Kentucky DCBS
Continuous Quality Improvement
State Plan
Making Ideas Happen
Catalyst for Change
Version 3.0
August 30, 2010
Revised August 2010
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Table of Contents
Chris – just put in the main headings 1, 2, 3, etc and the subheads 2.1 2.2 etc. There is
no need for the third level of content1.1.1 etc. So, hopefully this can be only one page or
less – or not.
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Introduction
The Continuous Quality Improvement (CQI) origin in Kentucky dates from 1998, when
cabinet leaders decided to seek national accreditation of all state child and adult
protective services and foster care and adoption programs. Requirements set by the
Council on Accreditation for Children and Family Services (COA) at that time included:
1 intensive self-study and case reviews by Protection and Permanency (P&P) staff ;
2 a means for all employees to regularly review service quality and identify ways
to improve; and
3 a means for clients and community partners to influence cabinet decisionmaking.
Since that beginning, CQI process and supports have evolved and matured throughout
Kentucky. The DCBS CQI process implements the Department’s vision and mission to
apply principles of a learning organization, make data informed decisions and engage
staff and the community in continuous improvement. Kentucky uses the term CQI for its
quality improvement because this term is historically embedded in practice throughout
the state and depicts a process of ongoing striving for sustainable improvements in both
practices and results for children and families.
DCBS Vision
To provide leadership in building high quality, community based human services systems
that enhance safety, permanency, well-being and self-sufficiency for Kentucky’s families,
children and vulnerable adults.
DCBS Mission
A nationally recognized department comprised of a highly skilled workforce that:
1 Provides services to enhance the self-sufficiency of families;
2 Improves safety and permanency for children and vulnerable adults;
3 Engages families and community partners in a collaborative decision-making
process;
4 Utilizes innovative technological resources to improve outcomes and efficiencies;
5 Creates information systems and uses evidence-based practice to guide
management decisions;
6 Practices system-wide continuous quality improvement and shared accountability;
7 Fosters a dynamic learning organization; and
8 Adapts to changing community needs and challenges.
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1.0 Leadership and CQI
1.1. Historical Background (Kentucky’s CQI Story)
1.1.1
Initiation of CQI
The cabinet (now DCBS) launched the Continuous Quality Improvement initiative in the
summer of 2000. Soon thereafter, CQI specialists, one in each of the 16 then-existing
service regions, were hired through the cabinet’s contract with Eastern Kentucky
University. These specialists were to play a key role in ensuring their regions’
implementation of the state CQI Plan. The plan developed by the cabinet mirrored the
COA standards in specifying a case review process, a process for meetings that involve
all agency staff and general standards for involving customers and the community in
quality improvement.
P&P case reviews were instituted at the peer-to-peer, supervisor and regional levels. Each
month, for every P&P team, four cases were randomly designated for review, first by
caseworkers from a separate team, then by supervisors not involved in the case. Within
each region, 10 of the cases reviewed at the peer-to-peer and supervisory levels were
randomly designated for review at the regional office level. The ratings assigned at each
level were shared with the other levels. Local P&P teams were expected to use the results
of the case reviews to improve casework. Case reviews in Family Support, which
administers federal public aid programs, were and are conducted by a separate process
that reflects federal mandates but is parallel to the P&P process. CQI specialists are
involved in using the data from both P&P and Family Support case reviews in the CQI
process, and they coordinate case reviews in some regions.
During 2000-2001, CQI teams were established at all levels of the cabinet. Each region
could structure its teams as it saw fit, so long as every employee had a place on a CQI
team. All teams were expected to resolve their own quality-related issues if possible. If
they could not, and the issue had broad or vital implications, they were to forward the
concern to a CQI team at a higher level that might be able to address it. At each level,
teams dealt both with their own issues and with any sent forward to them from the
previous level. Once an issue was resolved or declared incapable of resolution, the team
that reached that conclusion was to report and explain its decision to the team that first
raised the issue.
The DCBS commissioner’s office coordinated all aspects of CQI, but regions could adapt
the process to the needs and preferences of their personnel, so long as they met the
minimum requirements of the DCBS CQI Plan. One region, for example, supplemented
its basic set of CQI committees with standing committees that dealt with issues of
cabinet-wide importance, such as employee recognition, workload and customer service.
Some regions authorized separate county-level CQI teams for P&P and Family Support,
while other regions opted for unified teams.
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As CQI took root and matured within the cabinet, it became apparent that key cabinet
partners merited focused input and attention through CQI. Several DCBS regions took a
step in that direction by experimenting with foster parent CQI groups, which gave foster
and adoptive parents a formal process for input within DCBS that they had never had
before. In December 2003, the cabinet’s Program Improvement Plan (PIP) was revised to
require that each service region have a CQI group that includes foster parents and
convenes quarterly to discuss and resolve foster care issues.
In January 2006, the DCBS commissioner directed that a preexisting state-level panel of
cabinet partners – the Child and Family Services Community Stakeholders Advisory
Group – also meet quarterly as a CQI team. This group advises the commissioner, central
office staff and service region administrators, and it includes foster and adoptive parents,
health professionals and a wide range of child welfare advocates. A co-chair from this
group attends meetings of the CQI Coordination and Steering Committee.
Atop the CQI hierarchy was a state team consisting of the 16 CQI specialists, the DCBS
commissioner and DCBS division heads or their designees. This state-level team, which
met at least quarterly, developed processes for use at all levels of CQI, including a tool
for reviewing P&P cases and a format for recording CQI meeting minutes.
To broaden cabinet customers’ influence on cabinet decisions and to comply with COA
standards, the regional CQI specialists designed and conducted surveys of clients,
community partners and cabinet employees. Lacking region-to-region uniformity, these
surveys rarely yielded statistically meaningful results. That changed after the cabinet
retained a child welfare researcher in July 2001. The researcher designs customer
satisfaction surveys that are administered in uniform fashion statewide. Results of these
surveys are used in quality improvement efforts.
Improvement efforts also draw heavily on management reports. Generated from the
automated systems for handling P&P and Family Support data, these reports have
increased greatly in number since CQI’s inception. Consequently, they have placed a
growing responsibility on CQI specialists who help regional personnel interpret and
apply the findings. The CQI specialists have in turn provided information vital to the
completeness and accuracy of the management reports and have contributed greatly to the
reports’ quality and usefulness. Over the years, CQI specialists have had increased access
to data from other systems, such as child care, training and judicial data, to augment the
quality improvement process.
The Cabinet achieved full COA accreditation in late 2002. With CQI now embedded in
the cabinet’s business practice, the CQI specialists’ employment status was changed to
that of state merit system employees. Over the following two years, as the cabinet
prepared to renew its accreditation, all elements of the CQI process remained essentially
intact, except for the case reviews in P&P, which changed in two key respects:
1 The three-tiered review process for P&P cases shifted upward one level, as peerto-peer review was dropped and a cabinet-level review was added; and
2 The case review tool was expanded to include rating elements required for the
Child and Family Services Review (CFSR).
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The change in levels of case review resulted from a consensus among CQI specialists and
others closely involved with CQI that peer-to-peer reviews had proven largely
unproductive. Scores assigned by fellow caseworkers bore little relation to those assigned
by supervisors and regional review teams. The shift to a system of supervisor, regional
and cabinet-level reviews was negotiated with the Council on Accreditation, which
approved the change in February 2004.
The case review tool was revised in late 2003 to include quality-of-casework indicators
required for CFSR compliance. While this revision added to the time and effort required
for case reviews at all levels, it also provided DCBS with a case review process accepted
by the federal Administration for Children and Families as legitimate for tracking
progress on the Program Improvement Plan (PIP).
1.1.2. Changing Leadership and Expectations
As leadership and agency needs have changed, so has CQI. Cabinet-level CQI team
meetings were suspended in late 2003, and feedback to issues raised at the local and
regional levels diminished as a result. Still, from 2003 through 2005, CQI remained
central to the cabinet’s process for implementing its PIP. In September 2005, in an effort
to streamline CQI and make it less time-consuming, the DCBS commissioner removed
the requirement that every cabinet employee belong to a CQI team. He instead instituted
county-wide teams, with limited membership, as the basic CQI unit. While this conforms
to a COA standard that only requires “representatives” of employees and other
stakeholders to participate in CQI, it also reduced CQI’s role as a widely utilized forum
for addressing service quality and providing feedback on issues directly to every worker.
In September 2006, DCBS realigned the state into nine service regions. The realignment
expanded CQI specialists’ geographic areas of responsibility and increased the number of
cases regional teams must review monthly. Two CQI specialists, instead of just one,
serve in each of these nine regions. The reorganization and the reduction and almost
elimination of the CQI specialists and CQI meetings significantly weakened CQI in the
state and many CQI specialists left for other employment. However, the CQI process
was the foundation of Kentucky’s very successful efforts in the first Program
Improvement Plan and advocates and supporters recognized the value of CQI and kept it
alive through this challenging time.
1.2. Current Vision and Direction for CQI
1.2.1 Leadership of CQI
In September 2006, CQI was placed under new leadership of the Child Welfare
Researcher within the Information and Quality Improvement Unit. Although each CQI
specialist is supervised by their Service Region Administer, the IQI unit provides the
leadership and supports for CQI statewide. Interest in strengthening CQI led to the
creation of a CQI Coordination and Steering Committee, which convened in October
2006. This committee serves as a leadership group for CQI, with these initial priorities:
1 Implementing a Web-based system to efficiently record issues raised and
solutions proposed by CQI teams;
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Reconvening the state CQI team at the DCBS central office;
Strengthening feedback to issues sent forward for resolution;
Establishing supports for CQI specialists; and
Enhancing training for CQI specialists.
Members of the Coordination and Steering Committee took note of the pivotal role that
CQI specialists would play in efforts to reorganize and revitalize the CQI process. CQI
specialists have been engaged in setting state level practices and guiding CQI throughout
this time. The Committee also noted the key contributions the CQI specialists had made
in the past, including:
1 Improving data integrity for both family support and P&P
2 Shifting DCBS culture toward data-driven decisions;
3 Contributing vital information and problem solving instrumental in the
achievement of the PIP and development of the Dynamic Family Assessment; and
4 Solving staff and practice related problems in Family Support, P&P, Child Care,
and regional management.
1.2.2. CQI Progress and Current Practice
Since 2006, CQI and data have become the foundational component of all decision
making, quality improvement, and learning within the agency. CQI specialists hold
monthly phone conferences and quarterly videoconference to exchange information,
build specific skills, and CQI the CQI process. The Coordination and Steering
Committee met monthly, then every other month, and as the process improved to
quarterly meetings during 2010; the committee has guided and strengthened CQI and
each year develops specific goals for improving CQI. Two CQI specialists rotate to
represent the regions at the Coordination and Steering Committee Meetings and build
their leadership capacity. Regions were given the latitude to set up local teams using a
structure that best fit their needs and this resulted in rebuilding local team involvement
and buy in. Quarterly meetings with the State Team were reconvened and with improved
technology supports, the flow of feedback on issues to regional and local teams was
improved. In 2010, the Coordination and Steering Committee meeting was merged with
the State team to embed CQI leadership and coordination with addressing local and
regional issues. Both groups had become increasingly engaged in both steering CQI and
resolving CQI issues and had overlapping membership; a natural merger occurred
between the steering committee and the state CQI team.
1.2.3. Strategic Plan for CQI
The strategic plan for 2010 for CQI (February 2010) outlined these specific achievements
that strengthened the CQI infrastructure.
 Developed and implemented the CQI_MITS (minutes issues tracking system)
 Developed and implemented the CQI_CARES (case automated review and
evaluation system) that streamlined the case review process system in P and P.
 Developed reports from the KAMES data system for family support reports.
 Developed numerous new reports in P and P, fact sheets, data displays including
the Data in a Glance (DIGS), web-intelligence reports, and large datasets for
research. Similar processes are emerging with family support data. Both systems
are ready to support program improvement for federal initiatives.
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Leadership training and ongoing mentoring for CQI specialists through phone
conferences, videoconferences, on-site training, new and nearly new training,
special projects, and peer-to-peer mentoring.
Supports for field staff – scribe training, issues tracking and feedback, New
Employee Orientation for CQI
Technology supports (public folders, parsing tool, business objects and web
intelligence)
Building Central Office support through steering committee, State Team (for
resolving issues) with representatives from personnel, DCBS divisions of Family
Support and P and P, TWIST, finance, and KAMES.
Streamlined the handling of issues and feedback to the field in many ways.
Specific goals for 2010 include these:
1. Improve the integration of family support needs into the CQI process.
2. Intentionally use the CQI infrastructure built to improve results or outcomes
in FS and P and P.
3. Refocus or strengthen the focus of CQI meetings on results and outcome.
4. Increase the use of case review scores and review summaries in Family
support and P and P.
5. Rethink the mechanism for collaborating with the field on issue resolution
and/or communication.
6. Continue to build skills in using Business Objects and Web-Intelligence for
creating reports based on a ‘universe’ of data.
(This historic summary was current as of August 2010)
2.0 The Foundations of Statewide CQI Processes
2.1 CQI Purpose
In Kentucky, the Continuous Quality Improvement (CQI) process is designed to
empower staff in leading the agency toward improved quality through three fundamental
processes.
1. Building knowledge through data and reports on how each individual’s and each
group’s performance contributes to achieving outcomes for families and children
and then creating action plans for improvement.
2. Structuring and leading staff in identifying barriers and best practices, and
implementing solutions at the local team, county, regional or state level that will
enhance service delivery and achieve improved outcomes.
3. Implementing a case review process and using the reviews at the team level for
coaching and mentoring, and at the regional level to identify trends, best
practices, and needs for practice improvements.
CQI is a philosophy and set of techniques that allow service providers in many agencies
and industries to look at their activities, task performance and outcomes to create plans
for improvement. The concept is based on a Japanese principle, kaizen, which means
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progress through small, continuous steps toward a goal. Kentucky terms this
‘incremental and sustainable change’. CQI differs from traditional quality assurance in
that its focus is self-directed, self-determined change rather than change imposed by an
external entity. CQI is a process model of staff empowerment, creativity and
responsibility that also assists local staff on issues they cannot resolve.
CQI is a process, not an event, by which all staff (front line and support staff to
management and leadership) are involved in evaluating the effectiveness of services
provided to customers of the Department for Community Based Services. The DCBS
CQI process involves: the examination of internal systems, procedures and outcomes; and
the examination of relationships and interactions between DCBS and other stakeholders.
1. CQI evaluates the effectiveness and efficiency of services provided.
2. CQI determines whether services meet predetermined expectations of
quality and outcomes.
3. CQI attempts to correct observed deficiencies identified through the CQI
process.
4. CQI is intended to be a process that is:
Creative
Inclusive
Recurring
Empowering
Structured
Solution-focused
Efficient
Action-oriented
Common Sense Driven
Through the CQI process, problem issues can be addressed by those most directly
affected by and knowledgeable of the need and the possible solutions. CQI teams are
decision-making teams. CQI meetings result in the identification of needs, goals,
available resources and the strengths of the program, the staff and community partners.
Areas needing improvement are identified and discussed, action plans are developed and
strategies are implemented to improve service delivery. While CQI focuses on solving
issues in P&P and Family Support, CQI team members should remain mindful that those
issues have implications throughout the broad spectrum of public and private childcentered services. CQI teams are expected to implement local action plans to resolve
most issues they identify. Unresolved issues are advanced to the Regional CQI team for
possible resolution.
CQI specialists develop, prepare and disseminate to CQI teams the data and other
information needed to support data-informed decisions. CQI specialists also facilitate
action and improvement by:
 assisting, as needed, in the conduct of local CQI meetings and case reviews;
 coordinating, facilitating and recording regional CQI meetings;
 serving as a liaison between management and staff; and
 mentoring and guiding staff toward the use of best practices.
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Beyond their direct service to CQI teams, CQI specialists act in other ways to advance
the core mission of service improvement. They:
 coordinate the implementation of special initiatives and projects;
 advocate for statewide system changes that will improve results;
 gather ideas from staff, synthesize these and present them to management; and
 read and display trends, anticipate barriers and identify strengths.
2.2 CQI Guiding Principles
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The CQI process is intended to complement the existing agency administrative
structure. CQI is NOT intended to replace supervision.
As Fotena Zirps, an expert on the CQI process, stated, “CQI and Supervision provide
complementary functions to the Agency. The supervisor’s charge is to provide
personal feedback to staff and to work with employees on remediating weaknesses
and building strengths.”
“The CQI Process looks at a different piece of the work environment. Its job is to
look at the processes and programs and to remove barriers that exist in doing the
work. The specific work of the individual is not the focus, but rather the system that
all workers function within.” In other words, supporting and improving the system
will improve our outcomes.
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CQI uses case-related data in an aggregate, non-identifying way to provide
feedback and accountability to staff in a timely fashion. Worker and supervisory
units can then use the information to go back and look at their individual and unit
strengths and weaknesses.
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CQI provides a time to reflect on events and processes that have occurred since
the last CQI meeting. Staff should have time set apart from their day-to-day
activities to consider what works, what does not and how to improve the system.
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CQI process is NOT a quick fix for all problems. No matter what level within the
agency looks at a problem, successful resolution of the issues requires careful and
thoughtful consideration of all possible solutions. Some problems may lend
themselves to immediate resolution once identified, while others may require
research, evaluation and careful development of solutions within different levels of
the agency.
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CQI provides a chance to create and look at new and unique ways of resolving
one-time or ongoing problems and to build on agency and program strengths.
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CQI provides a chance to learn and develop by identifying training needs and
possible changes in policy and procedures.
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CQI is NOT a replacement for existing methods of agency communication or the
line of authority within the agency. It simply provides an additional method for
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systematically investigating, documenting and correcting all types of issues that affect
the effective operation of the agency.
2.3 Statewide Team Structure and Process
It is vital to the continued success of the CQI process for all staff to use their knowledge,
vision and skills in working together to lead the agency toward improved practices and
results. CQI processes of using data and information to stimulate discussion, designing
solutions to problems, and implementing action plans are internalized in most state,
regional and local meetings whether or not the meeting is labeled as a CQI meeting.
The formal DCBS CQI process consists of teams/meetings at the local, regional, central
office and department levels, supplemented by foster parent and community teams at
both the regional and state level. The multi-level process allows for information flow and
solutions to be generated and implemented by all levels of staff within the organization.
Problems that require input from multiple levels of the agency are advanced through the
system in an orderly way that assures a commitment to problem-solving and feedback.
This interactive process allows give and take and the presentation of data from the local
level to the state level. Meetings often include the use of data to examine trends or
opportunities to improve, generate solutions, or determine strategies that work. Teams
also discuss the results of case reviews or other information or reports to ground the
discussion in ‘what is’ and generate a solution-focused discussion.
Generally CQI Meetings occur at least quarterly at all levels. Minutes are taken by the
scribe and recorded in the CQI Minutes/Issues Tracking System (CQI_MITS). Issues
identified at each level can travel several routes. They can remain pending at the local,
regional, or departmental level until a solution is identified. Issues can be advanced to
the next level for resolution or returned to the previous level for additional information or
solution. Some issues may be deemed “irresolvable” for a variety of reasons and be held
as unresolved or pending for any period of time. The managers of the CQI process
(specialists and central office leads) will review these pending issues periodically and
resolve them as possible. Other issues require long-term system change and years of
work to implement; field staff appreciate updates on solutions in progress.
2.3.1 Local CQI Teams
The local CQI teams consist of approximately 8-12 staff members from within the
county. Because of vast county differences in Kentucky, a variety of configurations are
possible to meet county-specific needs. Decisions about team configuration will be made
by the regional leadership. Teams could consist of supervisors and workers within one
program or include representation from two or more programs. The goal is for every staff
member including county support staff, child care workers and others to have a voice in
decisions and access to performance data.
Local CQI teams are designed to consist only of agency staff to allow for free-flowing
discussion and decision-making on local issues. In addition, they may identify policies or
issues that impact local operations and require resolution at the succeeding level (or
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levels). The internal nature of meetings at this level is intended to focus on internal
issues rather than other agencies or community partners.
In formal meetings, scribes record local team meeting minutes in the CQI_MITS.
Agenda items are discussed and both resolved and unresolved issues are recorded with
action steps and ideas for resolution. The minutes and issues are then reviewed and
approved by regional CQI specialist in the CQI_MITS. Once approved, minutes, issues,
and solutions are available for all staff to see or download. CQI specialists use the
‘Issues Compilation Report’ from the CQI_MITS to compile issues advanced to the
regional level for discussion during regional CQI team meetings.
2.3.2 Regional CQI Teams
The regional CQI teams are composed of the SRA, SRAAs, SRCA, specialists (CQI, FS
and P&P) and representatives from each of the local teams or counties including the
foster parent CQI team. Optional members of regional teams also include community
partners, regional support staff (regional training coordinators, foster parents, MSW
consultants and youth or family representatives. Regional CQI teams meet quarterly with
representation of all or most of the team members to provide resolution and feedback to
issues addressed at the local level. Regional teams also identify policies or issues that
impact local or regional operations and require resolution at regional level or
advancement to the department or return to the local levels.
A regional scribe records the minutes and can add new issues that originate at the
regional meeting or an unresolved issue that originated at the local level. The origin of
the issue is retained in the CQI_MITS and the team that identified the issue is
automatically notified through email when the issue is resolved or updated.
2.3.3 Central Office Solution-Focused Workgroups
CQI Central Office teams are different than local or regional teams since CO is
responsible for generating policy, practice guidelines, and providing leadership to all
quality improvement efforts. Therefore, teams may be formed to address specific
practice or service delivery issues identified by regional or local teams, by internal
quality assurance processes or by federal reviews and other program oversight efforts.
These focused Central Office teams work to solve specific problems using a time-limited
workgroup structure. In addition to identifying issues, Central Office workgroups
provide employees with a voice in the agency leadership. State leads enter solutions to
issues advanced from the regional level into the CQI_MITS.
2.3.4 DCBS CQI Steering and State Team
The Department CQI Steering and State Team consists of the commissioner, the deputy
commissioners, commissioner’s office staff, all central office division directors or their
designees, the Training Branch manager, TWIST and KAMES representatives and two
CQI specialists that rotate attendance. The Department CQI Steering and State Team
meets at least quarterly to provide resolution and feedback to issues addressed at all
previous levels and to guide the direction and implementation of CQI.
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This team is co-lead by the CQI state leads (from both Information and Quality
Improvement and the CO Service Region leadership). As issues are advanced to this
State level, the leads screen and compile similar issues, send them to the appropriate
divisions for solutions or prepare the issues for discussion at the quarterly meeting of the
State Team. They enter solutions into the Tracking System or return an issue to a
previous level for more information or action.
2.3.5. CQI Specialists Team
Two CQI specialists are a part of regional leadership in each service region and are
supervised by the Service Region Administrator (SRA) or Associate Administrator
(SRAA). They assist CQI teams at all levels and in varied other ways work to improve
services and outcomes. Because of budget constraints, on-site meetings of the CQI
specialists have been limited to occasional 2-day to 5-day trainings for specific purposes.
The CQI Specialists hold monthly phone conferences, quarterly videoconferences, and
other special workgroup meetings to CQI the CQI process. These meetings focus on data
and reports, skills for analysis and facilitating change in the regions, feedback and skill
development for specific issues, or exchange of ideas or practices that work.
2.3.6 Resource Parent CQI Meetings
Each region is expected to operate a regional foster/adoptive parent group that meets with
resource parents to resolve problems and share information. These meetings most often
occur quarterly and may be embedded within other meetings such as those of the foster
parent association. It is not necessary to have a separate meeting labeled as the CQI
meeting; it is necessary to include exchange of data or information, discussion on
practices and outcomes, and/or a solution-focused approach to issues and barriers.
Resource parents may send representation as appropriate or possible to the regional level
team. Issues identified by foster/adoptive team are shared during the regional team
meetings. Representatives of the foster parent association meet quarterly with the
Commissioner and other state leadership to resolve issues that impact quality.
2.3.7 State and Regional Community Partner Teams
The Statewide Community Partner CQI Team includes representatives from other state
agencies; university faculty; DCBS administrators and supervisors; health agencies; child
advocacy groups; domestic violence prevention programs; Kentucky courts and law
enforcement and juvenile justice agencies; education agencies; local governments; and
housing and economic development agencies. It includes foster parents, youth, and
sometimes families as they are able to attend. The group has met quarterly as a CQI team
since early 2006. It advises the commissioner, central office staff and service region
administrators on implementation of the CFSR, PIP and other initiatives. Similar teams
meeting periodically in most regions through the CCC (Community Collaborations for
Children) regional networks.
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The interaction of these statewide teams is depicted in the following diagram
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3.0 Support of Outcomes Measurement
3.1 Management Information Systems (MIS)
The CQI process relies on data to inform decisions, identify best practices and
opportunities for improvement, and to spur action for change. The CQI specialists assist
the region in using a variety of management reports generated for all programs. They
also assist at times with program evaluation design, data collection, and dissemination of
information. Primary data sources include reports from the major automated systems and
other systems.
1 The Worker Information SysTem (TWIST) for child and adult protection cases;
2 The Kentucky Automated Management Eligibility System (KAMES);
3 The CQI-CARES for data on case work quality reviews in P and P; and
4 Data from the case reviews completed in Family Support through the 117 system.
5 The CQI_MITS (Minutes and Issues Tracking System) (discussed later)
6 Specialized surveys of customers and employees(discussed later)
In 1995, Kentucky began its Federal Statewide Automated Child Welfare Information
Systems (SACWIS) entitled The Worker Information SysTem (TWIST). TWIST, a
Windows-based application, has meet Federal SACWIS expectations to be a
comprehensive automated case management tool that supports social service workers’
foster care and adoptions assistance case management practice.
KAMES is an integrated statewide system that supports casework and reporting functions
for Food Stamp, Income Maintenance programs, TANF, Kinship care and other
eligibility programs. The system displays a daily updated case status menu to the worker
each day when sign-on occurs. A menu of functions supports applications,
recertifications, case changes, inquiry, child support interface, management reports and
appointment scheduling. KAMES exchanges data with MMIS (Department for Medicaid
Services) on recipient eligibility through a batch interface. KAMES interfaces with
KASES (Division of Child Support Enforcement) both on-line and in batch.
3.2 Case Reviews for Quality Improvement: Family Support and
Protection and Permanency.
Case reviews in Protection and Permanency are completed on-line. The CQI-CARES
(Case Automated Review and Evaluation System) web-based data entry site includes
separate review tools for various types of cases as follows:
 CPS Intake and Investigation
 CPS Ongoing and Assessment
 CPS Case Planning
 CPS Out of Home Care
 CPS Status
 CPS Foster and Adoptive Resource Home
 APS: Intake and Investigation Initiation Section
 APS: Protection Investigations Section
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APS: DV Investigations Section
APS: Ongoing Planning Management Section
A random selection of cases (TWS M-112) is generated on or before the 5th of each
month. The cases are automatically loaded in the CQI-CARES system for review. When
the supervisor logs on, the cases for review are visible. The forms for each case review
can be printed from the CQI-CARES if desired; however, the review is most efficiently
completed with data directly entered into CQI-CARES. Summary reports will be
immediately available to the FSOS to track and monitor trends within their team.
Supervisor Review:
 Each month, supervisors review (4) cases/children in the CQI-CARES system.
 Supervisors begin the reviews and select the elements of the case for review (e.g.,
investigation or OOHC) by the 12th of the month.
 Supervisors complete the reviews by the last day of the month.
 The FSOS coaches and mentors the case managers or the team to discuss
strengths, weakness and any corrective actions.
Regional Review:
 Regional reviewers complete 18 reviews per region each month in CQI-CARES.
 Regional reviews are completed by the end of the month following the M-112
pull.
Central Office Review:
 Central office (CO) reviews 32 cases each month in CQI-Cares.
 CO reviews are completed by the end of the second month after the M-112 pull.
Case reviews in Family Support are completed at two levels: Level 1-Supervisory
Review and Level 2 – Regional Review. Each supervisor (or designated principal or
peer) will review 35 case decision cases. The type of cases (Food Stamps [FS], Kentucky
Temporary Assistance Program [K-TAP], Related Medical [Related MA], Adult Medical,
or Kentucky Works Program [KWP]) will be regional decision to complement any state,
Quality Control (QC) or Management Evaluation (ME) action plan. The cases will be
randomly chosen by method chosen by region. Any needed corrections will follow
standard regional protocols.
The regional Family Support specialists will review a specified number of cases, each
randomly selected from the 1st level supervisory reviews. Any needed corrections will
follow standard regional protocols.
3.3 Data for Setting and Monitoring Performance Targets
Performance targets are identified by state and regional processes for initiative such as:
 the CFSR Program Improvement Plan,
 meeting specialized targets inherent in initiatives such as the Kentucky
Roundtables,
 embedded in contracts for providers such as family preservation programs,
 included for employee evaluations, and
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16
 set for teams at the local or regional level.
Program Improvement Plans in P and P and Family support usually involve region
specific plans with target goals set and monitored as the foundation for performance
improvement. Employee evaluations are based on achieving target pre-determined goals
and monitored through management reports at all levels of the organization.
Management reports are used to monitor the achievement of performance goals. Most
management reports have detailed versions that can be drilled down to the case (family,
child or individual level) level or aggregated by teams, counties, regions, or the state.
These management reports are used to set priorities in case work. When CQI Specialists
were hired in 2000, 3 reports were available to the regions including these three reports:
TWS-W058 Children in Placement Report; TWS-W029 Referrals 45/60 Days Past Due
and TWS-M004 Case Listing. Currently more than 100 TWIST reports are routinely
produced and include weekly, monthly, quarterly, yearly reports.
Management reports are used to track case and child information, to evaluate staff
productivity, to evaluate progress toward state and federal goals and to provide
information related to specific data research. Reports must be easily accessible and
provide information that is detailed for the frontline users and rolled up for management
users. Each region should have only their region’s data, however at Central office and
for longitudinal analysis statewide data is necessary.
Reports are stored on Business Objects websites and downloaded by CQI specialists.
Once downloaded, the CQI specialists often prepare the report for specific functions such
as guiding the work of investigative staff to complete referrals or identifying children
needing annual permanency reviews. Once prepared, the CQI specialists load the reports
into public folders accessed by regional and county staff and supervisors. Business
Objects also includes web-intelligence capacity. Data are now being stored in Business
Objects as large universes of data that can be manipulated to create a great range of
reports for case management, trend analysis, research and comparative efforts.
Central Office and Research
Central Office
FSOS and Regional Staff
Front line staff and FSOS
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Multiple years - combined data sets
Statewide Summaries
Cases – Clients - Staff
Summary data cases/clients
Detailed Case and Client Data
17
3.6 Employee Evaluation using Outcomes Data
For each level of employees, the performance evaluation system allows for goal setting
and monitoring of performance from individual front line employees to overall regional
performance. The expectation on the evaluation are reviewed and realigned as necessary
to be in line with the agency outcomes and structured to promote continuous
improvement.
Performance evaluation relies on data from TWIST management reports for P and P and
KAMES reports for Family Support. The results of regional level reviews of cases for
the quality of case work are also used as measure of work quality. For example, the
quality of ongoing case work and quality casework visits are used as performance
measures in P and P. In Family Support, the accuracy of benefits is measured with the
117 Case Review system.
3.5 Supporting Documents
Attachment 1- Reports Available from TWIST
Attachment 2- Family Support Outcomes
Attachment 3 – TWIST Reports of Federal Data Indicators
Attachment 4- CQI Case Review Tool (web-based summary of OOHC tool
attached as example)
Attachment 5- Family Support Case Review Tool
Attachment 6 – SRA Evaluation 2010
Attachment 7- Kentucky Federal Data Profile (AFCAR and NCANDS data)
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4.0 Data to Information: Analyzing and Reporting
4.1 A Data-Driven Organization
DCBS: A Data-Driven
Organization
Multiple Sources
• DCBS Data Systems
• Child and Family
Safety
• Community Partners
• Family SelfSufficiency
• Customer Surveys
• Child Well-being
Turning data into
information
useful to the field
and community
• Determine Needs
• Change Practice
• Reinforce Policy
• Solve Barriers
This cover design and the explanation above depict the CQI process in Kentucky. It is a
strong process making data a part of all decisions and information the basis of
improvement. At the most basic level, data is used to examine trends and monitor
improvement. Such trend analysis is displayed in the Data in a Glance (DIG), for
example, with scores from federal indicators displayed in the Federal DIG and aggregate
scores for case reviews displayed in the Casework quality DIG. These displays are
interactive displays with options to look at data trends for all indicators by the state or
regional level. Tabs in the system show linear trend lines for the state or region on each
item or compare bar graphs for one item across regions. Data can be downloaded for use
in customized data displays in power point or excel charts.
Three large datasets are generated by TWIST for use in analysis and reporting: TWS 272
that includes all calls and reports coming into the agency. This datasets is used to
generate monthly FACT sheets and for identifying needs among referrals. For example,
the finding that nearly 60% of children with substantiated abuse and neglect had
substance abuse as a risk factor with 80% of children in OOHC having risks due to
parental substance abuse and nearly 90% of children under age 3 years in OOHC having
risks due to substance abuse was instrumental in establishing the START (Sobriety
Treatment and Recovery Teams) program. This program targets families with cooccurring substance abuse and child maltreatment and is seeking to change the culture of
service delivery for these families in target regions.
The OOHC master dataset includes all children in out-of-home care since 1996 with
demographics and patterns of moves and exits/entries. This dataset is used for analysis of
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trends, needs, program evaluation, and multiple other efforts. For example, it has been
used to identify the needs of children with multiple placement changes to find that these
children often enter OOHC with more severe behavioral problems. Analysis can also
focus efforts by identifying the needs of subgroups, such as African American children,
for the Race, Community and Child Welfare Initiative.
A third large research dataset includes all children and families involved with in-home
services by DCBS. As with all such datasets, the data are used to identify trends, needs,
to answer specific research questions, or to focus efforts. Two examples are included as
attachments. The first is a CPS referral fact sheet that show statewide demographics on
referrals. The second is a map generated with TWIST data that shows the number of
children that would need to be placed in all foster homes if every child had a home in the
county of removal. Counties with darker colors have fewer homes relative to the number
of child removals. Such maps help target efforts for improvement.
4.2 Supporting Documents
Attachment 8_ Data in a Glance Overview
Attachment 9_CPS Referral Fact Sheet Statewide
Attachment 10_Ratio of Child Removals to all foster homes by county
5.0 Statewide Communication supporting CQI
5.1 Statewide CQI Meetings
A powerful statewide method for maintaining communication and providing a voice to all
employees is through the CQI-Meetings within teams as described in Section 2. These
teams meet quarterly and are supported by the CQI-Specialists, technology (CQI_MITS)
and a series of guidelines described here. Each team, at every level, must have a
facilitator/leader and scribe. Roles should generally rotate to allow other members of the
CQI team a chance to participate. It is recommended that alternates also be selected to
serve in the role if the designated person can’t attend the meeting.
Facilitator/Leader: The facilitator/leaders will have advanced knowledge of the
CQI process. They will facilitate their local CQI teams and help make them
effective and efficient. They must:
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Guide a meeting that is focused and recorded; they facilitate the work of the
scribe.
Represent their local CQI team as a member of the regional CQI team and report
on necessary items as identified in their local CQI team minutes.
Possess a clear understanding of the issues to be taken to the regional level team.
Report back on the regional level team’s discussion of those issues.
Support and strengthen team productivity and idea sharing.
Develop local CQI team agenda with scribe.
Assist in solution-building related to agenda.
Make final decision regarding what issues should be forwarded to next level.
Facilitate local CQI team meeting.
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Pay attention to time limits and point them out to team members.
Draw out quiet members.
Gently curb members who tend to run on.
Maintain focus on tasks and redirect distractions.
Ensure that the scribe accurately reflects the meeting in the minutes.
Encourage the scribe to read back minutes at the conclusion of each topic, or after
several brief topics, and ensure that the team members agree the minutes
accurately reflect the work done prior to the close of each meeting.
Ensure a means of ready access to the minutes.
Train the next facilitator/leader upon leaving the role.
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Helpful Qualities of a Facilitator/Leader:
Maintaining a positive attitude.
Willing to praise good efforts.
Able to be assertive in presenting issues.
Committed to Continuous Quality Improvement.
Actively supportive of team members.
Watchful and observant of process.
Inclusive and respectful of all team members
Ability to maintain awareness of time parameters during meetings.
Able to draw out quiet members.
Mindful of diversions and distractions.
Knowledgeable of tools for facilitating a meeting.
Willing to redirect discussions and individuals as needed to maintain focus.
Scribe: The scribe is the individual who will take the meeting minutes on the
form designated by DCBS. The CQI minutes must be detailed enough that
someone reading them can follow the process and discussion as if they were at
the meeting. The scribe must also document an action plan for every issue
discussed at the meeting in which someone was assigned to take action. The
action plan should include a time frame for completion.
Helpful Qualities of a Scribe
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Ability to separate from the discussion to listen objectively and capture the
wisdom, ideas and comments from team members while also participating in the
meeting.
Be a good, active listener.
Learn to separate the “wheat from the chaff” in discussion.
Willing to ask for clarification when needed.
Ability to use a computer to record the minutes in the required format.
Ability to organize information and documents while maintaining neat and
orderly records.
Distribute completed minutes to local staff and to regional CQI specialist.
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5.2 The CQI Meeting Agenda
Each team meeting should have an agenda. The minute format discussed later can serve
as the agenda format. This will assure the meetings are productive and focused. The
agenda items listed below should always be considered, yet may not be pertinent at every
meeting. The local level team should include as many of the following as are relevant.
At all levels, the agenda is set and prioritized by the facilitator and the scribe, who seek
input from other team members as needed.
Meeting agendas should include some or all of the following:
 Summary and analysis of all case record reviews. Discussions on the local teams to
be led by the FSOS and on the regional team by the specialists or their designees.
 Review of incidents, accidents, participant grievances, and safety.
The purpose of including the review of this material is to determine specific
immediate action that may be necessary at the level of the incident, accident, or
grievances to prevent further occurrences. Trends may also be identified so
action plans on the local or other levels may be developed to prevent further
occurrence. Discussions on the local teams are initiated by the FSOS and on the
regional team by the SRAAs or a designee.
 Review of data regarding participant and stakeholder satisfaction (as data is
available). Discussion initiated by FSOS on local team and by SRA or designee on
regional team.
 Summary of management report data. Discussion initiated by FSOS on local teams
and by CQI or person responsible for regional reports on regional team.
 Updates on unresolved past issues. Discussion initiated by facilitator on local team
and by CQI specialist on regional team.
 Updates on CQI projects or system. Discussion initiated by facilitator on local team
and by CQI specialist on regional team.
 Employee recognition. To be initiated by any team member.
 Other discussion.
5.3 CQI Minutes Format
At each level, agency CQI teams use the same basic format for their recording of
minutes, as required by DCBS. This helps facilitate consistency of minutes across the
state. The CQI Minutes and Issues Tracking System (CQI_MITS) is a web-based
interface with electronic storage and search capacity that includes the CQI format and
tracks issues. The minute format is printable from this website for guidance during the
meeting or minutes can be directly inputted into the system.
The minutes for CQI team meetings at the local and regional levels include entries for
the following topics:
 Review of Previous Minutes: Provide an overview update on ALL unresolved
issues.
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Safety Incidents/Issues: Record any “critical incidents,” such as a worker being
seriously threatened or attacked or an incident where the police had to be called.
Report the number of incidents and give a basic summary of each. Discuss and
assess any common trends and brainstorm ways to reduce or eliminate the
incidents. Review issues related to workplace safety, such as tornado drills,
building maintenance, etc.
 Service Complaints: Review the number of service complaints and basic content
of each. There are formal complaints that may include items completed on Form
1300, a 154, and/or verbal or written items submitted to management (SRA,
associates, FSS/FSOS). Discuss and assess any common trends and brainstorm
ways to reduce or eliminate the complaints.
 Community Partnerships: Report on any activities and meetings that have
occurred with community partners, including foster youth, foster parents,
providers, courts and others.
 Case Review Summary:
P&P: Discuss the actual number of reviews completed, the percentage of
reviews that were required to be completed compared to the actual number
reviewed and the overall compliance found in the reviews. NOTE: Any
brainstorming and action planning developed to improve your case review
data is to be included in the action planning documentation rather than the
summary.
Family Support: Discuss the number of reviews completed for each
program over the prior 3-months and the error rate. Discuss in action
planning how you plan to bring your error rate down.
 Employee Recognition: Discuss any employee recognition, formal or informal,
by the agency, community partners, or customers. Formal recognition would
include certificates, awards, employee of the month, etc. Informal recognition
includes items like thank-you cards, letters of appreciation, etc.
 Efforts to achieve federal or state outcomes: This might include trend analysis,
team level displays of target outcomes, design of initiatives or plans to achieve
outcomes or other topics related to achieving results important to children and
families.
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5.4 CQI Issue Identification and Screening
CQI is designed to improve the quality of outcomes for clients. A CQI issue is one that:
1 constitutes a barrier to outcomes;
2 requires teamwork for its resolution; and
3 is not addressed by existing guidelines.
Within local teams all concerns that are perceived as barriers to quality work may be
addressed as CQI issues. This open process is designed to empower staff to raise issues,
generate solutions, and fix problems. Most barriers can be solved by the local team and
may include looking up the guideline, speaking directly with regional supervisors, or
seeking clarification of policy from regional specialists.
Revised August 2010
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Issues advanced to the region or state for resolution, however, must meet additional
criteria. The following are screening guidelines important in making decisions whether
or not to advance an issue to the region or state for resolution. Each team is expected
to develop action plans and try to reduce the barrier at the local level or regional level
prior to advancing it to the state team. The local or regional teams are encouraged to
make specific suggestions that may improve quality or define the problem with as
much specificity as possible; these steps will enhance the quality of regional or state
feedback on issues.
Barrier
The CQI process focuses on barriers to the achievement and improvement of programs,
services and results for clients. To be appropriate for advancement through CQI, an issue
must constitute a barrier to one or more of the following:
1. the functioning of operations that influence the agency's capacity to deliver
services that cannot be resolved at the local or regional level;
2. the quality of service delivery that reflect regional or state practices;
3. regional or state practices that influence achieving program or client results;
and/or
4. regional or state conditions that diminish client satisfaction.
Barriers in any of these areas may become apparent to CQI team members in a variety
of ways, including their own and their colleagues’ casework, direct experiences with
service delivery, interaction with community partners, trends in data or issues
identified at the state or regional level.
Requires Teamwork
The barrier posed by a CQI issue must exist for multiple workers, clients or
community partners. Its removal must require joint effort by the members of a team,
rather than individual initiative or routine administrative action.
Not Addressed by Existing Guidelines
An issue can be advanced if policies, procedures and regulations:
 are unavailable or insufficient to resolve it; or
 need clarification or changes that require a work group or team effort for their
development; or
 cannot be solved by simple methods such as placing a phone call to central office
for clarification.
Formulation of CQI Issues
Having identified a CQI issue, the CQI team should formulate the issue to focus on
potential solutions at any of three levels:
 Client Level
 Are there ways to solve the problem by changing how we interact with the
client?
 Program Level
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Are there ways to solve the problem by modifying the program that serves
the client?
Community Level
 Are there ways to solve the problem by posing it to the local community
as a social problem that merits the community’s attention and resources?
Advancing CQI Issues to the next level
A CQI team at any level should forward an issue to another level only if it has first:
 determined that the issue meets all criteria for issue identification;
 tried to resolve the issue, without success;
 determined that resolving it would require a regulatory or policy change, rather
than a clarification;
 tried and failed to identify an agency official who might resolve the issue at the
local or regional level;
 concluded that the issue requires a CQI forum rather than any existing structure;
 described the issue in writing in sufficient detail to enable those unfamiliar with it
to understand its essential elements; and
 proposed, also in writing, a solution or ideas that might help in forming a solution.
A CQI team should give heightened consideration to forwarding an issue to another level
if the issue:
 clearly requires resolution at the regional or state level;
 overlaps boundaries between programs (such as Protection and Permanency,
Family Support and Child Support) that are ordinarily treated as distinct; or
 appears to be a new issue – one that is likely without precedent within the agency.
A team should NOT forward an issue within CQI if it constitutes an emergency. Such
issues should be brought to the attention of the service region administrator or other
official(s) who can take prompt remedial action.
5.5 Screening CQI Issues at the State Level
Before a regional CQI team advances a CQI issue to the state level, it must first
determine that the issue either:
 is a statewide issue for which a statewide resolution is necessary; or
 is local or regional in scope, but local and regional resources are insufficient to
resolve it.
CQI issues advanced to the cabinet’s central office will be managed and screened. They
will be assigned:
 to the appropriate department(s) or division(s) for resolution or clarification if the
issue affects only one or two departments; or
 to the CQI State Steering Tem if the issue is cabinet-wide in nature. The steering
committee will then determine a process for addressing the issue.
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5.5 CQI Minutes/Issues Tracking System
In November 2007, DCBS launched an automated, centrally located, web-based system
for capturing, updating and viewing CQI meeting minutes and tracking the status,
progress and resolution of issues raised through the CQI process. This system, developed
by the CHFS Office of Information Technology in consultation with DCBS staff,
replaced the previous manual process for recording meeting minutes and tracking and
assigning issues from one level to another. Compared with the manual method, the
automated system allows for faster and more accurate resolution of issues. It provides a
central repository of all data pertaining to CQI, enabling authorized staff at locations
throughout the state to retrieve and present CQI minutes and issues.
The CQI Minutes and Issues Tracking System (CQI_MITS) makes it possible for CQI
minutes and issues to be tracked through all levels to completion. Users of the system
include all DCBS employees within each department, administrative division and branch
at the local, regional and statewide levels. All employees entered into the MITS as team
members can search for issues and view their resolution, action steps, or status. Scribes
with authorization can enter minutes or issues into the system. CQI specialists and others
have administrative access for entering scribes, editing minutes or issues, approving
minutes, and entering issues and minutes from local or regional meetings.
Important features of the automated system include:
1 A standardized format for meeting minutes, with text boxes for attendees, meeting
notes, attachments, CQI issues and action plans;
2 A mechanism to advance issues from one to another of the three levels of the CQI
system (local, regional and state) with an automated notification system when
issues are resolved or updated to those that identified the issue.
3 The capacity to track issues by date, description, identification number, minute
identification number, current level, original level, category and status;
4 Reports functions that produce written, printable documents useful for meetings
and for tracking pending and resolved issues; and
5 The capacity to record and update action plans.
6.0 Staff and Stakeholder Support
6.1
New Employee Orientation to CQI
Beginning in August 2009, the Regional Training Coordinators include a standardized
script and power point presentation on CQI in all new employee orientations. This 15minute presentation provides an overview of the CQI process and alerts new employees
to the role of CQI in improving results. Regional CQI specialists are invited to attend
these orientations and can supplement the presentation with other comments, examples of
reports, or questions/answer sessions. See attachment 11 for the NEO script.
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6.2 Stakeholder Participation in the CQI Process
DCBS works with numerous types of stakeholders, such as the children or families we
serve, foster/adoptive parents and community partners (schools, mental health,
community action, and other related human service or advocate organizations). DCBS
embraces these stakeholders’ opinions, suggestions and recommendations through
numerous avenues, including but not limited to public hearings, surveys and foster parent
CQI meetings. Other participation will vary from region to region, but may include
involvement in advisory boards, focus groups, task forces, community planning groups
and family team meetings (FTM)
6.3
Public Hearings
The DCBS, in numerous public hearings, embraces all stakeholders. From the legislative
process as required in Kentucky Revised Statute (KRS) 13A to the development of the
numerous federal plans, such as Child and Family Services Plan (CFSP), Title IV-E, Title
IV-B, and the Chafee Independent Living plan, DCBS seeks the input and
recommendations of all stakeholders to improve service to the children and families of
the Commonwealth.
6.4
Policy/Procedure
Stakeholders include not only community partners but also our employees. Each region’s
employees are provided opportunities to comment on draft policy and procedures. Every
attempt is made to incorporate their suggestions into policy and procedure.
6.5 Incidents and Complaints
Each region is responsible for tracking incidents, accidents and trends from the
Ombudsman’s Justified Complaint reports. These issues are discussed and assessed no
less than quarterly at the regional level. Unresolved issues or problems may be
forwarded to the Department CQI State Team. Note: the Commonwealth of Kentucky
has a personnel grievance system, as well as a formal mediation system. Due to federal
and state confidentiality laws, the content of grievances is not discussed or assessed in the
CQI process. DCBS continually conducts risk management reviews to assess its overall
risk. In making these assessments and in developing and revising policy and procedures,
DCBS analyzes data from numerous sources (NCANDS, AFCARS, TWIST, CQI, Mock
CFSR, etc.).
6.6
Measuring Customer Satisfaction/Outcomes
Since State Fiscal Year 2001-2002, DCBS has employed a systematic, statewide survey
process to measure satisfaction with services among its clients, employees and
community partners. Surveys have been conducted by a variety of methods (mailed
surveys, web-based surveys, surveys handed out at meetings and mailed in, and face-toface interviews). Each survey employs the best practices in survey methods to ensure
Revised August 2010
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reliable, valid and representative findings. The survey process is designed and
implemented at the central office level with assistance from the regions. Results of
customer satisfaction surveys have provided rich information to guide program
improvements, the federal Child and Family Service Reviews, and a number of key
program initiatives.
DCBS annually seeks input from a variety of stakeholders. Surveys are developed and
distributed from the central office. When possible, analyses of the results are completed
by region and reports on the findings are provided to each region. Survey findings may
prompt further assessment through the CQI system and, where necessary, corrective
steps. For example, a survey of all circuit, district and family court judges in Kentucky,
conducted in 2004-2005, informed efforts to enhance partnerships between DCBS and
courts. Results of a pair of surveys conducted in 2006 – one directed at physicians and
one at P&P field staff – guided efforts to improve physicians’ awareness of the signs of
child abuse and neglect and to strengthen the relationship between community medical
providers and DCBS. Surveys of families receiving family preservation services in 2008
identified the need to expand services to more families because of their high satisfaction
with services. A survey of staff on their values and beliefs in 2010 identified needs for
focused discussion on values related to engaging families in decisions about their care.
See for example survey results include in the program evaluation of family preservation:
http://chfs.ky.gov/NR/rdonlyres/1C6C930E-A2D9-4336-8CBFCDA1C2D2D31A/0/FPPEvaluation_Final.pdf
Currently, a web-based customer satisfaction survey is in development. The URL for this
survey is printed on all forms shared with clients in P and P so that they can access the
survey and respond. Larger offices may include a computer terminal accessible to clients
for completing surveys while in the DCBS office.
7.0 Summary of Responsibility
7.1 Local Responsibilities
Local offices are required to adhere to the regional and department CQI plans, including
the following essentials:
1. Methods are developed to ensure all staff members can remain engaged in the
CQI process.
2. CQI meetings are held no less than quarterly.
3. During the CQI process, management data and outcomes are discussed and steps
are taken to improve outcomes are documented.
4. Local CQI minutes are maintained.
5. Local CQI minutes are submitted in a timely manner to the regional CQI
specialist.
7.2 Regional Responsibilities
Regions are required to meet items outlined in the DCBS CQI plan, including:
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A regional CQI plan is developed that addresses the region’s CQI system.
CQI meetings are held no less than quarterly.
Incidents and complaints are tracked and identified problems are solved.
Management data and outcomes are discussed; steps taken to improve outcomes
are documented.
5. CQI minutes are maintained at the local and regional levels.
6. Regional CQI minutes are submitted to the department in a timely manner.
1.
2.
3.
4.
7.3 Department Responsibilities
1. Maintain the department’s CQI plan.
2. Provide consistent information and data to regional and local teams.
3. Provide the resources and tools needed by local and regional teams to effectively
analyze services and outcomes.
4. Maintain CQI minutes at all levels and the CQI_MITS and CQI-CARES
5. Provide timely feedback on issues submitted by regional teams.
7.4 CQI Specialist Responsibilities
The CQI specialist performs duties that contribute to the efficient functioning of CQI at
the local and regional levels. The specialist will:
1 Manage the local and regional CQI process;
2 Manage the analysis, evaluation and synthesis of data related to all service areas;
3 Manage the regional level review of cases, including entering scores into state
databases or systems;
4 Coordinate, facilitate and ensure proper recording of local and regional CQI
meetings; and
5 Collaborate with staff members through the CQI process to analyze policies,
procedures and practices that influence the achievement of desired outcomes for
families and children.
Specific expectations for the position of CQI specialist are:
1
2
3
4
5
6
7
8
Prepares the analysis/ evaluation/synthesis of data related to CQI meetings for
Family Support, Protection and Permanency, and regional teams.
Collaborates with staff members through the CQI process in the analysis of
policies, procedures and practices that influence the achievement of safety,
permanency, well-being and self-sufficiency outcomes.
Trains staff on related CQI processes and procedures.
Supports and monitors the completion of local and regional meetings to fulfill
policy expectations.
Updates the regional CQI plan and communicates the plan to all staff.
Generates management reports and displays that support best practices in teams
and regional decision making in the time frames specified by the SRA.
Coordinates the data entry for CQI case review scores.
Monitors progress toward achieving state, federal, program and special project
goals and provides feedback to staff.
Revised August 2010
29
9
10
11
12
13
14
Analyzes, prepares, interprets and disseminates data from case reviews,
administrative sources and data systems, or from other research/information
systems.
Identifies patterns of excellence or deficiencies in achieving state, federal or
program compliance.
Coordinates with state, regional and local professional staff on self-assessment
processes.
Writes, recommends and assists with implementation of action plans to promote
improvements based on information from CQI meetings
Records CQI minutes in tracking system and participates in local and regional
resolution of issues and provides feedback to local and regional teams on issue
resolution.
Manage the CQI_MITS and CQI-CARES in their regions including
administrative functions, training, and feedback on system functioning.
Revised August 2010
30