Continuous Quality Improvement CQI One Way to Grow and Sustain Change

Abundant environments Abundant environments

Hostile and resource scarce environments

M y growing environment

Idaho’s CQI Process- Overview Three Primary COMPONENTS External Review External Review Internal Review Internal Review Case Review Case Review

External Review Activities of individuals outside the department who give feedback to promote quality improvement Activities of individuals outside the department who give feedback to promote quality improvement Comprehensive CW Plan – stakeholder input Comprehensive CW Plan – stakeholder input Keeping Child Safe Panels Keeping Child Safe Panels Stakeholder Surveys Stakeholder Surveys Judicial (case) Reviews Judicial (case) Reviews Fatality Reviews Fatality Reviews

Internal Review Activities of individuals inside the department that produce feedback to promote quality improvement Activities of individuals inside the department that produce feedback to promote quality improvement Regular supervisory reviews Regular supervisory reviews Using data and reports to monitor outcomes Using data and reports to monitor outcomes Development of Region Improvement Plans based on results of quarterly case reviews Development of Region Improvement Plans based on results of quarterly case reviews

Case Reviews Randomly selected cases Randomly selected cases Use of info system and hard case file Use of info system and hard case file Reviewers not from the field office being reviewed Reviewers not from the field office being reviewed Reviewers must be trained on review process and instrument Reviewers must be trained on review process and instrument Working in teams of two with staff from around the state Working in teams of two with staff from around the state

Reviewer Training All field supervisors are trained to conduct reviews All field supervisors are trained to conduct reviews Staff may attend training Staff may attend training Written curriculum – same trainers Written curriculum – same trainers Training provides a clear and consistent message on the important elements of a case Training provides a clear and consistent message on the important elements of a case Trains supervisors to review cases as part of the ongoing Internal Review Trains supervisors to review cases as part of the ongoing Internal Review

more on Case Reviews Quarterly review of 50 cases from 4 different regions of the State Quarterly review of 50 cases from 4 different regions of the State 25 in-home and 25 out- of-home cases 25 in-home and 25 out- of-home cases Process, review tool and rating instructions are closely aligned with the CFSR. Process, review tool and rating instructions are closely aligned with the CFSR.

Interviews Parents Foster Parents Children Child’s Social Worker Supervisors

Feedback Loop Following case review, reviewers provide specific feedback to the social worker and supervisor on the identified strengths and weaknesses of the case. Following case review, reviewers provide specific feedback to the social worker and supervisor on the identified strengths and weaknesses of the case.

Checks and Balances Strict adherence to Rating Instructions promotes reliability of the review tool Strict adherence to Rating Instructions promotes reliability of the review tool Reviewers staff cases for consensus on difficult items in a particular case Reviewers staff cases for consensus on difficult items in a particular case On-site second level review by limited number of central office program manager and program specialists On-site second level review by limited number of central office program manager and program specialists Second level reviewers taught through mentoring Second level reviewers taught through mentoring

Feedback at Exit Meeting Meet with all reviewers and all staff Meet with all reviewers and all staff Report outcomes Report outcomes Recognize strengths Recognize strengths Communicate areas needing improvement Communicate areas needing improvement Capitalize on “learning moments” Capitalize on “learning moments”

More on the exit meeting Reinforces practice expectations Reinforces practice expectations Promote continuous training on standards and rules Promote continuous training on standards and rules Provide setting for Central Office staff to discuss State and national trends and provides news and updates to the field Provide setting for Central Office staff to discuss State and national trends and provides news and updates to the field Take the opportunity to listen to staff concerns Take the opportunity to listen to staff concerns

Exit Meeting – more benefits Staff see other regional practices Chance to exchange ideas about practice Reinforces importance of following practice standards

Case reviews- just the beginning Following the review, Central Office provides timely “at-a-glance” data that includes “cheerleading/coaching” comments to the Regional Program Manager, Chief of Social Work and supervisors. Following the review, Central Office provides timely “at-a-glance” data that includes “cheerleading/coaching” comments to the Regional Program Manager, Chief of Social Work and supervisors.

Regional Program Managers and Supervisors meet to analyze the case review data. Regional Program Managers and Supervisors meet to analyze the case review data. They assess areas not meeting state goals and develop regional improvement plans (RIP) to improve their regional outcomes. They assess areas not meeting state goals and develop regional improvement plans (RIP) to improve their regional outcomes.

Regional Improvement Plans (RIPS) RIPS may be developed for the entire region, one field office, one team or even an individual social worker RIPS may be developed for the entire region, one field office, one team or even an individual social worker RIPS are sent to Central Office within 45 days RIPS are sent to Central Office within 45 days Progress is reported to Central Office quarterly as are any plan revisions Progress is reported to Central Office quarterly as are any plan revisions

CQI results aid in decision making Allows management to make data- informed decisions Allows management to make data- informed decisions The Child Welfare Subcommittee meets bi-monthly to monitor and discuss the CQI process, outcomes, to propose revisions to standards and identify statewide training needs. The Child Welfare Subcommittee meets bi-monthly to monitor and discuss the CQI process, outcomes, to propose revisions to standards and identify statewide training needs.

Sharing outcomes Quarterly presentation of CQI outcomes to Division and Deputy Administrators Quarterly presentation of CQI outcomes to Division and Deputy Administrators Newsletter to all staff and community partners reporting on outcomes Newsletter to all staff and community partners reporting on outcomes

Growing and sustaining change requires everyone Shared goals and outcomes Shared goals and outcomes Personal responsibility Personal responsibility Personal commitment to safety, permanency and well-being Personal commitment to safety, permanency and well-being Clear practice expectations Clear practice expectations Willing to share triumphs Willing to share triumphs and “bad breath” areas

Alignment Child welfare goals Child welfare goals Practice standards Practice standards Case review tool Case review tool Regional improvement plans Regional improvement plans