Quality Services Reviews:A process for understanding and

promoting best child welfare practice

Florida Department of Children and FamiliesQuality Assurance Managers MeetingMarch 14-15, 2011

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Goals for Reviewer Training

Learn how pilot QSR reflects the practice model

Review the scoring criteria Learn about interviewing techniques to

enhance information gathering Learn how to plan and lead an effective

caseworker debriefing

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Family-Centered Practice

Engagement

TeamFormation

Assessment&

Understanding

Planning

Implementation

Tracking&

Adaptation

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What is the Qualitative Case Review?

The Qualitative Case Review process is a method for organizing the conversation with our communities in terms of :

the results we want for children and families served, and

understanding how child welfare practice can be improved to get those results.

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Key attributes of the QSR Process

Language used is transparent to a wide audience

Underlying values as to child and family safety and well-being are broadly held

Practice model reflects a coherent approach to supporting and sustaining change in families

Process promotes learning at all levels in the organization, as well as in the larger community

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QSR Uses a Record Review and Interview Format

We evaluate outcomes and best practice, along with compliance to policy

Record is reviewed at the beginning to gain and understanding of the case

Information is gained through interviews with family members, the child, the caseworker, service providers, etc.

Last interview with caseworker to share and update information and findings.

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Quality Service Reviews: Common Understanding of Good Results for Children Served

Traditional Audit:

• Were investigations timely in accordance with policy?

• Are child’s educational needs reflected in case plan?

• Is there documentation in the record that ongoing therapy (if recommended) is being provided?

Quality Review:

• Are children safe from current, manageable risks of harm?

• Is the child leaning and progressing at a rate commensurate with his/her age and ability?

• Is the child doing well, emotionally and behaviorally?

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Quality Service Reviews: A Different Way of Looking at Practice

Traditional Audit

• Is there a plan in the file?

• Was the plan signed by the parents?

• Was the permanency goal presented to the court at the dispositional hearing?

Qualitative Review

• Is the plan relevant to family needs and goals, coherent in selection and assembly of strategies, supports, services, and timelines?

• Was the family effectively engaged in assessment and service planning, and tracking?

• To what degree are service implementation and results routinely monitored, evaluated and modified?

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Group Exercise 1: Understanding the QSR Indicators

What are we measuring? How do we currently assess this issue? How is this new description different? Who would need to be interviewed to learn more

about this? Provide some examples of circumstances that would

fall into the “No” category of practice? (NO, standard not met equals a 1, 2, or 3 rating)

(Teams of 3-4 persons)

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How the scoring works

6 – Optimal

5 – Substantially Acceptable

4 – Minimally Acceptable

3 – Partially Unacceptable

2 – Substantially Unacceptable

1 – Completely Unacceptable

Each indicator is scored on a scale of 1 to 6.

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Quality Service Reviews: Focus on Most Recent Segment of Practice

Child and family status indicators look at last 6 months– Exceptions are stability and permanence– Recent child/family status improvements may influence

scores– Any child/family may have positive status regardless of

length of involvement System performance looks at past six months

– Recent performance improvements have some influence on scores

– Any case can meet quality standards regardless of time open

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Safety always trumps

Safety is the only indicator that trumps

Safety is paramount to any case.

Overall status is acceptable only when Safety is rated in the 4 – 6 range.

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“Groundhog Day” Rule

Difference between a Rating of 3 and 4 (or a “Yes” or “No”

If this case were frozen in time as it is today, would it be acceptable?

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How the Review Process Works

Purposeful sample of cases selected for each agency (younger and older children, children in care for varying lengths of time and with different permanency goals)

Family permission obtained to participate in review and information releases obtained

Key team members in each case identified and appointments scheduled (place, time frames)

Lead reviewers and partners conduct the interviews, beginning and ending with the caseworker

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How the Review Process Works, continued

Answers are reviewed and scored in each indicator and domain

Feedback session with caseworker and supervisor to provide immediate feedback and elicit further suggestions for next steps on case

Presentation of stories at debriefing sessions during the week

Exit conference at end of week to present and discuss findings

Case story for each case reviewed

Final report which includes aggregate data and case stories.

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Expectations of QSR Reviewers

Prepare for interview by being oriented to basic facts

Thoughtfully explain the QSR process

Consider how to best engage children/families

Be attentive to clues about family culture

Know what you need to learn from person being interviewed

Allow each person to tell their story

Gather each person’s perspectives

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Expectations of QSR Reviewers, continued

Ask each person interviewed about child safety

Collaborate with your review partner

Prepare for special challenges

Stay within the role of reviewer

Remember the obligation to report child safety issues

Reviewers call it as they see it – score results and affirm efforts

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Some “Don’ts” for QSR Reviewers

Don’t be premature in making judgments

Don’t share information across informants

Don’t ask any leading questions

Don’t drift from the protocol or definitions

Don’t go unprepared into debriefing with Case Manager

Don’t overwhelm staff with too many suggestions

Don’t do “TA, Supervision or Training” during debriefing sessions

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Basics for Interviewing

Introducing yourself, partner and the process

Starting the interview

Allow the interviewee to tell the story

Gathering necessary information

Planning for the less than perfect situation (place and/or time constraints)

Closing the interview

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The Core “Script” for each interview.

Why your perspective matters

What is the story of your involvement?

What are both the strengths and needs of this child and family?

How is the system working to help this child and family? What are the goals?

What things are working well?

What would you like to see working differently? How might that happen?

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Interviewing

Core Conditions Skills

Genuineness

Respect

Empathy

Clarification

Closed questions

Open questions

Solution Defining questions

Past Successes

Exception Finding

Miracle Questions

Summarization

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Caseworker Debriefings: Making it Positive

Begin with a strength and affirmation

Ask how the caseworker achieved something you learned that was positive (“How did you make that happen?”)

Summarize and clarify child and family story, share any new information, clear up confusion

Review child and family status findings (begin with strengths)

Review system findings (begin with strengths)

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Caseworker Debriefings: Making it Positive

Elicit from caseworker/supervisor their thoughts as to next steps

As appropriate, suggestions might be stated as, “We wondered what might have happened if at that point, (particular team members) might have had a team meeting to figure out…”

Provide suggestions on some other options for next steps that MAY be useful

Direct more difficult system questions to the supervisor

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Group Exercise: Planning a Caseworker Debriefing

As a team, identify three strengths about Jorge and why they are important. (5 min.)

As a team, identify main concerns for Jorge. (5 min.)

As a team, identify the issues that remain a practice challenge. (5 min.)

As a team, develop a few suggestions for creating a positive caseworker debriefing. (10 min.)