The Future of Continuous Quality Improvement in Wisconsin’s Child Welfare System

1. The Future of Continuous Quality Improvement in Wisconsin’s Child Welfare System

2. Background • WI-DCF is in the process of evaluating current assumptions, processes and possibilities of CQI in Child Welfare in WI. • WI-DCF partnered with the National Resource Center for Organizational Improvement to develop a shared vision and commitment to action for CQI in child welfare for WI. • WI-DCF held a facilitated discussion and development session with the NRC for Organizational improvement on November 13th and 14th. • This meeting included DCF staff, county directors/managers, training partnership staff, children’s court improvement project staff, and University of WI-Madison Social Work staff. dcf.wisconsin.gov

3. Desired Future State Principles of WI Child Welfare CQI Program A strong partnership between counties and the state (DCF/DSP) Joint commitment to continual improvement of child welfare processes and practices Affect real positive change in outcomes for children, youth and families dcf.wisconsin.gov

4. Draft-Vision of Wisconsin Child Welfare CQI Framework • Making the Paradigm Shift From Quality Assurance to Improvement: • CQI= Process, Practice and Outcome Improvement • CQI process will help state and counties fully engage in improvement efforts • State, counties, and other partners (courts, tribes, etc.) work collaboratively on improvement efforts. • Facilitated sharing and ongoing analysis with counties to improve outcomes, practice and process at the local and state level • State would support counties to build and sustain internal CQI capacity • Data is transformed into information and knowledge and is used to make informed decisions about improving policy and practice. • CQI is more than a case review process; pieces are aligned and analyzed collectively • CQI tools and processes are available for county use (“inside out” application). • DCF actively supports and make capacity building investments in county action planning and organizational improvement efforts. dcf.wisconsin.gov

5. Current State of CQI • Multiple case review processes with inconsistent criteria • Multiple action plan processes; inconsistent support for action planning and no robust follow-up • Relatively few cases and few counties are reviewed per year across state • Primary focus is on quality assurance and not on afecting quality improvement • DCF Resources across divisions are not aligned to improve practice and policy dcf.wisconsin.gov

6. Problems Resulting from Current CQI Process • Current Quality Improvement efforts do not result in informing statewide program and policy changes or sustain change at the local level • Roles and responsibilities of partners are not clearly defined • Lack of integration of current resources creates duplication of effort and partners working at cross purposes • Primary focus is on meeting federal CFSR reporting and not on improving practice and policy • The current process does not significantly deepen our mutual understanding of the strengths and weaknesses of the child welfare system in Wisconsin dcf.wisconsin.gov

7. CQI Child Welfare in Wisconsin: Moving Towards a Learning System • Multiple Sources • Data Systems • Case Reviews • Worker Surveys • Court/Legal System data & knowledge • Child and Family Safety • Permanency • Child Well-being • Define Improvement Needs • Assesses & Understand • Develop Specific Actions Plans • Implement & Monitor Turning data into information & knowledge useful to the field and community Think, Talk and Identify/Define Areas for Improvement

8. Practice Model Future State Child Welfare CQI Model DSP/County • Assess • ID Strengths and Gaps • Root Cause • Identify Solutions • Prioritization DSP/County Inputs • Define • Strategic Plan • Performance Data • Case Reviews • County Need • Survey/Focus Groups • Federal Requirements County • Plan • Develop Specific Action Plan • Quick Wins • Immediate, short-term & • long-term • Determine Needs • Technical Assistance • Training • Coaching/Mentoring DSP/County County • Monitor • Progress/Adjust • Accountability • Evaluation • Continuous adaptation • Recognition • Implement • Action Plans • Charters • Communication • Resource management • Success Measures/Goals Assistance: DSP, Training Partnership and BRO Assistance: DSP, Training Partnership and BRO Organizational Effectiveness

9. Next Steps for CQI Future State • DCF will work with counties, tribes and legal partners to identify CQI players and define roles, responsibilities and relationships • Stakeholders will participate in design and implementation of future state: • Counties/Tribes/Legal System- WCHSA, Court and Tribe Appointed Advisory Group • Provide DCF feedback, advice and guidance on future design • Courts/Legal System will participate as partners in work groups to explore and develop CQI efforts linking Child Welfare and the Court/legal System counties, courts, tribes SHARED BUY-IN dcf.wisconsin.gov

10. CQI Action Plans • Building a Foundational Administrative Structure • Improving Child Welfare Outcomes, Practice and Processes • Improving Outcomes and Practice at the System Level • Improving Outcomes and Practice at the Local Level • Developing a learning collaborative • Developing a support structure: training, facilitation and TA • Supporting counties to practice CQI at the local level dcf.wisconsin.gov

11. CQI Action Plans • Design and Developing a Case review process • Develop a cross-walk to align practice model, federal standards, practice areas, intended results and outcome measures • Distinguish quantitative data and practice that requires a qualitative case review • Develop a universal case review tool to cover a range of case/practice functions • Define triggers for the reviews • Targeted and General • Align with overall CQI fame work and goals dcf.wisconsin.gov

12. CQI Action Plans • Building our Data Infrastructure • Support data collection, analysis and dissemination of quantitative and qualitative data • Understand and develop the Infrastructure to support increased analytic capacity • Create a case review database • Develop and support increased analytic support at the state and local level • Develop and administer a worker/supervisor survey to receive routine feedback and insight into key practice areas dcf.wisconsin.gov

13. CQI Action Plans • Action Planning Process • Develop Action Planning Model (Define, Assess, Plan, Implement and Monitor). • Use Organizational Effectiveness tools/process as a foundation for action planning • Translate learning into improved outcomes and practices dcf.wisconsin.gov

14. Comments, Ideas and Questions?

15. A new vision for Independent Living dcf.wisconsin.gov

16. Background dcf.wisconsin.gov

17. Background About 425 youth age out of care each year. In 2012, the youth who aged out averaged over 4 years in care in their life.

18. The Picture for aged out youth is bleak. • Homelessness: • Based on a study of child welfare youth in the Midwest, 37% are homeless after aging out; • Higher unemployment rates: • Former foster teens experience 52% unemployment rate versus 24% for their peers; • Lower enrollment in post-secondary education: • Approximately 20% of foster youth attend college compared to 60% of the general population; • Higher pregnancy rates: • By age 19, over half of former or current female foster youth had been pregnant at least once; and • Higher rates of criminal system involvement: • By age twenty-four, 59% of male former foster care youth had been convicted of a crime, compared to 10% of males of similar age in the general population.  

19. What have we done? • Funding to counties to provide a federally-designated array of services (since 2000). • Summer 2013, focus groups with various stakeholders to better understand the service delivery models. • October 2013, inclusive Organizational Effectiveness process to develop a strategic plan for Independent Living. • 2014 IL Allocations will go out as planned. Changes projected in 2015.

20. Eligible and Served Youth

21. Vision for the Future • More choice of how to deliver services • No wrong door for youth • Focus on the outcomes • Better use of community partnerships