Continuous Quality Improvement by malj


									Continuous Quality

       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
   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
   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
     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
   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
   Continuously assess and modify programs
    and processes based on objective
   Strategically plan to promote continued
Overview (cont)

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

   Develop the agenda jointly with QA
   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
       Liaison between management and staff
       Mentoring and guiding staff toward use of best
       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
CQI Teams
   Implement and monitor local corrective
    action plans to resolve identified
       Corrective Action Plans and Strength
        Analysis Plans will be posted on a shared
   Forward unresolved issues to State
    CQI Team for possible resolution
       Policy changes, statewide training needs,
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
   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,
   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
       Describes Agency achievement of the
Federal CFSR Findings

   Outcome Associations

   Includes the 35 States reviewed in

   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
                    Needs & Services of Child,
Significant         Parents, Foster Parents
associations        Parents’ Involvement in
exist between       Case Planning
Safety Outcome      Caseworker Visits with
2 and these         Child
indicators:         Caseworker Visits with
                    Timeliness of Initiating
Findings Regarding
           Relationship of Well-Being to
        Positive                               Substantial
       ratings on                            achievement on
                        supports . . .
• Services to children,                  • Timely achievement of
  parents, foster parents
                                           permanency (Outcome
• Involvement of parents                   P1)
  in case planning
• Caseworker visits with                 • Preserving children’s
  children                                 connections while in
• Caseworker visits with                   foster care (Outcome
  parents                                  P2)
 Factors Associated with Timely Reunification,
Guardianship, and Permanent Relative Placement

The strongest      Caseworker Visits with Parents
associations       Child’s Visits with Parents and
with timely        Siblings in Foster Care
reunification      Services to Children, Parents, &
guardianship,      Foster Parents
and permanent
                   Family/Child Involvement in
                   Case Planning
include:           ASFA Requirements Regarding
                   Termination of Parental Rights
                   Placement Stability
 Factors Associated with Timely Adoption
The strongest      Needs & Services for Children,
associations       Parents and Foster
with timely        Parents
include:           Holding timely permanency

                   Holding timely six-month
                   case reviews

                   ASFA requirements regarding
                   termination of parental rights
Factors Associated with Placement Stability

The strongest        Placement with relatives
associations         Services to children, parents,
with                 and foster parents
placement            Involvement of children and
                     parents in case planning
include:             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

 Six-Month Case     Permanency    Termination of
     Reviews         Hearings     Parental Rights

    Adoption        Adoption        Adoption
   Well Being                     Permanency
   Outcome 1                       Outcome 1
   Findings Regarding
Child & Family Well-Being
   Association with Systemic Factors

                        States in substantial
                        conformity with these 2
                        systemic factors had
Service Array           significantly higher
                        percentages of cases
                        rated substantially
Quality Assurance       achieved for Well
                        Being Outcome 1 than
                        States that were not in
                        substantial conformity
                        with these systemic
     Well Being:
  The Importance of
Caseworker Visits with
 Parents and Children
Caseworker Visits              Caseworker Visits
     with                           with
    Children                       Parents

      91% of the cases rated as a strength for
    Caseworker Visits with Parents were also
  rated as a strength for Caseworker Visits with
Strongest Associations Between Visits and
            Other Indicators

Both Caseworker            Risk of harm to
Visits with Parents   children (Item 4)
and Caseworker
Visits with                Needs & Services
Children were         for children, parents,
strongly associated   foster parents (Item 17)
                          Child and parent
                      involvement in case
                      planning (Item 18)
    Other Significant Associations
    Between Visits and Indicators
                  Services to protect children at
Caseworker        home
Visits with       Safety Outcome 1
Parents and       Safety Outcome 2
Caseworker        Timely permanency goals
Visits with       Timely reunification
Children were     Child’s visits with parents and
also strongly     siblings
                  Relative placements
                  Meeting educational needs
with:             Meeting physical health needs
                  Meeting mental health needs

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