The Role of the Quality Improvement Specialist in the Tiered Reimbursement Process

What is Tiered Reimbursement? It is a quality initiative that offers higher subsidy payments to child care programs that demonstrate they meet higher standards of care. Programs that are licensed as a center, facility or registered family child care homes are eligible to apply for a higher quality tier level.

Tier Reimbursement Program Levels West Virginia currently has three quality tier levels:   Tier I reimbursement rates for licensed or registered programs Tier II rates for programs that meet a state-specific set of quality standards Tier III reimbursement rates for programs that are accredited by an approved accrediting agency. Mention recognized accrediting bodies

Child Care Policy – Effective March 1, 2016 APPENDIX B -CHILD CARE RATE STRUCTURE These are the current subsidy rates for child care programs enrolling children for subsidized care. As you can see when you move from Tier I to Tier II there is an increase and should you move from Tier II to Tier III, there is an additional increase in the payment amount.

Specific Higher Quality Standards The Quality Standards are divided into seven sections: Administration and Management Health, Safety, and Nutrition Child Growth and Development Environment and Curriculum Child Observation and Assessment Family and Community Relationships Professionalism and Leadership The higher quality standards are divided into seven sections which you might notice are the same as our seven core knowledge and competency areas for WV STARS.

Benefits to Advancing Tier Levels Bonus payment for increasing Tier level Centers- $1,500 Marketing tool Grant opportunities Quality Support Services for financial assistance and mentoring Once you submit your documentation and it is approved, your program will receive a bonus payment in the amount listed for you to purchase additional materials to help maintain higher quality standards. With marketing, as more and more parents become aware of our Tiered Reimbursement System they will begin seeking higher quality programs. Once you achieve the higher tier level status, your program will receive a certificate in the mail that can be displayed for all parents to see. This will serve as evidence that your program goes above and beyond basic Licensing or Regulatory requirements to provide a higher standard of care for the children enrolled in your program. There are also various grant opportunities that become available for those currently on a higher tier level or who are seeking to move up to a higher tier level. Financial assistance and mentoring is available for programs that are looking to become accredited. Programs can apply for stipends to assist with the cost of certain accreditation fees: self-study enrollment fee, application fee, candidacy/site visit fee, and annual report and renewal fees. Quality Support Services will reimburse for half of the cost of these fees. Also when talking about financial assistance, make sure you clarify that it is available for those seeking NAFCC accreditation only and it is a reimbursement payment and that it is 50% reimbursed

Scenarios After becoming Tier II , your program will receive a validation certificate. How would you market within the community to promote your program as a program who provides quality care? A benefit of becoming Tier II is that your program is eligible for certain grants, the current grant amount is $3000, how would your program use the money to support quality standards? Group Discussion; Write responses on large easel pad

Where Can You Find the Application? Tiered Reimbursement applications can be found online at http://www.dhhr.wv.gov/bcf/Childcare/Pages/Tiered- Reimbursement.aspx You can also contact your local Child Care Resource and Referral agency for more information and assistance. Emphasize that all 3 provider applications are there and to make sure they select the appropriate center application.

Quality Improvement Specialists (QIS)

What is a Quality Improvement Specialist? The Quality Improvement Initiative consists of Quality Improvement Specialists (QIS) across the state from each child care resource and referral agency. QIS work with child care centers, family child care facilities and family child care homes to promote continuous quality improvement by helping programs enroll in and advance through the WV Tiered Reimbursement System. As well as, support programs with maintaining a higher tier level. This is a new position created for each Resource and Referral agency to assist in increasing the quality of care that is provided to the children in the state of West Virginia.

What is the Role of a Quality Improvement Specialist? Provide technical assistance to child care programs regarding the Tiered Reimbursement System. Offer community education to families about what the Tiered Reimbursement System and help them become more informed on how to select a high quality child care program. If you have questions about any of the documentation requirements found within the application such as the sections or standards, you can call your local Resource and referral agency and ask to speak to the Quality Improvement Specialist who will be able to assist you with any questions or provide clarification. Quality Improvement Specialists are available to visit your program and help get you started in the application and documentation process. Not only must you document that you are meeting the standards, it is important that what you have documented is being implemented. QIS will help determine whether additional technical assistance is needed from other members of the R&R training team. For example, one requirement is that lesson plans for each classroom must be posted. If this is an area that your staff need more training in, the QIS can link you to the appropriate training team member for that particular need based on the age group of the children. Another example could be that you aren’t sure what to include in your positive guidance policy and could be assisted by one of our Early Childhood Specialists or Behavior Consultants to develop this policy together. Another role of the QIS is to provide community outreach and education to parents and other early childhood agencies about the importance of high quality child care. QIS will present information on why this is important, the characteristics that make up quality child care, provide parents with questions to ask when making visits to potential programs they would like to enroll their child, how to locate non-compliance reports for child care programs, and getting word out that the Tiered Reimbursement System is in place, what the different tier levels are, and be given a list of providers in their area which is categorized by tier level.

What is the Role of a Quality Improvement Specialist? Cont. Assist programs by helping to determine training and technical assistance needs and linking programs to the appropriate Resource and Referral Professional Development team member. Provide monitoring visits to programs who have submitted documentation and received notification of being awarded a higher tier level status. Through telephone and on-site consultation visits, the QIS and child care program can communicate about the application standards and look at what areas the program may need help with. For example, there are certain professional development/training requirements that some or all staff must have. The QIS can assist in coming up with a plan to obtain the training needed, such as ensuring that staff register quarterly for trainings to get the appropriate number of hours annually, or by linking the provider to a training team member who can develop and conduct a specific training like if a provider would like their staff to receive training on one of the approved curriculums. For programs who have already submitted a documentation binder and received approval notification from Liz Teel, the QIS will then be tasked with helping to monitor those locations. You should note that in the application it states that you are to “keep a copy of this application and supporting documentation for your records. Material that is submitted to the Division (Liz Teel) will not be retained after review. Any Department employee (QIS, that’s us) may come to your program to check your validation material at any time. So this means when you compile your documentation into a binder or flash drive, you should automatically be making a duplicate for us to look at should we come to your program for a monitoring visit. Also, if Liz Teel (the Tiered Reimbursement/QRIS Coordinator for the Division of Early Care and Education- who receives your binders or flash drives) feels there is a question or concern she may contact the QIS located in your Resource and Referral and ask us to do a drop-in visit.

Child Care Resource Center Catholic Charities of WV VACANT 118 Adams Street, Suite 201 Fairmont, WV 26554 (304) 366-3615 Choices CCR&R Sarah Harvey, M.Ed. 4421 Emerson Avenue Suite 102 Parkersburg, WV 26104 (304) 485-2668 Sarah.N.Harvey@wv.gov Connect CCR&R Shante Ellis, M.Ed. 1 Players Club Drive Charleston, WV 25311 (304) 348-3674 Shante.Ellis@wv.gov Mountain Heart Community Services, North Jaime Price, MS 1200 Harrison Avenue, Suite 220 Elkins, WV 26241 (304) 637-3103 Jaime.L.Price@wv.gov Mountain Heart Community Services, South Linda Prutsok, BA 1020 Broad Street Summersville, WV 26651 (304) 872-9200 Linda.K.Prutsok@wv.gov Link CCR&R VACANT 611 7th Avenue, Suite 100 Huntington, WV 25701 (304) 523-9540 Tiered Reimbursement State Coordinator West Virginia DHHR Division of Early Care and Education ELIZABETH TEEL 350 CAPITOL STREET, ROOM B-18 CHALRESTON, WV 25301 (304) 356-4605 Elizabeth.D.Teel@wv.gov

Attendees will get the opportunity to sit with the QIS in their region to ask questions and address concerns about moving up in the tiered reimbursement system and set up appointments to discuss further. Bring your calendars! Perfect opportunity to recruit new providers!

Continuous Quality Improvement “One major purpose of the QRIS is to recognize quality and promote a culture of continuous improvement among providers. Your rating is not a destination; it is a set of benchmarks along a pathway of ongoing improvement” Anne Mitchell Leave providers with something to keep in mind when deciding to go through the process Explain that although West Virginia is not a full blown QRIS the state has goals set in that direction. Otherwise, the quote is a good representation of our work with providers. (good point to make)