Strengthening Service Quality © The Quality Service Review Institute, a Division of the Child Welfare Policy & Practice Group, 2014

What is Quality? What does Quality mean to you – as it relates to your service experiences? How should we define Quality – related to your services and service outcomes? How do we measure Quality now – related to your services and service outcomes? How do we use what we learn about Quality - - to improve our services & outcomes? Strengthening Service Quality © The Quality Service Review Institute, a Division of the Child Welfare Policy & Practice Group, 2014

A Person’s Perspective Meeting my needs, hopes, goals, and expectations Having good relationships and positive experiences Receiving helpful services Getting better, doing better, and staying better A Program’s Perspective Fulfilling the social purposes (mission) of the program Passing the next audit Doing good practice Providing good care Getting good outcomes Strengthening Service Quality © The Quality Service Review Institute, a Division of the Child Welfare Policy & Practice Group, 2014

PURPOSE -- Helping a person having major life needs for care, treatment, assistance, support, and/or protection to achieve and maintain adequate levels of: [OUTCOMES = > THRIVING] – Well-Being (safety, stability, health, mental health, positive relationships) – Supports for Living (housing, income, health care, transportation, and supports for daily living and, where necessary, supports for caregivers) – Daily Functioning (performing tasks necessary for successful daily living and socializing in community settings and activities) – Fulfillment of Key Life Roles (capacities and supports for being a friend, family member, tenant, and citizen) Strengthening Service Quality © The Quality Service Review Institute, a Division of the Child Welfare Policy & Practice Group, 2014

Person-Centered, Self-Directed, Team-Supported Strengths-Based & Need Responsive Outcome-Focused & Results Driven Individualized & Coordinated Protective, where Necessary Culturally-Competent C Well-Reasoned – Practically, Clinically, Socially Solution-Focused & Evidence-Based, where Possible Respectful, Convenient, Timely, Dependable, Effective * These Qualities should be Evident in Practice for Each Person Served

9 TEAMING To Unify Efforts &COORDINATINGInterventions Practices Supporting Good Care ENGAGING the Person, Informal Supporters, Interveners ASSESSING Strengths, Needs, Aspirations, Risks, Underlying Issues PLANNING Outcomes, Intervention Strategies, Actions, Assignments RESOURCING Planned Intervention Strategies, Actions, and Supports INTERVENING by Delivering Planned Strategies, Supports and Making Transitions TRACKING Progress, Results, What’s Working; Maintaining Situational Awareness ADAPTING Services Through On-going Assessment and Planning ELIGIBLE PERSON => SYSTEM ENTRY MEETING OUTCOMES, DISCHARGE REQMTS, STEP-DOWN => EXIT 10 1 CLINICAL REASONING: Understanding What Must Change & How 3 Strengthening Service Quality © The Quality Service Review Institute, a Division of the Child Welfare Policy & Practice Group, 2014

Questions How to Measure Quality? How to Use What is Learned to Improve Care Practices & Services? Strengthening Service Quality © The Quality Service Review Institute, a Division of the Child Welfare Policy & Practice Group, 2014

Chart Audit = 15-degree “KEY HOLE” View focused on a Record-Based COMPLIANCE CHECKLIST Quality Review = 360-degree “BIG PICTURE” View focused on Person-Centered PRACTICE & RESULTS

QSR is an ORGANIZATIONAL LEARNING PROCESS. QSR observes the PRACTICE & CARE being provided. QSR connects results to local FRONTLINE CONDITIONS. QSR supports TEACHING & LEARNING PROCESSES that clarify expectations, provide useful feedback, affirm good work. QSR stimulates NEXT STEP ACTIONS taken to improve practice, services, and results at all levels of the organization. Strengthening Service Quality © The Quality Service Review Institute, a Division of the Child Welfare Policy & Practice Group, 2014

Person’s Situation System’s Response Results PERSON’S STATUS : relative to well-being, key supports, adequate daily functioning, performing necessary life roles [essential for daily living] PERSON’S NEEDS: unmet, essential, qualifying SYSTEM ENTRY CRITERIA : met PRACTICE MODEL : Engagement, teamwork, assessment, planning, implementation, tracking BUSINESS MODEL* : Eligibility, access, funding, process requirements, infrastructure support (training, supervision, caseload, time demands, IT support, flexible resources, etc.) PERSON’S NEEDS being reduced or met PROGRESS being made toward outcomes OUTCOMES attained and/or maintained SYSTEM EXIT CRITERIA met Strengthening Service Quality © The Quality Service Review Institute, a Division of the Child Welfare Policy & Practice Group, 2014

Providers’ Lived Experiences with QSR Activities FAIR HELPFUL RESPECTFUL SAFE Strengthening Service Quality © The Quality Service Review Institute, a Division of the Child Welfare Policy & Practice Group, 2014

Functions as a GUIDE BOOK for focusing reviews Functions as a GUIDE BOOK for focusing reviews Provides qualitative indicators with fact patterns Provides qualitative indicators with fact patterns Provides rating scales for indicators Provides rating scales for indicators Sets time windows for reviewing Sets time windows for reviewing Provides a BASIS for the: Provides a BASIS for the: – DATA PROFILE or “roll-up sheet” – ORAL REPORT made a debriefing – WRITTEN REPORT of findings – NEXT STEP PLANNING Strengthening Service Quality © The Quality Service Review Institute, a Division of the Child Welfare Policy & Practice Group, 2014

Safety from harm by others Safety from harm by others Behavioral risk Behavioral risk Income adequacy & control Income adequacy & control Living arrangement Living arrangement Social network Social network Physical well-being Physical well-being Emotional well-being Emotional well-being Functional life skills (ADLs) Functional life skills (ADLs) Productive / contributory activities Productive / contributory activities Social integration /community Social integration /community Caregiver capacity & support Caregiver capacity & support Voice & choice in decisions Voice & choice in decisions OVERALL PERSON STATUS OVERALL PERSON STATUS Safety from harm by others Safety from harm by others Behavioral risk Behavioral risk Income adequacy & control Income adequacy & control Living arrangement Living arrangement Social network Social network Physical well-being Physical well-being Emotional well-being Emotional well-being Functional life skills (ADLs) Functional life skills (ADLs) Productive / contributory activities Productive / contributory activities Social integration /community Social integration /community Caregiver capacity & support Caregiver capacity & support Voice & choice in decisions Voice & choice in decisions OVERALL PERSON STATUS OVERALL PERSON STATUS Status Indicators Improved social integration Improved social integration Reduction in safety / health concerns Reduction in safety / health concerns Reduction in life disruptions Reduction in life disruptions Progress toward life goals Progress toward life goals GENERAL PROGRESS PATTERN GENERAL PROGRESS PATTERN Improved social integration Improved social integration Reduction in safety / health concerns Reduction in safety / health concerns Reduction in life disruptions Reduction in life disruptions Progress toward life goals Progress toward life goals GENERAL PROGRESS PATTERN GENERAL PROGRESS PATTERN Progress Indicators Strengthening Service Quality © The Quality Service Review Institute, a Division of the Child Welfare Policy & Practice Group, 2014

Engagement (trust-based working relationships) Engagement (trust-based working relationships) Teamwork & coordination Teamwork & coordination Assessing & understanding Assessing & understanding Setting personal goals Setting personal goals Planning strategies & supports for: Planning strategies & supports for: Personal goal attainment Personal goal attainment Advance care direction / estate mgt Advance care direction / estate mgt Income & basic necessities Income & basic necessities Supports for daily living Supports for daily living Social integration / leisure activities Social integration / leisure activities Productive / contributory activities Productive / contributory activities Managing chronic health concerns Managing chronic health concerns Other interventions Other interventions Engagement (trust-based working relationships) Engagement (trust-based working relationships) Teamwork & coordination Teamwork & coordination Assessing & understanding Assessing & understanding Setting personal goals Setting personal goals Planning strategies & supports for: Planning strategies & supports for: Personal goal attainment Personal goal attainment Advance care direction / estate mgt Advance care direction / estate mgt Income & basic necessities Income & basic necessities Supports for daily living Supports for daily living Social integration / leisure activities Social integration / leisure activities Productive / contributory activities Productive / contributory activities Managing chronic health concerns Managing chronic health concerns Other interventions Other interventions Implementing interventions Implementing interventions Medication management Medication management Transitions & life adjustments Transitions & life adjustments Status tracking & plan adjustment Status tracking & plan adjustment OVERALL PRACTICE PERFORMANCE OVERALL PRACTICE PERFORMANCE Implementing interventions Implementing interventions Medication management Medication management Transitions & life adjustments Transitions & life adjustments Status tracking & plan adjustment Status tracking & plan adjustment OVERALL PRACTICE PERFORMANCE OVERALL PRACTICE PERFORMANCE Strengthening Service Quality © The Quality Service Review Institute, a Division of the Child Welfare Policy & Practice Group, 2014

Powerful Person-Based Teaching Stories Respectful & Helpful Feedback for Staff Performance Results For Practice Indicators Understanding of Local Practice Conditions & Patterns Next Step Action Planning Better Services And Results

Selected QSR Results for a Person Named Robert Strengthening Service Quality © The Quality Service Review Institute, a Division of the Child Welfare Policy & Practice Group, 2014

Personal Summary Life Situation Outcome Status Practice Patterns Successes & Challenges Possible Next Steps Robert’s Status Profile Well-Being Supports Protections Functioning Voice & Choice Role Fulfillment Overall Status Robert’s Care & Practice Profile Engagement Teamwork Assessment Planning Implementing Coordinating Overall Practice Strengthening Service Quality © The Quality Service Review Institute, a Division of the Child Welfare Policy & Practice Group, 2014

QSR Results for a Group of Persons Being Served at a Provider Site Strengthening Service Quality © The Quality Service Review Institute, a Division of the Child Welfare Policy & Practice Group, 2014

Group Description Life Stage / Gender Living Arrangements Strengths & Needs Services Conditions Group Status Profile Well-Being Supports Protections Functioning Role Fulfillment Overall Status of Group Group Practice Profile Engagement Teamwork Assessment Planning Implementing Coordinating Overall Practice Strengthening Service Quality © The Quality Service Review Institute, a Division of the Child Welfare Policy & Practice Group, 2014

Strategic Tool of Leadership for stimulating improvement Helping leaders understand and improve the quality of practice and services Training, mentoring, and coaching of frontline practice Measuring Change for affirmation, instruction, and direction Guiding organizational development Becoming the best practitioners that we can be

Strengthening Service Quality © The Quality Service Review Institute, a Division of the Child Welfare Policy & Practice Group, 2014