Continuous Quality Improvement: Developing a Learning Culture

through Evaluation and Training

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First Thoughts

EvaluationTraining

Learning

Safe Horizon

• Our Mission…to provide support,

prevent violence, and promote justicefor victims,their families, andcommunities.

250,000 lives touched50+ locationsAll 5 boroughs of New York City

Safe Horizon

Our Programs• 24/7 Hotlines• Criminal/Family Court Project• Family Justice Center Programs• Domestic Violence Police Programs• 8 Domestic Violence Shelters• 4 Community Program Offices• Streetwork Homeless Youth Project

• 5 Child Advocacy Centers• Mental Health Counseling Center• Anti-Trafficking Program• Domestic Violence Law Project• Immigration Law Project

Respect

We honor and

respect our

clients

We respond

with compassion

to clients

Compassion

We use our expertise to offer clients information

so they can make informed decisions

Decisions

We take a non-

judgmental approach

with clients

Non-judgment

Respect – I respect you.

Attention – I am paying attention to you.

Partnership – I want to collaborate with you.

Issues – I am focusing on the issues you care about.

Decisions – I respect your right to make your own decisions.

Foundations of Client Centered Practice

Engaging Clients by communicating…

RAPID

Moving victims of violence from crisis to confidence

• Ask Client’s I & R Preferences

• Provide Appropriate I & R

• Clarify Next Steps

• Explore Past Safety Attempts

• Assess Client’s Current Resources

• Develop Plan to Address Risk

• Explore Beyond Client’s Service

Request• Assess Immediate

Risks• Support Client in

Prioritizing Risks

• Introduce Self• Assess Current

Safety• Review

Confidentiality• Utilize Open-Ended

Questions• Mirror Client’s

Language EngagementSafety

Assessment

Information

/ReferralsSafety Planning

Client Centered Practice Skills

Client Centered Practice

Supervision

Training Evaluation

Training Approach• 2010 to 2012: Appx. 600 staff trained, 1600 hours training

provided in role- and program-specific cohorts• 2013 to present: Ongoing sustainable structure: Cross-

program 35-hour core training in trimesters; division leadership drives program-specific application

• Extends over several weeks, to support reflection and practice

• Case examples and skill-building activities based on varied roles and programs

• Experiential, adult learning principles• Coaching: “Skills Labs”• Evaluation

Quality Supervision• Policy

– Individual supervision, at least every 2 weeks– Group supervision, at least once a month– Observations of client work

• Program-specific plans• Reflective Approach

– Training for supervisors and managers– Training for client-facing staff

• Monitoring of progress through record review, staff surveys

Quality Supervision

Baseline Year 2 Year 3 Year 40%

20%

40%

60%

80%

100%

% Bi-Weekly Supervision

Interrelated CapacitiesClient

Centered Practice

Vicarious Trauma

Awareness

Quality Supervision

Evaluation

• In-Depth Case Review (IDCR) was developed by Safe Horizon, drawing on successful models such as CompStat, ChildStat, and Grand Rounds.

• Purpose: To increase communication, clarity, alignment and accountability among program managers at all levels, and to promote program practice that is consistent across sites and programs, and evidence-supported.

• Components:– Review and analysis of program data– Case presentation using a segment of a recorded client interaction– Discussion focused on practice

Quality Improvement Initiative

• A QI Plan is a document about how a program will manage, deploy, and review quality.

• The main focus is assistance to clients and how to ensure that our interactions with clients are client-centered.

• The QI Plan describes the processes and activities that will be put into place to ensure that quality service is provided consistently to clients.

• A Quality Improvement Plan is not a one-time event but rather a continuing process of improvement.

• Each plan includes measurable short and long-term goals that are reviewed quarterly and revised annually to reflect new lessons learned from the IDCR process.

Synergistic Framework

Organizational Size Considerations

Larger organizations may have greater resources and internal support departments; harder to operationalize and monitor change

Smaller organizations may require more ingenuity to train and evaluate with less resources; can be more nimble in operationalizing and monitoring change

Learning Culture Capacity Continuum

Key Lessons Learned

• Not about “gotcha”• Investment from top critical• Establish shared vision and data points• Customer service communication approach• Change never ends… and that’s OK

Resources• Bell, Holly; Kulkarni, Shanti; Dalton, Lisa (2003). Organizational Prevention of Vicarious

Trauma. In Families in Society, 84(4). free download at www.vawnet.org• Morino, Mario (2011). Leap of Reason: Managing to Outcomes in an Era of Scarcity.

Washington: Venture Philanthropy Partners. order free at www.leapofreason.org; additional free resources on website

• Multiplying Connection (2012). What is Reflective Supervision? http://multiplyingconnections.org/become-trauma-informed/what-reflective-supervision

• Roberts, Liz (2013). Safety, Risk, and Self-Determination: Client Centered Practice with Survivors of Domestic Violence. Nat’l Assn of Social Workers, NYC Chapter. http://www.naswnyc.org/?446

• Schein, Edgar H. (2004). Organizational Culture and Leadership (3rd ed.) San Francisco: Jossey-Bass.

• Senge, Peter M. (2006). The Fifth Discipline: The Art and Practice of the Learning Organization (rev.). New York: Doubleday.

Thank you!Elizabeth Speck, LCAT, Ph.D.

Senior Director, Training

elizabeth.speck@safehorizon.org

718-238-7726

Twitter: @Learning_4_Good

Amanda Stylianou, MSW, LCSW, PhD(C)

Director, Research and Evaluation

amanda.stylianou@safehorizon.org

212-577-8827

Twitter: @AMStylianou

www.safehorizon.org Follow Safe Horizon on Facebook and Twitter