1. From QA to QI: The Kentucky Journey

2. In the beginning, we were alone and compliance reigned.

3. For years, we monitored activities, counted the ‘widgets’ and we remained an island.

4. Slowly, we began to realize that it was important to assess not only that events occurred, but also the content of events.

5. We also realized the importance of using all of our resources in order to protect children and plan for their ultimate permanency.

6. This is the story of that journey.

7. CQI Kentucky implemented Continuous Quality Improvement (CQI) on a statewide basis to provide a way for all staff to participate in the examination of the agency’s internal systems, procedures, and relationships with community partners to improve the quality of services.

8. It’s Official ! In 2002, Kentucky passed legislation requiring all cabinets to develop a four (4) year Strategic Plan. The Cabinet for Health and Family Services was the first to have an approved strategic plan with the following goals: In 2002, Kentucky passed legislation requiring all cabinets to develop a four (4) year Strategic Plan. The Cabinet for Health and Family Services was the first to have an approved strategic plan with the following goals:

9. To ensure that the children and vulnerable adults we serve are safe from harm. To ensure that the children and vulnerable adults we serve are safe from harm. To ensure well being for the children and families we serve. To ensure well being for the children and families we serve. To achieve timely permanency for the children we serve. To achieve timely permanency for the children we serve. To ensure that the individuals and families we serve achieve and maintain self-sufficiency. To ensure that the individuals and families we serve achieve and maintain self-sufficiency. To engage with families and communities as full partners for effective service delivery. To engage with families and communities as full partners for effective service delivery.

10. Since its implementation, the CQI process has been instrumental in the Department’s successful completion of the Program Improvement Plan and is embedded in the framework of local, regional and central office activities.

11. What CQI is and what it’s not CQI is a philosophy and set of techniques that allows service providers to look at their activities and outcomes to create plans for improvement. CQI’s focus is self-directed, self- determined change rather than change imposed by an external entity. CQI is a philosophy and set of techniques that allows service providers to look at their activities and outcomes to create plans for improvement. CQI’s focus is self-directed, self- determined change rather than change imposed by an external entity. CQI is a process, not an event, by which all staff are involved in the evaluation of the effectiveness of services provided to our customers. CQI determines whether services meet predetermined expectations of quality and outcomes. CQI is a process, not an event, by which all staff are involved in the evaluation of the effectiveness of services provided to our customers. CQI determines whether services meet predetermined expectations of quality and outcomes.

12. What CQI is and what it’s not CQI is NOT intended to replace supervision. CQI is NOT intended to replace supervision. CQI uses case related data in an aggregate, non- identifying way to provide feedback and accountability to staff in a timely fashion. CQI uses case related data in an aggregate, non- identifying way to provide feedback and accountability to staff in a timely fashion. CQI Process is NOT a quick fix for all problems. CQI Process is NOT a quick fix for all problems. CQI provides a chance to create and look at new and unique ways of resolving one-time or ongoing problems, and to build on program strengths. CQI provides a chance to create and look at new and unique ways of resolving one-time or ongoing problems, and to build on program strengths. CQI provides a chance to learn and develop by identifying training needs and possible changes in policy and procedures. CQI provides a chance to learn and develop by identifying training needs and possible changes in policy and procedures. CQI is NOT a replacement for existing methods of communication or authority within the agency. CQI is NOT a replacement for existing methods of communication or authority within the agency.

13. What questions do we ask? Problem issues to be addressed should focus on three areas: Client Level Are there ways to solve the problem by changing how we interact with the client? 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? 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? Are there ways to solve the problem through local community resources?

14. Who’s at the CQI Table? Community Stakeholders We work with numerous stakeholders, including children or families we serve and community partners (schools, mental health, community action, and other related human service or advocate organization). From the legislative process to the development of the numerous federal plans, we seek input and recommendations of all stakeholders. We work with numerous stakeholders, including children or families we serve and community partners (schools, mental health, community action, and other related human service or advocate organization). From the legislative process to the development of the numerous federal plans, we seek input and recommendations of all stakeholders. Agency Staff Stakeholders are not the only community partners, but also includes our employees. Each Region’s employees are provided opportunities to comment on draft policy and procedures. Every attempt is made to incorporate these suggestions and recommendations into policy and procedure. Stakeholders are not the only community partners, but also includes our employees. Each Region’s employees are provided opportunities to comment on draft policy and procedures. Every attempt is made to incorporate these suggestions and recommendations into policy and procedure. Foster Parent CQI Regional Foster Parent CQI Teams operate in each region to assist foster parents in resolving problems. Regional Foster Parent CQI Teams operate in each region to assist foster parents in resolving problems. Statewide Community Partner CQI The Statewide Community Partner CQI Team includes representatives from other state agencies, advocacy organizations and service agencies. The Statewide Community Partner CQI Team includes representatives from other state agencies, advocacy organizations and service agencies.

15. CQI Case Review Process The CQI Case Review process was developed to assess and improve performance for meeting standards that promote quality outcomes for families served by the Department for Community Based Services. The process is as follows: The CQI Case Review process was developed to assess and improve performance for meeting standards that promote quality outcomes for families served by the Department for Community Based Services. The process is as follows: Each service region reviews 10 randomly selected cases per month Each service region reviews 10 randomly selected cases per month Reviews are conducted on 3 levels: direct line supervisor, regional office and central office Reviews are conducted on 3 levels: direct line supervisor, regional office and central office A standardized review tool is used to evaluate each case A standardized review tool is used to evaluate each case Review tool items and outcomes are in alignment with federal Adoption and Safe Families Act (ASFA) and Child and Family Service Review (CFSR) requirements Review tool items and outcomes are in alignment with federal Adoption and Safe Families Act (ASFA) and Child and Family Service Review (CFSR) requirements Once cases are reviewed at each level, feedback is provided to staff and corrections made as required Once cases are reviewed at each level, feedback is provided to staff and corrections made as required Level 2 data are entered into a web-based system for analysis and reporting Level 2 data are entered into a web-based system for analysis and reporting Performance data are provided to each service region and are used to compare their performance to national standards, identify barriers to achieving outcomes and brainstorm solutions for improvement Performance data are provided to each service region and are used to compare their performance to national standards, identify barriers to achieving outcomes and brainstorm solutions for improvement

16. Incorporating CQI Case Quality Reviews into the PIP The CQI Case Review Tool is used in KY to evaluate the quality of casework. The CQI Case Review Tool is used in KY to evaluate the quality of casework. The measure was developed and aligned with KY CFSR outcomes. Ten cases per region are randomly selected each month and reviewed for compliance on 180 case quality indicators by regional specialists. The measure was developed and aligned with KY CFSR outcomes. Ten cases per region are randomly selected each month and reviewed for compliance on 180 case quality indicators by regional specialists. Each item is related to one of the CFSR outcomes and composite measures of compliance with best case quality practices are measured. Each item is related to one of the CFSR outcomes and composite measures of compliance with best case quality practices are measured. Each month 160 cases are reviewed and scores from these reviews are aggregated quarterly yielding scores on all CFSR indicators. These consistent and rigorous case reviews allow Kentucky to reliably and sensitively assess the quality of case work at the state and regional level each month. Each month 160 cases are reviewed and scores from these reviews are aggregated quarterly yielding scores on all CFSR indicators. These consistent and rigorous case reviews allow Kentucky to reliably and sensitively assess the quality of case work at the state and regional level each month. During the life of the PIP, more than 3,800 cases were scored using the CQI Case Review Measure for compliance with best practices. During the life of the PIP, more than 3,800 cases were scored using the CQI Case Review Measure for compliance with best practices.

17. DO NOT OVER THINK CQI!! It is a problem-solving method with a continuous feedback loop. The purpose is to solve problems on the micro or macro level. The ultimate goal is to provide staff and/or stakeholders with a clear, accurate and timely response for resolution of identified issues. Never Forget!

18. Questions?