Quality Services Reviews:
A process for understanding and
promoting best child welfare practice
Florida Department of Children and
Families
Quality Assurance Managers Meeting
March 14-15, 2011
Goals for Reviewer Training
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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
Family-Centered Practice
Engagement
Tracking
&
Adaptation
Team
Formation
Assessment
&
Understanding
Implementation
Planning
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What is the Qualitative Case Review?
The Qualitative Case Review process is a method for
organizing the conversation with our communities in
terms of :
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the results we want for children and families served,
and
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understanding how child welfare practice can be
improved to get those results.
Key attributes of the QSR Process
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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
QSR Uses a Record Review and
Interview Format
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We evaluate outcomes and best practice, along with
compliance to policy
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Record is reviewed at the beginning to gain and
understanding of the case
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Information is gained through interviews with family
members, the child, the caseworker, service
providers, etc.
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Last interview with caseworker to share and update
information and findings.
Quality Service Reviews: Common
Understanding of Good Results for Children
Served
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Traditional Audit:
Quality Review:
• Were investigations timely
in accordance with policy?
• Are children safe from current,
manageable risks of harm?
• Are child’s educational
needs reflected in case
plan?
• Is the child leaning and
progressing at a rate commensurate
with his/her age and ability?
• Is there documentation in
the record that ongoing
therapy (if recommended) is
being provided?
• Is the child doing well, emotionally
and behaviorally?
Quality Service Reviews: A Different
Way of Looking at Practice
Traditional Audit
•
•
•
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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?
Group Exercise 1:
Understanding the QSR Indicators
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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)
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How the scoring works
Each indicator is scored on a scale of 1 to 6.
6 – Optimal
5 – Substantially Acceptable
4 – Minimally Acceptable
3 – Partially Unacceptable
2 – Substantially Unacceptable
1 – Completely Unacceptable
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Quality Service Reviews: Focus on
Most Recent Segment of Practice
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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
Safety always trumps
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Safety is the only indicator that trumps
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Safety is paramount to any case.
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Overall status is acceptable only when Safety
is rated in the 4 – 6 range.
“Groundhog Day” Rule
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Difference between a Rating of 3 and 4 (or a
“Yes” or “No”
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If this case were frozen in time as it is today,
would it be acceptable?
How the Review Process Works
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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)
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Family permission obtained to participate in review and
information releases obtained
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Key team members in each case identified and appointments
scheduled (place, time frames)
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Lead reviewers and partners conduct the interviews, beginning
and ending with the caseworker
How the Review Process Works,
continued
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Answers are reviewed and scored in each indicator and domain
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Feedback session with caseworker and supervisor to provide
immediate feedback and elicit further suggestions for next steps
on case
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Presentation of stories at debriefing sessions during the week
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Exit conference at end of week to present and discuss findings
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Case story for each case reviewed
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Final report which includes aggregate data and case stories.
Expectations of QSR Reviewers
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Prepare for interview by being oriented to basic facts
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Thoughtfully explain the QSR process
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Consider how to best engage children/families
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Be attentive to clues about family culture
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Know what you need to learn from person being interviewed
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Allow each person to tell their story
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Gather each person’s perspectives
Expectations of QSR Reviewers,
continued
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Ask each person interviewed about child safety
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Collaborate with your review partner
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Prepare for special challenges
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Stay within the role of reviewer
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Remember the obligation to report child safety issues
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Reviewers call it as they see it – score results and affirm efforts
Some “Don’ts” for QSR Reviewers
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Don’t be premature in making judgments
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Don’t share information across informants
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Don’t ask any leading questions
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Don’t drift from the protocol or definitions
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Don’t go unprepared into debriefing with Case Manager
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Don’t overwhelm staff with too many suggestions
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Don’t do “TA, Supervision or Training” during debriefing sessions
Basics for Interviewing
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Introducing yourself, partner and the process
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Starting the interview
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Allow the interviewee to tell the story
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Gathering necessary information
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Planning for the less than perfect situation (place and/or time
constraints)
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Closing the interview
The Core “Script” for each interview.
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Why your perspective matters
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What is the story of your involvement?
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What are both the strengths and needs of this child and family?
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How is the system working to help this child and family? What
are the goals?
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What things are working well?
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What would you like to see working differently? How might that
happen?
Interviewing
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Core Conditions
Skills
Genuineness
Respect
Empathy
Clarification
Closed questions
Open questions
Solution Defining questions
Past Successes
Exception Finding
Miracle Questions
Summarization
Caseworker Debriefings:
Making it Positive
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Begin with a strength and affirmation
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Ask how the caseworker achieved something you learned that
was positive (“How did you make that happen?”)
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Summarize and clarify child and family story, share any new
information, clear up confusion
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Review child and family status findings (begin with strengths)
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Review system findings (begin with strengths)
Caseworker Debriefings:
Making it Positive
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Elicit from caseworker/supervisor their thoughts as to next
steps
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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…”
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Provide suggestions on some other options for next steps that
MAY be useful
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Direct more difficult system questions to the supervisor
Group Exercise:
Planning a Caseworker Debriefing
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As a team, identify three strengths about Jorge and why they
are important. (5 min.)
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As a team, identify main concerns for Jorge. (5 min.)
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As a team, identify the issues that remain a practice challenge.
(5 min.)
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As a team, develop a few suggestions for creating a positive
caseworker debriefing. (10 min.)