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

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

3. What is Quality? What does Quality mean to you – as it relates to your service experiences? How do we define Quality – related to your services and service outcomes? How do we measure Quality – 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

4. Person’s Perspective Meeting my needs, hopes, goals, and expectations Having positive relationships and live experiences Receiving helpful benefits Having positive life changes Program’s Perspective Fulfilling the social purposes of the program Meeting funding expectations and following guiding principles Doing good work Getting good results Strengthening Service Quality © The Quality Service Review Institute, a Division of the Child Welfare Policy & Practice Group, 2014

5. Approaches to Quality Do Things Right: Measure compliance using program reviews & records Enforce contracts Accredit service providers Measure satisfaction Track trends in system events and processes Lead quick-fixes for the problems that pop up Do the Right Things: Measure desired outcomes for people being served Measure key practice functions & strategies associated with outcomes Focus on quality of results, not just compliance with business requirements Lead practice developments that improve results Strengthening Service Quality © The Quality Service Review Institute, a Division of the Child Welfare Policy & Practice Group, 2014 BUSINESS MODEL PRACTICE MODEL

6. PURPOSE OF PRACTICE -- Helping a person having major life needs for care, treatment, 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, food, income, health care, transportation, and essentials for daily living, productivity, social integration) – Daily Functioning (performing tasks necessary for successful daily living, working, and playing in community settings and activities) – Fulfillment of Key Life Roles (capacities and supports for being a friend, family member, team player, tenant, employee, and citizen) Strengthening Service Quality © The Quality Service Review Institute, a Division of the Child Welfare Policy & Practice Group, 2014

7. Practice consists of the things we do to help a person in need to get better, do better, and stay better [THRIVE]. Practice involves how we conceptualize, organize, and deliver interventions, supports, and services that help people achieve important life outcomes. Effective practice depends on practical wisdom and smart problem solving to get good results. Strengthening Service Quality © The Quality Service Review Institute, a Division of the Child Welfare Policy & Practice Group, 2014

8. Framework LevelsContribution Made by Each Level 1.Social Purpose [Why our service agency exists] Helping persons improve their health and wellness, live a self-directed life, and strive to reach their full potential 2.Values & Guiding Principles [What values guide our work] Person-centered, strengths-based, need-responsive, individualized, solution-focused, well-reasoned, effective 3. Key Organizing Functions [How is our work organized] Engagement, teamwork, assessment & understanding, planning, implementation, tracking & adjusting 4.Strategies, Techniques, Tools [What we use to get results] Intervention approaches, evidence-based practices, specific techniques, screening tools, planning templates 5.Business Requirements [What funders require of us] Required processes, compliance & documentation requirements to meet funding & accreditation 6. Operational Infrastructure [What supports our work efforts] IT, HR, training, supervision, management, facilities, utilities, accounting, procurement, etc.

9. Services for Adults Services for Children & Families Social Purpose: Helping adults with disabilities to improve their health and wellness, live a self- directed life, and strive to reach their full potential Outcomes: Improved well- being, daily functioning, productivity, and social integration Social Purpose: Using well integrated and coordinated services to keep youth with disabilities successful in their homes, families, and schools to reach their full potential Outcomes: Building youth resiliency and family capacities to meet the youth’s needs at home and in the community Strengthening Service Quality © The Quality Service Review Institute, a Division of the Child Welfare Policy & Practice Group, 2014

10. Person-centered practice supports hope for a self-directed life It is person-driven and supports self- determination Supports come via many pathways Service provision is holistic – focuses on the whole person Services are supported through relationships and social networks Practice is culturally-based and influenced Practice is supported by addressing trauma, where indicated Practice involves the individual, family, and community supports and responsibilities Practice and service provision are based on respect Strengthening Service Quality © The Quality Service Review Institute, a Division of the Child Welfare Policy & Practice Group, 2014 Person-Centered Practice offers a process of life change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential as members of their community

11. Empowerment & Self-Determination Strengthening Service Quality © The Quality Service Review Institute, a Division of the Child Welfare Policy & Practice Group, 2014

12. Person-Centered & Team-Supported Strengths-Based & Need Responsive Outcome-Focused & Results Driven Individualized & Coordinated Trauma-Informed Culturally-Competent & Respectful C Supportive of Empowerment & Self-Determination Solution-Focused & Evidence-Based Clinically & Practically Well-Reasoned * These Qualities should be Evident in Practice for Each Person Served

13. Organizing Functions of Practice These Functions should be Evident in Practice for Each Person Served Strengthening Service Quality © The Quality Service Review Institute, a Division of the Child Welfare Policy & Practice Group, 2014

15. Person-Centered Planning Supported Employment Parent Enhancement Program Functional Behavioral Analysis Discrete Trial Training PECS Cards for communication Electronic Planning Template Strengthening Service Quality © The Quality Service Review Institute, a Division of the Child Welfare Policy & Practice Group, 2014

16. Business-Driven Tasks : – Formal system steps (e.g., intake, diagnosis, eligibility, service authorization) – Rule-guided business processes, agency procedures, timelines, forms, budgets, funding criteria – Producing documentation that passes billing audits – Compliance enforcement, meeting management metrics, and agency goals Practice-Driven Tasks : – Applying organizing practice functions, techniques, tools – Finding practical solutions to present life problems – Providing life change strategies that have to be designed and tried to find what works for the person – Helping achieve outcomes -- successful daily functioning, well-being, and fulfilling key life roles BUSINESS MODELPRACTICE MODEL Strengthening Service Quality © The Quality Service Review Institute, a Division of the Child Welfare Policy & Practice Group, 2014

17. Power = authority & enforcement Problem-focused (diagnosis) Organized around service delivery Rule-based action (form-based) Compliance-driven Isolated or “silo-based” agents Refer-out for services Focus on efficiency (costs) Meet target numbers (processes) Power = reasoning & consensus Solution-focused (success in life) Organized around people’s lives Reason-based action (functional) Outcome-driven Unified agents via teamwork Invite-in for decision-making Focus on effectiveness (results) Meet people’s needs (outcomes) Business Approach Practice Approach Strengthening Service Quality © The Quality Service Review Institute, a Division of the Child Welfare Policy & Practice Group, 2014

18. Counting is Not Enough Measuring Practice Quality to Improve Our Services & Outcomes Strengthening Service Quality © The Quality Service Review Institute, a Division of the Child Welfare Policy & Practice Group, 2014

19. Chart Audit = 15-degree Key Hole View focused on Record-Based COMPLIANCE QSR = 360-degree Big Picture View focused on Person-Centered PRACTICE

20. 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

21. QSR is an ORGANIZATIONAL LEARNING PROCESS. QSR observes the PRACTICE used in actual services. 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 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

22. Uses in-depth CASE REVIEWS to measure a person’s status, recent progress, and adequacy of current practices. [Drill Downs] Applies STORY-BASED LEARNING & TEACHING to understand what is happening and working for a person. [Stories Teach – Stories Reveal what Numbers Conceal] Explores aggregate PATTERNS of qualitative indicators to reveal and describe the quality and consistency of local practice. Combines FOCUS GROUP / KEY STAKEHOLDER INTERVIEWS along with case stories, data patterns, and local working conditions to find STRENGTHS, CHALLENGES, OPPORTUNITIES. Strengthening Service Quality © The Quality Service Review Institute, a Division of the Child Welfare Policy & Practice Group, 2014

23. Peoples’ 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

24. Reviewer Orientation Reviewer Orientation Day 1: Start Prep. Team Begin Case 1: Record, interviews Day 1: Start Prep. Team Begin Case 1: Record, interviews Day 5: QSR Sum-Up & Plan Next Steps Aggregate Results, Patterns, Findings, Recommendations Next Step Planning, using QSR findings and group’s analysis Day 5: QSR Sum-Up & Plan Next Steps Aggregate Results, Patterns, Findings, Recommendations Next Step Planning, using QSR findings and group’s analysis Day 2: Case 1 Feedback w/ worker & sup, Grand Rounds Day 2: Case 1 Feedback w/ worker & sup, Grand Rounds Day 3: Case 2 Prep. Team Begin Case 2: Record, interviews Day 3: Case 2 Prep. Team Begin Case 2: Record, interviews Focus Group Interviews/ Stakeholder Interviews Focus Group Interviews/ Stakeholder Interviews Day 4: Case 2 Feedback w/ worker & sup, Grand Rounds Day 4: Case 2 Feedback w/ worker & sup, Grand Rounds Strengthening Service Quality © The Quality Service Review Institute, a Division of the Child Welfare Policy & Practice Group, 2014

25. 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

26. Safety from harm by others Safety from harm by others Behavioral risk to self/others Behavioral risk to self/others Income adequacy & control Income adequacy & control Living arrangement Living arrangement Social network Social network Health/physical well-being Health/physical well-being Mental health status Mental health status Functional life skills Functional life skills Education/career preparation Education/career preparation Work Work Social activities Social activities Parent/caregiver functioning Parent/caregiver functioning 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 to self/others Behavioral risk to self/others Income adequacy & control Income adequacy & control Living arrangement Living arrangement Social network Social network Health/physical well-being Health/physical well-being Mental health status Mental health status Functional life skills Functional life skills Education/career preparation Education/career preparation Work Work Social activities Social activities Parent/caregiver functioning Parent/caregiver functioning Voice & choice in decisions Voice & choice in decisions OVERALL PERSON STATUS OVERALL PERSON STATUS Status Indicators Improved self-advocacy Improved self-advocacy Improved community integration Improved community integration Improved opportunities for productivity Improved opportunities for productivity Reduction in behavioral concerns Reduction in behavioral concerns Reduction in life disruptions Reduction in life disruptions Progress toward life goal attainment Progress toward life goal attainment GENERAL PROGRESS PATTERN GENERAL PROGRESS PATTERN Improved self-advocacy Improved self-advocacy Improved community integration Improved community integration Improved opportunities for productivity Improved opportunities for productivity Reduction in behavioral concerns Reduction in behavioral concerns Reduction in life disruptions Reduction in life disruptions Progress toward life goal attainment Progress toward life goal attainment 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

27. Response to cultural identity/need Response to cultural identity/need EngagementEngagement 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 Income & basic necessities Income & basic necessities Life skill development Life skill development Social integration / leisure activities Social integration / leisure activities Education or work Education or work Managing chronic health concerns Managing chronic health concerns Other interventions Other interventions Response to cultural identity/need Response to cultural identity/need EngagementEngagement 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 Income & basic necessities Income & basic necessities Life skill development Life skill development Social integration / leisure activities Social integration / leisure activities Education or work Education or work 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 Supports for community integration Supports for community integration Ongoing assessment & plan adjustment Ongoing assessment & plan adjustment OVERALL PRACTICE PERFORMANCE OVERALL PRACTICE PERFORMANCE Implementing interventions Implementing interventions Medication management Medication management Transitions & life adjustments Transitions & life adjustments Supports for community integration Supports for community integration Ongoing assessment & plan adjustment Ongoing assessment & 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

29. 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

30. Personal Summary Life Situation Outcome Status Practice Pattern Successes & Challenges Possible Next Steps Robert’s Status Profile Well-Being Supports Functioning Voice & Choice Role Fulfillment Overall Status Robert’s 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

31. Individual Profile

32. Individual Profile

33. Individual Profile

34. Individual Profile

35. Individual Profile

36. 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

37. Group Description Life Stage / Gender Living Arrangements Strengths & Needs Services Conditions Group Status Profile Well-Being Supports 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

38. Group Profile

39. Group Profile

40. Group Profile

41. Group Profile

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

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

44. Person-Based Teaching Stories Respectful & Helpful Feedback Performance Results For Practice Indicators Local Practice Conditions & Patterns Next Step Action Planning Practice Improvements

45. Strengthening Service Quality © The Quality Service Review Institute, a Division of the Child Welfare Policy & Practice Group, 2014 Strategic Tool of Leadership for stimulating system change Helping leaders understand and improve the quality of practice via targeted program design, training, supervision, and other practice development strategies Training, mentoring, and coaching of frontline practice Measuring change for affirmation and direction Guiding organizational development Becoming the best practitioners that we can be

46. Interim QSR Change Data Hawaii System Change Pattern Baseline QSR Data QSR Data: Sustainability Strengthening Service Quality © The Quality Service Review Institute, a Division of the Child Welfare Policy & Practice Group, 2014

47. Key FactorAgenda for LEADERS of Practice Change Common Agenda & Practice Model All participants have a shared vision for change including a common understanding of the practice model and joint approach to applying it through agreed upon actions. [Working from a Shared Practice Model] Shared Measurement Collecting data and measuring results consistently across all participants ensures efforts remain aligned and participants hold each other accountable. [QSR used as a central measure of practice & outcomes] Mutually Reinforcing Activities Participant activities are differentiated while still being coordinated through a mutually reinforcing plan of action. [An over-arching strategic approach used by leadership to guide decision-making and leadership action] Continuous Communications Consistent, open communications across many players builds trust, assures mutual objectives, creates common motivation. [Key leadership function] Backbone Support Creating and managing collective impact requires an organization with staff and specific skills to serve as the backbone for the entire initiative and coordinate across participating units, levels, agencies [QSR unit, possibly] Embracing Emergence: How Collective Impact Addresses Complexity. Stanford Social Innovation Review, Jan. 21, 2013

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

49. Courtesy & Convenience Responsiveness & Respect Communication Empathy & Understanding Accessibility & Availability Timeliness Adequacy & Sufficiency Efficiency Safety Reliability & Predictability Competence Credibility Affordability Continuity Effectiveness measured as Outcomes Achieved Satisfaction Strengthening Service Quality © The Quality Service Review Institute, a Division of the Child Welfare Policy & Practice Group, 2014