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substance abuse  services for
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Peer Review


Peer Review Policy & Procedure  

Alameda County Behavioral Health Care Services (ACBHCS) will require each provider site or other contracted Community Based Organization (CBO) to follow policy and procedure in accordance with the Peer Review Plan described below.  The primary mission of the Peer Review Plan is to facilitate ongoing quality improvement in delivery of services to consumers at the program level.  The process used is intended to be a vehicle for program transformation rather than individual clinician review.

Complete information...


As a result of the thoughtful feedback, comments and questions regarding the proposed changes to the Peer Review process being piloted by BHCS, it was thought that a FAQ (Frequently Asked Questions) format might be the best avenue to respond and share the information with staff.  If you have additional feedback or questions, please contact: Kyree Klimist, QA Assoc. Administrator 510-639-1360.  The FAQ will be updated periodically, as questions are posed.

1. The committee has been hearing feedback that some of you did not like the ‘work in progress’ aspect of the roll out of this project.

We understand that it does make certain things more difficult, most notably that, as progress happens, change happens.  If you came to the 1st training session, you may not get something that was changed in the 3rd training session.  This is, of course, frustrating.  However, we do feel that feedback, flexibility and change are good things.  Therefore, we have created this FAQ document which will be updated regularly, as needed, to communicate any changes that happen.  We hope this will help.

2. Why is the county doing this now? What happened that created the need for this change?

There are a number of things that are happening in the county.  One of the biggest is the push for system change in the directions of Wellness, Resiliency, Recovery and the use of Best Practices.  Quality Improvement is at the center of all of this.  As a result, there has been a corresponding increase in the size of the QA/QI staff.  BHCS now has the staff needed to focus on system evaluation and system improvement in line with those goals.

3. Performance Improvement Project or Peer Review -just what are we doing?

We are piloting a new form of Peer Review that includes best practices.  The goal is to use the peer review process as a tool for quality improvement on a system level.  In some ways, it does resemble a PIP.

4. We found the old Peer Review clinically useful and we enjoyed it. We don’t really want to abandon doing it.

Peer supervision and peer review has long been a part of most clinical programs because it has value to individual clinicians.  We strongly encourage you to continue this practice if it has been useful and/or enjoyable to staff.

Of course, you no longer have to report on that to the county.

5. Why the change from individual clinican performance to program performance? Don’t they really result in the same thing?

This is important for a few reasons.  Research tells us that problems in service delivery and quality of care are predominantly related to problems in care caused by system-based issues (85%) vs. (15%) individual causes.  The literature also establishes that the use of best practices improves the quality of care and improves client outcomes.   Therefore, the goal is for clinicians to use best practices as a way to facilitate program improvement.  By definition, program improvement means better client outcomes.

6. How many people are supposed to present? What should we consider when trying to decide the number of cases?

Here is a wonderful opportunity to be creative.  There are a couple factors to consider.  The number of cases that you need to present will depend on how you plan to measure change and how much information you need.  First, choose a topic that is relevant to improving client outcomes.  You need to define where you are at. What is your starting point?  Your baseline?

Case presentation is your primary vehicle for gathering information. How much information do you need? Do you need ‘before and after’ information? Are you exploring a problem or the results of a change you are making? Where in your process do you need to gather that information?

The number of case presentations depends on all of these factors. Be creative and have fun.

7. Plan your year ahead of time.

Remember to give yourself time towards the end of the fiscal year to make sense of the information and write your report.  You may find that you want to do the bulk of your case presentations in the middle of the year, so that you have plenty of time to do the rest of what you want to do.

8. What do you do with the information you gather?

Following the report format that you have been given, you will write a report summarizing what your have learned, what changes you may have made and/or how looking at a practice or problems has made a difference in your clinical practice.

9. What is the county going to do with all the gathered information?

The main benefit of this information is to use it to improve the service delivery system.  We will also share the information within the system in these ways:

a. We will be establishing a website specifically for the Peer Review Reports.  Providers will be able to view each others’ projects to see what you each are working on, what works, and what doesn’t, and to get ideas for the coming year.

b. In addition, we will be hosting a yearly conference featuring the most interesting Peer Review Reports, presented by their providers.  This will give the provider community an opportunity to share with the peer community in depth.

10. Next Steps

a. Training Session 2:

November 9th, 2007
2000 Embarcadero Cove
Alameda Room
Oakland, CA 94606

b. QA web page has been redone! click on Quality Assurance and then on General. There is a section for Peer Review where this FAQ is posted and will be updated regularly.

c. Report guidelines to be mailed and posted to the website within a week.

Report Format   

It is important that the report format of the Peer Review is consistent because the committee plans to collect and disseminate this information and conformity will help in this endeavor.  The expectation is that your reports will follow this format.

As always, if it doesn’t seem to fit and/or you have questions, please contact the QA Department at 510-639-1360.

Kyree Klimist, MFT
QA Associate Administrator


1. Program Details

  • Describe your Program
  • # of clinical staff with disciplines
  • # of staff participating with disciplines (including non-clinical staff)
  • # of cases reviewed

2. Statement of Topic/Problem:

  • How and why it was chosen
  • What is your goal?
  • By what process did you evaluate if you have met your goal?

3. Statement of information gathered through Peer Review and other means. If other means are used, please describe.

  • Clear statement of information gathered

4. Analysis of the information and what it means.

  • What does the information indicate needs to happen, if anything?
  • What conclusions can be drawn?
  • Did you meet your goal?
  • This may require more brainstorming at this point in time.
  • This may require more gathering of information and repeating of the process.
  • Document your process.
  • Attach any changes to documents etc.

5. Outcomes, conclusions & future plan (if any).