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

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

Desired Future State Principles of WI Child Welfare CQI Program

dcf.wisconsin.gov

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

Draft-Vision of Wisconsin Child Welfare CQI Framework

1. 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

2. Data is transformed into information and knowledge and is used to make informed decisions about improving policy and practice.

3. CQI is more than a case review process; pieces are aligned and analyzed collectively

4. CQI tools and processes are available for county use (“inside out” application).

5. DCF actively supports and make capacity building investments in county action planning and organizational improvement efforts.

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

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

Multiple Sources

• Data Systems

• Case Reviews

• Worker Surveys

• Court/Legal System data & knowledge

•Child and Family Safety

• Permanency

• Child Well-being

Think, Talk and Identify/Define Areas for Improvement

CQI Child Welfare in Wisconsin:Moving Towards a Learning System

Turning data into information & knowledge useful to the field and community

• Define Improvement Needs

• Assesses & Understand

• Develop Specific Actions Plans

• Implement & Monitor

Future State Child Welfare CQI Model

Assess• ID Strengths and Gaps

• Root Cause• Identify Solutions • Prioritization

Assess• ID Strengths and Gaps

• Root Cause• Identify Solutions • Prioritization

DSP/County

Plan• Develop Specific Action Plan

• Quick Wins• Immediate, short-term & long-term

•Determine Needs•Technical Assistance• Training• Coaching/Mentoring

Plan• Develop Specific Action Plan

• Quick Wins• Immediate, short-term & long-term

•Determine Needs•Technical Assistance• Training• Coaching/Mentoring

Define• Strategic Plan• Performance Data• Case Reviews• County Need• Survey/Focus Groups• Federal Requirements

Define• Strategic Plan• Performance Data• Case Reviews• County Need• Survey/Focus Groups• Federal Requirements

County

Assistance: DSP, Training Partnership and BRO

Implement• Action Plans

• Charters• Communication• Resource management• Success Measures/Goals

Implement• Action Plans

• Charters• Communication• Resource management• Success Measures/Goals

County

Assistance: DSP, Training Partnership and BRO

Monitor• Progress/Adjust• Accountability• Evaluation• Continuous adaptation• Recognition

Monitor• Progress/Adjust• Accountability• Evaluation• Continuous adaptation• Recognition

DSP/County

DSP/County

Practice ModelPractice Model

InputsInputs

Organizational EffectivenessOrganizational Effectiveness

Next Steps for CQI Future State

1. DCF will work with counties, tribes and legal partners to identify CQI players and define roles, responsibilities and relationships

2. 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

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

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

CQI Action Plans

dcf.wisconsin.gov

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

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

CQI Action Plans

Comments, Ideas and Questions?

dcf.wisconsin.gov

A new vision for Independent Living

dcf.wisconsin.gov

Background

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.

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.

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.

Eligible and Served Youth

    Under 18   18 and Over

  Number Percent   Number Percent

Milwaukee

Served

188 63%  263 43%

Eligible, Not Served

111 37%  346 57%

Balance of State

Served

403 55%  394 35%

Eligible, Not Served

327 45%  720 65%

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