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Quality Service Review
Organizational Learning for System Improvement
The Philadelphia Department of Human Services’ mission is to provide and promote safety, permanency, and well-being for children and youth at risk of abuse, neglect and delinquency
Mission Statement
Organizational Chart
Division of PMA started in 2009
Mission: The division of Performance Management and Accountability will support system improvement by monitoring and evaluating the efficiency, effectiveness, and availability of our services both internal and external
Five Pillars: DIM, QI, PREP, PBC, and Research
Performance Management and Accountability (PMA)
Case File Review
Quality Visitation Review
Quality Service Review
Child Fatality Review
ChildStat
Quality Improvement (QI)
The Quality Service Review (QSR) is a practice improvement approach designed to assess current outcomes and system performance by gathering information directly from families, children and service team members
Quality Service Review
Mid 1990’s: The first QSR protocol developed Other states that use the QSR process
◦ Alabama◦ Utah◦ Wisconsin
Fall of 2009: Pennsylvania and Philadelphia management observe Utah’s QSR process
January 2010: PA’s OCYF adopts the QSR process and selects Philadelphia to participate in the first QSR pilot process
June 2010: Philadelphia begins internal QSRs
Quality Service Review History
Occurs six times a year
Small sample of randomly selected cases
Stratified by service area
◦ Congregate Care
◦ Children with Special Medical Needs
◦ Adoption
◦ General Foster Care (Foster and Kinship Care)
◦ Treatment Foster Care
◦ In-Home Services Array
◦ Older Youth (SIL/TLP)
Philadelphia’s Local QSR Process
Review teams Brief review of the case file Initial interview with DHS worker and supervisor Interviews with stakeholders and families
◦ Focus child/youth and biological family◦ Foster parents and group home parents◦ Private provider workers◦ Attorneys◦ Mental health, educational, and medical
personnel Focus Groups
QSR: Gathering Information
Traditional Review Were visits timely?
Is the child’s IEP in the file?
Was there a referral to a mental health
service?
Quality Service Review
Are children currently safe?
Is the child progressing well academically?
Is the child functioning well emotionally?
Difference between Traditional Reviews and the QSR
Traditional Review
Is there a current plan in the file?
Did the parents sign the plan?
Is there a written assessment?
Quality Service Review
Is the plan likely to lead to permanence?
Do the parents feel that the plan is their own?
Does the assessment accurately identify underlying needs?
Difference between Traditional Reviews and the QSR
Pennsylvania QSR Protocol◦ 9 Child/Youth and Family Indicators◦ 11 Practice Performance Indicators
Scoring Process◦ 6 – Optimal◦ 5 – Substantial Acceptable Range◦ 4 – Fair◦ 3 – Marginal◦ 2 – Poor Unacceptable Range◦ 1 – Adverse
QSR: Scoring Process
Case specific feedback◦ Final interview with DHS worker and supervisor◦ Written Case Story◦ Debriefing
Aggregate system-level feedback◦ Findings Present Meeting◦ Findings Present Report
QSR: Feedback
Aggregate scores from all 12 cases
Comparison of acceptable and unacceptable scores with all QSR cases
Content analysis◦ Case Story recommendations◦ Focus Groups
Trends and recommendations
Data Analysis
Demographic information
Indicator ratings◦ Child/Family◦ Practice Performance
Comparison with overall QSR ratings
Case Stories
Recommendations
Findings Present Report
All QSR reviewers
DHS management
Private provider representatives
Leaders from the courts
Child advocate and parent attorney offices
Representatives from the mental health, educational, and medical systems
Findings Present Meeting
Findings Present Graph
Safety
Physical health
Engagement of child/youth and substitute caregiver
Overall Trends: Strengths
Increase the use of Family Finding and Family Group Decision Making to support family engagement and culturally appropriate practice
Use of specific teamings at key case intervals (e.g. Permanency Action Teamings) to improve planning, permanency, and teaming indicators
Current Improvement Initiatives
Suggested improvements◦ Submitted to the Commissioner and her cabinet for
approval◦ Assigned to a responsible person
Quality Improvement tracking system◦ Used to track recommendations from all QI reviews◦ Recommendations entered into a database◦ Monthly updates recorded to track individual
implementation◦ Quarterly reports published to track overall
implementation
Tracking Recommendations
“This process allows the child, family and team members to be seen and heard rather than just read about. This allows for a better understanding of actual service delivery and needs.” -DHS Worker
“I like that the QSR takes more than just the case record into account. By speaking to all parties a person is able to get a better understanding of the case.” - DHS Supervisor
Response to the QSR from DHS Staff
“I like being heard and feeling that providers are recognized for the service that is being provided. I appreciated the reviewers coming out to our facility making it convenient for me to participate. The reviewers did a great job making me comfortable to share my honest opinions.” – Provider Worker
“I think this process of review is very important to make improvements and give better service.” –Medical Personnel
Response to the QSR from Outside Stakeholders
Interested in observing the QSR process?◦ Contact Brian Clapier ([email protected])
Pennsylvania QSR Protocol◦ http://www.pacwcbt.pitt.edu/Resources/PA%20Q
SR%20Protocol%20Version%201%200.pdf
Come Observe!
