1. Quality Case Practice Improvement
Trainer: Trina Payne, MSW

2. OBJECTIVES How to conduct an assessment of service needs
Determining if your client’s goals are being met
Identifying the barriers & how to advocate for change
Learn why supervision is useful in guiding case practice
Understand why it is necessary to track case practice trends

3. IF you Do Ongoing Assessment of Case Practice, THEN you will have A Better Understanding of the Client’s Needs and Identify Gaps in Service Delivery and this WILLResult In the Implementation of Supports and Services

4. Ask Yourself: Did You PASS?
Performance
+ Achievements
+ Standards
+ Solutions
= Quality Case Practice
Remember, you always want to be able to PASS…

5. What Does Quality Case Practice Look Like?
Comprehensive documentation is in the case record as well as electronic record.
All reasonable efforts are documented (i.e. education, physical/dental health & mental health).
There is evidence of family connections (i.e. engagement, locating family and lifelong connections).
The client is building healthy relationships with family.

6. What Does Quality Case Practice Look Like?
Client has a good placement “match”.
Interventions are implemented to address safety and risk factors.
A written safety plan is developed, monitored and signed.
Permanency barriers are being addressed.
The client is in the most appropriate educational setting.
Educational status is understood, special needs are identified and monitored.

7. What Does Quality Case Practice Look Like?
Has any service gaps been identified?
All involved parties are participating on the team.
Everyone on the team is all singing the same song and not working in silos.
Case manager should be guiding the case.
There is a clear understanding of each person’s role on the team.
The client and family’s thoughts and beliefs about the direction of the case is being heard.
Ongoing determination of whether there are any service gaps.

8. What Does Quality Case Practice Look Like?
Visits should be documented as well as efforts to arrange visits between the client and their birth parent, sibling, other family members and kin.
Efforts have been made to ensure that the client is preserving connections with their neighborhood, community, faith, extended family, school, etc.
Documentation regarding medication compliance/non- compliance.
There is evidence of medication management.

9. What Does Quality Case Practice Look Like?
Any barriers to adding new team members is being addressed.
The client is participating in team meetings.
case manager is able to manage any conflicts between the team members.
Boundaries are set for how the team will operate.
Clear understanding of any history of the client and/or family’s trauma and a strategy to address this issue.

10. Examples of Performance Indicators
Stability of Foster Care Placement
Efforts to Achieve Permanency Goal
Fostering Family Connections 
 client and Family Involvement in Case Planning
 Educational Needs
 Physical Health Needs
 Mental Health Needs
Physical Plant Compliance

11. Identify What is Missing
Treatment goals to match the client’s current challenges
Who is missing from the team?
Documentation
What needs to be completed in the next week, month, quarter, etc.?

12. Quantitative Review vs. Qualitative Review
Quantitative Review – a determination of whether all of the required documentation is filed in the case record
vs.
Qualitative Review – an assessment of whether the client’s treatment goals and identified services are being met and to what degree is the impact on the client.

13. Client’s Treatment Goals
Determine if the client is making progress on the treatment goals
Identify barriers to quality case practice
Develop performance improvement strategies

14. Supervision
Conduct a quantitative check on required case record documentation
Meet with direct care staff on a regular basis to discuss updates on the case status and ensure that the team is addressing any barriers.
If you do not get regular updates on the status of the case you will not be as helpful in making sure that the client’s needs are being met.

15. Supervision
Ask questions to have a good understanding of the client and family’s dynamics on each case.
Track the status of the client’s goals and when necessary make sure they are adjusted and/or identify new goals when appropriate.
Establish clear expectations and timelines on any missing documentation or next steps
Establish a date to check-in and verify that the work is done

16. Ongoing Assessment of client & Family Practice
Quality case practice involves conducting ongoing assessments of the client’s safety, permanency and well-being. Below are action items to consider:
Documentation of referrals and timely assessments
Evidence of assessing the client and family’s strengths, challenges, needs, and appropriate services
Ongoing assessment of the impact of the client and/or family’s trauma
Current psychiatric and psychological evaluations in the case record
The case manager should have purposeful meetings with the client

17. Ongoing Assessment of client & Family Practice
There should be evidence of teaming among all team members
If the client/youth and family declines the assessment or service it should be documented
Documentation in the case record that there were reasonable efforts to request the educational, medical and mental health records from service providers.
There should be a common understanding of the plan for services
Conduct peer-to-peer case record reviews

18. Strengths-Based Case Practice
A strengths-based approach is a philosophy for working with individuals, families, groups, organizations and communities. It is an ecological perspective that recognizes the importance of people’s environments and the multiple contexts that influence their lives.
This perspective recognizes the resilience of individuals and focuses on the potentials, strengths, interests, abilities, knowledge and capacities of individuals, rather than their limits. It is in this way that a strengths-based approach is seen to differ from traditional deficit models.

19. Strengths-Based Case Practice
Six Key Principles:
Every individual, family, group and community has strengths, and the focus is on these strengths rather than pathology
The community is a rich source of resources
Interventions are based on client self-determination
Collaboration is central with the practitioner-client relationship as primary and essential
Outreach is employed as a preferred mode of intervention, and
All people have the inherent capacity to learn, grow and change.

20. What Does Ongoing Assessment of the Agency’s Practice Look Like?
There is adequate clinical, supervisory and administrative support.
The service providers demonstrate that they are able to respect the client and family’s values, culture and norms.
Any team members who are operating in silos need to be addressed and the issues resolved keeping the progress of the client and family as the priority.

21. What Does Ongoing Assessment of the Agency’s Practice Look Like?
Ensure that the parents continue to be engaged and if necessary re-engaged in a timely manner.
Help to foster healthy relationships among the client and their family.
Keep the parents in the loop on updates.
Make sure to conduct an ongoing assessment of the birth parents needs.

22. What Does Ongoing Assessment of the Agency’s Practice Look Like?
Schedule regular treatment team/case staffing meetings.
Ensure that all moving parts of the case are being addressed.
The team clearly understands what are the client and family’s strengths, needs, risks and any underlying issues.
The team should be strategically addressing any barriers to permanency.

23. What Does Ongoing Assessment of the Agency’s Practice Look Like?
Make sure that there is ongoing monitoring of any chronic health concerns and medication.
There should be documentation of all reasonable efforts.
Ongoing oversight is needed to address any identified safety and risk concerns and monitor the progress until this issue is resolved.
Discuss strategies for improving case practice, meeting benchmarks and identifying possible supportive services for families.  

24. Advocating for Change
Any involved party who is participating on the case can be a change agent.
The requested change should be conveyed clearly with the expected outcome.
It would be helpful to provide any background history when necessary.
Share what the advantage would be to making the change.

25. Tracking Case Practice Trends
Tracking a trend is the practice of collecting information and attempting to spot a pattern in the case practice.
Benefits Include:
Identify Processes/Practices Needing Improvement
Identify/Replicate Successful Practices
Build on Strengths
Identify Training Needs
Use Information for Making Decisions

26. The End!