Family Home Visiting (FHV)
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Continuous Quality Improvement
Continuous Quality Improvement (CQI) is a deliberate, defined process focused on activities that are responsive to community needs and improving population health. It is a continuous and ongoing effort to achieve measurable improvements in the efficiency, effectiveness, performance, accountability, outcomes, and other indicators of quality for state and local program levels.
The goal of CQI at the Minnesota Department of Health (MDH) family home visiting program is to improve outcomes by building capacity of local partners through:
- Establishing a culture of CQI.
- Building CQI infrastructure.
- Applying CQI methods to daily practice.
For more information about Minnesota’s FHV CQI efforts, contact health.fhvcqi@state.mn.us.
Why we promote CQI
CQI is considered a best practice in public health. MDH is a Maternal, Infant, Early Childhood Home Visiting (MIECHV) awardee that administers funding on behalf of the U.S. Health Resources and Services Administration (HRSA) to local grantees throughout Minnesota to deliver home visiting programs. MDH family home visiting is required by HRSA to develop a CQI work plan and report on it annually. MDH family home visiting must demonstrate utilization of CQI best practices and measurable improvement at the state program level while assisting family home visiting programs to increase their capacity to use consistent and planned CQI methods to improve program outcomes.
Who we support
MDH family home visiting supports local family home visiting programs who receive federal and state funds to deliver home visiting programs. Family home visiting programs can be managed by local public health agencies, county health boards, tribal nations, and nonprofit organizations. Most programs that MDH family home visiting supports are those using an evidence-based home visiting model funded by state and/or federal home visiting dollars.
Ways we support CQI
An interdisciplinary team made up of a CQI coordinator, home visiting practice consultants, research scientists, and student workers work closely to support local family home visiting programs in building their CQI capacity by providing:
- Consultation
- Training
- Facilitation
- Coaching
- Peer learning opportunities
- Technical assistance
- Data collection, reporting, and analysis
CQI essentials
The MDH family home visiting section is committed to the principles of CQI and supports efforts at both the state and local levels to improve the effectiveness and delivery of family home visiting services provided to families with young children.
These guiding principles include:
- A focus on improving services from the client’s perspective
- Meaningful engagement at all levels is required for success
- Recognition that all processes can be improved
- Continual learning using an “all teach, all learn” philosophy
- Decision-making is improved by using both data and team knowledge
- CQI data is used for learning and improvement, not for judgment or supervision
MDH uses many different resources to support CQI efforts, but several essentials will get you on the path to success when planning a CQI project. Visit family home visiting toolkits webpage to read the CQI toolkit that has more information on CQI practice and essentials.
Model for improvement
The Model for Improvement provides a framework for rapid testing and change leading to improvement. This model consists of two parts: addressing three fundamental questions and then engaging in tests of change using the Plan-Do-Study-Act cycle.
Langley, G.J., Nolan, K.M., Nolan, T.W, Norman, C.L., & Provost, L.P. (2009). The improvement guide: A practical approach to enhancing organizational performance (2nd Ed.). San Francisco: Jossey-Bass. P.24.
Charter
A document to describe and launch the improvement project through establishing a common vision for the work.
Measures
Key indicators that are used to measure performance and track improvement. Measures are used to evaluate if the aims and goals of an improvement project have been met.
Driver diagram
A visual display of the theory for what “drives” or contributes to the achievement of a project aim. The driver diagram shows the relationship between primary drivers (those that contribute directly to achieving the aim), secondary drivers (components of primary drivers), and the goal(s) to achieve. The driver diagram is a tool that helps you translate a high-level improvement goal into a logical set of smaller goals and projects.
PDSA cycle
The Plan-Do-Study-Act (PDSA) cycle is a method for rapidly testing a change by developing a plan to test (Plan), carrying out the test (Do), observing and learning from the results (Study) and determining what modifications should be made to the test (Act).
Project planning
A document that strategically sets smaller goals by timeframe. It helps plan when and who is responsible for PDSA cycles being completed in either the test, implementation, or spread stages during different action periods of an improvement project.
Parent leadership in CQI
Parents engaged with CQI efforts as active leaders can offer valuable feedback and develop innovate ideas for improving services and processes. To improve services for families, it is important to partner with families.
The HV CoIIN Parent Leadership Toolkit is available at no cost. Download the HV CoIIN Parent Leadership Toolkit here.
For additional CQI resources and tools, visit MDH Center for Public Health Practice's Public Health and QI Toolbox.
Learning collaboratives
A collaborative is a time-limited effort of multiple organizations that come together with leaders and experts to learn about and to create improved processes in a specific topic area. MDH uses the Institute of Healthcare Improvement’s Breakthrough Series (BTS) Collaborative model as a framework for CQI in family home visiting services.
The topic selection process engages internal and external stakeholders. Topics that are chosen are issues that have a high level of interest at the state and local program levels, as well as room for improvement based on national benchmarks in FHV performance measures. Below are descriptions of the current and past statewide CQI learning collaboratives.
2025 Project: Parent-child interactions and decreasing missing data
Project documents/resources:
Office Hours:
For continued support to family home visiting program staff, MDH hosts CQI office hours on the third Wednesday of each month at 10 a.m. via Microsoft Teams. To join the meeting, visit CQI office hours. Meeting ID: 291 599 506 372, Passcode: 7KLT87.
2024: Family retention and prenatal enrollment, decrease missing data
In 2024, MDH supported a CQI project related to family retention, with a focus on increasing prenatal enrollment. Efforts were made to decrease missing data in MIECHV performance measures.
Project documents and resources:
2023: Family engagement and family retention
In 2023, MDH is supported a CQI project related to family engagement and family retention. Two local family home visiting agencies also participated in the CQI Practicum with MDH. The 2023 CQI Practicum Showcase highlights this project.
MDH also created a poster to showcase qualitative data that was collected during 2023. This poster, A 2023 MN Initiative: Collaborative Use of Qualitative Data in Continuous Quality Improvement Efforts (PDF), was presented at the MIECHV All Grantee Meeting in January 2024.
2022: Early language and literacy and referral measures
In 2022, MDH supported a CQI project related to the MIECHV performance measures for early language and literacy and referrals. The Showcase shares the outcomes from this project and highlights Dakota County's work on implementing the Mothers and Babies curriculum aiming to reduce maternal depression.
2018: Family enrollment, engagement, and retention
In 2018, MDH facilitated an eight-month statewide family enrollment, engagement, and retention learning collaborative with 16 teams. The goal of this collaborative was to increase the proportion of eligible, referred families who participate at high levels by changing how family home visiting staff enroll, relate to, and engage families in services.
- Family engagement toolkit (PDF)
- Improving Family Engagement in MIECHV-funded home visiting programs poster (PDF)
Project documents
Screening and referrals for maternal depression and development risk
In 2017, MDH facilitated a nine-month statewide screening and referrals learning collaborative with 16 teams. The goals of the collaborative were to improve early identification, connection to services, and follow-up for families after a developmental, social-emotional, and/or caregiver depression screening indicated a need for referral.
Project documents:
- Screening and Referrals Summary (PDF)
- Screening and Referrals Collaborative Charter (PDF)
- Screening and Referrals Measures (PDF)
- Screening and Referrals Driver Diagram (PDF)
To request additional collaborative materials, please contact: health.FHVcqi@state.mn.us.
Data collection, reporting, and analysis
MDH family home visiting evaluation staff support CQI initiatives by providing guidance related to data collection and reporting. Guidance documents for reporting can be found on the current family home visiting evaluation resources page. Further, data reports are generated regularly to support current CQI efforts and inform future project focus. To request assistance with data collection, please contact: health.FHVcqi@state.mn.us.