Transcript Document
Building a DataDriven Culture in Nevada June 10, 2013 The Performance Indicators Project is a collaboration of the California Department of Social Services and UC Berkeley, and is supported by CDSS , and the Stuart Foundation. Summit Content Areas • Leading with Data: A Focus on Outcomes – – – – Review of basic terminology Avoiding pitfalls and data abuse Key concepts in performance measurement Telling the NV Story: State and National Context • Connecting Data to Practice: Defining the problems • From Data to Action: Strategy Development and Implementation • CQI Structure and Function in NV Data Analytics 101 BASIC TERMINOLOGY AND FORMULAS Basic Terminology Descriptive Data • Point-in-time • Trends • Comparisons data source: AFCARS Basic Terminology Process Measures - familiar to staff, relevant at a caseworker level, current Outcome Measures - the “big picture” measure of system performance, especially when looked at longitudinally Measures of Central Tendency Mean: the average value for a range of data Median: the value of the middle item when the data are arranged from smallest to largest Mode: the value that occurs most frequently within the data 124 44 15 7 963 127 15 9 417 1763 4 4 7 9 12 15 17 63 Mean 16.4 = 9.7 87 9 12 Median 10.5 = 9 2 Mode 4 Measures of Variability Minimum: the smallest value within the data Maximum: the largest value within the data Range: the overall span of the data 4 4 7 9 12 15 17 63 Minimum 4 Maximum 63 Range 63 4 59 Disaggregation • One of the most powerful ways to work with data… • Disaggregation involves dismantling or separating out groups within a population to better understand the dynamics and plan strategies for improvement • Useful for identifying critical issues that were previously undetected Aggregate Permanency Outcomes Race/Ethnicity Region/Circuit Age Placement Type Measuring Change •How much has this measure changed over time? •What will our performance be next quarter if we increase or decrease by 10% (latest yr - baseline yr) netchange 100 baseline yr 10% increase = baseline x 1.1 10% decrease = baseline x .90 Data Analytics 101 COMMON DATA PITFALLS Common Pitfalls • Small N – impact on rates and trends • Seasonal variation • Faulty comparisons – failing to consider demographic and policy differences • Outlier impact on central tendency • Data integrity/Data entry (over or under emphasized) • Missing or incomplete definitions • Data overload: lack of focus on and connection to key outcomes Common Pitfalls: Seasonal variation Period 1 to 7: 10.2% reduction Period 1 to 2: 38.5% reduction Period 2 to 5: 41.7% increase Common Pitfalls: Small n (impact on rates and trends) 100% reduction! But…from 2 children in care to 0 children in care 57% increase! But from 7 to 11 children in care Common Pitfalls and Graph Interpretation Guilford County: First Entries by Initial Placement Type 20% 250 15% 200 150 10% 100 5% 50 0 % of all entries # of children 300 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 # initial place Group Home 25 25 17 23 11 5 9 4 2 1 7 Total Entries 269 215 236 253 236 194 190 197 148 156 150 % Initial place Group Home 9% 12% 7% 9% 5% 3% 5% 2% 1% 1% 5% Data source: UNC at Chapel Hill Jordan Institute for Families website. URL: http://ssw.unc.edu/ma/ 0% Avoiding data overload and Managing with data One thing the modern computer age has given everyone is data. Lots and lots of data. There is a large leap, however, between having data and learning from it. W. Gregory Mankiw Professor of Economics, Harvard New York Times, Sunday Business Section (Sept. 5 2010) p. 5 Manage with Data Provides us the ability to: • Compare metrics with agency mission and practice model • Connect to evidence-based practice and link processes to desired outcomes • Strategize on what work needs to be done • Focus on end outcomes • Identify what needs attention • Tell the story Manage with Data • Pick the right measures for the job • Prioritize reports and measures in line with agency values, mission, vision • Connect process measures to outcomes/practice model • Move beyond compliance and “gotcha” • Make it fun! • Celebrate success and tell the story • Use your data to engage the community, create urgency for action, maintain support Pick the Right Measures for the Job • • • • • Federal Accountability Overall Performance Monitoring Outside Auditing (i.e. consent decrees, monitors) Contractor or Provider Performance Office, Supervisor, Worker Level accountability Compliance Performance Continuum Outcomes Prioritize Measures in line with Agency Values • To keep children safe and at home • To improve a child or youth’s well-being • To facilitate a child or youth’s move to swift & certain permanency Performance is Guided by Your Values as an Agency: Missouri Key Outcomes Key Data Reports: How are they all connected? CFSR and PIP NCANDS AFCARS ROM SCRT COA SEE Results Connecting the Dots Case Review Measure: Caregiver involvement in case planning Management Report: Frequency of Visits with Caretakers Process Data: Accountability Relevant to workers and supervisors Case Review Measure: Individualized Services Intermediate Outcomes Relevant to workers, supervisors, managers Outcome Measure: Timely Reunifications Outcomes: “So What?” Reflect Key Priorities of Leadership CFSR Findings: Relationship of Well-Being to Permanency Substantial achievement on Positive ratings on supports . . . • Services to children, parents, foster parents • Involvement of parents in case planning • Caseworker visits with children • Caseworker visits with parents • Timely achievement of permanency • Preserving children’s connections while in foster care Administration for Children and Families, U.S Department of Health and Human Services, Findings From the Initial Child and Family Services Reviews, 2001–2004. Available at http://www.acf.hhs.gov/programs/cb/cwmonitoring/results/index.htm Factors Associated with Timely Reunification, Guardianship, and Permanent Relative Placement The strongest associations with timely permanency included: Caseworker Visits with Parents Child’s Visits with Parents and Siblings in Foster Care Services to Children, Parents, & Foster Parents Family/Child Involvement in Case Planning ASFA Requirements Regarding Termination of Parental Rights Placement Stability Administration for Children and Families, U.S Department of Health and Human Services, Findings From the Initial Child and Family Services Reviews, 2001–2004. Available at http://www.acf.hhs.gov/programs/cb/cwmonitoring/results/index.htm Strongest Associations Between Visits and Other Indicators Both Caseworker Visits with Parents and Caseworker Visits with Children were strongly associated with: Risk of harm to children Needs & Services for children, parents, foster parents Child and parent involvement in case planning Administration for Children and Families, U.S Department of Health and Human Services, Findings From the Initial Child and Family Services Reviews, 2001–2004. Available at http://www.acf.hhs.gov/programs/cb/cwmonitoring/results/index.htm Other Significant Associations Between Visits and Indicators Caseworker Visits with Parents and Caseworker Visits with Children were also strongly associated with: Services to protect children at home Safety Outcome 1 Safety Outcome 2 Timely permanency goals Timely reunification Child’s visits with parents and siblings Relative placements Meeting educational needs Meeting physical health needs Meeting mental health needs Administration for Children and Families, U.S Department of Health and Human Services, Findings From the Initial Child and Family Services Reviews, 2001–2004. Available at http://www.acf.hhs.gov/programs/cb/cwmonitoring/results/index.htm Connecting process to outcomes Use Data to Create Urgency for Action – Target improvements based on your own baseline Regional variation should generate productive discussion about differences in: • Service array • Community differences in reporting and tolerance for “risk” • Differences across partner agencies, courts, juvenile justice, behavioral health etc… • Demographic risk factors and “case mix” • Case loads, turnover (staff and leadership), and training • A variety of other policy/practice differences Your Role as a Data Leader Grounded in good case practice model principles Develop presentation skills Understand & demystify data Master qualitative & quantitative tools Recognize challenges Celebrate good practice Support positive change Act as a local resource Grow as managers & leaders Knowing when you’ve got it right • No more “the data are wrong” • Folks own data, know it, act on it • Practice people know the data, data people know the practice • Field pulls data, asks for reports, initiates actions tied to the data • Constantly talking about data in a positive way After a really busy day, the data manager comments: “I think I liked it better when no one paid attention to the data” Telling the Story: Key Child Welfare Indicators So What’s the Story? Describe the issue with as much detail as possible, variation is key to hypothesis development. • What’s happening right now for all kids? • Has it always been this way? • Is it true in all places, for all ages, for all racial/ethnic groups? • Is this indicator correlated with any others? • Does it look the same for all types of cases, or in places where practice is different? interdependence between measures… Rate of Referrals/ Substantiated Referrals Reentry to Care Permanency Through Reunification, Adoption, or Guardianship Counterbalanced Indicators of System Performance Shorter Lengths Of Stay Stability Of Care Home-Based Services vs. Out-of-Home Care Use of Least Restrictive Form of Care Maintain Positive Attachments To Family, Friends, and Neighbors the current placement system* (highly simplified) the foster care system CHILD IN a bunch of stuff happens CHILD OUT *adapted from Lyle, G. L., & Barker, M.A. (1998) Patterns & Spells: New approaches to conceptualizing children’s out of home placement experiences. Chicago: American Evaluation Association Annual Conference Trends in Out of Home Care Nationwide, the number of children in out of home care is declining. In NV, both the entry rate (per 1,000 children in the population) and the in-care rate are higher than the national average. 6000 9.0 8.0 5000 NV Trends 7.0 4000 6.0 # in care on 9/30 <18 # entries in FY 5.0 # exits in FY 4.0 NV In care rate <18 3000 2000 3.0 National In care rate <18 NV Entry rate 2.0 1000 1.0 0 0.0 FY07 Data source: AFCARS FY08 FY09 FY10 FY11 FY12 National entry rate 100 New York Rhode Island Iowa Massachusetts Michigan New Mexico Nebraska Connecticut Florida Alaska Ohio Utah California Indiana Illinois Washington National Avg Arkansas Maine Mississippi District of Columbia Oklahoma New Jersey Wisconsin Nevada National Standard Kentucky Minnesota Louisiana South Dakota West Virginia Colorado Montana Maryland Arizona Tennessee South Carolina Idaho Delaware Georgia New Hampshire Texas Kansas Missouri Puerto Rico Pennsylvania North Carolina Hawaii Virginia Wyoming Vermont Alabama Safety – The Absence of Repeat Maltreatment Of all children who were victims of substantiated or indicated abuse or neglect during the first 6 months of the reporting year, what percent did not experience another incident of substantiated or indicated abuse or neglect within a 6-month period? (FY10 98 96 94 92 90 88 86 84 82 Managing with Data in Child Welfare CHILDREN ENTERING CARE Children Entering Care: Nevada Key Questions: Entries • What is the entry rate – by age/race? • Are entries increasing/decreasing? for all groups? • What strategies are in place/planned to reduce entries (and re-entries) into care? Possible reasons for county differences in entry rates: • Service array – preventive and in home • Standard of evidence • Law enforcement removals • Demographic risk factors • A variety of other policy/practice differences Substantial variation year to year is also common in counties with few removals/small populations Managing with Data in Child Welfare CHILDREN IN CARE POINT IN TIME Key Questions: Children in Care • • • • What groups of children are in care NOW What types of placements? How long have they been in care? What is needed to move them to permanency? Washington Oregon New Mexico Alaska Kansas Nevada District of Columbia Hawaii New Jersey Maine Idaho Oklahoma Louisiana Indiana Illinois Montana California (AFCARS) Utah Missouri North Carolina Puerto Rico Wisconsin Florida Maryland New Hampshire National Arizona Mississippi New York Michigan Delaware Ohio Virginia Texas Tennessee Georgia Massachusetts Nebraska Kentucky Alabama Arkansas Vermont Iowa Pennsylvania South Dakota South Carolina North Dakota Connecticut West Virginia Minnesota Rhode Island Wyoming Colorado Placement Type (Ages 0-17) Of all the children (age 0-17yrs) in care on the last day of the FY, what percent were placed in a congregate care setting? (Group home, shelter care, or residential facility: excludes detention, and hospitalization) 40% 35% 30% 25% 20% 15% 10% 5% 0% 12% Kansas Oregon Louisiana Tennessee Michigan Nebraska Washington Ohio Indiana Alaska Utah Iowa Wisconsin New York California New Mexico Maryland Pennsylvania West Virginia Illinois Idaho Virginia Georgia Nevada New Jersey District of Columbia Hawaii Kentucky Delaware Missouri Colorado North Carolina Wyoming New Hampshire Mississippi Connecticut National Maine North Dakota Oklahoma Massachusetts Alabama Florida Rhode Island Arizona Minnesota Montana Vermont Texas Arkansas South Dakota Puerto Rico South Carolina Placement Type (ages 0-10) Of all the children (age 0-10yrs) in care on the last day of the FY, what percent were placed in a congregate care setting? (Group home, shelter care, or residential facility: excludes detention, and hospitalization) 10% 8% 6% 4% 2% 0% National and State Level OUTCOMES: EXITS AND LENGTH OF STAY Key Questions: Permanency Outcomes •What proportion of children entering care will eventually reunify? •How does this differ by age at removal? •What percent of children remain in care after 3 years? •Are there differences by age/race? •Is this trend changing over time? Know which view to use data the view matters… January 1, 2012 July 1, 2012 Source: Aron Shlonsky, University of Toronto (formerly at CSSR) December 31, 2012 the view matters… Nevada: Length of Stay in Months 2011 (children in care 5 days or more) 2011 entries N=2103 q1 (25% exited) Jan 1, 2011 (point-in-time) N=4135 q2 (50% exited) 2011 exits N=3138 insufficient time elapsed to determine this estimate q3 (75% exited) 0 5 10 15 Months in Care 20 25 30 35 40 entries, point in time and exits views… Nevada: Age of Children in Foster Care, 2012 45 40 39 35 Entries 30 25 % 20 23 22 15 10 5 8 7 12-14 yrs 15-17 yrs 0 <1 yr 1-5 yrs 6-11 yrs entries, point in time and exits views… Nevada: Age of Children in Foster Care, 2012 45 40 39 35 37 Entries 30 25 % 20 Point in Time 29 23 22 15 10 5 14 12 8 8 7 12-14 yrs 15-17 yrs 0 <1 yr 1-5 yrs 6-11 yrs entries, point in time and exits views… Nevada: Age of Children in Foster Care, 2012 45 43 40 39 35 37 Entries 30 29 25 % 20 Point in Time 27 Exits 23 22 15 10 5 14 12 11 8 13 8 7 12-14 yrs 15-17 yrs 5 0 <1 yr 1-5 yrs 6-11 yrs Exit Cohort View… but what about those that remain in care? Proportion of Exits by Type: Statewide 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Death of child Transfer Runaway No response Live with relatives Guardianship Emancipation Adoption 2007 2008 2009 2010 2011 2012 Reunification 80 Puerto Rico Illinois Delaware North Carolina Vermont Oklahoma Alaska Michigan Arizona New Mexico Connecticut Washington Maine Texas Virginia Missouri Kansas Nevada Florida Maryland California Oregon National Iowa North Dakota Utah New York Montana South Dakota Alabama Pennsylvania New Jersey New Hampshire District of Columbia West Virginia Indiana Rhode Island Nebraska Louisiana Georgia Wisconsin Mississippi Massachusetts Idaho Tennessee Ohio Hawaii Kentucky Colorado Wyoming Minnesota South Carolina Arkansas % Timely Reunification (entry cohort) Timely Reunification (FY11): Measure C1.3 Of all first entries who remain in care at least 8 days, what % reunify within 12 months? 70 60 50 40 30 20 10 0 Nationally, there has been almost no improvement in timely reunification Timely Reunification (C1.3 Entry Cohort) National Median NV 60% 50% 40% 39% 41% 42% 39% 41% 41% 41% 41% 42% 44% FY08 FY09 FY10 37% 37% 30% 20% 10% 0% FY05 FY06 FY07 30 Puerto Rico North Carolina Virginia Texas Maine Mississippi Michigan Louisiana Delaware Nevada Oklahoma Missouri Kansas Idaho South Carolina Alaska Georgia Indiana Hawaii Alabama New Mexico New Jersey Arkansas Maryland Utah Tennessee District of Columbia Oregon National Connecticut California Illinois Kentucky North Dakota Montana Washington West Virginia Nebraska New York Ohio Wyoming Vermont Florida Massachusetts South Dakota Colorado Iowa Arizona Wisconsin Rhode Island New Hampshire Minnesota Pennsylvania Re-Entry after Reunification Re-Entry (FY11) Measure C1.4 of all the children reunified, what % re-enter care within 12 months? 25 20 15 10 5 0 Permanency for Longer Stayers Nationally, exits to permanency among children already in care two years or more has been improving (C3.1) Nat'l Median NV 60% 50% 40% 40% 31% 33% 32% 33% 34% 30% 26% 26% 26% FY05 FY06 FY07 28% 29% 31% FY08 FY09 FY10 20% 10% 0% Puerto Rico Utah Delaware Connecticut Illinois Minnesota California Colorado Alabama Oregon South Dakota Maryland Virginia District of Columbia Massachusetts North Dakota Texas New York South Carolina Missouri Rhode Island Ohio Vermont Arkansas Wisconsin Wyoming National Mississippi Kentucky Montana North Carolina Florida Iowa New Hampshire Maine Oklahoma Indiana Kansas Michigan Georgia Hawaii Louisiana Pennsylvania New Jersey Tennessee Nebraska Washington New Mexico Alaska Idaho Arizona Nevada West Virginia Permanency for Longer Stayers Achieving Permanency for Longer Stayers (FY11) Measure C3.1: Of all children in care at least two years, what % achieve permanency within the following year? 60% 50% 40% 30% 20% 10% 0% Connecting Data to Practice: Using the CQI Framework Continuous Quality Improvement (CQI)…an ongoing process of identifying, describing, and analyzing strengths and problems and then testing, implementing, learning from, and revising solutions. CQI Relies on… • An organizational culture that is proactive and supports continuous learning. • A strong foundation – the mission, vision, and values of the agency. • The active inclusion and participation of staff at all levels of the agency, children, youth, families, and stakeholders throughout the process. Key Principles • Use data and information from multiple sources, qualitative and quantitative • Data have a purpose: Identify trends and anomalies; find areas for improvement; tell stories about what is happening in practice and policy • CQI must support staff to improve outcomes for families Key Principles • If it ain’t “broke”, it can probably still be “fixed” • CQI goes beyond “compliance” to “quality” • Meaningful and active engagement of staff at all levels, children, youth, families, and stakeholders • CQI requires training, preparation, and consistent ongoing support CQI Group Exercise 2 DEMYSTIFYING THE LOGIC MODEL • We’ve noted that: Observe • Children are not exiting to permanency quickly enough • And we believe it is because: Explain • Case management and case consultation has not been consistent • So we plan to: • Improve training and supervision; ensure practice is aligned with Strategy policy • Which will result in ENVISIONED OUTCOME: Outcome • An increase in children exiting to permanency within three years Developed by NY OCFS …if he had one hour to save the world he would spend 55 minutes defining the problem and only 5 minutes finding the solution. Before jumping right into solving a problem • Step back • Invest time and effort • Improve understanding Source: http://litemind.com/problem-definition/ (accessed 6/3/11) Where areSTATEMENT we now? HYPOTHESIS : A HIGH LEVEL CAUSE AND EFFECT STATEMENT Observe performance on key measures: review trends and patterns Establish priorities by considering: mandates, greatest areas of need/opportunity for impact etc… Explain/Explore key underlying factors: both internal and external Consider subpopulations: is performance different by age? Race? Maltreatment type? that: We have noted So we plan Which will We believe it is&because: to: result in: Define strengths areas needing improvement Administrative Data is only one part of the assessment. LOGIC MODEL: DIGGING DEEPER – MORE DETAIL Needs and Strengths Assessment Activities Outputs Initial and Intermediate Key End Outcomes HYPOTHESIS STATEMENT: A HIGH LEVEL CAUSE AND EFFECT STATEMENT Where do we want to be? What are the ultimate outcomes that we hope to achieve? Outcome Observe Explain Prescribe Reduce entries into care Improve likelihood and timeliness of a permanent exit Reduce re-entry We have noted that: So we plan We believe it is because: Improve health, mental health and education to: indicators Which will result in: LOGIC MODEL: DIGGING DEEPER – MORE DETAIL Observe and Explain Needs and Strengths Assessment Strategies Activities Outputs Outcome Short Term Outcomes Long Term Outcomes Group Exercise!! • We examined the data and noted that: Observe • How are you doing on key outcomes? Are they going in the right direction? Is this true everywhere, and for all children? What other indicators are related to this outcome? • And we believe it is because: Explain • Why? Start with brainstorming, then look to a variety of existing data – where is there variation? What more do you need to know? How will you find out? Observe Developed by NY OCFS Explain Strategy Outcome Table Discussion 1 – Trends in Timely Permanency Review regional data packets and CQI handout: Focus on WHAT and WHY • Describe the trends in timely permanency and related measures • Are these indicators – Increasing? – Decreasing? – Staying about the same? • What does this tell us? • What more do we need to know? CQI Group Exercise 2 MOVING FROM DATA TO ACTION HYPOTHESIS TATEMENT: A HIGH LEVEL CAUSE AND EFFECT STATEMENT What willSwe do to address the issue? Strategies should align with the strengths and needs. What activities are supporting good performance? the barriers? Observe ExplainWhat are Prescribe Outcome Consider Strategies: What do you control? Where do you need to partner or advocate? We have noted that: Training We believe it is because: Programs/Services Policies/practices So we plan to: Which will result in: LOGIC MODEL: DIGGING DEEPER – MORE DETAIL Needs and Strengths Assessment Activities Outputs Short term outcomes Long Term Outcomes HYPOTHESIS STATEMENT: A HIGH LEVEL CAUSE AND EFFECT STATEMENT How do we know that the strategy was implemented as planned? What are our timeframes? Examples of outputs: Often a count (and percent) # of people trained # ofWe clients haveserved noted that: #We of believe referralsit is because: # of meetings held So we plan to: Which will result in: LOGIC MODEL: DIGGING DEEPER – MORE DETAIL Needs and Strengths Assessment Activities Outputs Short Term Outcomes Long Term Outcomes How will Swe know theSright HYPOTHESIS TATEMENT : A we HIGHare LEVELheading CAUSE ANDin EFFECT TATEMENT direction? Short Term outcomes can be expected to Prescribe change quickly. Observe Explain Examples of measurable improvements: Improve diligent search and engagement We have that: So we plan Reduce timenoted to adjudication and disposition We believe it is permanency because: Increase timely hearings to: Improved family engagement in case planning Outcome Which will result in: LOGIC MODEL: DIGGING DEEPER – MORE DETAIL Observe and Explain Needs and Strengths Assessment Strategies Activities Outputs Outcome Short Term Outcomes Long Term Outcomes