QualityStandardsforGroupCare

ShamraBoel-Studt,Ph.D.,MSW,FloridaStateUniversityCollegeofSocialWorkKenBender,MS,BoysTownXiomaraTurner,MSW,FloridaDepartmentofChildrenandFamiliesHuiHuang,Ph.D.,MSW,FloridaInternationalUniversitySchoolofSocialWork

ChildProtectionSummitAugust31,2017

FocusingonQualityinResidentialCare

QualityResidentialCareisNeededQualityMatters– “Allresidentialprogramsarenotcreated,ormanagedequally.Theresultscorrespond”(Barth,2005).Qualityisacombinationof:

• Structure• Processes• Experiences• Outcomes

Sowhatisqualityresidentialcare?

HighQualityResidentialCareReviewofconsensusforresidentialperformancestandards

• Serviceplanning• Safe,abusefreeenvironment• Maintainpositivepeergroupculture• Familyandculture• Leastrestrictiveenvironment• Programelements• Education,skills,&outcomes• Aftercare

QualityResidentialGroupCareinFlorida

MovingfromTheorytoPractice• Late2015,strongpushinFloridatoeliminategroupcare

programs• BoysTownandotherlike-model,qualityproviderswere

abletochangetheconversationfromeliminating groupcaretoquality groupcare

• Abletochangefocusby– Creatingpositivemediacoverage– PersuadingpolicymakersattheFloridaDepartmentofChildrenandFamilies(DCF)

– InfluencingtheFloridastatelegislature 6

Howwedidit,andactionstaken…• Leveragedexistingallianceswithlike-mindedproviders• FloridaCoalitionforChildren(FCC;provideradvocacy

group)ResidentialCommitteeChair• UsedFCCChairpositontodeliverandempower

statewidegrouphomeprovidersonmessaging• Developedmaterialsandmessaging– Outcomesincommon(onepager)– WhyQualityResidentialCareisGoodforAmerica’sAt-RiskKids:ABoysTownInitiative

Howwedidit,andactionstaken• MetwithDCFleadership

– Sharedconcernwithqualityhomes,resultinginaworkgrouptodevelopqualitystandards(changedtheconversation)

– ChairedtheGroupCareQualityStandardsWorkgroup– Educatedoncommunityinvestment(donors,boardmembers,localbusiness)

• 3agencieswroteopeds andmetwitheditorialboardsinourareas,had6articlespublished

• Metwithreporterwritingnegativearticlesoutofthecapital,tourof2ofthegrouphomeprovidersfacilities

• Metwithlegislatorsandstartedthediscussiononquality:educatingthemondifferentiators,modelsofcare,andcomparisonstofostercare

Whatmadethedifference?• Outcomesandonepager

− Helpedwitheducation/Notmuchinfluenceonthelegislators/Hadimpactonpolicymakers(legislativestaff)andDCFstaff

• Mediacoverage− Impactonlegislators,communitydonors(FCCConferenceLegislator

Panel)• Unifiedmessage

− Impactonlegislators,policymakers,detractors• Developmentofthestandards

− Impactonpolicymakers,legislators,detractors,providers

DevelopmentofCareQualityStandardsforResidentialGroupCareinFlorida

Purpose• TheGroupCareQualityStandardsWorkgroupwasestablishedbythe

DepartmentofChildrenandFamiliesandtheFloridaCoalitionforChildrentodevelopasetofqualitystandardsforDepartmentlicensedresidentialgrouphomes.

Responsibilities• Analyzeresearchsurroundingqualitystandardsforresidentialgroup

caresettings.• Establishasetofcorequalitystandardscommontoresidentialcare

settings.

CoreQualityStandardsforGroupCareEightQualityDomains• Assessment,Admission,&ServicePlanning• Positive,SafeLivingEnvironment• Monitor&ReportProblems• Family,Culture,&Spirituality• Professional&CompetentStaff• ProgramElements• Education,Skills,&PositiveOutcomes• Pre-Discharge/Post-DischargeProcessesLinktoQualityStandardsforGroupCareBooklet:http://www.dcf.state.fl.us/programs/foster-care/group-care/docs/1507-255%20Quality%20Standards%20for%20Residential%20Group%20Care%20Booklet.pdf

Wherewearenow…• Standardscompletedandaccepted• 2016legislativesessionlanguage,billkilledlastdayofsession.

• 2017legislativesession,languagewrittenandsignedintostatute- HB1121lines2036– 2100.

• Dissentionandoppositionnowthatitisstatute

MeasuringQualityinFlorida’sResidentialGroupHomes

GroupCareQualityStandardsAssessmentPurpose• TheFloridaDepartmentofChildrenandFamiliesengagedtheFlorida

InstituteforChildWelfaretodevelopandvalidateanassessmenttooltomeasure,document,andfacilitatequalityservicesinFlorida’sDCFlicensedgrouphomes

Objectives• Designandvalidateanassessmenttomeasurethecorequality

standardsasdefinedbytheGroupCareQualityStandardsWorkgroup• Developsystemforimplementingtheassessmentaspartof

Department’sre-licensureprocess

ProjectTimeline

Project Handoff from DCF to FICW

December 2015

Draft Scale & Implementation

ProtocolJanuary 2016 –

August 2016

Test PilotNovember 2016-

January 2017

Field TestFebruary-July 2017

Data Analysis/Finalization

of ToolJuly-September 2017

Statewide Roll-OutDecember 2017

Year One ValidationJanuary 2018-March

2019

Year Two ValidationJanuary 2019-March

2020

ProjectTeamCollaborationiskey!• FloridaInstituteforChildWelfare• FloridaDepartmentofChildrenandFamilies• GroupCareQualityStandardsWorkgroup• FloridaCoalitionforChildrenResidentialCommittee• BoysTownNationalResearchInstitute• Formerfosteryouth• Childadvocates• Childwelfarescholars• Community-basedcareagencies

DevelopmentoftheQualityAssessmentGuidelines• Flexible/allowsindividualizedapproaches• Equitable• Informedbymultiplekeystakeholders• Complementsandexpandsuponlicensingcriteria/

integratedintolicensingprocess• Reliable/validmeasure(psychometrics)• Implementationscience/Developmentalevaluation

frameworks

StepsinDevelopment1. Distill&operationalizestandards(Nov.– Feb.)2. Crosswalkstandardswithstatelicensingcode(Feb.– March)3. Selectionofprioritystandards(survey)(April– May)4. Draftofassessmenttool(June)5. Developimplementationplan(July)6. Contentvalidationreview(July)7. Finalizepilotassessmenttool(Aug.)8. ApprovalfromDCFLeadership

Consult

ReviewRevise

AssessmentToolOverviewMulti-dimensional• Subscalesmeasureeightpracticedomains;Itemsmeasurestandardswithineach

domainsThreetypesofItems• Structural– Measuresinfrastructureofcaresetting(e.g.,staffing,policies,resources)

– E.g.,Theprogramhaspoliciesandproceduresforsupervisingyouthandrespondingwhenayouth’sactionsthreatenthesafetyofother.

• Process– Measuresextenttowhichprovidersconsistentlyprovideservicesthatfollowrecommendedguidelines– E.g.,Acomprehensiveassessment(includingpre-admissionandfollow-up

assessmentsasneeded)arecompletedforallyouthwithin30daysofadmission.• Experiential – Measuresexperiencesofconsumersandproviderswiththecaresetting

– E.g.,Igetalothelpfromstaff.

AssessmentToolOverview

Triangulationofdatasources• Self-report,documentreview,observation,&interviews• Multi-informant– ServiceProviders– Youth– LicensingSpecialists

Time-oriented- Assessmentofpracticesandconditionsingrouphomewithinpast12monthsOn-line– Qualtrics

PilotStudyPurpose- EvaluatefeasibilityofimplementationplanandperformpreliminarypsychometricanalysesofqualitymeasureSample/Setting – 10grouphomes,oneserviceregion• 94assessmentformscompleted

– 56serviceproviders,27youth,11licensingspecialists– Responserates- 100%directors,directcareworkers,licensing,casemanagers&youth;70%placementspecialists

ImplementationData• Weekly/biweeklytriagecallswithlicensingteams• Post-pilotdebriefingwithallparticipants

ReliabilityofSelf-ReportForms

Note.Alpha>.70=Acceptable;SEM=StandardErrorofMeasurement

LessonsLearned– Whatwentwell?• Participantsupportforassessment&willingnesstoengage

inprocess• Feasible/manageabletocomplete• Itemsgenerallyviewedasrelevant;easytocomprehend• Reliabilityacrossmostsubscalesoftheyouthandprovider

formswereacceptable- excellentrange• Preliminaryfindingssupportfeasibilityofimplementing

qualityassessmentwithinstatelicensingsystem;Establishpromisingfoundationforassessmentandinsighttoguidenextphaseofdevelopment

LessonsLearned–Whatchallengeswereencountered?

FieldTestPurpose: Evaluateassessmentintworegionsusinglargersample;Collectdatatofurtherdevelopassessment,implementationprocedures,andstatewidetrainingTimeline:March- July2017Sample/Setting– 34grouphomes• NER=19(55.9%),CR=15(44.1%);Grouphomes=28,Shelters=6Completedassessmentforms=299• 34licensing,115groupcareproviders,72casemanager/placement,78

youthTriagecalls– NER=3;CR=3Sitevisits– ConductedinMay(NER)andJune(CR)

FieldTest- PreliminaryResultsEmergingthemesthatwereconsistentwithtestpilot:• Support/willingnesstoparticipate• Fewissueswithimplementation• Mostrespondentscompletedformsuponrequest• Needforadditionalguidanceonsampling– who

shouldbecompletingforms?– Issueswithproviderscompletingmultipleformsfordifferent

homesthatarepartofsameprogram

FieldTest– PreliminaryResultsNeedtodefinesometermsandprovideadditionalguidanceonhowtorate• 6.1.Levelofcareismatchedtoyouths’needswithasfew

restrictionsaspossible• 1.4.Youthareinvolvedintheadmissions processViewsonfeasibilityofcertainstandards• Familyinvolvement

‒ 1.5.Familiesareinvolvedincreatingserviceplans• 8.7.Theprogramfollows-upwithyouthandtheircaregivers

tomonitorpost-dischargeoutcomes.

FieldTest– PreliminaryResults

Differencesinpracticesofgrouphomesacrossregions-sometimesrelatedtorequirementsofleadagencies• 3.6.Theprogramusessurveystoassessconsumersatisfaction• 6.18.Staffworkwithapsychiatristtomanageyouth

medicationsDifferencesinapplicabilityofsomestandardsforemergencyshelters• 1.12.Serviceplansincludeclearlydefined,measureablegoals.• 7.1.Theprogramensuresyouthreceiveon-goingeducational

assessmentstodeterminetheireducationalneeds

FieldTest– PreliminaryResults

Topicstospendmoretimeonduringtraining:‒ Trauma-informedcare‒ Evidence-basedpractice‒ Guidance/providingmoreexamplesofhowtorateitems

• Offerweb-basedtraining

FieldTest• Additionalanalysesinprogress– participantfeedback,

reliability,andvalidity• Preliminaryresultsprovideguidanceon:

‒ Itemrevisions‒ Adjustmentstosampling‒ Training

• Supportrelevancy/applicabilityofmajorityofstandardstoqualitygroupcarepracticeandembeddingassessmentintoDCFrelicensing

GroupCareQualityAssessmentTool–Demonstration

NextStepsPre-ImplementationActivities(July– October2017)• Dataanalysis– refinetoolandassessmentprocess• Developstatetrainingandtechnicalsupportprotocol• Finalizeplansforstatewideroll-out&validationstudyStatewideRoll-out(December2017)• Orientation,training,andon-goingtechnicalsupportacrossallsixregionsFirstYearAssessmentToolValidation(January2018– March2019)• FullyearofdatacollectionusingassessmentdatafromallDepartment

licensedgrouphomesthroughoutthestateConveneWorkgroup/AdvisoryBoard(October2017)• Developqualityaccountabilitysystem

ResourcesBoysTownAdvocacyExternalResourceDocument

Thompson,R.W.,Huefner,J.C.,Daly,D.L.,&Davis,J.L.(2014).WhyisQualityResidentialCareGoodforAmerica’sAt-RiskKids:ABoysTownInitiative.BoysTown,NE:FatherFlanagan’sBoys’Home(http://www.boystown.org/documents/quality-care/why-quality-care.pdf)

FloridaInstituteforChildWelfareQualityStandardsforResidentialGroupCareProjectBriefsandReports(http://ficw.fsu.edu/technical-assistance-training)Boel-Studt,S.M.(2015).ImprovingtheQualityofResidentialGroupCare:AReviewofCurrentTrends,EmpiricalEvidence,andRecommendations.TechnicalReport.FloridaInstituteforChildWelfare(http://ficw.fsu.edu/sites/g/files/imported/storage/original/application/d274e89564cd47d4b98ee14f68817127.pdf)

ContactInformationShamra Boel-Studt, PhD, MSWFlorida State University & Affiliate Of the Florida Institute for Child Welfaresboelstudt@fsu.edu

Xiomara Turner, MSWFlorida Department of Children and Families Xiomara.Turner@myflfamilies.com

Ken Bender, MS Boys TownKenneth.bender@boystown.org

Hui Huang, PhD, MSWFlorida International University & Affiliate of the Florida Institute for Child Welfarehuanhu@fiu.edu

Thankyouforyourparticipation!