Home Visiting Collaborative Improvement and Innovation Network (HV CoIIN)
This announcement solicits applications to develop a Home Visiting Collaborative Improvement and Innovation Network (HV CoIIN) to provide support for the delivery of maternal and early childhood services, including (but not limited to) home visiting services provided under the Maternal, Infant, and Early Childhood Home Visiting program (MIECHV), which was authorized by section 2951 of the Affordable Care Act.  MIECHV seeks to identify families with children ages 0 to 5 years and pregnant women who reside in at-risk communities and provide comprehensive services to improve outcomes for these families. The purpose of the HV CoIIN is to facilitate the delivery and accelerate the improvement of home visiting and other early childhood services, both globally and as provided by MIECHV grantees, so as to obtain good results faster for low-income and other at-risk families served.  More specifically, in partnership with the Maternal and Child Health Bureau’s (MCHB) Division of Home Visiting and Early Childhood Systems (DHVECS), the successful applicant will plan and implement a HV CoIIN to facilitate the dissemination of methods and tools on continuous quality improvement (CQI) to up to forty (40) home visiting local implementing agency (LIA) pilot teams in partnership with other early childhood service agencies that operate within up to 12 MIECHV grantee states. Ultimately, the purpose of the HV CoIIN is to produce faster and more consistent health and development results benefiting families served by MIECHV program agencies and other early childhood service agencies in at-risk communities across the country.  Concrete examples of the contemplated results are parental smoking cessation, reduction of adult depression or child developmental delays or child maltreatment, and attaining family economic self-sufficiency. These results are achievable through dissemination of proven practices and the building of leadership and technical mastery of CQI methods at the state and LIA sites. If successful, lessons learned in this project could be in turn further spread to other states and localities. A CoIIN has been described as a group of self-motivated people with a collective vision, enabled by the Web to collaborate in achieving a common goal by sharing ideas, information, and work.[[]1]  The CoIIN provides a platform for collaborative learning and quality improvement toward common goals and benchmarks using rapid cycles of change. Key features include collaborative learning, common benchmarks, coordinated strategies, rapid test cycles, and real-time data to drive real-time improvement. Applicants should adapt the structure and process of an established collaborative model to their proposed HV CoIIN project.[[]2] In collaboration with HRSA, the successful applicant will plan and implement the HV CoIIN by engaging willing and able MIECHV state grantees and their LIAs. These participating organizations will collaborate and learn from each other and from an expert home visiting faculty to advance the common aim of improving the quality of home visiting services to improve specific outcomes for families who reside in at-risk communities. The awardee will engage up to 12 MIECHV state grantees and support the provision of intensive technical assistance to up to 40 LIA pilot teams within those states to make system-level changes that will lead to accelerated improvements in outcomes for the at-risk families served by spreading and adapting best practices across these multiple settings. Specifically, teams from local home visiting service agencies will seek improvement in 4-8 topics to be selected by MCHB, in consultation with subject matter experts outside the scope of this funding opportunity announcement, based on their relevance to clients and on the availability of evidence- or experience-based practices likely to yield favorable results for the families served. Selected topics may include some of the goals within the legislatively specified benchmark areas (e.g., maternal and newborn health, child development, family economic self-sufficiency, etc.) of the MIECHV program in order to take advantage of the extensive data collection required and the wide variety of process and outcome measures already in place. However, the topics ultimately selected need not be restricted to these MIECHV constructs. Other topics could be found “ripe” for inclusion in the HV CoIIN such as, for example, family or staff program retention or early childhood service system integration.   The awardee shall plan activities that bring home visiting and other early childhood service agency teams together to learn about the selected topics and CQI methods and later on to share results and solutions to challenging issues. Beyond coordinating structured learning sessions, the awardee shall support teams to remain engaged in HV CoIIN activities in their own front-line organizations and communities. The awardee will work in partnership with MCHB’s DHVECS staff (constituting the planning or management team) and expert faculty to coach participants in applying and mastering CQI methods.  Such coaching and learning will take place during action periods in which LIA teams will test and customize recommended changes in their home environments utilizing “Plan/Do/Study/Act” (PDSA) cycles among other QI tools. During the entire collaborative project, the awardee shall ensure that teams have access to an Internet-based platform(s) to share data and other information with the faculty, their peers and the HV CoIIN management team.  The awardee should also maintain an Internet-based “data dashboard” with the capability of aggregating data at the local agency, state and overall collaborative levels and displaying these data graphically utilizing primarily run charts but also other graphs useful for quality improvement purposes (e.g., scatter plots, frequency plots, Pareto charts, Shewhart charts).[[]3] Teams are expected to share their progress reports monthly with peers, faculty and management team to participate in peer-to-peer mentoring and sharing of ideas and insights via periodic conference calls and other forms of communication. This sharing of experience and the production of real-time, periodic and graphically displayed data (primarily as run charts) for the LIA teams will help make the powerful technology of qualitative and quantitative data-driven CQI available to the home visitors and other staff at the front line implementing agencies.  Eventually HRSA expects that CQI skills will become a core competency for the home visiting workforce. Under a contract and separate from this FOA, the DHVECS staff will reach out to experts including home visiting model developers and subject-matter experts to narrow down the selection of programmatic topics for improvement that will establish the technical content for the HV CoIIN.  This will likely include a preliminary charter, measurement system and a set of strategies or best practices associated with the 4-8 goals for the HV CoIIN (or Change Package).  The successful applicant shall review any previously developed material for the HV CoIIN and, in collaboration with HRSA, revise and update such technical content as needed as the HV CoIIN is formally launched. The following is an illustrative set of activities under the HV CoIIN: A core group of (4-6) experts constitutes the faculty of the HV CoIIN learning collaborative who remain engaged with participating teams, grantees and the planning group (involving awardee and DHVECS staff) for the duration of the HV CoIIN. Individual grantees and the selected LIAs commit to a working period of 18-24 months. Each LIA or pilot site constitutes a continuous quality improvement (CQI) team. The HV CoIIN platform and the Model for Improvement are introduced to grantee and LIA teams during the initial phase of the project.  Team members learn quality improvement methods and tools in structured virtual or in-person sessions. Local teams then apply these CQI techniques to test, innovate and customize the recommended changes in their agencies throughout the project with the support of the expert faculty, the awardee staff and the DHVECS staff (which constitute the collaborative management or planning team). Teams have access to a common Internet-based platform to post periodic progress reports, run charts, and to share lessons learned across settings via conference calls and other forms of communications in between planned technical assistance virtual or in-person activities. [[]1] Gloor P. Swarm Creativity: Competitive Advantage through Collaborative Innovation Networks. New York, NY: Oxford University Press, 2005. [[]2] For instance, the HV CoIIN could follow the publicly available Breakthrough Series (BTS) Learning Collaborative model pioneered by the Institute for Healthcare Improvement (IHI), which is a time-limited technical assistance platform involving learning and improvement activities for participating organizations. The Breakthrough Series: IHI’s Collaborative Model for Achieving Breakthrough Improvement. IHI Innovation Series white paper. Boston: Institute for Healthcare Improvement; 2003. [[]3] G Langley, R Moen et al. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. 2nd edition. Jossey Bass. 2009.
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