Quality Service Review

Organizational Learning for System Improvement

The Philadelphia Department of Human Services’ mission is to provide and promote safety, permanency, and well-being for children and youth at risk of abuse, neglect and delinquency

Mission Statement

Organizational Chart

Division of PMA started in 2009

Mission: The division of Performance Management and Accountability will support system improvement by monitoring and evaluating the efficiency, effectiveness, and availability of our services both internal and external

Five Pillars: DIM, QI, PREP, PBC, and Research

Performance Management and Accountability (PMA)

Case File Review

Quality Visitation Review

Quality Service Review

Child Fatality Review

ChildStat

Quality Improvement (QI)

The Quality Service Review (QSR) is a practice improvement approach designed to assess current outcomes and system performance by gathering information directly from families, children and service team members

Quality Service Review

Mid 1990’s: The first QSR protocol developed Other states that use the QSR process

◦ Alabama◦ Utah◦ Wisconsin

Fall of 2009: Pennsylvania and Philadelphia management observe Utah’s QSR process

January 2010: PA’s OCYF adopts the QSR process and selects Philadelphia to participate in the first QSR pilot process

June 2010: Philadelphia begins internal QSRs

Quality Service Review History

Occurs six times a year

Small sample of randomly selected cases

Stratified by service area

◦ Congregate Care

◦ Children with Special Medical Needs

◦ Adoption

◦ General Foster Care (Foster and Kinship Care)

◦ Treatment Foster Care

◦ In-Home Services Array

◦ Older Youth (SIL/TLP)

Philadelphia’s Local QSR Process

Review teams Brief review of the case file Initial interview with DHS worker and supervisor Interviews with stakeholders and families

◦ Focus child/youth and biological family◦ Foster parents and group home parents◦ Private provider workers◦ Attorneys◦ Mental health, educational, and medical

personnel Focus Groups

QSR: Gathering Information

Traditional Review Were visits timely?

Is the child’s IEP in the file?

Was there a referral to a mental health

service?

Quality Service Review

Are children currently safe?

Is the child progressing well academically?

Is the child functioning well emotionally?

Difference between Traditional Reviews and the QSR

Traditional Review

Is there a current plan in the file?

Did the parents sign the plan?

Is there a written assessment?

Quality Service Review

Is the plan likely to lead to permanence?

Do the parents feel that the plan is their own?

Does the assessment accurately identify underlying needs?

Difference between Traditional Reviews and the QSR

Pennsylvania QSR Protocol◦ 9 Child/Youth and Family Indicators◦ 11 Practice Performance Indicators

Scoring Process◦ 6 – Optimal◦ 5 – Substantial Acceptable Range◦ 4 – Fair◦ 3 – Marginal◦ 2 – Poor Unacceptable Range◦ 1 – Adverse

QSR: Scoring Process

Case specific feedback◦ Final interview with DHS worker and supervisor◦ Written Case Story◦ Debriefing

Aggregate system-level feedback◦ Findings Present Meeting◦ Findings Present Report

QSR: Feedback

Aggregate scores from all 12 cases

Comparison of acceptable and unacceptable scores with all QSR cases

Content analysis◦ Case Story recommendations◦ Focus Groups

Trends and recommendations

Data Analysis

Demographic information

Indicator ratings◦ Child/Family◦ Practice Performance

Comparison with overall QSR ratings

Case Stories

Recommendations

Findings Present Report

All QSR reviewers

DHS management

Private provider representatives

Leaders from the courts

Child advocate and parent attorney offices

Representatives from the mental health, educational, and medical systems

Findings Present Meeting

Findings Present Graph

Safety

Physical health

Engagement of child/youth and substitute caregiver

Overall Trends: Strengths

Increase the use of Family Finding and Family Group Decision Making to support family engagement and culturally appropriate practice

Use of specific teamings at key case intervals (e.g. Permanency Action Teamings) to improve planning, permanency, and teaming indicators

Current Improvement Initiatives

Suggested improvements◦ Submitted to the Commissioner and her cabinet for

approval◦ Assigned to a responsible person

Quality Improvement tracking system◦ Used to track recommendations from all QI reviews◦ Recommendations entered into a database◦ Monthly updates recorded to track individual

implementation◦ Quarterly reports published to track overall

implementation

Tracking Recommendations

“This process allows the child, family and team members to be seen and heard rather than just read about. This allows for a better understanding of actual service delivery and needs.” -DHS Worker

“I like that the QSR takes more than just the case record into account. By speaking to all parties a person is able to get a better understanding of the case.” - DHS Supervisor

Response to the QSR from DHS Staff

“I like being heard and feeling that providers are recognized for the service that is being provided. I appreciated the reviewers coming out to our facility making it convenient for me to participate. The reviewers did a great job making me comfortable to share my honest opinions.” – Provider Worker

“I think this process of review is very important to make improvements and give better service.” –Medical Personnel

Response to the QSR from Outside Stakeholders

Interested in observing the QSR process?◦ Contact Brian Clapier (Brian.Clapier@phila.gov)

Pennsylvania QSR Protocol◦ http://www.pacwcbt.pitt.edu/Resources/PA%20Q

SR%20Protocol%20Version%201%200.pdf

Come Observe!

QUESTIONS

Contact Information:

Susan.Kinnevy@phila.govBrian.Clapier@phila.gov

Allison.Thompson@phila.govCynthia.Brown@phila.gov