Continuous Quality Improvement Enter YOUR Service Area along with Lead and Facilitator Name!

Making Ideas Work Catalyst for Change

CQI Purpose CQI is a process that empowers staff by involving everyone in the evaluation and improvement of the effectiveness and efficiency of services provided by Children and Family Services

CQI Philosophy Basic concept: small, continuous steps toward achieving better results Focus: self-directed, self-determined change; leadership is by all Process through which teams:  Identify needs, goals, resources and strengths toward achieving results;  Develop action plans to improve services; and  Forward unresolved issues to the next CQI level.

Key Processes in CQI CQI Service Area and State Teams: Identify and solve barriers to service delivery and achievement of outcomes Management Reports and Data: Keep the work on track and watch the results Reviews of Case Work Quality: Promote high quality case work and best practices

CQI Process Identify and solve barriers to service delivery and achieve outcomes Increase knowledge through data and reports Create action plans for improvement & continued improvement Case reviews and use of the review results to improve practice

CQI Process (cont) All Staff members are involved in evaluating the effectiveness and efficiency of services provided to Children and Families Examines internal systems, procedures and outcomes Examines relationships and interactions between CFS and other stakeholders Identifies strengths

CQI Process (cont) Creative Inclusive Recurring Empowering Structured Solution-focused Efficient Action-oriented Common Sense Driven

Evolution of CQI in Nebraska Development of CQI Unit and Quality Assurance Team Performance Based Contracting Compliance vs. Improvement Accreditation (future)

Accreditation Overview Purpose of Accreditation: Accreditation provides a number of benefits to agencies:  set of nationally recognized standards of excellence to gauge DCF against  means of system reform and practice improvement  national recognition as an accredited agency  peer review from people who truly understand public human service practice  an opportunity to conduct a self study that will lead to improved and streamlined policies and practices

Types of Accreditation Joint Commission for The Accreditation of Healthcare Organizations (JCAHO) – medical model, used with hospitals and behavioral healthcare organizations Commission on Accreditation for Rehabilitative Facilities (CARF) – geared as the name suggests for rehabilitative facilities National Association for the Education for Young Children (NAEYC) – child care associations The Council on Accreditation of Services for Children and Families (COA) – designed for services based on a social-work, community model

Overview of CQI Provide Children and Families with the highest quality programs with demonstrated positive outcomes Ongoing process of identifying, describing and analyzing system strengths and weaknesses Continuously assess and modify programs and processes based on objective information Strategically plan to promote continued improvement

Overview (cont) Dependent upon active inclusion and participation of staff, children, youth, families and stakeholders throughout CQI process Supports system-wide initiatives such as the development and implementation of Program Improvement Plans (PIP), case reviews, Accreditation processes and other critical initiatives

CQI Key Principles Data and information Data and measurement Active engagement of Staff Improvement Continuous learning

CQI Cycle of Improvement

CQI Teams: Service Areas and State Level Identify and solve barriers to service delivery and achievement of outcomes

CQI Team Mission Statement This team, through a partnership with internal and external stakeholders, will focus active attention on the unique strengths and needs of the children and families we serve, in order to achieve measurable, positive outcomes in safety, permanency, and well-being at the local Service Area Level.

Service Area CQI Teams Members of a Service Area CQI team:  Membership means that every staff member has a voice in decisions about the agency  Everyone helps to lead the agency Your Team may:  Have 8-12 members within the Service Area  Meet at least quarterly Service Area Team represented on State Network Teams to be facilitated by Central Office Quality Assurance Program Specialist

CQI Team Members Local Service Area HHS Staff & Contractors Field Staff Training Staff Legal parties (County Attorneys and/or Judges & DHHS Legal) Foster Care Review Board CASA Education Probation Foster Parents Youth and Families Family Organizations

CQI Team Roles Team Leader (DHHS Children and Family Services Administrators or other designee) – reinforces work of the teams and represents team’s work to internal and external entities Team Facilitator (DHHS Central Office QA) – manages team meeting process Team Scribe (Local DHHS Staff) – logistics, records comments and activities of the team Team Members – participate and represent their area

Team Leader – DHHS Administration Develop the agenda jointly with QA Facilitator Discuss with QA Staff available data for meeting Delegate team tasks as needed Ensure that the developed corrective action plans and strength plans are monitored and updated Report progress State CQI Team

Facilitator - Quality Assurance Program Specialists Role Develop, prepare and disseminate data and additional information to Service Area CQI Teams Facilitate action and improvement by:  Coordinating and facilitating Service Area CQI meetings  Liaison between management and staff  Mentoring and guiding staff toward use of best practices  Coordinating with other Service Area QA Staff

Facilitator - Quality Assurance Program Specialists Role (cont.) Coordinate implementation of special initiatives and projects Advocate for statewide system changes that will improve results Present participants’ ideas that are unable to attend Read trends Anticipate barriers Identify strengths

CQI Teams Decision-Making Identification of needs, goals, available resources and strengths of services, staff and community partners  Current performance (baseline) to future performance (agency goals) Focus on topics of interest such as Safety, Mini CFSR, Family Team Meeting, Contract Monitoring, etc.

CQI Teams Design and promote development of strategies which can be implemented to alleviate the identified issues  Identify 3 areas for change  Identify 3 areas of strength  If data indicates an issue related to Safety, at least one of the areas for change will be in Safety: otherwise, areas for change will be selected for which the information and data indicates the greatest need for improvement

CQI Teams Implement and monitor local corrective action plans to resolve identified issues  Corrective Action Plans and Strength Analysis Plans will be posted on a shared website Forward unresolved issues to State CQI Team for possible resolution  Policy changes, statewide training needs, etc.

CQI Statewide Team Team will review all Corrective Action Plans from the Service Areas as well as strengths in practice Team will identify statewide trends of best practice and areas needing improvement Analyze statewide information and data Develop statewide strategies for change in areas of Practice, Policy and Training

Management Reports and Data Keeping the work on track Monitoring the results

Management Data Reports Team Participants will analyze existing data, contribute additional data/relevant information, and hypothesize contributions at the following levels:  Client Level (Are there ways to solve the problem by changing how we interact with the client?)  Program Level (Are there ways to solve the problem by modifying the program that serves the client?)  Community Level (Are there ways to solve the problem through local community resources?)

Management Data Reports Management information systems (NFOCUS, Case Review, QA Reports) Outcome measurements (Mini CFSR reports, Safety Model reports, FTM reports, Compass) Case Review quality (Case Review System) Customer surveys Required Contractor program evaluation reports (EBP, Disaster Plan, Quarterly reports, etc.)

CFSR Outcomes Safety Permanency Well-Being

CFSR Performance Baseline Data  Describes current and historical views of outcomes  Describes Agency achievement of the outcomes

Federal CFSR Findings Outcome Associations Includes the 35 States reviewed in Case worker contacts with children and families demonstrate a high performance on Safety, Permanency and Well Being Outcomes

Findings Regarding Safety

Associations Between Safety Outcome 2 and other Indicators Significant associations exist between Safety Outcome 2 and these indicators: Needs & Services of Child, Parents, Foster Parents Parents’ Involvement in Case Planning Caseworker Visits with Child Caseworker Visits with Parents Timeliness of Initiating Investigations

Findings Regarding Permanency

Relationship of Well-Being to Permanency Positive ratings on Services to children, parents, foster parents Involvement of parents in case planning Caseworker visits with children Caseworker visits with parents Substantial achievement on Timely achievement of permanency (Outcome P1) Preserving children’s connections while in foster care (Outcome P2) supports...

Factors Associated with Timely Reunification, Guardianship, and Permanent Relative Placement The strongest associations with timely reunification guardianship, and permanent relative placement include: Caseworker Visits with Parents Child’s Visits with Parents and Siblings in Foster Care Services to Children, Parents, & Foster Parents Family/Child Involvement in Case Planning ASFA Requirements Regarding Termination of Parental Rights Placement Stability

Factors Associated with Timely Adoption The strongest associations with timely adoption include: Needs & Services for Children, Parents and Foster Parents Holding timely permanency hearings Holding timely six-month case reviews ASFA requirements regarding termination of parental rights

Factors Associated with Placement Stability The strongest associations with placement stability include: Placement with relatives Services to children, parents, and foster parents Involvement of children and parents in case planning Caseworker contacts with parents (not children) Age of child – most stable are ages and – least stable are ages

Item and Outcome Ratings that were Significantly Associated with Case Review Indicators Permanency Hearings Adoption Termination of Parental Rights Adoption Permanency Outcome 1 Reunification Six-Month Case Reviews Adoption Well Being Outcome 1

Findings Regarding Child & Family Well-Being

Association with Systemic Factors States in substantial conformity with these 2 systemic factors had significantly higher percentages of cases rated substantially achieved for Well Being Outcome 1 than States that were not in substantial conformity with these systemic factors. Service Array Quality Assurance

Well Being: The Importance of Caseworker Visits with Parents and Children

91% of the cases rated as a strength for Caseworker Visits with Parents were also rated as a strength for Caseworker Visits with Children. Caseworker Visits with Children Caseworker Visits with Parents

Strongest Associations Between Visits and Other Indicators Both Caseworker Visits with Parents and Caseworker Visits with Children were strongly associated with: Risk of harm to children (Item 4) Needs & Services for children, parents, foster parents (Item 17) Child and parent involvement in case planning (Item 18)

Other Significant Associations Between Visits and Indicators Caseworker Visits with Parents and Caseworker Visits with Children were also strongly associated with: Services to protect children at home Safety Outcome 1 Safety Outcome 2 Timely permanency goals Timely reunification Child’s visits with parents and siblings Relative placements Meeting educational needs Meeting physical health needs Meeting mental health needs