The Qualitative Service Review Process Overview Developed by The Child Welfare Policy and Practice Group & its QSR Institute Division

The QSR is a Practice Improvement Approach Designed to Assess Current Outcomes and System Performance by Gathering Information Directly From Families, Children and Service team Members What is the QSR? The Child Welfare Policy and Practice Group/QSR Institute

Reviewer Skills and Abilities Understand how the overall QSR process works Understand the basics of the protocol content Understand the application of interview techniques relative to the protocol Develop the ability to score status and performance Learn how to provide worker feedback Understand the case debriefing process Learn the structure of a written case story Reviewer Skills and Abilities The Child Welfare Policy and Practice Group

Reviewer Skills and Abilities Basic understanding of the QSR Process Ability to employ active Ability to accurately summarize the QSR process to respondents listening Ability to employ basic interviewing skills Knowledge of the protocol Ability to anticipate directions in the course of interviews Understanding of scoring rules Ability to distinguish effort from performance Ability to engage respondents Reviewer Skills and Abilities The Child Welfare Policy and Practice Group

Reviewer Skills and Abilities Ability to use confidentiality appropriately Ability to observe the boundaries of the reviewer role Ability to score objectively Ability to accurately summarize the case in debriefings Ability to provide accurate, strength-based worker feedback Ability to write a descriptive and accurate case story that supports the scores assigned Reviewer Skills and Abilities The Child Welfare Policy and Practice Group

Developed during Alabama’s class action child welfare lawsuit Unique settlement focused on practice, not process Answered the question – How do you judge compliance with practice principles? Met organizational needs (feedback on performance) as well as settlement needs How was it created? The Child Welfare Policy and Practice Group

Where has the QSR process been used? Alabama Tennessee New Mexico Oregon North Carolina Hawaii New Jersey Florida Iowa NYC Washington DC Georgia Indiana Missouri Utah Kentucky Wisconsin Pennsylvania Los Angeles Virginia Where has the QSR process been used? The Child Welfare Policy and Practice Group

QSR Settings Child Welfare Mental Health Special Education Juvenile Justice Welfare to Work QSR Settings The Child Welfare Policy and Practice Group

How is the QSR different from case file reviews? If you didn’t document it didn’t happen. The worker and family’s team can verify agency practice in interviews. Did you do it on time? Timely or not, did the casework achieve the right outcome? Were services provided? Did you meet the child and family’s needs? Is there a case plan on file? Does the family see the plan as their own? How many moves has the child experienced? Does the team understand why the child is unstable? How is the QSR different from case file reviews? The Child Welfare Policy and Practice Group

Shifting from Blaming to Safe Learning* Blame the Person Improve the System Individual: Let’s find-out who messed up, “ding‘em,” require “Corrective Action!” Person Focus: Who did it? What you did was wrong! Punishment: It’s your fault! [Got Ya!] Cover-up/Fear = No Learning: I won’t reveal my mistakes. It’s not worth it to take risks. *Human Systems & Outcomes Inc System: Let’s find things in our system that increase problems and reduce good results Problem Focus: What happened here? Performance: Let’s see what we can do to get the results we want! Openness & Safe Learning: We want to learn more about this problem so that we can do better in the near future!

How is information gathered? Through a small representative sample of randomly chosen cases Using a structured protocol Through interviews with all members of a case team A professional appraisal of case status and performance Identifying what’s working and not working and why Yielding an aggregate status and performance score, immediate feedback to caseworker and site, written case story and ideas for case and systemic analysis How is information gathered? The Child Welfare Policy and Practice Group

Child and Family Status Safety from Exposure to Threats of Harm Child Vulnerability Stability Living Arrangement Permanency Overall Physical Health Emotional Well-Being Early Learning & Development (0-5 years) Academic Status (6-18+years) Pathway to Independence Parent & Caregiver Functioning & Resourcefulness What gets assessed? The Child Welfare Policy and Practice Group

What gets assessed? Practice Performance Engagement Efforts Voice & Choice Teamwork Assessment & Understanding Planning for Safe Case Closure Supporting Transitions & Life Adjustments Implementation Maintaining Quality Connections Evaluating and Adjusting Psychotropic Medication Management What gets assessed? The Child Welfare Policy and Practice Group

Who is interviewed? Case manager Parents and child (interviewed or observed) Kin (in some cases) Foster parents Therapists Teacher Other providers and professionals Attorneys Whoever is important in the case Who is interviewed? The Child Welfare Policy and Practice Group

How the Review Process Works Random representative sample of cases Structured protocol guides inquiry and scoring Family permission obtained to participate in review and information releases obtained Key informants in each case identified and appointments scheduled Lead reviewers and partners conduct the interviews, beginning with the caseworker Case is scored and review results aggregated How the Review Process Works The Child Welfare Policy and Practice Group

How the Review Process Works 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 Case story for each case reviewed Final report which includes aggregate data, case stories and systemic analysis How the Review Process Works The Child Welfare Policy and Practice Group

Understanding the QSR Indicators What’s being measured? Difference from current description? What do we need to learn to score this indicator? Examples of circumstances not meriting an acceptable rating? Child and Family Status Safety from Exposure to Threats of Harm (Home & School) Child Vulnerability Stability Living Arrangement Permanency Overall Physical Health Emotional Well-Being Early Learning & Development (0-5 yrs) Academic Status (6-18 yrs) Pathway to Independence (14+yrs) Parent & Caregiver Functioning & Resourcefulness Understanding the QSR Indicators The Child Welfare Policy and Practice Group

Understanding the QSR Indicators What’s being measured? Difference from current description? What do we need to learn to score this indicator? Examples of circumstances not meriting an acceptable rating? Practice Performance Engagement Efforts Voice & Choice Teamwork (Formation & Functioning) Assessment & Understanding (Child and Family) Planning for Safe Case Closure Supporting Transitions & Life Adjustment Implementation Intervention Adequacy and Resource Availability Maintaining Quality Connections Evaluating and Adjusting Understanding the QSR Indicators The Child Welfare Policy and Practice Group