CQI at Franklin County Children

Services

Metro PresentationAugust 15, 2014

Julia Harrison & Linda Peters

FCCS Board Policy: Franklin County Children Services, its Board, advisory committees, and employees are committed to providing the highest quality services and to a continuous quality improvement process

Administrative Support- resources CQI Plan:

◦ Describes how CQI is integrated into the agency’s work

◦ Highlights CQI services & activities that the PIE (Performance Improvement, IT, Evaluation, Data Mgmt, and Professional Development) Division will provide to the agency

Important Foundations

Council on Accreditation (COA)◦ Non-direct service standards:

Administration and Management Service Delivery Administration

◦ Direct service standards: Adoption Services Child Protective Services (Regions & Intake) Volunteer Mentoring Services Kinship Care Services

CFSR/CPOE

CQI Drivers

Orientation- CQI introduction for all new employees, personal commitment

Committees are key◦ “Effective committees can help us bring continuous

improvements to our internal agency functioning and to the services we provide children and families. In addition, well-organized committees can help us draw on the talents of large numbers of staff, promote teamwork and enhance coordination across departments within the agency.”

◦ CQI Infrastructure◦ Strengthens staff involvement in CQI activities-

learning environment

CQI is Agency-wide

a. Best Practice Council Committee j. Executive Councilb. Board and Administrative Policies Committee k. Green Space Committeec. C3 (COA, CPOE, CFSR) Committee l. Information & Technology

d. Chairs’ Cabinet (IT) Review Panele. Child Risk Review Committee m. Multi-Cultural Development

i. Child Death Review Panel n. Risk Management Committee f. Clerical Committee o. Safety Committeeg. Committee Communications Council p. Speaker’s Bureau h. Continuous Quality Improvement (CQI) q. Supportive Work Environment i. CQI Short Term Plan (STP) Workgroups

i. Employee Handbook Committee

FCCS Committees

ROM and CFSR SACWIS data entry/data quality Automated data collection, analysis, and

measurement consulting to CQI teams Ad hoc data analysis for BPC and CQI teams Provider services-placement provider scorecard Disseminate, analyze, and present the Survey of

Employee Engagement (SEE) Provide reports to Program Services; Screening,

Intake, Regions, and Adoptions to monitor performance- FCCS Dashboard

PIE Support- Evaluation

Family Team Meetings; Case planning, 90 Day Reviews, SARs, TDMs, and PRTs

Deceased Child Review Process- internal and external

CPOE review and QIP monitoring CFSR review and PIP monitoring Peer Review- transition from QA approach to

CQI

PIE Support – Performance Improvement (PID)

Adoption Services - MEPA compliance, process review of pre-matching & conferences

Child Protective Services/Intake - CAPMIS; Safety & Family Assessment timeliness & quality

Child Protective Services /Regions – CAPMIS; Case Plan & Reunification Assessment timeliness & quality

Volunteer Mentoring Services – Process review for provider approval, matching, maintenance, and documentation

Kinship Care Services – Process review for timeframes, quality of documentation, and activity logs for quality

“Cross-pollination” workgroup- CAPMIS Safety Plan timeliness & quality

PID and Peer Review

Shift from QA style, 3rd party reviews focused on compliance

Identify strengths and areas needing improvement Aim is to improve practice/outcomes and align with

Rule Involving employees and stakeholders; ensuring staff

are engaged and part of the entire process. Focus on supervisors!

Data gathered, analyzed, & reported at case and aggregate levels

Using data, team knowledge, and collaboration to improve decision-making and bring systemic improvements

Link Strategic planning, goal setting and monitoring improvements

Peer reviews for a process, specific tool, program, or case

Useful for individual workers/unit, refresher training, coaching/mentoring

Continuous cycle –repeat the process!

FCCS “True” Peer Review

PIES PLAN IMPLEMENT EVALUATE next STEPS

◦SHARE Results◦STRATEGIZE◦SUSTAIN**CQI STP Workgroups-where the work happens-

Program service supervisors, caseworkers, & administrators

**Use PID Peer Reviewers to Facilitate**Partner with Evaluations, IT, PDD, others

FCCS Steps in Peer Review

◦ Select a process, specific tool, program, or a case ◦ Determine what is to be improved. Focus on timeliness,

quality, efficiency, accuracy, etc.◦ Develop a peer review tool from ORC/OAC,

CAPMIS/SACWIS, COA, Agency policies & procedures◦ Create instructions/guides, tool and answer sheet◦ Determine the pool, sampling, timeframes, etc.◦ Detail logistics of reviewers, process, assignment,

collecting and recording data◦ Get baseline data to help determine goals◦ Evaluation plan – measuring, operationalize/define; for

quality use; y/n, OR not, substantially, or partially achieved.◦ Communication plan- how to share results, not

punitive, unit level may spur competition, STPs/departments and “BIG” CQI, agency-wide

◦ Think about IMPROVEMENTS and Strategies

PLANNING for Peer Review

◦Get started, per the plan◦Use the STP workgroup/committee members as

subject matter experts/champions◦Be flexible; things will change; tools,

instructions; continuous learning◦Need oversight, responsibility, keep things

moving- CQI timeline◦Data and evaluation are key-analyze results,

goals, progress◦Communicate as you go! Share with CQI Workgroup,

BIG CQI, agency-wide◦ Improvement strategies; policy/procedures, SACWIS,

agency processes, training, tools-Red Letter Guides, Q-tips, Reports

◦Campaigns/competition- reward success!

IMPLEMENTATION with Peer Review

◦Gather data and compare peer review results, baseline and improvements

◦Automate our process- Scantron & EXCEL◦Create reports and charts to show analysis of data- remember your audience!

◦Report at supervisor level – not worker level, not for performance evaluations

◦Set goals and benchmarks, determine when improvement is reached

◦Remember to evaluate the process and implementation as well- satisfaction surveys

EVALUATION with Peer Review

SHARE Results, STRATEGIZE, and SUSTAIN◦ Share-- communicate results, remember your

audience, REWARD success! All levels-individual, supervisor, dept., agency wide. Use FCCS rotator, bathroom posts, “best” peer reviews, campaigns like QTSA, Awesome sauce, Father’s Day cards & Engagement

◦ Strategize--Identify areas for improvement, ideas/strategies to use. Plan for improvements- process, clarification of policies/guides, Q-tips, training/education, measuring/monitoring with reports

◦ Sustain—through accountable processes, use data, SACWIS, reports & monitoring, FCCS Dashboard

Next STEPS with Peer Review

FCCS Region CQI STP group worked to improve the timeliness and quality of CAPMIS RAs. Support FCCS PIP activities for more inclusive peer review process, supervisor involvement , CAPMIS tool improvements, and improvements in CFSR 1.1 – Timeliness & Permanency of Reunification.

FCCS Baseline data indicated that RAs were not being completed or used as a tool to drive decision-making. Also inconsistency among Regions, units, supervisors, or workers in the completion and quality of the RAs.

Timeliness and quality had to be defined and operationalized.◦ Timeliness determined to be completion 0 to 30 days prior

to the youth’s discharge. ◦ Quality was determined by thorough review of SACWIS,

CAPMIS and the RA tool with changes in agency policies and procedures, creation of instructions, and a Red Letter Guide.

◦ Additional training and quality tips (Q-tips) ◦ Data was instrumental and reports were analyzed and

shared so that progress was evident.

Peer Review Highlight-CAPMIS Reunification Assessments (RAs)

Reunification Assessment Timeliness

2009

2010

2011

2012

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

38

41

45

74

28

27

31

17

34

32

24

9

Timely

Not Timely

Not Completed

Reunification Assessment Quality

Q2 2009

Q3 2009

Q4 2009

Q1 2010

Q2 2010

Q32010

Q4 2010

Q1 2011

Q2 2011

Q3 2011

Q4 2011

Q1 2012

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

34%

56%

59%

56%

69%

66%

65%

72%

77%

79%

80%

77%

Overall Quality Score

2013 Peer Review Satisfaction Survey

Strongly Disagree

Disagree Agree Strongly Agree1%

9%

57%

33%