National Child Welfare Resource Center Page 1
for Organizational Improvement
DRAFT
Notes from QI Peer Network Call
March 23, 2010
Participating Locations
Clark County (NV), Colorado, Florida, Idaho, Indiana, Kentucky, Louisiana, Michigan, Missouri, Nebraska, Oklahoma, Tennessee, Texas, Norfolk (Virginia), Santa Clara County (CA), Washington
Updates:
§ The NRCOI has a remodeled website: www.nrcoi.org. As part of that remodeling process, we have migrated all our peer network extranet sites to the site. So the new URL for the QI Peer Network site is the following: http://www.nrcoi.org/QINetwork.htm
No password is needed. Let us know if you have any feedback.
§ The NRCOI has released the schedule forour free Spring/Summer 2010 teleconference/webinar program: http://www.nrcoi.org/tele.htm Visit the website to register for any calls you wish to participate in. We also now offer CEUs for these sessions.
§ We’re planning to offer future QI Peer Network calls as webinars.
Topic: Key issues in creating and supporting local QI teams
A number of state agencies rely on local QI teams to review data and information and then adjust their practice and systems to make improvements. Based on your experiences with such teams, we would like to discusssome issues agencies should consider in creating and supporting these teams:
1. How much structure should the state agency create to assist in the development and operation of these teams (e.g., expectations for team membership, team leadership, frequency of meetings, standard agenda items,etc.)
2. What are some of the key ways state and local agencies must support these teams to make them effective?
3. What are the main challenges in creating and maintaining local QI teams?
4. What are the main benefits?
Cheryl Earles, Michigan
§ When Michigan wrote its CQI implementation plan as a result of the current lawsuit, they included some information on how local teams would be organized. These have not been implemented yet.
§ But they specified the types of information and reports the local teams should review and these related to some of the focus areas in the lawsuit and settlement agreement:
· Fatality reviews—local teams should review the results of these and decide what to do in response.
· The settlement requires special reviews on 5 cohorts of youth (e.g., those with 3+ allegations in a foster home, those with an allegation in a foster home who are still living in the home, 3+ placements in the past 12 months, those living in residential for 12+ months, children living with fictive kin, etc.)
§ So they want the local offices to look for ways to address these types of cases. But they have not provided much guidance to the local offices on how to review the data and information.
Becky Porter, Missouri
§ Missouri has worked with its local offices on these types of issues. Recently, had its local offices prepare for the upcoming CFSR by writing their own readiness assessments.
§ MO has 7 QA Specialists in its Regional Offices across the state.
§ They provided training to these staff a few years ago when they were hired. Focused on Excel, using data, etc. These staff are key in helping local offices collect and use data and gave the local offices three years of experience in understanding data and focusing on data quality issues.
§ Then when MO had more funding available a few years ago, they created 7 QI Specialist positions for the Regional Offices. These staff are responsible for helping local managers as they figure out how to strategize and implement changes based on what they learn from data. The QI Specialists also follow-up on local improvement strategies to make sure they are implemented.
§ The QI Specialists also received training, but the focus was different than training for QA Specialists. For example, the QI Specialists received training on strategic planning.
§ Local offices in Missouri required to have QI teams. The QA/QI staff support these teams as they operate. Circuit Managers are expected to have teams and they have their own local PIPs that focus on three major areas at a time. But the managers have flexibility in how they organize their teams, develop their PIPs, etc.
§ MO has COA accreditation and it must have case reviews as part of that accreditation. The QA/QI staff work together to conduct and use the case reviews on the local level. Some variation across the Regional Offices in how this occurs.
Shirley Alexander, Idaho
§ The Division Administrator in ID talks about results at every level of the agency. She goes to the Regional Offices and presents their statistics so they know where they are in relation to the state and the PIP.
§ The Division Administrator’s presence punctuates that it is important to look at data. As a result, the Regional Offices then request help on how to use data and information in their planning.
Carolyn Bidwell, Clark County, NV
§ Clark County has its own QA process and training. Carolyn manages both QA/QI, including reports, case reviews, and training activities. This helps close the loop with data. So they identify areas of concern through their reports and can then address some of the issues through training.
§ Nevada has an unusual system where Clark County (Las Vegas), Washoe County (Reno) and the balance of rural counties operate fairly independently.
§ Clark County reviews its data and conducts qualitative case reviews on in-home and out-of-home cases. So they will target certain units for case reviews if they have noticeable variation from the rest of the county.
§ Then they can implement training to address those workers’ needs as revealed through the data and case reviews.
§ Clark County provides/accesses a wide array of training:
o Core training through the state
o New worker training and OJT to complement the Core training
o Workers assigned a few cases before they are assigned to a Supervisor as part of the OJT activities
o They also create specialized training to help specific units. These help workers meet state-mandated training requirements as well (e.g., 30 hours a year).
o Also many great speakers from the community will come and provide sessions for free on various topics (e.g., SIDS, reactive attachment disorders, child development issues, etc.)
o Carolyn will send her training plan to Peter Watson for people in the QI Peer Network who are interested.
Shirley Alexander, Idaho
§ Idaho is about to try something new for its PIP. They want to push and sustain performance in certain outcomes.
§ Idaho requires the Regional Offices to create PIPs and the central office QA staff monitor these plans and renegotiate them when necessary.
§ Idaho still needs to improve 5 specific CFSR Items (e.g., 18, 20, 3, 4). The state plans to do some specialized QA reviews focused on these Items. Not every Regional Office needs to focus on all of them and the QA staff will focus most on Regional Offices that are struggling.
§ So they will pull an increased random sample for these 5 Items during their Regional CFSR reviews in an effort to identify what is going well and what needs improvement in these areas.
§ They will just complete those Items from the CFSR instrument and rely only on case file reviews for these specialized reviews. They are hoping that putting additional focus on these Items will drive improvements in these areas.
Tony Nease, Tennessee
§ Tennessee is doing something similar. They conduct a case process review in each county. Local CQI teams look at particular pieces of the review that need improvement in a given county. The local CQI teams look at what they can do to meet their goals in these areas.
§ Tennessee’s CQI teams are described in its CQI manual, and this is updated annually. Each Regional Office has a CQI Coordinator. These staff help and support the local CQI teams. Local CQI teams vary—some are just a few people and others may include the entire staff of an office.
§ Each county has at least three teams. For the teams to be “active,” they must meet at least quarterly. The CQI manual includes some recommendations for what CQI teams should review (e.g., specific practice issues). The CQI teams are supposed to make recommendations and send them up to Regional and/or Central Office CQI teams for decisions.
§ Some Regional Offices also include “CQI Cheerleaders” who usually are social workers who are committed to CQI.
§ Central Office provides monthly videoconferences for CQI Coordinators to support them. Each CQI Coordinator completes a quarterly report on how the CQI process is going in his or her Region.
§ Tennessee also conducts an annual CQI survey of all staff to see how to improve the process.
§ Every DCS employee in Tennessee must participate in annual CQI training—this is on-line training. Also, the Regional Offices conduct in-person CQI training for all staff.
§ CQI Coordinators receive training from central offices staff. Toni also tries to sit down at least quarterly with each CQI Coordinator and she surveys the CQI Coordinators each year so she can gauge their needs.
§ Tony will send Peter Watson some of these materials for other interested QI Peer Network members.
Diane ______, Kentucky
§ Diane is a CQI Specialist in Kentucky. KY has 9 Regions and each has 2 CQI Specialists. In her Regional Office, one person supports the CQI Team meetings and the other focuses on management reports.
§ Kentucky has had this type of structure since 1998. The state has an automated database (CQI-MITS) where CQI teams enter the results of their meetings. So all results from the local, Regional and State CQI teams can be analyzed and addressed.
§ The teams meet at least quarterly and some meet monthly. They are required to meet and engage in outcome-based discussions. But the topics vary across the committees.
§ The Kentucky CQI plan details the system and is currently available on the QI Peer Network extranet site: http://muskie.usm.maine.edu/helpkids/QINetwork.htm
Terri Farrell, Nebraska
§ Does anyone include contract monitoring or utilization management in their local CQI activities?
Lynn ______, Norfolk, VA
§ Norfolk does include contract monitoring in its work and they plan to move towards utilization management.
Tony Nease, Tennessee
§ All Regional Offices have cross functional CQI Teams. So they include foster parents and providers who discuss issues in the Region. Three Regional offices are using data such as incident reports, disruptions, etc. as part of these team meetings. So they can brainstorm some of the solutions.
Topic: Assessing different types of case review processes
In many states, child welfare cases may be subject to a variety of case review processes. Among the different types of reviews that may occur are: temporary removal and adjudicatory hearings, annual permanency hearings,multidisciplinary team meetings, foster care review board/citizen review boards, CQI qualitative reviews, Supervisory reviews, utilization reviews, case planning conferences, family team meetings. While the description and types of reviews vary across agencies, most agencies engage inmultiple kinds of reviews.
1. Have any of your agencies assessed the various reviews of your casesto better understand what is reviewed, who is involved, where there may be significant overlap, and how you might be able to use the resulting information more effectively?
2. What process did you use to assess the various types of reviews?
3. Were you able to adjust, combine and/or eliminate any of the reviews as a result?
Shirley Alexander, Idaho
§ Idaho has not done this, but they have put together a comprehensive list of all the reviews that could hit a case, including supervisory reviews, courts, community reviews, etc. They have many reviews--some are mandated by state or federal statute, some are QA-focused. So compiling the list revealed how many mandates exist that sometimes overlap.
§ Idaho has concurrent planning reviews and they have developed a tool for supervisors to use in conducting these. The tool helps the supervisors focus on different issues for cases <30 days, 30-60 days, 60-90 days, etc.
§ Idaho had hoped to condense some of the reviews after putting the together the comprehensive list but this is difficult. For example, Regions sometimes don’t want to give up certain reviews that they have come to rely on.
§ Idaho includes Citizen Review Board staff/volunteers in its Regional CFSR reviews. They serve as reviewers and as a result of participating, the CRB has modified its own reviews somewhat. So this has brought the CRB and CFSR approaches more in alignment and this helps.
§ Participating in the CFSRs also has given the CRB staff a better sense of the issues since Idaho conducts interviews of key case participants. CRB staff rely on case file reviews only for the CRB process.
§ Idaho also has tried to consolidate its Foster Care Licensing and CFSR reviews. They will use different instruments, but want to use the same case sample for both and conduct them on-site in Regions during the same week. They hope this will be more efficient, but will have to see if this is too overwhelming for the Regional Offices.
Rusty Kline, United for Families, Florida CBC