Summit County Pathways HUB Project
Our Fail Forward Stories
Standardizing the Process
How we started?
The Pathways HUB launched on April 11, 2016. There was an initial training of the software system on April 1, 2016 with 2 agencies that agreed to participate in the launch team. The two agencies had staff that were funded by grant dollars and were currently implementing home visiting programs. From a program implementation stand point, it made sense to have these 2 agencies launch the new model and software system.
The first group of newly trained staff members were from 2 different organizations funded by grants. The group was made up of 4 community health workers that had been using components of the model for many years and documented their work on paper. The second group comprised of public health nurses and social workers that implemented a home visiting program focusing on parent-child relationships and development. In an effort to go live and launch the Summit County Pathways HUB, these 2 groups of staff attended a one day software training with the anticipation that they would be operational within several weeks.
How did we fail forward?
The fail forward was that both grant funded programs had specific requirements that added complexity to the implementation of pathways. Although there were similarities in the types of information collected, there were distinct differences in the process for data collection and the expectations of the home visits. The staff that were trained continued to work as they have been, seeing families and providing education per their grant deliverables. During the first few weeks, there were several times that the staff met with Pathways staff to enter the information into the Pathways software. It became very apparent the transition to the new system was not a simple one. For the one program, staff were trying to retrofit the information they collected from one program and enter into the other. Moreover, they were now doing double-data entry when they were promised a “more efficient system.” Secondly, the community health workers from the other agency continued to operate on paper and only collected the information that was required by the grant. They were feeling the burden of the additional paperwork and new processes. Thirdly, the consenting process became overwhelming because each organization had a consent form to participate in the program, to share information and for HIPPA. Then, the Pathways HUB was asking for an additional consent form. The staff was feeling overwhelmed and burnt out by the amount of paperwork that had to be completed.
What we learned and how that impacted our process going forward?
We learned the importance of understanding the grant requirements and processes for these programs. It was not enough to review the information that was collected because the process of the data collection impacted their practice. When the HUB launched and there were new forms to be completed, the process to complete these forms had not been developed or implemented. This much change was difficult for staff to adopt. Another lesson was the importance of sharing the consent form with senior leadership at each organization so that the form could be modified, merged or vetted by legal staff before going live. The consent form review has become part of the discussions with senior leadership during the initial contract discussions. A third lesson was that it is difficult to implement a new model, let alone couple it with grant deliverables and a new software system. In retrospect, we thought that utilizing existing programs that served the target population would be more efficient, however, this approach created more challenges.
After many trainings, technical assistance sessions, conversations with state grant funders, the HUB in Summit County tabled the merging of these programs in the HUB. While the programs collaborate informally via meetings, quality improvement efforts and referral sharing, these initial launch agencies have not implemented Pathways Community HUB model. Rather, they have continued to serve their families using the tools and documents developed by their grant programs. The lesson learned was that it is an easier process to start with staff and organizations that can fully implement Pathways without the constraints of grant funded deliverables.
Getting the Right People Trained
Training Community Health Workers (CHWs)
Through a partnership with a county agency and its generous local funding, the Summit County Pathways HUB was able to train 10 community health workers at no charge. In the state of Ohio, Community Health Workers (CHWs) are certified through the Board of Nursing. The training standards are defined in Ohio Revised Code.
The first training in Summit County to build the CHW workforce was held in May and June 2016. The local training enabled the county to build a workforce of community health workers that could serve the pregnant women within several months of the launch of the HUB. A local scholarship process was developed and letters were sent to partners that signed MOUs that were submitted with the grant proposal. Agencies applied for training slots, were awarded scholarships for the CHW training and sent their staff to the training. The agencies that sent staff were told that they would gain access into the software system after contracts were signed between the HUB and their organization.
How did we fail forward?
The fail forward was that the agencies were told in their scholarship letter that they had to attend and complete the training. If they did not complete the training, they would have to pay the training dollars back. While the agencies may have read this language, there was not any formally agreement or contract that could hold them accountable to a re-payment.
All of the individuals that were awarded scholarships completed the training and became certified. The fail forward was that there was a delay in launching the new agencies that sent staff to the training and there was some attrition. When the HUB was ready to contract with two of the organizations, the staff that they had sent to training had left the organization and the capacity to serve the number of pregnant women was reduced. Because the agencies were awarded a scholarship but did not sign contract with language that included a re-payment clause, there was nothing that could be done to re-coop the dollars spent on the training. This impacted the number of women that could be served because a new CHW would have to be hired by the organization or a new staff member would have to be trained.
How we changed what we did?
There is now contract language that states that agencies have to pay for the training initially and will be reimbursed once the individual is certified and meets caseload for certification standards. Additionally, organizations must demonstrate that they have hired the staff that will be attending this CHW training and for their training to be reimbursed, they must serve pregnant women in the HUB.