1. Overview of Continuous Quality Improvement (CQI) and Quality Service Review (QSR) Process

2. Meeting Objectives Introductions of QSR State Site Lead(s) and Local Site Lead(s) Overview of the Continuous Quality Improvement (CQI) process and the role of Quality Service Review (QSR) in that process Purpose of the QSR process – Case-specific review; Focus Groups and Key Stakeholder Interviews Overview of the components of the QSR process and timelines associated with the onsite 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. What’s in it for your County? Establishes an environment that encourages learning and program improvement. Provides a tool for the evaluation of best case practice rooted in Pennsylvania’s Practice Model/Standards In depth review of child/youth and family’s safety, permanency and well being outcomes as well as the agency’s practice performance. Provides information/data that will help support/guide ongoing improvement efforts Practice improvements Organizational and systemic improvements Improved outcomes for children, youth and families

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

6. © 2011 American Public Human Services Association. All rights reserved. Organizing for Continuous Improvement Work Team IIIWork Team II Sponsor Group Provide high level oversight; obtain resources; set expectations that align to strategy Continuous Improvement Team Initiate and manage continuous improvement effort; maintain hands-on responsibility for CI efforts during and after the facilitated process TIME Work Team I: Implement plans that require complex and/or extended efforts (e.g., process design)

7. 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 and 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.

8. 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/youth/family team  Rates the status of the child/youth/family and the system performance on a 1-6 scale  Written case review summary “tells the story” of what was learned from the team

9. 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 County Improvement Plan (CIP)

10. Connecting QSR and Licensure QSR Case Reviews DPW Licensure 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 Review Summary Aggregate quantitative results Summation, Discussion, Next Steps Planning, County Improvement Plan Development QSR Focus Groups and Key Stakeholder Interviews Caseworkers Supervisors Other: may consider youth, birth families, foster families, courts, etc.

11. 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

12. 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

13. 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).

14. Final Report The Final Report provides an analysis of the qualitative and quantitative data collected during onsite review, as well as relevant data from other sources.

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

16. County Improvement Plan (CIP) Purpose: The County Improvement Plan (CIP) outlines the priorities the county agency chooses to focus on to improve specific outcomes as a result of a comprehensive review of their practice. This review is not limited to the QSR findings, and may also include a review of additional data such as the County data packages provided by the State, quantitative measures produced by the county, as well as the results of other qualitative data.