1. St. Louis County Public Health and Human Services Foster Care System Changes: Moving Into the Future

2. AGENDA Overview Systems/Considerations Casey Family Programs – Breakthrough Series Collaborative (BSC) BSC – Basics BSC – Premises BSC – Methodology/Improvements/Tests/PDSA’s Spread Minnesota Framework References

3. Overview On any given day, approximately 350 St. Louis County children are in out-of-home placement. About 320 are in foster care

4. Overview Purpose of foster care: Provide temporary or long-term primary care for children who have been maltreated, experienced family problems, or who have special needs; Provide a planned, goal directed service to children and their families; Assist the department in its permanency planning efforts

5. An Appreciation of Systems… Child welfare systems are increasingly identifying the need for more flexibility regarding… how they allocate financial resources; the design of a more thorough array of supports and services that truly respond to the real needs of families and children; how they respond to families; how they make decisions about placement; how they factor in considerations of race, culture, identity and the many forms of diversity found in our society.

6. For Your Consideration… We sell many “systems” improvement efforts on the basis of improved outcomes for families and children. Yet, the substance of systems improvement is really about the day-to-day work and experiences of administrators, supervisors, and workers. We tend not to frame the conversation around the benefits for the individuals responsible for creating the improvements.

7. For Your Consideration… Individuals most familiar with the needs of families, and the demands of the work, are often left out of the conversation about what is working well and what really needs improvement. The BSC Model for Improvement is designed to center the improvement process in the daily experiences and realities of the individuals most connected to the work.

8. Casey Family Programs: Breakthrough Series Collaborative (BSC) December 2000: Casey Family Programs - Seattle, Wash. – joined with the Institute for Healthcare Improvement (IHI) & Associates in Process Improvement (API) to learn the Breakthrough Series Collaborative (BSC) methodology; 2001-2002: Casey National BSC on Recruitment and retention in foster care 2005 & 2006: Minnesota BSC

9. Basics Quality improvement method; Existing program or framework; Core team of key actors; Identify and test new strategies or ideas for best practice ; in key domains; Allows the team to make dramatic changes in focused areas over short periods of time

10. BSC Premises There is a gap between knowledge or theory and practice; BSC uses existing knowledge based on what has worked – apply to system needs There is a significant variation in practice in the field; some agencies do well, whereas others not = room for improvement

11. BSC Premises All improvement requires change, but not all changes lead to improvement; measurement critical – small tests of change done to allow for rapid implementation – track to see impact; “Every system perfectly designed to achieve the results it gets”; systems need fixing – not the people within the system

12. Basic Components of Improvement Developing a Change Examination vs. innovation… or both? Change requires action Testing a Change Trial and learning process Modifications may be made over time Discard change efforts when necessary Cycles of learning… continuous feedback Implementing a Change Balance between demonstration and consensus- building

13. Testing Changes: What Is a PDSA? PLAN Determine objective, questions, & predictions Create plan to test idea (who, what, where, when, how?) ACT Make adjustments Ensure that the next cycle reflects the learnings DO Carry out the plan Document problems and unexpected results Begin analysis of data STUDY Complete analysis of data Compare data to predictions Summarize what was learned Adapted from © 2001 Institute for Healthcare Improvement 1 23 4 Generation of a Good Idea SMALL!!! Don’t Forget To Study! Adjust and Do Again

14. Supporting Improvement Methods Using data Recognizing and making sense of patterns of variation Appreciation for a rapid action orientation to change Developing a change Testing a change Implementing a change Working with people Understanding motivation is critical in obtaining cooperation to sustain improvements.

15. Progression of Changes Testing Implementation in pilot site Spread P S A D P S A D P S A D

16.  Moves the changes into new areas of the jurisdiction or beyond  Requires that a change has been tested and has been shown successful in pilot site  Uses a new set of strategies (e.g., key message and messengers identified, etc.) P S A D S A D P S A D Testing Implementation in pilot site Spread

17. The Life Cycle of a “Best Practice” Innovation Best Practice Promising Practice Emerging Practice Smooth out the Bumps Work out the Details The needs of the field are always changing. Some Best Practices No Longer Effective Now What? “Evidence Based” Practice

18. Minnesota BSC Framework for Foster Care Recruitment Retention Ensuring Voice Birth Parent Foster Parent Child

19. Using the Minnesota Framework Barriers or Stick Points Strategies to Overcome Generate Ideas – PDSA’s Measurement

20. Small Group Exericse Breakout and discuss Generate an idea

21. References MN BSC: Recruitment and Retention – Presentation by Lori Lutz – Consultant for Casey Family Programs. Handouts – Minnesota State Department of Human Services Langley, Gerald, J., Nolan, Kevin M., Norman, Clifford L., & Provost, Lloyd P. (1996). The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. Jossey-Bass: A Wiley Company: San Francisco, CA.