Transcript Pennsylvania’s Quality Service Review (QSR) Protocol

Overview of Continuous
Quality Improvement (CQI)
and Quality Service Review
(QSR) Process
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
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
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
The DAPIMTM Model: A “Flywheel”
Define
Monitor
Assess
Performance
& Capacity
Implement
Plan
-© 2009 American Public Human Services Association
Organizing for Continuous Improvement
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
Work Team I:
Work Team II
Implement plans that
require complex
and/or extended
efforts (e.g., process
design)
TIME
© 2011 American Public Human Services Association. All rights reserved.
Work Team III
• 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.
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
 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)
Connecting QSR and Licensure
QSR Case
Reviews
QSR Focus
Groups and
Key
Stakeholder
Interviews
DPW
Licensure
Stakeholder
interviews
Caseworkers
Same cases as
QSR sample
Feedback to
Caseworker and
Supervisor
Written Case
Review Summary
Aggregate
quantitative
results
Supervisors
Other: may
consider youth,
birth families,
foster families,
courts, etc.
Additional
intake, foster
home, and
personnel files
Review for
regulatory
compliance
Summation, Discussion, Next Steps Planning,
County Improvement Plan Development
PA QSR Protocol: Child/Youth and Family Status
Indicators
•
•
•
•
•
•
•
•
•
•
1a. Safety: Exposure to Threats of Harm
1b. Safety: Risk to Self/Others
2. Stability
3. Living Arrangement
4. Permanency
5. Physical Health
6. Emotional Well-being
7. Learning & Development
8. Pathway to Independence
9. Parent & Caregiver Functioning
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
Interpretive Guide for Child/Youth and Family Status
Indicator Ratings
Unacceptable Range: 1-3
Acceptable Range: 4-6
Improvement Zone: 1-2
Refinement Zone: 3-4
Maintenance 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.
1
2
3
4
5
6
Adverse
Status
Poor
Status
Marginal
Status
Fair Status
Substantial
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 shortterms needs or
objectives now 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).
Status is at least
minimally or
temporarily
sufficient for the
individual to meet
short-term needs
or objectives in
this area.
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.
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.
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.