Overview of Continuous Quality Improvement (CQI) and Quality Service Review

(QSR) Process

Meeting Objectives

• Introductions of QSR State Site Lead(s) and Local Site Lead(s)

• Overview of the Continuous Quality Improvement (CQI) process and the role of Quality Service Review (QSR) in that process

• Purpose of the QSR process – Case-specific review; Focus Groups and Key Stakeholder Interviews

• Overview of the components of the QSR process and timelines associated with the onsite review

• Overview of the QSR indicators• Composition of the review team

Continuous Quality ImprovementWhat 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

What’s in it for your County?• Establishes an environment that encourages learning and

program improvement.• Provides a tool for the evaluation of best case practice

rooted in Pennsylvania’s Practice Model/Standards• In depth review of child/youth and family’s safety,

permanency and well being outcomes as well as the agency’s practice performance.

• Provides information/data that will help support/guide ongoing improvement efforts• Practice improvements • Organizational and systemic improvements• Improved outcomes for children, youth and families

The DAPIMTM Model: A “Flywheel”

Implement Plan

Define

Performance

& Capacity

Monitor Assess

-© 2009 American Public Human Services Association

© 2011 American Public Human Services Association. All rights reserved.

Organizing for Continuous Improvement

Work Team IIIWork Team II

Sponsor GroupProvide high level oversight; obtain resources; set expectations that align to strategy

Continuous Improvement TeamInitiate and manage continuous improvement effort; maintain hands-on responsibility for CI efforts during and after the facilitated process

TIME

Work Team I:Implement plans that require complex and/or extended efforts (e.g., process design)

• 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 and action learning processes that clarify expectations, provide useful feedback, and affirm good work.

• QSR stimulates actions taken to improve practice and results at all levels of the organization.

State and local review team members review case of one focus child/youth

Brief review of the record Focused interviewers with members of the

child/youth/family team Rates the status of the child/youth/family and the

system performance on a 1-6 scale Written case review summary “tells the story” of

what was learned from the team

Immediate feed back to the Caseworker and Supervisor with strengths/needs/ recommendations

Case specific Agency specific

Focus groups with stakeholders and key stakeholder interviews

Debriefing with QSR Team Exit Conference of preliminary findingsFinal findings reportNext Steps MeetingCounty Improvement Plan (CIP)

Connecting QSR and Licensure

QSR Case Reviews

DPW Licensure

Same cases as QSR sample

Stakeholder interviews

Feedback to Caseworker

and Supervisor

Additional intake, foster

home, and personnel files

Review for regulatory compliance

Written Case Review

Summary

Aggregate quantitative

results

Summation, Discussion, Next Steps Planning, County Improvement Plan

Development

QSR Focus Groups and

Key Stakeholde

r Interviews

Caseworkers

Supervisors

Other: may consider

youth, birth families,

foster families,

courts, etc.

PA QSR Protocol: PA QSR Protocol: Child/Youth and Family Status Child/Youth and Family Status IndicatorsIndicators

PA QSR Protocol: PA QSR Protocol: Child/Youth and Family Status Child/Youth and Family Status IndicatorsIndicators

• 1a. Safety: Exposure to Threats of Harm1a. Safety: Exposure to Threats of Harm• 1b. Safety: Risk to Self/Others1b. Safety: Risk to Self/Others• 2. Stability2. Stability• 3. Living Arrangement3. Living Arrangement• 4. Permanency4. Permanency• 5. Physical Health5. Physical Health• 6. Emotional Well-being6. Emotional Well-being• 7. Learning & Development7. Learning & Development• 8. Pathway to Independence8. Pathway to Independence• 9. Parent & Caregiver Functioning9. Parent & Caregiver Functioning

PA QSR Protocol: Practice Performance IndicatorsPA QSR Protocol: Practice Performance IndicatorsPA QSR Protocol: Practice Performance IndicatorsPA QSR Protocol: Practice Performance Indicators• 1a. Engagement Efforts

• 1b. 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 short-terms 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 ReportThe Final Report provides an analysis of the qualitative and quantitative data collected during onsite review, as well as relevant data from other sources.

Purpose:

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

County Improvement Plan (CIP)County Improvement Plan (CIP)Purpose:

The County Improvement Plan (CIP) outlines the priorities the county agency chooses to focus on to improve specific outcomes as a result of a comprehensive review of their practice. This review is not limited to the QSR findings, and may also include a review of additional data such as the County data packages provided by the State, quantitative measures produced by the county, as well as the results of other qualitative data.