contexts: Lessons Learned from Tribal Home Visiting

Using a Continuous Quality Improvement Collaborative Approach in Indigenous Contexts: Lessons Learned from Tribal Home Visiting

Publication Date:November 20, 2024

Introduction

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In 2016, the Tribal Maternal Infant and Early Childhood Home Visiting Program (THV) became the first federal grant program to require a Continuous Quality Improvement Collaborative (CQIC) approach in Tribal early childhood settings. The decision to incorporate the CQIC approach stemmed in part from generally positive experiences of participants in similar initiatives for states, territories, and their local implementing agencies, and from THV grantees' previous success conducting individual continuous quality improvement (CQI) projects. However, questions remained about the applicability of a CQIC approach in Indigenous settings as a required grant activity.

To answer these questions, the Office of Planning, Research, and Evaluation (OPRE) in the Administration for Children and Families (ACF) contracted with James Bell Associates (JBA) to conduct a process study of the THV CQIC approach as it was implemented from 2019 to 2022. The process study found that grantees thought the THV CQIC was culturally appropriate and feasible to implement within their programs.

Primary Research Questions

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The research team examined the following research questions:

  1. How was the THV CQIC approach implemented?

  1. What were the outcomes of the quality improvement work?

  1. Was the approach appropriate for Indigenous settings?

  1. Was the approach feasible in Indigenous settings?

Purpose

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The purpose of this brief is to present the findings for each primary research question and to provide implications for future implementation of CQICs in Indigenous contexts.

Key Findings and Highlights

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Most participants recommended repeating this initiative and also provided suggestions for increased feasibility in future efforts. Key takeaways related to each research question include:

Research Question 1

  • The THV CQIC approach aligns with the Breakthrough Series (BTS) model used in the Home Visiting Collaborative Improvement and Innovation Network (HV CoIIN) initiative; however, changes were made to tailor implementation for an Indigenous context.

  • The collaborative topics, early language and literacy and family engagement, were chosen based on grantee input. Two collaborative groups ran simultaneously for 16 months. Federal staff assigned the grantees, based on preference, to one of two collaborative groups with distinct areas of focus and provided resources to support flexibility in grantee choice of their specific improvement efforts.

  • Implementation of the THV CQIC approach within the grant program required intensive support and extensive resource development from federal staff and contracted technical assistance (TA) providers.

Research Question 2

  • There were small to medium improvements across many of the THV CQIC measures and significant fluctuation over time in most measures.

Research Question 3

  • Many grantees felt that working collaboratively with other Tribal programs and communities was important and peer engagement was one of the most meaningful aspects of the THV CQIC design.

Research Question 4

  • Grantees noted receiving various valuable supports and resources over the course of the THV CQIC implementation which made participation more feasible.

  • Grantees expressed that a strong leader and a fully staffed team were crucial to effective participation in the THV CQIC.

  • The greatest challenge grantees faced throughout the course of the THV CQIC was conducting CQI activities during the COVID-19 pandemic.

  • Grantees indicated three main areas for improving feasibility of implementation - (1) reduce administrative burden, (2) secure initial support, and (3) ensure staff buy-in.

Methods

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The data collection plan for this study and the write-ups of this brief were reviewed and approved by all participating grantee teams with Tribal Institutional Review Boards and Research Review Boards. The research team collected data through surveys, semi-structured interviews with THV grantee staff, and document review of administrative data and planning documents.

Recommendations

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Based on the elements of the THV CQIC that grantee participants found to be particularly helpful, the following are lessons learned that may guide others seeking to implement a CQIC approach in an Indigenous context.

  • Ensure sufficient resources are committed up front by building in an extensive planning period, allocating funding for appropriate staffing, and devoting time to creating resources.

  • Prioritize a culturally informed and collaborative approach to developing the structure, activities, and resources that are a part of a CQIC initiative within Indigenous contexts.

  • Work closely with partners to identify meaningful and feasible measures that limit burden, align with the chosen topic, and can accurately reflect improvements.

Glossary

Appropriate: A term that describes the fit, relevance, and compatibility of a program, intervention, or approach with the cultural and contextual characteristics within a community served. Continuous Quality Improvement (CQI): A formal, ongoing, measurable process that can be used to streamline processes, enhance services, and achieve better outcomes. Continuous Quality Improvement Collaborative (CQIC) approach: A structured and facilitated process for testing evidence-based as well as innovative strategies to make improvement toward group-level aims. Feasible: A term that describes the practicality and logistical aspects of implementing a program. Process Study: A descriptive study using qualitative and quantitative data from interviews, surveys, and document reviews to examine the implementation of a complex process with multiple interacting parts. THV CQIC: A 16-month effort that engaged 19 Tribal Home Visiting grantees in a structured and facilitated process for testing evidence-based or innovative strategies to make improvement toward collaborative-level aims in two distinct areas: early language and literacy and family engagement.