Case Reviews

Overview

Kim McDowellSocial Services SupervisorContinuous Quality Improvement- Solano County

The Administration for Children and Families (ACF) is responsible for Federal oversight of the state Child Welfare programs.

As part of that oversight, ACF has conducted Child and Family Service Reviews (CFSR) in each state to evaluate performance on key outcome measures.

The CFSR includes multiple assessments, and has included case reviews in California since 2002.

Beginning in 2015, California has applied to conduct internal case reviews, and began training reviewers in each county to complete the case review tool for the 2016 CFSR.

Background

What do case reviews do for:California Child Welfare agencies?

Case Reviewsare completed to ensure conformity with federal child welfare requirements.

collect qualitative data in addition to the quantitative data captured by the CWS/CMS database, in order to help determine some of the “why” behind the outcome numbers.

assist states and counties in enhancing their capacity to help children and families achieve positive outcomes.

What do case reviews do for:Children and Families?

Case ReviewsFocus assessment on key outcome areas:

Safety, Permanency, Well-being Place significant attention on the needs of the child (educational, medical, dental, mental health) and services needs of the parents being met.In addition to case file review, collect information from in-person interviews of involved parties, soliciting direct client feedback.Create a continuous feedback mechanism within the Department to improve processes and outcomes for children and families.

What do case reviews do for:Foster Agencies, and foster/relative providers?

Case ReviewsFocus on agency efforts to support placement, including:

Efforts to place with relativesEfforts by the Department to assess and meet the needs of the foster (including relative) parents.

Encourages and allows for efforts by substitute care providers and collaborative agencies to be considered as part of the review.Gives SCPs a “voice” on a consistent basis regarding their interaction with the agency.

What do case reviews do for:CWS Staff?

Case ReviewsConnect practice to the principles of a case practice model.Focus staff on practice skills and activities used in every day casework.Provides meaningful feedback to staff about quality of practice.Allows for focused teaching and training of staff directed by local agency outcomes on key practice standards through the review of those key areas.Using a case file review offers a more promising approach to capturing the complex dynamics of CWS work.Provides equal weight to interviews with staff regarding their work with families, allowing staff to clarify and elaborate on their efforts.

Training•Classroom training•Practice case reviews•1 supervisor•1 SW III•Certification Test

Implemen-tation•70 cases/year for Solano County•Each review takes about a week•Reviewed for a period of 18 months or less

Data review•Ongoing reporting to Federal Gov’t•Ongoing local review of practice•Solano CQI/QA process under development

The case review process:Out of home cases are proportionately divided between CWS and Probation foster care cases; and foster care/in-home cases The 18 month “Period Under Review” may capture all or part of the case, and ends at the time of the case closure or review, whichever is earlier

The “PUR” is designated by CDSS at the time that the randomly selected cases are provided to the team for review

The case may be closed at the time of review, or may still be open for service

More…

Includes all cases (VFM, FM, FR, PP, Adopt), but does not extend beyond the client’s 18th birthdayConsiders ONLY services and efforts made during the “Period Under Review” in the review, with a couple of exceptions

Collecting information:Reviewers consider available documentation, including:

Case file recordsCWS/CMSSafeMeasuresSDM

Reviewers conduct interviews of key case participants, including:

Case ManagersParentsFocus Children

Other siblings in the home

Foster/relative care providersOther collaterals as needed

What does this mean to CWS staff?

The case reviewers will be requesting Case files for review

File review should take no more than several days, and advance notice will be provided to allow file to be filed and prepped

Interviews with social workers (or supervisors if social workers are no longer with the Department)

Interviews are expected to take about an hour, and there may be some follow up questions after other interviews are completed

What does this mean to SCPs?FFA’s/ Group home agencies

Interviews with social work staff may be conducted for:

Information on services providedFeedback on ways the Department met or did not meet the needs of the SCP, and ways the Department worked with the SCP

Support regarding contacting SCPs in your agency

Individual SCPsCase Reviewers WILL be contacting current/prior placement providers for:

Interviews- The case review tool requires interviews of SCPs with whom the child was placed during the review period.Information on services provided/neededFeedback on ways that the SCP was or was not supported by the Department

What does this mean to clients (parents and children)?

Client voice heardActive engagement with randomized group of clients for feedback regarding Department’s effortsSeeking feedback on an ongoing basis

in the past, client voice was generally sought during stakeholder interviews for peer review cycle

Confidential feedback that does NOT impact caseYouth as key participants

Interviews with youth to collect their views on how they were served

What about … ?Adoptive cases

-All of the same standards apply-If parental rights were

terminated PRIOR to the review period, the adoptive parents (and their services) are what the review is assessing, and the parents are not interviewed

-if parental rights were terminated DURING the review period, parents are still interviewed, as are the SCPs/adoptive parents

Closed cases-All of the same standards apply-The reviewer makes a “diligent

effort” to meet with the family-

Interviews- in a nutshellInterviews are conducted to:

Collect information for the Case Review Tool Clarify or verify information obtained in the case documentation or other interviewsProvide caseworkers, clients, and SCPs with a venue to express concerns, strengths and their needs

The information obtained is CONFIDENTIAL, and is used for the purpose of the case review and CQI process only

Case Review Staff are still mandated reporters, so new allegations of abuse and neglect are reportable. Clear ethical violations will also require additional consultation.

The Case Review interview guide includes suggested questions items, but this is NOT a structured interview

Equal weight placed on interview as on case file review

This allows for addition/clarification of information All caseworkers who carried the case during the Period Under Review are to be interviewed, and the supervisor if the worker is no longer availableOpportunity for caseworkers to discuss strengths and barriers they encountered during the period, which may not have been in reports or case notes

Interviews with caseworkers or supervisors

Sample caseworker interview questions

How stable is the child’s current placement? How was concurrent planning implemented in the case? What were/are the barriers in achieving the permanency goal(s) timely? What efforts were made to identify, locate, inform, and evaluate relatives as placement resources? Describe the process you used to engage the parents/caregivers in case planning. How did you describe the purpose of the case plan to parents/caregivers?

Interviews with SCPs (foster and relative)The amount of information needed may vary depending on the length of time the target child was placed with the SCP during the period under review.

The information provided is confidential, and will NOT be provided to the current caseworker, or used in the case in any way (barring safety issues).

While the case reviewer is interested in understandingbarriers in communication betweenSCPs and the Department, these Interviews are not a mechanism toresolve case specific issues.

Sample SCP interview questionsQuestions may include:

Did you have any concerns about the child’s safety during visitation with parents and/or other family members? Do you believe the child’s permanency goal is/was appropriate based on the child’s needs and the circumstances of the case? Why or why not? Was a visitation plan developed for the family? If so, were you involved in developing it? What kinds of services did the child receive? Were the services helpful? Was there anything the child needed that the agency did not provide for? How often did the caseworker visit with you? What types of things were discussed during visits/contact with the caseworker?

Interviews are CONFIDENTIALThis is very important- especially for cases that are still openThe information collected will not be used for case management, or be shared with the caseworker

Caseworkers will be asked to make introductions on open or recently closed cases, so an understanding of the process is necessary if the parent/youth have questionsFlexible times/placesCompletely voluntary, but active efforts to encourage the family to participate will be made

Interviews with clients (parents and youth)

Parents:

Were services offered to your family to keep your children safe in your home? If not, do you know why not? Did the caseworker discuss the permanency goal(s) with you? If so, can you tell me what those conversations were like? Were any of your children placed in separate foster homes? If so, do you know why? Do you believe the agency accurately assessed your child(ren)’s needs during the period under review?

Sample client interview questions

Children:Did/do you feel safe in your family home? If not, what was/is going on to make you feel unsafe? How often do/did you visit with your parents? What about visits with siblings? Were you involved in any meetings where your case plan was discussed? Has anyone discussed your permanency goal with you? If yes, what did you talk about?

More questions…

More to come…The CQI team is still working on the details of exactly what data we

need AND how to use it:Here’s the direction we’re going…

Collect Key Outcomes from workgroups, initiatives, staff, and other key stakeholdersMerge Case Review with review tools from SDM, SOP, Core Practice Model etc.

Some Ideas below

Structured Decision Making

Assessment tool completed per

policy

Does record narrative match

item scores?

Is final tool recommendation

correct?

Safety Organized Practice

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?

?

Katie A

?

?

?

CSEC

?

?

?

SIP Strategies

?

?

?

Perman-ency

PTM’s

Concurrent placements

?

Safety/ Investiga-

tion

?

?

?

Other goals

?

?

?

Where does the information go after it is collected?

Data regarding outcomes, and feedback regarding barriers in practice, is used to improve outcomes for children and familiesWorking together to move from compliance focus to learning focus

Identify areas for:• Training• Policy development or

adjustment• Advocacy

Peer review /SIP

Case ReviewsOutcomes

Data

What do we hope to get from Case Reviews?1. Learn more about our practice, so that we can

improve it “from the inside”• For areas of success- find out what we did right,

and replicate it• For areas of struggle- find out what are the

barriers, and work toward practice change2. Even better teaming with collaborative

agencies3. Exceptional engagement with families4. Meet state requirements for 70 case reviews

per year