Early Intervention Financing and Resources: Final Report. Appendix 2. Case Study Interview Protocols

10/01/2012

Interview with Agency Administrator or Administrative Designee

INTERVIEWER: [PARAPHRASE AS NEEDED]: My name is [INSERT NAME] and this is [INSERT NAME]. We both work for Westat, a private research company in Rockville, Maryland. Westat is collecting information on the RAISE NAVIGATE programs, which is being sponsored by NIMH. The site visit study is being sponsored by ASPE within the HHS.

As the agency administrator for the organization sponsoring the RAISE NAVIGATE program, you are a vital source of information. The broad focus of our interviews is to obtain your perspectives on the challenges you have encountered during implementation. We are particularly interested in how your site addresses these issues:

  • Fidelity to the RAISE NAVIGATE service package
  • Funding for different components of the services package
  • How funds are combined and accessed to support the overall model, and
  • Perceived conflicts between service requirements and funding options, and any other barriers to successful implementation of first-episode services.

Before we begin, we'd like your permission to record our conversation to make sure we capture all of your comments. The recordings will only be used by Westat and will be disposed of after the study ends. Do we have your permission for this? [PAUSE] Do you have any other questions? [PAUSE] Thank you. Let's begin.

A. Overview of the RAISE NAVIGATE program

1.  I'd like to start off by having you describe your experiences with the project thus far.

  • What were your objectives for the RAISE NAVIGATE project at the beginning? In what ways, if at all, have your objectives changed since then? Explain.

  • Describe how you have provided education and training for RAISE project staff & providers.

  • What changes, if any, have been made to your original implementation plan and why?

2.  We'd like to ask you some information about the past calendar or fiscal year. Which time period is applicable for the RAISE NAVIGATE program, a calendar year (1/1/10 to 12/31/10) or a fiscal year (e.g., 9/1/10 to 8/31/11)? ___________________________________ (Specify)

Funding and Billing

3.  Which of the following were typical sources of funding for your agency during the past year? (Select all that apply.)

___Federal Grant or Contract ___Private Insurance
___Private Foundation Grant ___Other Insurance (e.g., state or county)
___State or County Grant or Contract ___Client payment for services (FAMILY)
___ Special Program/Study
(similar to but other than RAISE NAVIGATE)
___Client payment, Sliding scale
___Medicare ___Ticket to Work, subcontract work
___Medicaid ___School Contracts, donations
___Agency fundraising, donations, or endowments (Please specify) ______________________________________________________

4.  Were any special or ear-marked funds used to meet the needs of RAISE NAVIGATE clients compared to the funding typically used for your traditional clients? Please describe.

B. Program Components and Activities

Now we'd like to focus on the primary activities and how services are delivered to RAISE NAVIGATE clients. We'd like to capture all the components of the program that are being offered and then discuss how each of the components is funded. [Hand informant a laminated chart of components.] Using this chart as a reference point, let's establish which components are available to RAISE NAVIGATE clients through your site. Then we'll talk about the provider (i.e., your site or another organization) and the funding source for each of the services that are available.

TABLE 1. RAISE NAVIGATE Early Treatment Components and Funding Sources
    In-house  
or Other*
  Out-of-Pocket   Private
  Insurance  
  Medicaid     Medicare   Other
  Insurance  
State MH
  Resources  
Local MH
  Resources  
Bad
  Debt  
Outreach and engagement                  
Medication                  
Medication visits                  
Alcohol and substance use treatment                  
Family psycho-education                  
Family therapy                  
Other outpatient visits                  
Inpatient care as needed                  
Supported employment                  
Job development                  
Planning (e.g., treatment and/or recovery plans)                  
Job coaching and other vocational supports                  
Supported education                  
Individual resilience training                  
Case management                  
Benefits counseling (e.g., WIPA)                  
Treatment and primary care coordination                  
Other (e.g., occupational or psychosocial therapy, groups, etc.)                  
* Include grant-funded sources here and specify whether grant is federal, state, or local.

Outreach and Intake, Engagement, Referrals, and Service Coordination

1.  How does intake into RAISE NAVIGATE services occur? Where do most referrals for RAISE enrollees come from? Please describe.

  • Use checklist for probes, as needed:
    • Local hospitals?
    • Local universities?
    • School-based clinics?
    • High school guidance counselors or other staff?
    • Community or school-based police or security guards?
    • Pediatricians?
    • Adolescent health care facilities?
    • Individual or family "walk-ins" or "call-ins"?
  • Please walk us through the referral process for RAISE NAVIGATE (e.g., method of referral, typical time to start of services) and highlight any problematic aspect of it (e.g., fee-for-service, transportation issues, referral paperwork, privacy and information-sharing issues, etc.).

  • Are there any difficulties associated with the process you have in place, or are you considering changes in the process? If so, please describe.

2.  Are there funding challenges associated with adding, and also maintaining, the first-episode intervention program at your site? If so, are these challenges likely to continue into the future?

3.  For some agencies, the type of outreach associated with the RAISE package of interventions is a "new" model of community engagement than usually associated with community mental health practice. How have staff and community partners reacted to this approach?

  • From your perspective, have you observed factors that facilitate this kind of outreach?

  • Have you encountered barriers to developing this kind of outreach?

4.  What is your experience with using existing staff to implement RAISE services?

  • Has this approach been balanced, or has this overburdened staff, or do staffing demands vary?

  • Would you describe the uptake of RAISE services as slow, or as expected, or in some other way?

  • How has your agency's administration handled the staff shifts?

  • Are there issues about staffing that need to be reconciled as funding for RAISE services comes to an end?

Employment and Job-Related Services

5.  Does the state Department of Vocational Rehabilitation have any role in the RAISE NAVIGATE? For instance, has the project involved VR in (or leveraged any VR funds for) micro-enterprises or self-employment efforts among project participants?

6.  Was funding for the employment-related services to RAISE NAVIGATE program clients a problem for your site? Do you anticipate that funding these services will be problematic for your site after this grant ends? Please describe the situation and your thoughts about problem resolution, if applicable.

7.  Has supported employment or supported education (or a combination of the two) been the greatest priority for the RAISE population you're seeing? Please describe.

C. Professional Development: Information and Training for Staff on RAISE NAVIGATE

Now we'd like to discuss training issues & its impact for staff involved with RAISE NAVIGATE partner organizations.

1.  Did you encounter any problems while providing information and training? Please describe.

2.  What funding is used to cover the costs of training and professional development associated with the RAISE NAVIGATE program?

3.  Do you anticipate that funding for professional development will be ongoing? If so, please describe how you believe training costs might be funded after the RAISE NAVIGATE program ends.

4.  Are details about the amount, duration, and frequency of training sessions for staff compiled by your agency? If so, please describe how or if that information affects decision-making about professional training needs. (If available, may we obtain a copy of the report?)

5.  What are your goals and plans for providing information and training specific to first-episode interventions in the future (e.g., does a project management team handle these issues, partners are discussing cost-sharing approaches, etc.)?

Impacts of Information and Training

6.  How is the fidelity of evidence-based practices used in RAISE NAVIGATE program services assessed (e.g., motivational interviewing techniques, supported education, supported employment, Individual Resilience Training)?

D. Policy

Now we'd like your perspectives on policy changes that might address barriers you have identified in launching the RAISE NAVIGATE program and how support for first-episode programs might be strengthened here.

1.  Have you encountered problems with funding RAISE NAVIGATE program services that are associated with existing policies (e.g., providing services to clients who do not meet income thresholds for Medicaid or low-income assistance available in your state)? Please describe.

2.  Given your knowledge of the existing coverage used by new, first-episode clients (e.g., remain on parents' insurance, indigent, Medicaid), have you already encountered, or do you anticipate, impacts to clients' coverage associated with the Affordable Care Act (ACA)? Please elaborate.

3.  Do you/your site have any policy recommendations for funding first-episode interventions, employment services, or other content areas that you might recommend for federal, state, or local levels? If so, have any of the following concerns been a focus for your agency or for RAISE NAVIGATE program partners (formal or informal)?

  • Eliminating barriers to identifying, facilitating referrals, and/or delivering first-episode interventions that are connected to adverse economic situations in your community.

  • Activities with project partners or providers to improve employment prospects for first-episode intervention clients.

E. Sustaining Program Elements

1.  Please describe the components of the RAISE NAVIGATE program that you think should be sustained in the future. If not all components can be sustained, which of them are the most important? Use checklist below for probes, as needed.

  • Targeted outreach and engagement strategies
  • Supported employment (including job development and job coaching)
  • Supported education
  • Family supports (e.g., psycho-education, therapy)
  • Individual Resilience Training
  • Medication visits and/or medication management assistance
  • Case management
  • Treatment and recovery plans
  • Coordination with primary care

2.  What are the plans (emerging or in place) to ensure these elements will be sustained after RAISE NAVIGATE funding ends?

3.  Is sustainability of first-episode interventions an investment your agency hopes or plans to make? Please describe whether your agency thinks that programs like RAISE NAVIGATE should be sustained.

4.  What funding sources (either new or existing funding streams) will be available to support program services during and after the grant period?

5.  Are federal, state, and local public sector commitments contributing to the sustainability of project activities (e.g., have there been changes in policies, procedures, or relevant legislation)? Please explain.

Thank you. That concludes our interview. We appreciate your time and help with this study!

Interview Topics for RAISE NAVIGATE Project Director or Designee

[INTERVIEWER:]: Good morning and thank you for taking the time to meet with me today. My name is [INSERT NAME] and this is [INSERT NAME]. We both work for Westat, a private research company in Rockville, Maryland. Westat is collecting information on the RAISE NAVIGATE programs, which are being sponsored by NIMH. The site visit study is sponsored by ASPE in HHS.

As a provider of RAISE NAVIGATE program services, you are an important source of information about the implementation and funding sources for first-episode intervention services offered by the program. I have some specific questions I need to ask, but I am also interested in your general comments and feedback. I'd like your permission to record our conversation so that we do not miss any of your comments. These recordings will be used by Westat only, and will be disposed of after the study is complete.

May we record our talk? [PAUSE] Do you have any questions before we start? [PAUSE]

O.K. Thank you. Let's Begin.

Outreach and Intake, Engagement, Referrals, and Service Coordination

1.  How does intake into RAISE NAVIGATE services occur? Where do most referrals for RAISE enrollees come from? Please describe.

  • Use checklist for probes, as needed:
    • Local hospitals?
    • Local universities?
    • School-based clinics?
    • High school guidance counselors or other staff?
    • Community or school-based police or security guards?
    • Pediatricians?
    • Adolescent health care facilities?
    • Individual or family "walk-ins" or "call-ins"?
  • Please walk us through the referral process for RAISE NAVIGATE (e.g., method of referral, typical time to start of services) and highlight any problematic aspect of it (e.g., fee-for-service, transportation issues, referral paperwork, privacy and information-sharing issues, etc.).

  • Are there any difficulties associated with the process you have in place, or are you considering changes in the process? If so, please describe.

2.  Are there funding challenges associated with adding, and also maintaining, the first-episode intervention program at your site? If so, are these challenges likely to continue into the future?

3.  For some agencies, the type of outreach associated with the RAISE package of interventions is a "new" model of community engagement than usually associated with community mental health practice. How have staff and community partners reacted to this approach?

  • From your perspective, have you observed factors that facilitate this kind of outreach?

  • Have you encountered barriers to developing this kind of outreach?

4.  What is your experience with using existing staff to implement RAISE services?

  • Has this approach been balanced, or has this overburdened staff, or do staffing demands vary?

  • Would you describe the uptake of RAISE services as slow, or as expected, or in some other way?

  • How has your agency's administration handled the staff shifts?

  • Are there issues about staffing that need to be reconciled as funding for RAISE services comes to an end?

Employment and Job-Related Services

5.  Please describe how your RAISE NAVIGATE works with the Career Centers (One Stop Offices) in this area.

  • Do any of your clients routinely receive services at the WorkSource Centers?

  • Do you have any outreach or screening staff co-located in the Career Center(s) involved with RAISE NAVIGATE?

6.  Does the state Department of Vocational Rehabilitation have any role in the RAISE NAVIGATE? For instance, has the project involved VR in (or leveraged any VR funds for) micro-enterprises or self-employment efforts among project participants?

7.  Was funding for the employment-related services to RAISE NAVIGATE program clients a problem for your site? Do you anticipate that funding these services will be problematic for your site after this grant ends? Please describe the situation and your thoughts about problem resolution, if applicable.

RAISE NAVIGATE Clients Served by Your Organization

8.  Are there any financial or other barriers that prevent individuals in need of first-episode interventions from receiving services in the RAISE NAVIGATE program? Please describe.

  • Do funding issues for the supports or service needs you identify present an obstacle that your program is trying to resolve? Please describe any funding issues connected to addressing the ongoing needs in the program.

Professional Development and Technical Assistance on RAISE NAVIGATE

9.  Have you (personally) participated in training opportunities associated with RAISE and the NAVIGATE program interventions?

10.  Have these offerings being helpful in your work with RAISE NAVIGATE clients? Has any topic or training been especially useful to you or your organization? Please describe the topical area and why it has been beneficial.

11.  Are there other training areas of which you are aware that you think would better prepare you or your staff members to work more effectively with RAISE NAVIGATE clients? Are there certain topics that haven't been covered in training(s) that you'd like to see added?

12.  What data are gathered to include in reports (if any) that are generated about the program? How are reports that present or analyze program operations used by your organization (e.g., to inform policy suggestions or professional development content decisions, to disseminate information about client outcomes, to monitor the fidelity of practices to models in use, etc.?). Please describe. (If available, please provide interviewers with a copy of relevant reports.)

Barriers to Reaching and Serving NAVIGATE Clients

13.  What do you think are the biggest barriers (beyond the population typically served in community mental health centers) -- if any -- to outreaching, engaging, and helping people who are experiencing their first episode obtain access to appropriate interventions, treatments, or referrals?

  • Are there barriers that affect whether people come in for or agree to be screened for certain issues (e.g., mental health, substance use, cultural issues)?

  • How are those barriers being addressed now?

Perspectives on Program Impact and Sustainability

14.  Please describe the components of the RAISE NAVIGATE program that you think should be sustained in the future. If not all components can be sustained, which of them are the most important? Use checklist below for probes, as needed.

  • Targeted outreach and engagement strategies
  • Supported employment (including job development and job coaching)
  • Supported education
  • Family supports (e.g., psycho-education, therapy)
  • Individual Resilience Training
  • Medication visits and/or medication management assistance
  • Case management
  • Treatment and recovery plans
  • Coordination with primary care

15.  What do you see as the RAISE NAVIGATE program's biggest accomplishments? What contributed to the success?

16.  What have you wanted to accomplish through RAISE NAVIGATE but been unable to achieve? Give examples. What would have made a difference?

17.  Based on your knowledge of how RAISE NAVIGATE program services are currently funded, which, if any, of the program components do you believe will continue to be funded after the project ends?

Thank you. That concludes our interview. We appreciate your time and help with this study!

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