1. Case Reviews Overview Kim McDowell Social Services Supervisor
4/23/2017 9:42 PM
Case Reviews Overview
Kim McDowell
Social Services Supervisor
Continuous Quality Improvement- Solano County
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2. Background
The Administration for Children and Families (ACF) is responsible for Federal oversight of the state Child Welfare programs.
As part of that oversight, ACF has conducted Child and Family Service Reviews (CFSR) in each state to evaluate performance on key outcome measures.
The CFSR includes multiple assessments, and has included case reviews in California since 2002.
Beginning in 2015, California has applied to conduct internal case reviews, and began training reviewers in each county to complete the case review tool for the 2016 CFSR.

3. What do case reviews do for: California Child Welfare agencies?
are completed to ensure conformity with federal child welfare requirements.
collect qualitative data in addition to the quantitative data captured by the CWS/CMS database, in order to help determine some of the “why” behind the outcome numbers.
assist states and counties in enhancing their capacity to help children and families achieve positive outcomes.

4. What do case reviews do for: Children and Families?
4/23/2017 9:42 PM
What do case reviews do for: Children and Families?
Case Reviews
Focus assessment on key outcome areas:
Safety, Permanency, Well-being
Place significant attention on the needs of the child (educational, medical, dental, mental health) and services needs of the parents being met.
In addition to case file review, collect information from in-person interviews of involved parties, soliciting direct client feedback.
Create a continuous feedback mechanism within the Department to improve processes and outcomes for children and families.
© 2007 Microsoft Corporation. All rights reserved. Microsoft, Windows, Windows Vista and other product names are or may be registered trademarks and/or trademarks in the U.S. and/or other countries.
The information herein is for informational purposes only and represents the current view of Microsoft Corporation as of the date of this presentation. Because Microsoft must respond to changing market conditions, it should not be interpreted to be a commitment on the part of Microsoft, and Microsoft cannot guarantee the accuracy of any information provided after the date of this presentation. MICROSOFT MAKES NO WARRANTIES, EXPRESS, IMPLIED OR STATUTORY, AS TO THE INFORMATION IN THIS PRESENTATION.

5. What do case reviews do for: Foster Agencies, and foster/relative providers?
Focus on agency efforts to support placement, including:
Efforts to place with relatives
Efforts by the Department to assess and meet the needs of the foster (including relative) parents.
Encourages and allows for efforts by substitute care providers and collaborative agencies to be considered as part of the review.
Gives SCPs a “voice” on a consistent basis regarding their interaction with the agency.

6. What do case reviews do for: CWS Staff?
Connect practice to the principles of a case practice model.
Focus staff on practice skills and activities used in every day casework.
Provides meaningful feedback to staff about quality of practice.
Allows for focused teaching and training of staff directed by local agency outcomes on key practice standards through the review of those key areas.
Using a case file review offers a more promising approach to capturing the complex dynamics of CWS work.
Provides equal weight to interviews with staff regarding their work with families, allowing staff to clarify and elaborate on their efforts.

7. Training Implemen-tation Data review Classroom training
Practice case reviews
1 supervisor
1 SW III
Certification Test
Implemen-tation
70 cases/year for Solano County
Each review takes about a week
Reviewed for a period of 18 months or less
Data review
Ongoing reporting to Federal Gov’t
Ongoing local review of practice
Solano CQI/QA process under development

8. The case review process:
Out of home cases are proportionately divided between CWS and Probation foster care cases; and foster care/in-home cases
The 18 month “Period Under Review” may capture all or part of the case, and ends at the time of the case closure or review, whichever is earlier
The “PUR” is designated by CDSS at the time that the randomly selected cases are provided to the team for review
The case may be closed at the time of review, or may still be open for service

9. More…
Includes all cases (VFM, FM, FR, PP, Adopt), but does not extend beyond the client’s 18th birthday
Considers ONLY services and efforts made during the “Period Under Review” in the review, with a couple of exceptions

10. Collecting information:
Reviewers consider available documentation, including:
Case file records
CWS/CMS
SafeMeasures
SDM
Reviewers conduct interviews of key case participants, including:
Focus Children
Other siblings in the home
Foster/relative care providers
Case Managers
Other collaterals as needed
Parents

11. What does this mean to CWS staff?
The case reviewers will be requesting
Case files for review
File review should take no more than several days, and advance notice will be provided to allow file to be filed and prepped
Interviews with social workers (or supervisors if social workers are no longer with the Department)
Interviews are expected to take about an hour, and there may be some follow up questions after other interviews are completed

12. What does this mean to SCPs?
FFA’s/ Group home agencies
Interviews with social work staff may be conducted for:
Information on services provided
Feedback on ways the Department met or did not meet the needs of the SCP, and ways the Department worked with the SCP
Support regarding contacting SCPs in your agency
Individual SCPs
Case Reviewers WILL be contacting current/prior placement providers for:
Interviews- The case review tool requires interviews of SCPs with whom the child was placed during the review period.
Information on services provided/needed
Feedback on ways that the SCP was or was not supported by the Department

13. What does this mean to clients (parents and children)?
Client voice heard
Active engagement with randomized group of clients for feedback regarding Department’s efforts
Seeking feedback on an ongoing basis
in the past, client voice was generally sought during stakeholder interviews for peer review cycle
Confidential feedback that does NOT impact case
Youth as key participants
Interviews with youth to collect their views on how they were served

14. What about … ? Adoptive cases
-All of the same standards apply
-If parental rights were terminated PRIOR to the review period, the adoptive parents (and their services) are what the review is assessing, and the parents are not interviewed
-if parental rights were terminated DURING the review period, parents are still interviewed, as are the SCPs/adoptive parents
Closed cases -All of the same standards apply -The reviewer makes a “diligent effort” to meet with the family-

15. Interviews- in a nutshell
Interviews are conducted to:
Collect information for the Case Review Tool
Clarify or verify information obtained in the case documentation or other interviews
Provide caseworkers, clients, and SCPs with a venue to express concerns, strengths and their needs
The information obtained is CONFIDENTIAL, and is used for the purpose of the case review and CQI process only
Case Review Staff are still mandated reporters, so new allegations of abuse and neglect are reportable. Clear ethical violations will also require additional consultation.
The Case Review interview guide includes suggested questions items, but this is NOT a structured interview

16. Interviews with caseworkers or supervisors
Equal weight placed on interview as on case file review
This allows for addition/clarification of information
All caseworkers who carried the case during the Period Under Review are to be interviewed, and the supervisor if the worker is no longer available
Opportunity for caseworkers to discuss strengths and barriers they encountered during the period, which may not have been in reports or case notes

17. Sample caseworker interview questions
How stable is the child’s current placement?
How was concurrent planning implemented in the case?
What were/are the barriers in achieving the permanency goal(s) timely?
What efforts were made to identify, locate, inform, and evaluate relatives as placement resources?
Describe the process you used to engage the parents/caregivers in case planning. How did you describe the purpose of the case plan to parents/caregivers?

18. Interviews with SCPs (foster and relative)
The amount of information needed may vary depending on the length of time the target child was placed with the SCP during the period under review.
The information provided is confidential, and will NOT be provided to the current caseworker, or used in the case in any way (barring safety issues).
While the case reviewer is interested in understanding
barriers in communication between
SCPs and the Department, these
Interviews are not a mechanism to
resolve case specific issues.

19. Sample SCP interview questions
Questions may include:
Did you have any concerns about the child’s safety during visitation with parents and/or other family members?
Do you believe the child’s permanency goal is/was appropriate based on the child’s needs and the circumstances of the case? Why or why not?
Was a visitation plan developed for the family? If so, were you involved in developing it?
What kinds of services did the child receive? Were the services helpful?
Was there anything the child needed that the agency did not provide for?
How often did the caseworker visit with you? What types of things were discussed during visits/contact with the caseworker?

20. Interviews with clients (parents and youth)
Interviews are CONFIDENTIAL
This is very important- especially for cases that are still open
The information collected will not be used for case management, or be shared with the caseworker
Caseworkers will be asked to make introductions on open or recently closed cases, so an understanding of the process is necessary if the parent/youth have questions
Flexible times/places
Completely voluntary, but active efforts to encourage the family to participate will be made

21. Sample client interview questions
Parents:
Were services offered to your family to keep your children safe in your home? If not, do you know why not?
Did the caseworker discuss the permanency goal(s) with you? If so, can you tell me what those conversations were like?
Were any of your children placed in separate foster homes? If so, do you know why?
Do you believe the agency accurately assessed your child(ren)’s needs during the period under review?

22. More questions… Children:
Did/do you feel safe in your family home? If not, what was/is going on to make you feel unsafe?
How often do/did you visit with your parents? What about visits with siblings?
Were you involved in any meetings where your case plan was discussed?
Has anyone discussed your permanency goal with you? If yes, what did you talk about?

23. More to come… The CQI team is still working on the details of exactly what data we need AND how to use it :
Here’s the direction we’re going…
Collect Key Outcomes from workgroups, initiatives, staff, and other key stakeholders
Merge Case Review with review tools from SDM, SOP, Core Practice Model etc.
Some Ideas below
Structured Decision Making
Assessment tool completed per policy
Does record narrative match item scores?
Is final tool recommendation correct?
Safety Organized Practice ?
Katie A
CSEC
SIP Strategies
Perman-ency
PTM’s
Concurrent placements
Safety/ Investiga-tion
Other goals

24. Where does the information go after it is collected?
Identify areas for:
Training
Policy development or adjustment
Advocacy
Peer review /SIP
Case Reviews
Outcomes Data
Where does the information go after it is collected?
Data regarding outcomes, and feedback regarding barriers in practice, is used to improve outcomes for children and families
Working together to move from compliance focus to learning focus

25. What do we hope to get from Case Reviews?
Learn more about our practice, so that we can improve it “from the inside”
For areas of success- find out what we did right, and replicate it
For areas of struggle- find out what are the barriers, and work toward practice change
Even better teaming with collaborative agencies
Exceptional engagement with families
Meet state requirements for 70 case reviews per year

26. Information for supervisors
Staff may be worried about:
Whether this is an “audit”
What will happen if the case doesn’t “pass” the review
Getting in trouble, having performance consequences, or being negatively identified in some way as a result
The case review protocol is clear, this is confidential
Information from clients and SCPs will not be provided to social workers
Information from social workers will not be “used against them”

27. How can supervisors help?
Knowledge
Support
Understanding of case review process
The more information you have about how the case review process works, the more you can alleviate the fears of your staff
Understanding of Federal/State outcome measures
Knowing how the outcome measures are assessed can help guide practice, and is a tool to understanding the case review
Familiarity with case review tool items
The items guide the interview questions, which are framed around missing/unclear information in the file
Talking with staff about reviews BEFORE they have a case reviewed
Familiarity reduces anxiety
Assessing for outcome measure progress during supervision
Many of the case review items measure things that social workers do, but don’t always document well. Talk with social workers about documenting specific topics
Be aware that the interview will be asking about areas of strength AND deficiency in the case records. This may be an area that causes workers anxiety.