Upload
baldwin-anderson
View
213
Download
0
Embed Size (px)
Citation preview
Quality Services Reviews:A process for understanding and
promoting best child welfare practice
Florida Department of Children and FamiliesQuality Assurance Managers MeetingMarch 14-15, 2011
2
Goals for Reviewer Training
Learn how pilot QSR reflects the practice model
Review the scoring criteria Learn about interviewing techniques to
enhance information gathering Learn how to plan and lead an effective
caseworker debriefing
3
Family-Centered Practice
Engagement
TeamFormation
Assessment&
Understanding
Planning
Implementation
Tracking&
Adaptation
4
What is the Qualitative Case Review?
The Qualitative Case Review process is a method for organizing the conversation with our communities in terms of :
the results we want for children and families served, and
understanding how child welfare practice can be improved to get those results.
5
Key attributes of the QSR Process
Language used is transparent to a wide audience
Underlying values as to child and family safety and well-being are broadly held
Practice model reflects a coherent approach to supporting and sustaining change in families
Process promotes learning at all levels in the organization, as well as in the larger community
6
QSR Uses a Record Review and Interview Format
We evaluate outcomes and best practice, along with compliance to policy
Record is reviewed at the beginning to gain and understanding of the case
Information is gained through interviews with family members, the child, the caseworker, service providers, etc.
Last interview with caseworker to share and update information and findings.
7
Quality Service Reviews: Common Understanding of Good Results for Children Served
Traditional Audit:
• Were investigations timely in accordance with policy?
• Are child’s educational needs reflected in case plan?
• Is there documentation in the record that ongoing therapy (if recommended) is being provided?
Quality Review:
• Are children safe from current, manageable risks of harm?
• Is the child leaning and progressing at a rate commensurate with his/her age and ability?
• Is the child doing well, emotionally and behaviorally?
8
Quality Service Reviews: A Different Way of Looking at Practice
Traditional Audit
• Is there a plan in the file?
• Was the plan signed by the parents?
• Was the permanency goal presented to the court at the dispositional hearing?
Qualitative Review
• Is the plan relevant to family needs and goals, coherent in selection and assembly of strategies, supports, services, and timelines?
• Was the family effectively engaged in assessment and service planning, and tracking?
• To what degree are service implementation and results routinely monitored, evaluated and modified?
9
Group Exercise 1: Understanding the QSR Indicators
What are we measuring? How do we currently assess this issue? How is this new description different? Who would need to be interviewed to learn more
about this? Provide some examples of circumstances that would
fall into the “No” category of practice? (NO, standard not met equals a 1, 2, or 3 rating)
(Teams of 3-4 persons)
10
How the scoring works
6 – Optimal
5 – Substantially Acceptable
4 – Minimally Acceptable
3 – Partially Unacceptable
2 – Substantially Unacceptable
1 – Completely Unacceptable
Each indicator is scored on a scale of 1 to 6.
11
Quality Service Reviews: Focus on Most Recent Segment of Practice
Child and family status indicators look at last 6 months– Exceptions are stability and permanence– Recent child/family status improvements may influence
scores– Any child/family may have positive status regardless of
length of involvement System performance looks at past six months
– Recent performance improvements have some influence on scores
– Any case can meet quality standards regardless of time open
12
Safety always trumps
Safety is the only indicator that trumps
Safety is paramount to any case.
Overall status is acceptable only when Safety is rated in the 4 – 6 range.
13
“Groundhog Day” Rule
Difference between a Rating of 3 and 4 (or a “Yes” or “No”
If this case were frozen in time as it is today, would it be acceptable?
14
How the Review Process Works
Purposeful sample of cases selected for each agency (younger and older children, children in care for varying lengths of time and with different permanency goals)
Family permission obtained to participate in review and information releases obtained
Key team members in each case identified and appointments scheduled (place, time frames)
Lead reviewers and partners conduct the interviews, beginning and ending with the caseworker
15
How the Review Process Works, continued
Answers are reviewed and scored in each indicator and domain
Feedback session with caseworker and supervisor to provide immediate feedback and elicit further suggestions for next steps on case
Presentation of stories at debriefing sessions during the week
Exit conference at end of week to present and discuss findings
Case story for each case reviewed
Final report which includes aggregate data and case stories.
16
Expectations of QSR Reviewers
Prepare for interview by being oriented to basic facts
Thoughtfully explain the QSR process
Consider how to best engage children/families
Be attentive to clues about family culture
Know what you need to learn from person being interviewed
Allow each person to tell their story
Gather each person’s perspectives
17
Expectations of QSR Reviewers, continued
Ask each person interviewed about child safety
Collaborate with your review partner
Prepare for special challenges
Stay within the role of reviewer
Remember the obligation to report child safety issues
Reviewers call it as they see it – score results and affirm efforts
18
Some “Don’ts” for QSR Reviewers
Don’t be premature in making judgments
Don’t share information across informants
Don’t ask any leading questions
Don’t drift from the protocol or definitions
Don’t go unprepared into debriefing with Case Manager
Don’t overwhelm staff with too many suggestions
Don’t do “TA, Supervision or Training” during debriefing sessions
19
Basics for Interviewing
Introducing yourself, partner and the process
Starting the interview
Allow the interviewee to tell the story
Gathering necessary information
Planning for the less than perfect situation (place and/or time constraints)
Closing the interview
20
The Core “Script” for each interview.
Why your perspective matters
What is the story of your involvement?
What are both the strengths and needs of this child and family?
How is the system working to help this child and family? What are the goals?
What things are working well?
What would you like to see working differently? How might that happen?
21
Interviewing
Core Conditions Skills
Genuineness
Respect
Empathy
Clarification
Closed questions
Open questions
Solution Defining questions
Past Successes
Exception Finding
Miracle Questions
Summarization
22
Caseworker Debriefings: Making it Positive
Begin with a strength and affirmation
Ask how the caseworker achieved something you learned that was positive (“How did you make that happen?”)
Summarize and clarify child and family story, share any new information, clear up confusion
Review child and family status findings (begin with strengths)
Review system findings (begin with strengths)
23
Caseworker Debriefings: Making it Positive
Elicit from caseworker/supervisor their thoughts as to next steps
As appropriate, suggestions might be stated as, “We wondered what might have happened if at that point, (particular team members) might have had a team meeting to figure out…”
Provide suggestions on some other options for next steps that MAY be useful
Direct more difficult system questions to the supervisor
24
Group Exercise: Planning a Caseworker Debriefing
As a team, identify three strengths about Jorge and why they are important. (5 min.)
As a team, identify main concerns for Jorge. (5 min.)
As a team, identify the issues that remain a practice challenge. (5 min.)
As a team, develop a few suggestions for creating a positive caseworker debriefing. (10 min.)