Overview of Continuous Quality Improvement CQI First QSR

Overview of Continuous Quality Improvement (CQI)

First QSR Orientation Meeting Objectives • Introductions of QSR State Site Lead(s) and Local Site Lead(s) • Overview of the Continuous Quality Improvement process and the role of QSR in that process • Purpose of the Quality Service Review process – Casespecific review; Focus Groups and Key Stakeholder Interviews • Overview of the components of the QSR process and timelines associated with the on-site review • Overview of the QSR indicators • Composition of the review team

Continuous Quality Improvement What it isn’t and what it is… Continuous Quality Improvement (CQI) is not a time limited project or initiative. It is the ongoing process by which an agency makes decisions and evaluates its progress. “A framework for implementation” Casey Family Programs & NRCOI

The DAPIMTM Model: A “Flywheel” Define Monitor Assess Performance & Capacity Implement Plan -© 2009 American Public Human Services Association

A Closer look at Monitoring What is a Quality Service Review? • Measures child, youth, and family outcomes • Reveals the practice model being used in actual cases. • QSR is an organizational learning process offering helpful ways of knowing what’s working and not working in practice -- for which children and families and why. • QSR connects results to local frontline conditions. • QSR supports teaching & action learning processes that clarify expectations, provide useful feedback, and affirm good work. • QSR stimulates actions taken to improve practice and

How Does QSR Work? üState and local review team members review case of one focus child/youth § Brief review of the record § Focused interviewers with members of the child/family team § Rates the status of the child/family and the system performance on a 1 -6 scale § Written case review summary “tells the story” of what was learned from the team

ü Immediate feed back to the Caseworker and Supervisor with strengths/needs/ recommendations § Case specific § Agency specific ü Focus groups with stakeholders and key stakeholder interviews ü Debriefing with QSR Team ü Exit Conference of preliminary findings ü Final findings report ü Next Steps Meeting

QSR Activities QSR Case Reviews QSR Focus Groups and Key Stakeholder Interviews DPW Licensure Stakeholder interviews Caseworkers Same cases as QSR sample Feedback to Caseworker and Supervisors Written Case Summary Aggregate quantitative results Other: may consider youth, birth families, foster families, courts, etc. Additional intake, foster home, and personnel files Review for regulatory compliance Summation, Discussion, Next Steps Planning

PA QSR Protocol: Child/Youth and Family Status Indicators • • • 1 a. Safety: Exposure to Threats of Harm 1 b. Safety: Risk to Self/Others 2. Stability 3. Living Arrangement 4. Permanency 5. Physical Health 6. Emotional Well-being 7. Learning & Development 8. Pathway to Independence 9. Parent & Caregiver Functioning

PA QSR Protocol: Practice Performance Indicators • 1 a. Engagement Efforts • 1 b. Role and Voice • 2. Teaming • 3. Cultural Awareness & Responsiveness • 4. Assessment & Understanding • 5. Long-Term View • 6. Child/Youth and Family Planning Process • 7. Planning for Transitions and Life Adjustments • 8. Efforts to Timely Permanence • 9. Intervention Adequacy & Resource Availability • 10. Maintaining Family Connections • 11. Tracking & Adjusting

Interpretive Guide for Child/Youth and Family Status Indicator Ratings Unacceptable Range: 1 -3 Acceptable Range: 4 -6 Improvement Zone: 1 -2 Refinement Zone: 3 -4 Maintenance Zone: 5 -6 Status is problematic or risky. Quick action should be taken to improve the situation. Status is minimum or marginal, may be unstable. Further efforts are necessary to refine the situation. Status is favorable. Efforts should be made to maintain and build upon a positive situation. 1 2 3 4 5 6 Adverse Status Poor Status Marginal Status Fair Status Substantial Status Optimal Status The individual’s status in this area is poor, unacceptable and worsening. Status is and may continue to be poor and unacceptable. Any risks may be mild to serious. Status is mixed, limited or inconsistent and not quite sufficient to meet the individual’s shortterms needs or objectives now in this area. Status is at least minimally or temporarily sufficient for the individual to meet short-term needs or objectives in this area. Substantially and dependably positive status for the individual in this area with an ongoing positive pattern. Status is good and likely to continue. The best of most favorable status presently attainable for this individual in this area (taking age and ability into account).

Final Report QSR Findings Report – – – Demographics Child/Youth and Family Status Domain Practice Performance Status Domain QSR Results Summary Key Questions to Consider for Next Steps Planning

Purpose: The Next Steps Meeting is designed to be a starting point or continuation of the county’s efforts in the Continuous Quality Improvement (CQI) process which focuses on the development of an action plan for enhancing case practice and system performance.

Sponsor and Improvement Teams Sponsor Team • Defines high-level vision of CQI efforts • Secures resources • Creates and charters Improvement Team Sponsor Team Improvement Team • Guides CQI work day-to-day • Maintain hands-on responsibility for CQI efforts • Charters and oversees smaller CQI work groups • Communicates with Sponsor Team Implementation Team Work Groups • Implement improvement efforts focused on specific target areas • Representation from agency staff, providers, consumers

County Improvement Plan (CIP) Section I. Sponsor Team Members Section II. Background Section III. Priority Outcomes Section IV. Findings Section V. Strategies and action steps for each outcome

Bringing CQI to Life CQI Sponsor Team receives findings Improvement Team monitors and analyzes work groups CQI Work Groups identify and implement strategies to actualize CIP Review and analysis of CQI findings (with focus on QSR results) CYS leadership, CQI staff, with support of TA Collaborative CQI Sponsor Team reviews County Improvement Plan and approves for submission to state Identify recommended improvement priorities CQI Sponsor Team creates CQI Charter and approve priorities CQI Improvement Team receives CQI Charter and develops County Improvement Plan

What’s in it for your County? • Provides a great source of information and data related to your specific case, related to agency trends, systems’ issues (report on each sample case generated after reviews) • Supports the framework for the county’s current change efforts • Case-specific improvement

QUESTIONS AND COMMENTS