The following structural requirements provide the foundation for building and managing all the components of a HMG system effectively over time:
Continuous Quality Improvement
The first structural requirement is an organizing entity.
The design and implementation of an HMG system is dependent upon communication, coordination, and integration of resources and services. Genuine collaboration is required to make changes in policies, governance, and operating procedures at the administrative and direct service levels. One of the first steps in developing an HMG system is to enlist partners who have mutual interests, service the same populations, and/or have the capacity to move the agenda forward.
The organizing entity provides administrative and fiscal oversight and initially helps identify and coordinate partners into a leadership team or steering committee that will guide the HMG system as it evolves. As the roles of each partner are defined, the responsibility for administrative and fiscal oversight may change, but having a stable administrative "home" is essential for system sustainability over the long term.
The second structural requirement is a strategy for expanding statewide over time.
Initiating HMG at the state systems level and having a statewide vision from the beginning is critical for success. HMG depends on building broad-based ownership of the system across service sectors to leverage resources and improve linkages in communities. While this type of collaboration can happen initially at the county or regional level, a system limited in geography will be limited in its ability to identify and address gaps and barriers, which are often rooted in larger, statewide challenges. In addition, the flow of funds to community services is often based on state budgets and policies and directed by state departments and agencies.
At the same time, research on early child development indicates that promoting optimal child development depends on:
1) universal screening and surveillance, so that children who may be at risk for developmental or behavioral health issues can receive services before their issues become more serious and difficult to remedy;
2) the ability to connect with services that are comprehensive and aligned with children's developmental phases and needs.1 A statewide system helps to ensure universal access and identification of children for intervention as early as possible, and it facilitates a multidisciplinary approach to service delivery. A statewide system also creates cost efficiencies through achieving economies of scale, thereby lessening the cost of administering and delivering the system.
*\1.American Academy of Pediatrics, "Identifying Infants and Young Children." http://pediatrics.aappublications.org/cgi/content/full/118/1/405.
The third structural requirement is the capacity and commitment to implement a process for continuous quality improvement.
Continuous Quality Improvement (CQI) refers to a methodology that attempts to ensure the success of programs and services through ongoing analyses and modifications in response to lessons learned. CQI recognizes that many organizational problems result from systems and processes, rather than from individuals. CQI encourages staff members at all levels to:
- Work as a team
- Draw on their collective experiences and skills
- Analyze systems and processes
- Use information to identify the nature and size of each problem
- Design and implement activities to improve services
Implementing CQI starts by forming a committee of staff members who represent each component of the HMG system. Meeting agendas typically cover a review of policies and procedures, feedback on data collection and intake procedures, a review of in-house training needs, and updates on statewide initiatives or changes that may affect the system.