Annual Summary of Quality Management Review Findings

Transcription

1 Summary of FY Quality Management Activities Heartland for Children (HFC) has three (3) staff who have primary responsibilities for quality management reviews. Additionally one (1) of these three (3) staff was involved the entire year in a statewide quality management activity where they were rolling out Florida Safety Decision Making Methodology training and implementation activities. This Quality Management Specialist served as our local Safety Practice Expert (SPE) and was the primary trainer from the CBC side throughout the year and has been the local expert as we have moved forward with the pilot and implementation. This took away enormous amounts of time that he was available to conduct quality management reviews. During the fiscal year, HFC conducted 50 Quality of Practice Standards (QPS) reviews, 6 Quality Service Reviews (QSRs) and 112 Rapid Safety Feedback Reviews all of which were reported in the DCF Web Portal. In addition to these reviews, HFC conducted in excess of 1700 specialized reviews which were of limited or focused scope. These specialized reviews included QSR type reviews and file based reviews in areas including, but not limited to, barriers to permanency, critical incidents, child health checkups, psychotropic medication, human trafficking, missing children, adoptions, master trust, independent living, exit interviews, and sexual safety planning. Other quality management activities during the year have included, but are not limited to, training to group care providers, pre-service classes, and HFC new hires; coaching to case managers, supervisors, and Program Directors; tracking, monitoring and follow-up on incident reporting and client concerns/grievances; facilitating client record requests; and obtaining feedback from foster parents, biological parents, relative caregivers, non-relative caregivers, adoptive parents, and community stakeholders. Quality Practice Review (QPS) Analysis QPS reviews were conducted during the first two quarters of FY 13/14. During this time we observed an overall improvement in the following areas: Outcome Quarter 1 Quarter 2 Safety Outcome 1 78% 85% Permanency Outcome 2 54% 59% Wellbeing Outcome 1 61% 68% Wellbeing Outcome 2 52% 72% We observed a decrease in the following areas: Outcome Quarter 1 Quarter 2 Safety Outcome 2 62% 55% Permanency Outcome 1 92% 90% Wellbeing Outcome 3 67% 63%

2 Overall we observed an increase in positive responses from 61% in Quarter 1 to 63% in Quarter 2. Several strengths were identified from the QPS reviews completed during the fiscal year which continued to mirror the strengths identified in previous years. These include: Keeping children, both those who are in out of home care and those who are in home, safe from re-abuse. Referrals were made to families to ensure appropriate linkage with services. Overall, for children in out of home care, the placements were fairly stable and we have continued to improve over time. Maintaining connections was also a strength identified in the QPS reviews. Ensuring that the children receive appropriate mental health services was another identified strength. Meeting the Medical and Dental needs of the children was identified as a rising strength throughout the year. These reviews identified several gaps that require continued improvement, including: While children were kept safe from re-abuse, safety interventions that were implemented to prevent re-abuse or to address a re-abuse were not qualitative. The quality of supervisory reviews was another identified gap; although these reviews were completed at least quarterly, they did not consistently fully address safety, permanency, and well-being. Family assessments have not been consistently completed in FSFN or completed in a qualitative manner. Quality Service Review (QSR) Analysis Based upon the QSR reviews, there were a couple of areas identified as trends across our Circuit. These recommendations include: Inconsistent engagement of all parents in all aspects of services to meet their needs and the needs of their children. We saw an improvement in the engagement of mothers from years past and fathers were also on the rise but there is still considerable room for continued improvement. Inconsistency in case management relationships. Staff turnover was a significant concern identified during the reviews. Additional recommendations were identified by the various participants in the cases; however, these recommendations did not reflect a trend across all cases and many were case specific.

3 Overall, the were several areas of strength for the Child and Family Status Indicators section including the early learning and development status for children who were not school age. Children that were evaluated in this age group generally met their developmental milestones, and there was evidence of support being provided to address their early learning needs. Another area of strength in this section was that the children s physical and dental needs were being met. The area in need of greatest improvement was determined to be the independent living services for youth who are 13 years or older and in the foster care system. The performance in this area was 64%; however, it should also be noted that this indicator applied to a small portion of the cases reviewed. There has also been a lot of flux in expectations for Independent Living and changes were implemented statewide mid fiscal year. During the reviews we conducted Independent living youth were identified as not having long term connections and supports for the majority of the QSR cases completed. Another area in need of continued improvement was in regards to stability of children in out of home care. This standard evaluates the child s stability over the past year, and it includes stability factors, such as the placement, the assigned Case Manager, service providers, and school. The greatest area of instability was in regards to the child s Case Manager. The Practice Performance Indicators revealed a greater need for improvement efforts when compared to the Child and Family Status Indicators. The area identified as having the greatest gap in the Practice Performance Indicators related to teamwork. This area was identified as having a strong team formation but as being weak in the area of team functioning and team meetings. Another indicator in need of further improvement is related to the planning for transitions and life adjustments and it indicated that this area was weak in both the planning for transitions and the implementation of supports that were needed. Rapid Safety Feedback (RSF) Analysis Beginning in the 3 rd quarter of the fiscal year we made a shift statewide to discontinue the QSR and QPS reviews and provide intensive focus on extremely high risk in-home cases. We conducted these reviews for the 3 rd and 4 th quarters of the fiscal year. Cases were stratified to include children ages 0-3 years old, living in home with a parent where the allegation was family violence and/or substance use. While we did identify several areas as strengths during the RSF reviews we recognized there was still room for continued improvement. Many of them were really simple cleanup processes that needed to be done. Additionally we identified some areas that needed more focused efforts towards improvement. Below are some of the identified strengths from the RSF reviews:

4 Review Area Is the frequency of contacts with the child and family sufficient to ascertain and respond to known threats and emerging dangers? Is the quality of contacts sufficient to ascertain and respond to known threats and emerging dangers? Is safety planning sufficient? Is the case plan individualized for the family's needs and related to known dangers? Below are some of the identified areas needing improvement: Review Area Is there evidence the case management supervisor is regularly consulting with the case manager, recommending actions when concerns are identified, and ensuring recommended actions followed up on urgently? Is the case manager aware of any emerging dangers and, if so, are they followed up on urgently? Are background checks and home studies sufficient and responded to appropriately? Consultations were held with the Case Management Agency staff following the RSF reviews. This was also a learning process as the agency staff was expecting a more straightforward approach to what they got positive ratings on and what they got negative ratings on. The consultative, partnering approach to improvement took some time for them to get used to. Client Concerns Analysis HFC ended this fiscal year ( ) with a total of 288 client concerns. Of this total, 195 concerns were filed on active cases assigned to a Case Management Organization (CMO). The remaining 93 concerns were handled internally by HFC (mostly due to no CMO involvement). As shown below, CHS tallied up the most concerns for this fiscal year. However, it should be noted that this data includes an extraordinary number of concerns filed by one person who is well known by DCF Community Relations staff local as well as at the region level and at Central Office. Devereux (56) and Gulf Coast (48) ended the year fairly close in numbers and One Hope had the fewest concerns filed with 21.

5 In reviewing the number of concerns received by quarter, there was a relatively even amount received per quarter with the exception of Quarter 2 which yielded the most concerns at 89. See the chart below for a breakdown by quarter. Although more complaints were filed by persons in a non-caregiver role, this is a good indication that there is a lot of support/advocacy for children beyond the child s actual caregiver.

6 Case status analysis determines whether a complaint is filed on an open/active case or a closed/non-active case. The chart below shows that 189/288 complaints filed were on cases with open for services. In reviewing the data by Method of receipt of concerns, telephone contact remains to be the method used to communicate concerns to HFC.

7 In reviewing the data by the kinship of the caller to the child, data shows that parents filed the most concerns this past year which is an indicator that there s still work to do with parent engagement.

8 Calls were randomly made to explore the level of satisfaction as to the handling of the complaint by the agency assigned to resolve. Although this process was not implemented for the entire fiscal year, a total of 45 calls were made in an effort to evaluate customer satisfaction. As a result, there were 27 satisfied callers; 9 dis-satisfied callers; and 9 calls not answered. Incident Reporting Analysis HFC received and processed a total of 1425 incident reports for this fiscal year ( ). In reviewing the data by Quarter, the most incidents occurred in Quarter 1 and the fewest occurred in Quarter 2. However, the noticeable dip in quart 2 was temporary as the number of incident gradually increased in the last 2 Quarters of the fiscal year.

9 Out of the 1425 incident reports received this fiscal year, 54% were high-risk critical incidents as outlined in CFOP The chart below shows the exact number of incidents received for each CMO. With the exception of 47 incident occurrences, the vast majority of reports processed already had CMO involvement at the time that the incident occurred (1378/1425).

10 The illustration below shows the five (5) most reported categories in this fiscal year. To no surprise, runaway activity leads all other categories in the number of overall occurrences; however, this number includes a smaller population of teenage youth who have multiple run episodes. In analyzing the data by placement, data shows that licensed settings account for the greatest number of incidents this fiscal year. A breakdown of the licensed incidents reveals that 147 incidents occurred in foster care settings and the remaining 936 incidents occurred in group home settings, whereas substantially fewer incidents occur in non-licensed placements (i.e. parent s home, relative, non-relative, etc).

11 The chart below reveals the top 5 licensed group homes that had the most incident occurrences. Anchor House Ministries account for the most incidents. All other licensed placements (not shown on the chart below) had fewer than 50 reported incidents. A drill down of the data shows how group home reports align with the top 5 reporting categories. Data reveal that arrests occur more often at Anchor House than the other four (4) groups home combined. Whereas, backer act is more frequent at Miracles Group Home. Runaway Arrest Client Illness/Injury Baker Act Hotline Report TOTAL Anchor House Integrity Hansen House Miracles Florida Baptist

12 This has been a concentrated focus this past year with Anchor House. As they have undergone executive management changes HFC has worked with this provider to ensure the new management was aware of our concerns and we have instituted additional supports into the program. Addressing Findings HFC has implemented a multi-faceted intensive approach to improvement targeted at specific areas which have been deemed as needing improvement. Some of these initial areas include, but are not limited to, case management staff turnover and caseload ratios, wellbeing areas such as medical, dental and behavioral health services, permanency, and child arrests. These areas will continuously be evaluated and as we recognize consistent improvement in these areas we will adapt and shift to other areas needing improvement and intensive work to achieve sustained improvement. Additionally we are looking at how we can institute fidelity monitoring as it relates to Florida Safety Decision Making Methodology, Evidenced Based Parenting programs and other specific model approaches which have strict criteria for implementation and utilization. 8/13/14 Signatures (deemed pertinent by the CBC) Date