General Questions & Acronyms
What do you mean by “consumers and family members”?
CQT defines a consumer as someone who has lived with mental illness.
CQT defines a family member as someone who has a family member or close relative who has lived with mental illness.
CQT chooses to use the word consumer and maintain a simple definition. There are many but other terms (peer, client, member, patient, user, ex-patient, survivor, person with mental illness, person with psychiatric disability, person in recovery, etc.) and definitions used throughout the mental health community.
What is the Public Mental Health System (PMHS)?
The public mental health system (PMHS) includes any services funded or monitored by the Department of Health and Mental Hygiene of the State of Maryland.
Services provided in the PMHS include: psychiatric inpatient care, partial hospitalization, residential treatment, respite, outpatient mental health clinics (OMHC), individual mental health practitioner services, psychiatric rehabilitation programs (PRP), residential rehabilitation programs (RRP), mobile treatment services, supported living services, supported employment and vocational services, case management services and residential crisis services. Service providers are credentialed and contracted by DHMH.
Most PMHS service providers take public health insurance (Medicaid, Medicare, Medical Assistance), though some may also accept private health insurance.
For more information about the PMHS, visit the Mental Hygiene Administration’s website here.
What is the Mental Hygiene Administration (MHA)?
Mental Hygiene Administration is a subdivision of the Department of Health and Mental Hygiene of the State of Maryland.
MHA operates inpatient psychiatric facilities for adults and residential treatment centers for children and adolescents, funds community mental health services for Medicaid eligible individuals, and monitors the quality of those services.
For more information about MHA, visit the website here.
What is a Core Service Agency (CSA)?
A Core Service Agency (CSA) is a funding/oversight agency responsible for managing the PMHS services within a specific jurisdiction. Most CSAs are responsible for monitoring all of the PMHS services in a county, though some CSAs oversee services in multiple counties. CSAs can be a part of the county government or an independent non-profit organization.
Click here for a list of all CSAs in Maryland.
What do you mean by “funding/oversight agency”?
Within the PMHS, there are several departments, administrations and organizations that are responsible for funding, monitoring, credentialing, licensing, providing administrative support to and resolving problems with mental health services providers in any given area. CQT uses “funding/oversight agency” to denote the organization with these responsibilities in a particular situation.
What do you mean by “provider associations”?
Like in most fields, there are professional associations in the field of mental health services. Provider associations in Maryland include the Community Behavioral Health Association of Maryland (CBH) and the Maryland Association of Resources for Family and Youth (MARFY). These organizations advocate for, and provide support and technical assistance to their members.
CQT includes representatives from provider associations at Feedback Meetings to give input on consumers’ requests, suggestions and concerns from the provider’s point of view. Concerns and suggestions brought up by consumers and reported at CQT Feedback Meetings have also inspired new agenda items, work groups and training initiatives to be created by provider associations to address program and system issues.
CQT Organization & Staff
Is CQT a state agency? How is CQT funded?
CQT is housed at the Mental Health Association of Maryland (MHAMD), a private, non-profit organization which provides education and advocacy on behalf of individuals with mental illnesses. CQT is supported by funding from the Mental Hygiene Administration of the Department of Health and Mental Hygiene and is authorized by MHA to conduct site visits to programs in the public mental health system; however, CQT is not a state agency.
Where is CQT located?
CQT is housed at the Mental Health Association of Maryland (MHAMD), located in the Hampden neighborhood in Baltimore City. CQT Interviewers travel around the state to conduct site visits.
How is CQT staffed?
CQT is currently comprised of part-time and full-time Interviewers, Program Assistant, Program Manager and Director.
Read more about our team here.
Contact information for key CQT Staff members can be found here.
Why is CQT staffed exclusively by consumers and family members?
We are staffed exclusively by consumers and family members because:
- Our mission is to empower individuals who receive services as partners with providers, policy makers and family members, to improve care in the public mental health system and ensure services meet the expressed needs of consumers.
- We believe mental health consumers have significant personal knowledge and experience that is essential to building a recovery-oriented and effective system of care.
- We know that people share their thoughts, feelings, opinions and suggestions honestly only when they trust that person listening understands, cares and respects them. As consumers and family members, CQT Interviewers have the personal knowledge and shared experience that is needed for a trusting, open and respectful dialogue.
What kind of training do CQT Interviewers have?
As CQT has developed since its first site visit in January 2007, the training process has undergone regular revisions and updates. CQT Interviewers usually spend their first weeks getting oriented to the CQT program and trained on interviewing techniques and reporting procedures. Interviewers then spend at least two weeks in the field, observing site visits and continuing training on procedures. When they are comfortable with the procedures, new Interviewers are assigned to partner with an experienced team member and go on site visits in the role of note-taker. From that point, CQT Management and existing staff work with new Interviewers until they are able to handle all aspects of the process.
CQT also participates in training events throughout the year, including conferences, workshops, and special events. Many CQT interviewers have completed other mental health training, including: Mental Health First Aid, Wellness Recovery Action Planning, NAMI’s Peer-to-Peer classes, etc.
Current Program
How many sites do you currently visit? Where does CQT operate?
Click here for the list of sites CQT currently visits.
Does CQT analyze data about the PMHS?
CQT does not collect data about programs or the public mental health system. CQT does not use a standardized data collection instrument or generate scientific findings based on a random sample of a population. CQT does not validate the information given by consumers. The information collected reflects the feelings and beliefs of the individuals who choose to be interviewed on any given day; thus it should not be used as an independent tool to evaluate a provider or a program.
Still, as CQT makes site visits to programs throughout the state, some things are reported over and over and themes emerge. CQT publishes an Annual Report each year highlighting the top issues, both positive and negative, that consumers reported.
Can I read a copy of the Site Visit Report for my agency?
CQT Site Visit Reports are not public documents and are only sent to designated agency staff. For site visits to PRPs, reports are sent to the director of the program and the CSA. For inpatient facilities, reports are sent to the building director, division director and CEO.
CQT does publish Quarterly Reports spotlighting recently reported issues.
What types of changes have you seen in programs?
The most drastic changes CQT has seen involve the removal of abusive staff. Other changes include new classes, better food, a new van service and other quality of life improvements.
Click here to read stories of how CQT helped ensure that PMHS services met the expressed needs of consumers.
From CQT’s 2-year program evaluation:
“Many PRP staff members said their PRPs were able to successfully resolve individual consumer concerns contained in CQT feedback, such as individuals’ problems with roommates or needs for medical attention. Other PRP providers reported CQT feedback led them to make improvements that helped multiple PRP consumers; these changes ranged from the availability of healthier vending machine snacks to the disciplining or replacement of PRP staff members who were treating consumers poorly.”
Are there problems that cannot be resolved through CQT?
CQT does not resolve problems; we report issues to the agencies in the PMHS that have the capacity and authority to resolve problems via Site Visit Reports and Feedback Meetings. Any suggestion, concern or request can be referred to an appropriate agency through CQT.
There are requests, concerns or complaints made by consumers that are not able to be resolved as the consumer would like. Often this is because the agency providing services does not have the power to make a change, or because there are not viable alternatives to the current situation.
Issues that may not be able to be resolved through CQT include such things as:
- Dissatisfaction with the amount of SSI or SSDI payments: SSI and SSDI amounts are mandated by the federal government
- Dissatisfaction with placement in a particular RRP: There may be no other available RRP beds in the county.
or
All requests are recorded by CQT Interviewers, included in the Site Visit Report and addressed at the Feedback Meeting.
What follow-up does CQT do with individual consumers?
CQT does not formally follow up with individual consumers. Every consumer interviewed receives contact information for CQT and is encouraged to contact us if their issue is not addressed.
Program staff and/or the CSA are able to follow up with those individual consumers who gave permission for their name to be shared with agency staff.
CQT visits most sites 3-6 times each fiscal year. Consumers can choose to interview with CQT to discuss a previously reported issue.
What’s the best program? What’s the worst program?
CQT doesn’t evaluate programs. We report what consumers tell us about a program or services on the day of the site visit. CQT does not validate the information given by consumers. The information collected reflects the feelings and beliefs of the individuals who choose to be interviewed on any given day; thus it should not be used as an independent tool to evaluate a provider or a program.
Are program staff and funding/oversight agencies receptive to CQT?
Programs and funding/oversight agencies have been exceedingly receptive to the CQT program. When CQT expands – to a new jurisdiction or a new program - CQT staff meet with the funding/oversight agency or program/facility staff to explain the CQT process, learn about the programs in the jurisdiction and answer any questions. Programs and funding/oversight agencies are able to use information from CQT Site Visit Reports in their own quality improvement processes.
Program staff and oversight agency staff interviewed during CQT’s 2-year evaluation said:
- “What is helpful [about CQT’s process] is that there is an exit interview before [the team] leaves, which gives us immediate feedback. This is collaboration with everyone. CQT is not intimidating and you also get documented feedback… Also, with CQT, we can always count on them to follow up.”
- “[CQT] generates ideas about how to improve our services and sometimes helps us to explain to our administration why we may need to spend more money in some areas.”
- “… I have to go to a lot of meetings, and I dread most of them – a lot of theoretical stuff. [CQT Feedback Meetings are] concrete, and after each meeting I feel like I have more power to do my job. This is one of the meetings I look forward to.”
- “All problems have not been solved, but there are steps in the right direction.”
- “It is generally easy for [programs] to make the changes or address the issue. It is nice to be alerted to issues.”
Are consumers receptive to CQT?
From CQT’s 2-year program evaluation:
- “Virtually all of the consumers who reported being interviewed by CQT indicated that they felt comfortable with the process. Overall, consumers had positive things to say about the manner in which the interview were conducted. CQT interviewers were described as: very friendly, very professional, good listeners, and caring.
- “I felt comfortable [being interviewed by CQT] because they say they wouldn’t put my name out and they listened to me.”
- “… They ask the right questions”
Does CQT do audits or investigations?
CQT does not conduct audits or investigations. The purpose of a CQT Site Visit is to collect unbiased, objective information about consumers’ satisfaction with the services they receive from a facility. This information is given to the director of the program or facility and the CSA for that county. It is also reviewed by the Mental Hygiene Administration.
How often do interviewers alert the CSAs about issues?
CQT meets with the CSAs every month at the Feedback Meeting. If there are issues of staff misconduct or pressing safety issues, CQT alerts the CSA or CEO immediately.
Does CQT verify comments or complaints?
CQT listens non-judgmentally to what consumers share about their lives, their needs, and their satisfaction with the services they are receiving. In some cases, consumers will discuss a particular problem, concern, or incident during an interview. CQT staff will ask follow-up questions to determine the nature and scope of the issue and, depending on the preferences of the consumer, will refer the consumer to an internal or external resource, alert program staff to the issue, and notify the CSA.
Comments or complaints can be verified by the program and/or the CSA. CQT may also report team member’s observations to program staff and alert staff to concerns or comments echoed by multiple consumers.
Can a program “opt-out” of being visited?
CQT is an ongoing program and will make 3-6 site visits to programs each fiscal year. CSAs determine the programs in a jurisdiction that will be visited.
Additionally, CQT teams understand the daily challenges and unexpected situations that can arise on any given day in mental health programs. CQT maintains a working partnership with providers; if a crisis situation arises during an announced or unannounced site visit, CQT teams will end the visit early and return another day.
Does CQT currently or have plans to visit other programs (youth, residential, clinics)?
CQT hopes to expand to visit Transitional Age Youth (TAY) programs, Residential Rehabilitation Programs (RRPs), Outpatient Mental Health Clinics (OMHCs), Wellness and Recovery Centers, and other mental health facilities. Expansion is dependent on funding availability.
Does CQT ever stop visiting programs? Is there a quota on the number of visits?
CQT makes continual site visits to programs, between 3-6 site visits each fiscal year. The review process is continual; this way CQT’s visits benefit consumers new to the program and those that have been attending for some time. CQT’s reports strive to give a more complete picture of the program. CQT does not stop visiting programs, unless directed to do so by the CSA or MHA.
Doesn’t Maryland have enough oversight and quality assurance programs?
There are very conscientious oversight and quality assurance programs in Maryland that measure outcomes and general satisfaction in the PMHS as well as individual programs/facilities. Some use annual surveys, some use site visits to check for violations of heath and safety regulations, and some rely on submitted reports of violation. These kinds of evaluation, oversight and quality assurance programs are always necessary.
What these kinds of programs aren’t able to capture are the pressing individual needs or requests and the “how and why” aspects of program improvement. Many of these activities are year-end or one-time evaluations, looking backward to find out if a program or activity met expectations.
CQT, in contrast, offers:
- Forward-looking recommendations, suggestions and explanations from the very users of the program.
- Immediate, real-time and ongoing feedback about emerging issues.
Here’s what providers say about CQT’s effectiveness:
- “[CQT] is a good tool that tries to establish a direct relationship to the provider”
- “[CQT helps consumers] feel they have an advocate to intercede on their behalf with the program”
- “[CQT is] the missing link in quality assurance monitoring.”