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Pennsylvania’s Practice Model and Quality Service Review (QSR) Protocol

Leadership Academy Conference

September 29, 2010

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Activity

What do you want children, youth, and families to achieve as result of your intervention?

What do you want children, youth, and families to experience as you work with them?

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Practice Model Defined(NRCOI, a working document series, July 2008)

It is the agency’s guide to the daily interactions among employees, children, families, stakeholders, and community partners working together to achieve defined outcomes.

It should be the explicit link connecting the agency’s policy, practice, training, supervision, and quality assurance with its mission, values, and strategic plan.

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Measures child, youth, and family outcomes

Reveals the practice model being used in actual cases.

QSR is an organizational learning process offering helpful ways of knowing what’s working and not working in practice -- for which children, youth and families and why.

QSR connects results to local frontline conditions.

QSR supports teaching & action learning processes that clarify expectations, provide useful feedback, and affirm good work.

QSR stimulates actions taken to improve practice and results at all levels of the organization.

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Pennsylvania background

Practice Standards A non-regulatory method of establishing

benchmarks for defining optimal, but achievable, results for child welfare services in Pennsylvania.

Evolution of standards

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Pennsylvania background (continued)

Quality Service Review history CFSR round 1 CFSR round 2

What’s different from round 1 to 2

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PA’s Model of CQI1

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• State and local review team to review one case • Review of the record• Focused interviewers with every member of the child/family TEAM• Rates the status of the child/family and the system performance on a 1-6

scale• Narrative that “tells the story” of what was learned from the TEAM

• Immediate feed back to CW and Supervisor with strengths/needs/recommendations• Case specific• Agency specific

• Includes focus groups with stakeholders• Debrief of preliminary findings• Final findings report

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Indicators in the PA QSR ProtocolIndicators in the PA QSR ProtocolIndicators in the PA QSR ProtocolIndicators in the PA QSR Protocol

• 1a. Safety: Exposure to Threats of Harm1a. Safety: Exposure to Threats of Harm• 1b. Safety: Risk to Self/Others1b. Safety: Risk to Self/Others• 2. Stability2. Stability• 3. Living Arrangement3. Living Arrangement• 4. Permanency4. Permanency• 5. Physical Health5. Physical Health• 6. Emotional Well-being6. Emotional Well-being• 7a. Learning & Development: Early Learning and Development7a. Learning & Development: Early Learning and Development• 7b. Learning & Development: Academic Status7b. Learning & Development: Academic Status• 8. Pathway to Independence8. Pathway to Independence• 9. Parent and Caregiver Functioning9. Parent and Caregiver Functioning

• 1a. Safety: Exposure to Threats of Harm1a. Safety: Exposure to Threats of Harm• 1b. Safety: Risk to Self/Others1b. Safety: Risk to Self/Others• 2. Stability2. Stability• 3. Living Arrangement3. Living Arrangement• 4. Permanency4. Permanency• 5. Physical Health5. Physical Health• 6. Emotional Well-being6. Emotional Well-being• 7a. Learning & Development: Early Learning and Development7a. Learning & Development: Early Learning and Development• 7b. Learning & Development: Academic Status7b. Learning & Development: Academic Status• 8. Pathway to Independence8. Pathway to Independence• 9. Parent and Caregiver Functioning9. Parent and Caregiver Functioning

Child, Youth and Family Status IndicatorsChild, Youth and Family Status IndicatorsChild, Youth and Family Status IndicatorsChild, Youth and Family Status Indicators

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Indicators in the PA QSR ProtocolIndicators in the PA QSR ProtocolIndicators in the PA QSR ProtocolIndicators in the PA QSR Protocol

• 1a. Engagement: Engagement Efforts

• 1b. Engagement: Role & Voice

• 2. Teaming

• 3. Cultural Awareness & Responsiveness

• 4. Assessment & Understanding

• 5. Long-Term View

• 6. Child/Youth and Family Planning Process

• 7. Planning for Transitions and Life Adjustments

• 8. Timely Permanence

• 9. Intervention Adequacy & Resource Availability

• 10. Maintaining Family Relationships

• 11. Tracking & Adjusting

• 1a. Engagement: Engagement Efforts

• 1b. Engagement: Role & Voice

• 2. Teaming

• 3. Cultural Awareness & Responsiveness

• 4. Assessment & Understanding

• 5. Long-Term View

• 6. Child/Youth and Family Planning Process

• 7. Planning for Transitions and Life Adjustments

• 8. Timely Permanence

• 9. Intervention Adequacy & Resource Availability

• 10. Maintaining Family Relationships

• 11. Tracking & Adjusting

Practice Model FunctionsPractice Model FunctionsPractice Model FunctionsPractice Model Functions

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6 = OPTIMAL & ENDURING PERFORMANCE. Consistent, effective practice for theperson in this area for the past 6 months or since admission if less. The level ofperformance is indicative of exemplary practice and results for the person.

5 = GOOD ONGOING PERFORMANCE. The practice function is working depend-ably for the person, under changing conditions over the past 3 months .Effectiveness level is consistent with long-term outcomes for the person.

4 = FAIR PERFORMANCE. Performance is minimally or temporarily sufficient tomeet short-term need or objectives . Performance in this area of practice hasbeen no less than minimally adequate at any time in the past 30 days, but maybe short-term due to changing circumstances, requiring change soon.

3 = MARGINALLY INADEQUATE PERFORMANCE. Practice may be under-powered, inconsistent or not well-matched to need . Performance is insufficient attimes or in some aspects for the person to meet short-term needs or objectives .With refinement, this could become acceptable in the near future.

2 = POOR PERFORMANCE. Practice is fragmented, inconsistent, lacking neces-sary intensity, or off-target . Elements of practice may be noted, but it isincomplete or not operative on a consistent or effective basis .

1 = ADVERSE PERFORMANCE. Practice may be absent or not operative .Performance may be missing (not done) . - OR - Practice strategies, if occurringin this area, may be contra-indicated or may be performed inappropriately orharmfully .

AcceptableRange: 4-6

UnacceptableRange: 1-3

QSR Interpretative Guide for Practice Performance Indicator Ratings

MaintenanceZone: 5-6

Performance is effective.Efforts should be made tomaintain and build upon apositive practice situation.

RefinementZone: 3-4

Performance is minimal ormarginal and maybechanging. Further effortsare necessary to refine thepractice situation.

ImprovementZone: 1-2

Performance is inadequate.Quick action should betaken to improve practicenow.

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Activity

Rate a scenario based on assigned indicator with your partner

Discuss ratings

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Next steps: connections to CQI

Finalization of QSR protocol and process (including manual and training

Roll out of CQI in phased-in approach across the state

Finalization Of Practice Model & Resource To Support Implementation (GUIDE BOOK)

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How can I get involved?

If you are not a phase one county, are you interested in phases two or three?

Can volunteer staff to be reviewers in phase one county QSRs

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Who to contact for more information:

Mike Byersmib39@pitt.edu(717) 795 - 9048

Stephanie Maldonado smaldonado@state.pa.us(717) 783 – 7376

Jeanne Schott jls192@pitt.edu (717) 795 - 9048