1. Biennial Service Review Training
Putting it All Together

2. Quality improvement through focused analysis and planning
Biennial Service Review
Key Words QUATITY IMPROVEMENT
Quality improvement through focused analysis and planning

3. Pulling together six HFA required analyses/reviews
Analysis of access to the population
Analysis of Assessment & Program Acceptance
Analysis of Participant Retention
Analysis of Home Visit Completion
Cultural Review
Analysis of Staff Retention and Satisfaction
~~~

4. Where to Start? Review the 2014-2015 BSR
Analyze improvement plans for each category
Did you do what you planned?
If so, what was the impact?
If not, why not?
Did you do anything you hadn’t planned?

5. Analysis of Access to the Population
Description of Target Population
Basic demographics of the target population such as race, ethnicity, age, language, general description of the area
Easidemographics.com
Edr.state.fl.us
Floridacharts.com
Zipwho.com
Factfinder.census.gov
Target population must be specific to your actual target. If you are serving specific zip codes rather than county wide, analysis should be limited to zip code areas. Include information about cultural characteristics that describe your population, such as high number of migrant families or high number of immigrants or refugees.

6. Analysis of Access to the Population Continued
Description of Target Population
Basic demographics of the target population such as race, ethnicity, age, language, general description of the area
How target population was determined
Agreements in place to access population
Memoranda of agreement (MOAs)
Process for accessing target population
Community outreach activities
Percent of births screened (use Birth Rata Analysis)

7. Analysis of Access to the Population Continued
To improve the screening rate, explore:
Are you getting all the screens from Healthy Start?
Does Healthy Start have a low screening rate, too?
Are there other service providers/places that might provide access to the population?
Has there been an increase or decrease in Record Referral Screens? If so, why?
Has there been an increase or decrease in Prenatal Risk Screens? If so, why?
Develop a plan to expand methods of access.
~~~

8. Analysis of Assessment Acceptance
Include formal and informal data and identify sources
Formal data=hard data or numerically recorded data
Informal data=soft data or anecdotal data, gathered by discussion with staff, families, stakeholders, Advisory Committee members
Include a description that explains the data
What happened to families that screened positive, but were never assessed.

9. Analysis of Assessment Acceptance
Use the Screening Analysis Report
One year of data minimally required, two years optional
Determine factors impacting positive screens not resulting in assessment
By FAW (Unable to locate, Refusals)
Exploration of high “unable to locate”(how long between screen to offer, outreach techniques, etc.)
Root causes of “unable to process-limited resources”
Analysis of “other”
Develop a plan to increase percentage of positive screens resulting in an assessment

10. HEALTHY FAMILIES SOMEWHERE
Screening Analysis Report (07/01/2016 – 06/30/2017)
HFF Record Screen/Referral Forms
Prenatal Risk Screens
Infant Risk Screens
TOTAL
 Total screens
386 
655   0
1041 
 Total # of negative screens
163
172 
335 
(A) Total # of positive screens
223
483 
706 
(B) # of positive screens not assessed due to MOOSA 0 
17 
(C) # of positive screens not assessed  due to vanished/unable to locate
125 
(D) # of positive screens not assessed due to TC adopted out/died prior to assessment
19 
E) Positive screens not assessed due to unable to process - limited resources
0 (0%)
(F) # of positive screens not assessed for other reasons 98
160 
258 
 # of positive screens offered     assessment [A-(B+C+D+E)]
125
162
287 
 # of positive screens that refused  assessment 1
37 
38 
 Total # that should be assessed     (Offered - Refused)
124 
249 
 Assessment Acceptance Rate (# that should have been assessed / # offered assessment): 87%
 Total # assessed during period (07/ /2009): 250
 Other reasons positive screens were not assessed: (HFF Record Screen/Referral Forms) . (Prenatal Risk Screens), 4 no translator, assessment, current participant,no translatort, no translator, incarcerated, past participant, pst 3 mos, current participant,
Note the high number of “unable to locate” and “other reasons.” “Other Reasons” will need more in depth analysis. Both categories may provide opportunities for improvement that will have impact on performance.

11. Analysis of Program Acceptance
Include formal and informal data and identify sources
Formal data=hard data or numerically recorded data
Informal data=soft data or anecdotal data, gathered by discussion with staff, families, stakeholders, Advisory Committee members
Include a description that explains the data
What happened to families that assessed positive, but never enrolled.
Data Report from HFF Performance Management System

12. HEALTHY FAMILIES SOMEWHERE
Aggregate Report for Assessment Result
(Assessed From 07/01/2016 Through 06/30/2017)
Assessment Result # %
MOOSA 15
6% 
Consented To Participate
102
41% 
Refused 10
4% 
Refused Program During Creative Outreach 17
7% 
Active CPS Case 6
2% 
Scored Out 13
5% 
Target Child Adopted 1
0% 
Target Child Miscarried/ITOP/Died 4
Referred To More Appropriate Service
Other
Family Vanished/Unable To Locate 51
20% 
Not Enrolled/At Situational Capacity 30
12% 
Not Enrolled/At Actual Capacity
Refused CPS Background Check
None Selected
1% 
Program Acceptance Rate
79% 
All areas shaded in green are the reasons families assessed positive were not offered services. These are excluded from the Program Acceptance Rate calculation. “Other” should be reviewed for accuracy.
Total: 250

13. Analysis of Program Acceptance continued
Report the program acceptance rate for the reporting period. This is the percent of families accepting services out of all those offered services.
One year of data minimally required.
Consider including a performance trend line for at least three years.

14. HEALTHY FAMILIES SOMEWHERE
Aggregate Report for Assessment Result
(Assessed From 07/01/2016 Through 06/30/2017)
Assessment Result # %
MOOSA 15
6% 
Consented To Participate
102
41% 
Refused 10
4% 
Refused Program During Creative Outreach 17
7% 
Active CPS Case 6
2% 
Scored Out 13
5% 
Target Child Adopted 1
0% 
Target Child Miscarried/ITOP/Died 4
Referred To More Appropriate Service
Other
Family Vanished/Unable To Locate 51
20% 
Not Enrolled/At Situational Capacity 30
12% 
Not Enrolled/At Actual Capacity
Refused CPS Background Check
None Selected
1% 
Program Acceptance Rate
79% 
Total: 250

15. 102/129 = 79% Program Acceptance Rate
The program acceptance rate is determined by dividing the number that consented to participate by the total number offered an assessment (consented to participate + assessment + outreach)
Consented To Participate
102
Refused 10
Refused Program During Creative Outreach 17
Consented to Participate (102)
129
Consented to Participate (102) + (10) + (17)
102/129 = 79% Program Acceptance Rate

16. Analysis of Program Acceptance continued
Analysis of those that refused services
Must include a comparison to those that accepted services
HFA requires the analysis include the following factors:
Demographic
Programmatic
Social

17. Analysis of Program Acceptance continued
Demographic factors (use the Assessment Demographic Report)
gender:
age:
race & ethnicity;
marital status;
education;
language;
employment; and
city, zip code, community, etc.

18. Analysis of Program Acceptance continued
Programmatic Factors
referral sources*
staffing issues (patterns & trends among assessment staff or assigned FSW; use the Assessment Demographic Report)
timeframe between screen and assessment*
timeframe between assessment and initial contact*
number and/or type of attempted contacts*
* These data would require local tracking mechanisms.

19. Analysis of Program Acceptance continued
Assessment Demographic Report
Result: Consented To Participate
Result: Refused
Result: Refused Program During Creative Outreach (Assessed between 7/1/2016 and 6/30/2017)

20. Assessment of Program Acceptance continued
Social Factors
assessment score (use Participant Assessment by Results Report)
working or in school*
economic factors*
teen parent(s) living with parents*
cognitively delayed parents*
the big three – substance abuse, mental health or domestic violence*
* This would require informal data since this data is not collected for those who do not enroll and is not easily accessed for those enrolled.

21. Participant Assessments by Result(Result: All Results)
(Assessed During 7/1/2016 Thru 6/30/2017)
Run by:
Result: Consented To Participate
Result: Refused
Result: Refused Program During Creative Outreach

22. Analysis of Program Acceptance continued
Analysis of those that refused the program
HFA requires that the analysis be based on the following factors
Demographic
Programmatic
Social
Findings (including comparison to those that accepted services)
Plan (based on findings) to increase program acceptance
~~~

23. Analysis of Retention Rates
Definition of Retention Rate
The percent of families enrolled in a given fiscal year that remain in the program for a specified period of time after the initial home visit.
Retention Rate
12 Months Months
24 Months OR Months
36 Months Months
Minimally use 1-year cohort
Consider using 3 1-year cohorts for trend analysis

24. Closure Reason Table for Those Participants Not Retained
HEALTHY FAMILIES SOMEWHERE
Participant 12 Month Retention Rate
Closure Reason Table for Those Participants Not Retained
Closure Reason
Enrolled 13-14
Enrolled 14-15
Enrolled 15-16
Parent Incarcerated
0.0%
1.8%
Target Child Miscarried/ITOP/Died
2.6%
Moved Out Of Service Area
46.2%
29.7%
32.7%
Lost Contact
10.3%
5.4%
3.6%
Other
8.1%
Completed HFF Program
Referred Out
Parent School/Work Fulltime
7.7%
27.0%
18.2%
TC Adopted Out/Custody Change
5.1%
Child Removed By CPS
2.7%
Referred To a Non-HFF HF Program
Transferred To Another HFF Site
Primary Participant Died
Not Interested
23.1%
21.6%
23.6%
Aged Out
Refusing New FSW
10.9%
Non-target Child Died
State Budget Cuts
Local Budget Cuts
Total
100%
12 Month Retention Rate
57%
54%
HFF Performance Management Reports are data source. Reports must be run one year of enrollment at a time, and then the chart is developed to identify the multi-year analysis.

25. Closure Reason Table for Those Participants Not Retained
HEALTHY FAMILIES SOMEWHERE
Participant 24 Month Retention Rate
Closure Reason Table for Those Participants Not Retained
Closure Reason
Enrolled 12-13
Enrolled 13-14
Enrolled 14-15
Parent Incarcerated
0.0%
Target Child Miscarried/ITOP/Died
6.7%
3.4%
7.2%
Moved Out Of Service Area
33.3%
22.0%
9.6%
Lost Contact
28.9%
25.4%
31.3%
Other
4.4%
11.9%
Completed HFF Program
1.7%
1.2%
Referred Out
Parent School/Work Fulltime
2.2%
5.1%
6.0%
TC Adopted Out/Custody Change
2.4%
Child Removed By CPS
Referred To a Non-HFF HF Program
Transferred To Another HFF Site
Primary Participant Died
Not Interested
20.0%
27.1%
27.7%
Aged Out
Refusing New FSW
3.6%
Non-target Child Died
State Budget Cuts
Local Budget Cuts
Total
100%
24 Month Retention Rate
50%
39%
40%

26. Closure Reason Table for Those Participants Not Retained
HEALTHY FAMILIES SOMEWHERE
Participant 36 Month Retention Rate
Closure Reason Table for Those Participants Not Retained
Closure Reason
Enrolled 11-12
Enrolled 12-13
Enrolled 13-14
Parent Incarcerated
0.0%
Target Child Miscarried/ITOP/Died
6.7%
3.4%
7.2%
Moved Out Of Service Area
33.3%
22.0%
9.6%
Lost Contact
28.9%
25.4%
31.3%
Other
4.4%
11.9%
Completed HFF Program
1.7%
1.2%
Referred Out
Parent School/Work Fulltime
2.2%
5.1%
6.0%
TC Adopted Out/Custody Change
2.4%
Child Removed By CPS
Referred To a Non-HFF HF Program
Transferred To Another HFF Site
Primary Participant Died
Not Interested
20.0%
27.1%
27.7%
Aged Out
Refusing New FSW
3.6%
Non-target Child Died
State Budget Cuts
Local Budget Cuts
Total
100%
36 Month Retention Rate
50%
39%
40%

27. Analysis of Retention
Analysis is based on those families leaving the program in the reporting period
HFA requires that the analysis be based on the following factors
Demographic
Programmatic
Social

28. Analysis of Retention HEALTHY FAMILIES SOMEWHERE
Aggregate Report for Closure Reasons
(Closed During 07/01/2016 Thru 06/30/2017)

29. Analysis of Retention continued
Demographic factors (use the Participant Demographic Report-Closed Cases Only, All)
gender
age
race & ethnicity
marital status
education
language
employment
city/zip code, etc.

30. Analysis of Retention continued
Programmatic Factors
closure reasons
assessment scores*
timeframe from assessment to first home visit*
Prenatal versus postnatal enrollment*
staffing issues (by FSW, by team)
current service level at time of closure (from QPR)
length of time in program (from QPR)
* This would require informal data or checking individual records since it is not aggregately reported for those enrolled.

31. Analysis of Retention continued
Social Factors
assessment score
working or in school*
economic factors*
teen parent(s) living with parents*
cognitively delayed parents*
the big three – substance abuse, mental health or domestic violence*
*This would require informal data since this data is not collected or easily accessed for those enrolled.

32. Analysis of Retention continued
Analysis of those that left the program
HFA requires that the analysis be based on the following factors:
Demographic
Programmatic
Social
Findings (must include comparison to those that remained in the program)
Plan (based on findings) to increase family retention
~~~

33. ~~~ Home Visit Completion Describe monitoring system
Review home visit completion rates
By project
By team
By FSW
Include any findings from HFF QA monitoring
Develop plan to increase home visit completion based on findings of monitoring (not required if all FSWs achieve 90 percent or higher)
~~~

34. Cultural Review
Description of Service Population (those served in reporting period)
Include:
Ethnic/racial characteristics
Other demographic characteristics
Language
Other cultural characteristics
Compare to target population to determine any gaps
Compare to staff/home visitors
Discuss ability to serve the major cultures within the population including agreements with partners if needed

35. Cultural Review continued
Discuss cultural competence of the program regarding the Materials used by the FAWs and FSWs.
You must include input from both families and staff in the discussion of materials. Examples and survey results are great here. Item #5 and #6 of the Participant Satisfaction Survey provides family input.
Caution: Include how you got input from families and staff, but – don’t stop there! Include the actual input (survey results, what you learned from the focus group or staff meeting discussion, what you observed in shadowing, what you heard during QA calls, etc.)

36. Cultural Review continued
Training on the Unique Characteristics of the Population
Often confused with training on cultural sensitivity
Describe what training was provided, when and who attended.
Compare the needs identified in the last BSR and whether you completed your plan to meet those needs.
Identify new training needs identified through the BSR process and plan to meet those needs.

37. Cultural Review continued
Some tips on identifying the unique characteristics of the population:
Comparison of demographic reports
Comparison of Aggregate Report for Assessment
Concerns
Areas that staff may have had difficulty in
Areas staff have requested training in
Include how you determined the need in your BSR.

38. Cultural Competence in Service Delivery
Describe systems that ensure cultural competence in each service delivery area
Assessment
Home Visiting
Supervision
Management
Describe accommodations and adaptations to meet cultural needs in each of the service delivery areas
Discuss barriers and plans to address them

39. Cultural Review continued
Provide input from families on how they regard cultural competence of the program regarding:
Materials (may already have in materials section)
Communications/linguistics
Staff and family interventions

40. Cultural Competence continued
Items from Participant Satisfaction Survey that provide input on these items:
Materials – “The materials my home visitor gives me are easy to understand” (#5), “The materials my home visitor gives me respect my culture” (#6)
Communications – “My home visitor talks with me in a language I understand or has an interpreter to help” (#12)
Staff/Family Interactions – “My home visitor treats me with courtesy and respect,” (#1) “My home visitor understands and respects my culture” (#13)

41. Cultural Review continued
Provide input from staff on how they view cultural competence of the program regarding:
Materials (if not already included in materials section)
Communications/linguistics
Staff and family interventions
Tell how you obtained the input from staff. Also, include the input. Discuss any barriers to communication or challenges with interventions that might need to be addressed.

42. Cultural Competence continued
Feedback from the advisory committee on last BSR ( )
Best practice is to review the whole BSR and get
feedback
HFA Standards require feedback from the committee on
the Cultural Review
Describe any actions taken on the feedback
from the committee
Describe plan to present the current BSR to
the committee
~~~

43. Staff Retention Analysis
Discuss how long current staff have been employed
Provide information on:
Any positions that became vacant in the reporting period
Reasons for leaving for each person that left
Demographics of staff that left compared to those that remained
Input from staff who are currently employed regarding satisfaction
Discuss any challenges to staff retention
Review the plan from the previous BSR
Discuss any changes made or planned to increase staff retention.

44. Staff Retention Analysis
Staff (by position title) who left during the timeframe (12 months for new sites, 24 months for all others)
their hire date
termination date
reason why they left
any other pertinent characteristics
Summary of staff satisfaction
Strategies developed based on what was learned from data
Strategies which have been implemented

45. Biennial Service Review
Involve others – make it a team effort
Cite your references
Be a detective – find out what’s working; why or why not
Include formal and informal data
Include a plan that is reasonably linked to the findings

46. Process after submission
BSRs are due November 15th for the reporting period of the previous fiscal year.
Once submitted, HFF staff will review the BSR and provide feedback, including requested revisions if the BSR does not cover everything required by the HFA Standards
Along with the feedback, projects will be given a deadline to submit revisions.

47. Any Questions
If you have any questions at any time regarding what is required, what you are finding in your analyses, suggested activities to address your findings, or the process, etc…please feel free to contact your program specialist or me at