Continuous Quality Improvement

Enter YOUR Service Area along with Lead and

Facilitator Name!

Making Ideas Work

Catalyst for Change

CQI Purpose

CQI is a process that empowers staff by

involving everyone in the evaluation and improvement of the effectiveness and

efficiency of services provided by Children and Family Services

CQI Philosophy Basic concept: small, continuous steps

toward achieving better results Focus: self-directed, self-determined

change; leadership is by all Process through which teams:

Identify needs, goals, resources and strengths toward achieving results;

Develop action plans to improve services; and Forward unresolved issues to the next CQI level.

Key Processes in CQI

CQI Service Area and State Teams: Identify and solve barriers to service delivery and achievement of outcomes

Management Reports and Data: Keep the work on track and watch the results

Reviews of Case Work Quality: Promote

high quality case work and best practices

CQI Process

Identify and solve barriers to service delivery and achieve outcomes

Increase knowledge through data and reports

Create action plans for improvement & continued improvement

Case reviews and use of the review results to improve practice

CQI Process (cont)

All Staff members are involved in evaluating the effectiveness and efficiency of services provided to Children and Families

Examines internal systems, procedures and outcomes

Examines relationships and interactions between CFS and other stakeholders

Identifies strengths

CQI Process (cont)

Creative Inclusive Recurring Empowering Structured Solution-focused Efficient Action-oriented Common Sense Driven

Evolution of CQI in Nebraska

Development of CQI Unit and Quality Assurance Team

Performance Based Contracting Compliance vs. Improvement Accreditation (future)

Accreditation Overview

Purpose of Accreditation: Accreditation provides a number of benefits to

agencies: set of nationally recognized standards of

excellence to gauge DCF against means of system reform and practice

improvement national recognition as an accredited agency peer review from people who truly understand

public human service practice an opportunity to conduct a self study that will

lead to improved and streamlined policies and practices

Types of Accreditation Joint Commission for The Accreditation of

Healthcare Organizations (JCAHO) – medical model, used with hospitals and behavioral healthcare organizations

Commission on Accreditation for Rehabilitative Facilities (CARF) – geared as the name suggests for rehabilitative facilities

National Association for the Education for Young Children (NAEYC) – child care associations

The Council on Accreditation of Services for Children and Families (COA) – designed for services based on a social-work, community model

Overview of CQI

Provide Children and Families with the highest quality programs with demonstrated positive outcomes

Ongoing process of identifying, describing and analyzing system strengths and weaknesses

Continuously assess and modify programs and processes based on objective information

Strategically plan to promote continued improvement

Overview (cont)

Dependent upon active inclusion and participation of staff, children, youth , families and stakeholders throughout CQI process

Supports system-wide initiatives such as the development and implementation of Program Improvement Plans (PIP), case reviews, Accreditation processes and other critical initiatives

CQI Key Principles

Data and information Data and measurement Active engagement of Staff Improvement Continuous learning

CQI Cycle of Improvement

CQI Teams: Service Areas and State Level

Identify and solve barriers to service

delivery and achievement of

outcomes

CQI Team Mission Statement

This team, through a partnership with internal and external stakeholders, will focus active attention on the unique strengths and needs of the children and families we serve, in order to achieve measurable, positive outcomes in safety, permanency, and well-being at the local Service Area Level.

Service Area CQI Teams Members of a Service Area CQI team:

Membership means that every staff member has a voice in decisions about the agency

Everyone helps to lead the agency Your Team may:

Have 8-12 members within the Service Area Meet at least quarterly

Service Area Team represented on State Network

Teams to be facilitated by Central Office Quality Assurance Program Specialist

CQI Team Members Local Service Area HHS Staff & Contractors Field Staff Training Staff Legal parties (County Attorneys and/or Judges &

DHHS Legal) Foster Care Review Board CASA Education Probation Foster Parents Youth and Families Family Organizations

CQI Team Roles Team Leader (DHHS Children and Family

Services Administrators or other designee) – reinforces work of the teams and represents team’s work to internal and external entities

Team Facilitator (DHHS Central Office QA) – manages team meeting process

Team Scribe (Local DHHS Staff) – logistics, records comments and activities of the team

Team Members – participate and represent their area

Team Leader – DHHS Administration

Develop the agenda jointly with QA Facilitator

Discuss with QA Staff available data for meeting

Delegate team tasks as needed Ensure that the developed corrective action

plans and strength plans are monitored and updated

Report progress State CQI Team

Facilitator - Quality Assurance Program Specialists Role

Develop, prepare and disseminate data and additional information to Service Area CQI Teams

Facilitate action and improvement by: Coordinating and facilitating Service Area CQI

meetings Liaison between management and staff Mentoring and guiding staff toward use of best

practices Coordinating with other Service Area QA Staff

Facilitator - Quality Assurance Program Specialists Role (cont.)

Coordinate implementation of special initiatives and projects

Advocate for statewide system changes that will improve results

Present participants’ ideas that are unable to attend

Read trends Anticipate barriers Identify strengths

CQI Teams

Decision-Making

Identification of needs, goals, available resources and strengths of services, staff and community partners Current performance (baseline) to future

performance (agency goals)

Focus on topics of interest such as Safety, Mini CFSR, Family Team Meeting, Contract Monitoring, etc.

CQI Teams Design and promote development of

strategies which can be implemented to alleviate the identified issues Identify 3 areas for change Identify 3 areas of strength If data indicates an issue related to

Safety, at least one of the areas for change will be in Safety: otherwise, areas for change will be selected for which the information and data indicates the greatest need for improvement

CQI Teams

Implement and monitor local corrective action plans to resolve identified issues Corrective Action Plans and Strength

Analysis Plans will be posted on a shared website

Forward unresolved issues to State CQI Team for possible resolution Policy changes, statewide training needs,

etc.

CQI Statewide Team

Team will review all Corrective Action Plans from the Service Areas as well as strengths in practice

Team will identify statewide trends of best practice and areas needing improvement

Analyze statewide information and data Develop statewide strategies for change

in areas of Practice, Policy and Training

Management Reports and Data

Keeping the work on track

Monitoring the results

Management Data Reports Team Participants will analyze existing data,

contribute additional data/relevant information, and hypothesize contributions at the following levels: Client Level (Are there ways to solve the

problem by changing how we interact with the client?)

Program Level (Are there ways to solve the problem by modifying the program that serves the client?)

Community Level (Are there ways to solve the problem through local community resources?)

Management Data Reports Management information systems (NFOCUS,

Case Review, QA Reports) Outcome measurements (Mini CFSR reports,

Safety Model reports, FTM reports, Compass) Case Review quality (Case Review System) Customer surveys Required Contractor program evaluation

reports (EBP, Disaster Plan, Quarterly reports, etc.)

CFSR Outcomes

Safety Permanency Well-Being

CFSR Performance

Baseline Data Describes current and historical views of

outcomes Describes Agency achievement of the

outcomes

Federal CFSR Findings

Outcome Associations

Includes the 35 States reviewed in 2002-2004

Case worker contacts with children and families demonstrate a high performance on Safety, Permanency and Well Being Outcomes

Findings Regarding Safety

Associations Between Safety Outcome 2 and other Indicators

Significant associations exist between Safety Outcome 2 and these indicators:

Needs & Services of Child, Parents, Foster Parents

Parents’ Involvement in Case Planning

Caseworker Visits with Child

Caseworker Visits with Parents

Timeliness of Initiating Investigations

Findings Regarding Permanency

Relationship of Well-Being to Permanency

Positive ratings on

• Services to children, parents, foster parents

• Involvement of parents in case planning

• Caseworker visits with children

• Caseworker visits with parents

Substantial

achievement on

• Timely achievement of permanency (Outcome P1)

• Preserving children’s connections while in foster care (Outcome P2)

supports . . .

Factors Associated with Timely Reunification, Guardianship, and Permanent Relative Placement

The strongest associations with timely reunification guardianship, and permanent relative placement include:

Caseworker Visits with Parents

Child’s Visits with Parents and Siblings in Foster Care

Services to Children, Parents, & Foster Parents

Family/Child Involvement in Case Planning

ASFA Requirements Regarding Termination of Parental Rights

Placement Stability

Factors Associated with Timely Adoption

The strongest associations with timely adoption include:

Needs & Services for Children, Parents and Foster Parents

Holding timely permanency hearings

Holding timely six-month case reviews

ASFA requirements regarding termination of parental rights

Factors Associated with Placement Stability

The strongest associations with placement stability include:

Placement with relatives

Services to children, parents, and foster parents

Involvement of children and parents in case planning

Caseworker contacts with parents (not children)

Age of child – most stable are ages 0 - 6 and 16 - 18 –

least stable are ages 13 - 15

Item and Outcome Ratings that were Significantly

Associated with Case Review Indicators

Permanency

Hearings

Adoption

Termination ofParental Rights

Adoption

Permanency Outcome 1

Reunification

Six-Month Case Reviews

Adoption

Well Being Outcome 1

Findings Regarding Child & Family Well-Being

Association with Systemic Factors

States in substantial conformity with these 2 systemic factors had significantly higher percentages of cases rated substantially achieved for Well Being Outcome 1 than States that were not in substantial conformity with these systemic factors.

Service Array

Quality Assurance

Well Being: The Importance of

Caseworker Visits with Parents and Children

91% of the cases rated as a strength for Caseworker Visits with Parents were also

rated as a strength for Caseworker Visits with Children.

Caseworker Visits

with

Children

Caseworker Visits

with

Parents

Strongest Associations Between Visits and Other Indicators

Both Caseworker Visits with Parents and Caseworker Visits with Children were strongly associated with:

Risk of harm to children (Item 4)

Needs & Services for children, parents, foster parents (Item 17)

Child and parent involvement in case planning (Item 18)

Other Significant Associations Between Visits and Indicators

Caseworker Visits with Parents and Caseworker Visits with Children were also strongly associated with:

Services to protect children at home Safety Outcome 1 Safety Outcome 2 Timely permanency goals Timely reunification Child’s visits with parents and siblings Relative placements Meeting educational needs Meeting physical health needs Meeting mental health needs