Transcript St. Louis County Public Health and Human Services Foster Care

St. Louis County Public Health
and Human Services
Foster Care
System Changes: Moving Into the
Future
AGENDA
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Overview
Systems/Considerations
Casey Family Programs – Breakthrough Series
Collaborative (BSC)
BSC – Basics
BSC – Premises
BSC – Methodology/Improvements/Tests/PDSA’s
Spread
Minnesota Framework
References
Overview
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On any given day, approximately 350 St.
Louis County children are in out-of-home
placement.
About 320 are in foster care
Overview
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Purpose of foster care:
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Provide temporary or long-term primary
care for children who have been
maltreated, experienced family problems,
or who have special needs;
Provide a planned, goal directed service to
children and their families;
Assist the department in its permanency
planning efforts
An Appreciation of Systems…
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Child welfare systems are increasingly identifying
the need for more flexibility regarding…
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how they allocate financial resources;
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the design of a more thorough array of
supports and services that truly respond to
the real needs of families and children;
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how they respond to families;
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how they make decisions about placement;
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how they factor in considerations of race,
culture, identity and the many forms of
diversity found in our society.
For Your Consideration…
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We sell many “systems” improvement efforts on
the basis of improved outcomes for families and
children.
Yet, the substance of systems improvement is
really about the day-to-day work and experiences
of administrators, supervisors, and workers.
We tend not to frame the conversation around
the benefits for the individuals responsible for
creating the improvements.
For Your Consideration…
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Individuals most familiar with the needs of
families, and the demands of the work, are often
left out of the conversation about what is working
well and what really needs improvement.
The BSC Model for Improvement is designed to
center the improvement process in the daily
experiences and realities of the individuals most
connected to the work.
Casey Family Programs:
Breakthrough Series Collaborative
(BSC)
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December 2000: Casey Family Programs Seattle, Wash. – joined with the Institute for
Healthcare Improvement (IHI) & Associates
in Process Improvement (API) to learn the
Breakthrough Series Collaborative (BSC)
methodology;
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2001-2002: Casey National BSC on
Recruitment and retention in foster care
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2005 & 2006: Minnesota BSC
Basics
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Quality improvement method;
Existing program or framework;
Core team of key actors;
Identify and test new strategies or ideas
for best practice ; in key domains;
Allows the team to make dramatic
changes in focused areas over short
periods of time
BSC Premises
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There is a gap between knowledge or
theory and practice; BSC uses existing
knowledge based on what has worked –
apply to system needs
There is a significant variation in
practice in the field; some agencies do
well, whereas others not = room for
improvement
BSC Premises
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All improvement requires change, but not all
changes lead to improvement; measurement
critical – small tests of change done to allow
for rapid implementation – track to see
impact;
“Every system perfectly designed to achieve
the results it gets”; systems need fixing – not
the people within the system
Basic Components of
Improvement
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Developing a Change
 Examination vs. innovation… or both?
 Change requires action
Testing a Change
 Trial and learning process
 Modifications may be made over time
 Discard change efforts when necessary
 Cycles of learning… continuous feedback
Implementing a Change
 Balance between demonstration and consensusbuilding
Testing Changes: What Is a PDSA?
Adjust and
Do Again
4
ACT
• Make
adjustments
• Ensure that the
next cycle
reflects the
learnings
STUDY
Don’t Forget
3
To Study!
• Complete analysis
of data
• Compare data to
predictions
• Summarize what
was learned
PLAN
• Determine
objective,
questions, &
Generation of a
Good
1 Idea
predictions
• Create plan to
test idea (who,
what, where,
when, how?)
DO
• Carry out the plan
• Document problems
and unexpected
results
• Begin analysis of
data
2
SMALL!!!
Adapted from © 2001 Institute for Healthcare Improvement
Supporting Improvement
Methods
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Using data
 Recognizing and making sense of patterns of
variation
Appreciation for a rapid action orientation to change
 Developing a change
 Testing a change
 Implementing a change
Working with people
 Understanding motivation is critical in obtaining
cooperation to sustain improvements.
Progression of Changes
Testing
P
A
P
DA
S
P
D A
S
D
S
Implementation in
pilot site
Spread
Spread
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Moves the changes into new areas of the
jurisdiction or beyond
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Requires that a change has been tested and has
been shown successful in pilot site
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Uses a new set of strategies (e.g., key message
and messengers identified, etc.)
Implementation in
pilot site
Testing
P
P
A
S
DA
S
D
A
D
S
Spread
The Life Cycle of a “Best Practice”
The needs of the field
are always changing.
“Evidence Based”
Practice
Best Practice
Promising Practice
Some
Best Practices
No Longer Effective
Emerging Practice
Smooth out the Bumps
Now What?
Work out the Details
Innovation
Minnesota BSC Framework for
Foster Care
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Recruitment
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Retention
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Ensuring Voice
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Birth Parent
Foster Parent
Child
Using the Minnesota
Framework
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Barriers or Stick Points
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Strategies to Overcome
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Generate Ideas – PDSA’s
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Measurement
Small Group Exericse
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Breakout and discuss
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Generate an idea
References
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MN BSC: Recruitment and Retention –
Presentation by Lori Lutz – Consultant for
Casey Family Programs.
Handouts – Minnesota State Department of
Human Services
Langley, Gerald, J., Nolan, Kevin M., Norman,
Clifford L., & Provost, Lloyd P. (1996). The
Improvement Guide: A Practical
Approach to Enhancing Organizational
Performance. Jossey-Bass: A Wiley
Company: San Francisco, CA.