1. Overview of Continuous Quality Improvement (CQI)

2. First QSR Orientation Meeting Meeting Objectives Introductions of QSR State Site Lead(s) and Local Site Lead(s) Overview of the Continuous Quality Improvement process and the role of QSR in that process Purpose of the Quality Service Review process – Case- specific review; Focus Groups and Key Stakeholder Interviews Overview of the components of the QSR process and timelines associated with the on-site review Overview of the QSR indicators Composition of the review team

3. Continuous Quality Improvement What it isn’t and what it is… Continuous Quality Improvement (CQI) is not a time limited project or initiative. It is the ongoing process by which an agency makes decisions and evaluates its progress. “A framework for implementation” Casey Family Programs & NRCOI

4. The DAPIM TM Model: A “Flywheel” Implemen t Plan Define Performance & Capacity Monitor Assess -© 2009 American Public Human Services Association

5. What is a Quality Service Review? Measures child, youth, and family outcomes Reveals the practice model being used in actual cases. QSR is an organizational learning process offering helpful ways of knowing what’s working and not working in practice -- for which children and families and why. QSR connects results to local frontline conditions. QSR supports teaching & action learning processes that clarify expectations, provide useful feedback, and affirm good work. QSR stimulates actions taken to improve practice and results at all levels of the organization.

6. State and local review team members review case of one focus child/youth  Brief review of the record  Focused interviewers with members of the child/family team  Rates the status of the child/family and the system performance on a 1-6 scale  Written case review summary “tells the story” of what was learned from the team

7. Immediate feed back to the Caseworker and Supervisor with strengths/needs/ recommendations  Case specific  Agency specific Focus groups with stakeholders and key stakeholder interviews Debriefing with QSR Team Exit Conference of preliminary findings Final findings report Next Steps Meeting

8. QSR Activities QSR Case Reviews QSR Focus Groups and Key Stakeholder Interviews DPW Licensure Caseworkers Supervisors Other: may consider youth, birth families, foster families, courts, etc. Same cases as QSR sample Stakeholder interviews Feedback to Caseworker and Supervisor Additional intake, foster home, and personnel files Review for regulatory compliance Written Case Summary Aggregate quantitative results Summation, Discussion, Next Steps Planning

9. PA QSR Protocol: Child/Youth and Family Status Indicators 1a. Safety: Exposure to Threats of Harm 1a. Safety: Exposure to Threats of Harm 1b. Safety: Risk to Self/Others 1b. Safety: Risk to Self/Others 2. Stability 2. Stability 3. Living Arrangement 3. Living Arrangement 4. Permanency 4. Permanency 5. Physical Health 5. Physical Health 6. Emotional Well-being 6. Emotional Well-being 7. Learning & Development 7. Learning & Development 8. Pathway to Independence 8. Pathway to Independence 9. Parent & Caregiver Functioning 9. Parent & Caregiver Functioning

10. PA QSR Protocol: Practice Performance Indicators 1a. Engagement Efforts 1b. Role and Voice 2. Teaming 3. Cultural Awareness & Responsiveness 4. Assessment & Understanding 5. Long-Term View 6. Child/Youth and Family Planning Process 7. Planning for Transitions and Life Adjustments 8. Efforts to Timely Permanence 9. Intervention Adequacy & Resource Availability 10. Maintaining Family Connections 11. Tracking & Adjusting

11. Interpretive Guide for Child/Youth and Family Status Indicator Ratings Unacceptable Range: 1-3Acceptable Range: 4-6 Improvement Zone: 1-2Refinement Zone: 3-4Maintenance Zone: 5-6 Status is problematic or risky. Quick action should be taken to improve the situation. Status is minimum or marginal, may be unstable. Further efforts are necessary to refine the situation. Status is favorable. Efforts should be made to maintain and build upon a positive situation. 123456 Adverse Status Poor Status Marginal Status Fair StatusSubstantial Status Optimal Status The individual’s status in this area is poor, unacceptable and worsening. Status is and may continue to be poor and unacceptable. Any risks may be mild to serious. Status is mixed, limited or inconsistent and not quite sufficient to meet the individual’s short- terms needs or objectives now in this area. Status is at least minimally or temporarily sufficient for the individual to meet short-term needs or objectives in this area. Substantially and dependably positive status for the individual in this area with an ongoing positive pattern. Status is good and likely to continue. The best of most favorable status presently attainable for this individual in this area (taking age and ability into account).

12. Final Report QSR Findings Report –Demographics –Child/Youth and Family Status Domain –Practice Performance Status Domain –QSR Results Summary –Key Questions to Consider for Next Steps Planning

13. Purpose: The Next Steps Meeting is designed to be a starting point or continuation of the county’s efforts in the Continuous Quality Improvement (CQI) process which focuses on the development of an action plan for enhancing case practice and system performance.

14. Sponsor and Improvement Teams Sponsor Team Implementatio n Team Work Group Sponsor Team Defines high-level vision of CQI efforts Secures resources Creates and charters Improvement Team Improvement Team Guides CQI work day-to-day Maintain hands-on responsibility for CQI efforts Charters and oversees smaller CQI work groups Communicates with Sponsor Team Work Groups Implement improvement efforts focused on specific target areas Representation from agency staff, providers, consumers Work Group

15. County Improvement Plan (CIP) Section I. Sponsor Team Members Section II. Background Section III. Priority Outcomes Section IV. Findings Section V. Strategies and action steps for each outcome

16. Bringing CQI to Life Review and analysis of CQI findings (with focus on QSR results) Identify recommende d improvement priorities CQI Sponsor Team creates CQI Charter and approve priorities CQI Improvement Team receives CQI Charter and develops County Improvement Plan CQI Sponsor Team reviews County Improvement Plan and approves for submission to state CQI Work Groups identify and implement strategies to actualize CIP Improvement Team monitors and analyzes work groups CQI Sponsor Team receives findings CYS leadership, CQI staff, with support of TA Collaborative

17. What’s in it for your County? Provides a great source of information and data related to your specific case, related to agency trends, systems’ issues (report on each sample case generated after reviews) Supports the framework for the county’s current change efforts Case-specific improvement