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.
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