Overview of Continuous Quality Improvement (CQI)

First QSR Orientation Meeting

Meeting Objectives

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

• Overview of the Continuous Quality Improvement process and the role of QSR in that process

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

• Overview of the components of the QSR process and timelines associated with the on-site 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

The DAPIMTM Model: A “Flywheel”

Implement Plan

Define

Performance& Capacity

Monitor Assess

-© 2009 American Public Human Services Association

What is a Quality Service Review?

• 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 & 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/family team Rates the status of the child/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 Meeting

QSR Activities

QSR Case Reviews

QSR Focus Groups and

Key Stakeholde

r Interviews

DPW Licensure

Caseworkers

Supervisors

Other: may consider

youth, birth families,

foster families,

courts, etc.

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 Summary

Aggregate quantitative

results

Summation, Discussion, Next Steps Planning

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 ReportQSR Findings Report

– Demographics – Child/Youth and

Family Status Domain

– Practice Performance Status Domain

– QSR Results Summary

– Key Questions to Consider for Next Steps Planning

Purpose:

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

Sponsor and Improvement Teams

Sponsor Team

Implementation Team

Work Grou

p

Sponsor Team• Defines high-level vision of CQI efforts• Secures resources • Creates and charters Improvement Team

Improvement Team• Guides CQI work day-to-day• Maintain hands-on responsibility for CQI

efforts• Charters and oversees smaller CQI work

groups• Communicates with Sponsor Team

Work Groups• Implement improvement efforts focused on

specific target areas• Representation from agency staff,

providers, consumers

Work Grou

p

Work Grou

p

County Improvement Plan (CIP)County Improvement Plan (CIP)Section I. Sponsor Team Members

Section II. Background

Section III. Priority Outcomes

Section IV. Findings

Section V. Strategies and action steps for each outcome

Bringing CQI to LifeReview and analysis of

CQI findings

(with focus on QSR results)

Identify recommend

ed improvement priorities

CQI Sponsor

Team creates

CQI Charter

and approve priorities

CQI Improvemen

t Team receives CQI Charter and

develops County

Improvement Plan

CQI Sponsor Team

reviews County

Improvement Plan and approves

for submission

to state

CQI Work Groups identify

and implement strategies

to actualize

CIP

Improvement Team

monitors and

analyzes work groups

CQI Sponsor

Team receives findings

CYS leadership, CQI staff,

with support of TA

Collaborative

What’s in it for your County?• Provides a great source of information

and data related to your specific case, related to agency trends, systems’ issues (report on each sample case generated after reviews)

• Supports the framework for the county’s current change efforts

• Case-specific improvement