PERFORMANCE AND QUALITY IMPROVEMENT PLAN FISCAL YEAR

Transcription

1 Building Strong Links for Children in Need PERFORMANCE AND QUALITY IMPROVEMENT PLAN FISCAL YEAR Mission: The Children s Network of Southwest Florida is committed to working with the community to protect children and preserve families.

2 TABLE OF CONTENTS Introduction...3 Mission Vision...4 Core Principles Lead Agency Table of Organization Quality Assurance Processes Quality Assurance, CQI and Staff Resources Data Collection, Analysis and Internal Reporting Case Reviews Executive Management and DCF Discretionary Reviews

3 INTRODUCTION In 2003 Children s Network of Southwest Florida, (CNSWFL), was awarded the Lead Agency contract to provide community based care services to children and families in Charlotte, Lee, Collier, Hendry and Glades counties by the Florida Department of Children and Families. Under the leadership of its governance Board of Directors and Executive Management, in 2009 Children s Network obtained accreditation as a Network Management Agency through the Council on Accreditation (COA). Three years later, Children s Network demonstrated its commitment to continuous quality performance and improvement, exemplary service delivery, stakeholder inclusion and implementation of innovative practices so successfully secured the lead agency contract for another ten years. In 2013, COA validated Children s Network s strength in providing administrative oversight of a robust network of contracted Case Management Organizations (CMO), faith based agencies, specialty providers and community partners responsible for direct service delivery to children and families, and granted reaccreditation. Children s Network values collaboration with its community stakeholders and strives to achieve and promote positive outcomes related to safety, well-being and permanency based on the individual s need. The agency ensures accountability across the system of care with all partners involved in providing the vast array of services including prevention; safety management; foster home recruitment, training, licensing, and support; adoption recruitment, training, placement, pre-and-post-adoption support; independent living services; family preservation services; clinical services; shelter and residential care; nurse case management, and educational supports. Children s Network contracts with two Case Management Organizations that provide case planning, well-being services, permanency planning, and safety management of children and their families. A third subcontracted agency provides supervision, transition planning, case management to young adults to extended foster care and those receiving other independent living services. MISSION The mission of the Children s Network of Southwest Florida is to work with the community to protect children and preserve families. The agency endeavors to support family stabilization through diversion services, restore families that are disrupted through removal when appropriate, identify and promote permanent connections for children in a timely manner, engage relatives through family centered practice, equip adolescents for adulthood, maintain an array of service providers, assure provider accountability and emphasize respect for the worth and dignity of all people. 3

4 VISION It is the vision of the Children s Network of Southwest Florida to build strong links for children in need by proactively seeking and assessing their natural supports and utilizing a trauma sensitive approach to achieve safety, permanency and well-being in a timely manner. The system of care created by the Children s Network of Southwest Florida and its community partners reflect the following important principles: CORE PRINCIPLES Safety Oriented Safety determinations will be made by assessing child vulnerability and threats, in conjunction with parental /caregiver capacity to protect. Action based crisis and safety plans will be developed to mitigate risk factors and assess ongoing safety of children. Access Children and families will have timely access to relevant services. Barriers to service will be identified and solutions will be actively pursued to expedite intervention. Individualized Services Each family member will receive individualized services in accordance with strengths and needs identified by the family and consistent with valid professional assessments. Services will be delivered in accordance with the case plan drawing from both formal and natural supports. Services will be provided at the level, intensity and duration necessary, and in the least intrusive manner possible. Family-Centered Focus Service planning, provision and decision making will be designed to meet the unique strengths and needs of the families. Full participation from the families will be strongly encouraged throughout all junctures in the life of the case. Culturally Competent and Respectful Practice culturally competent services will be delivered in a manner that respects individual and family needs and cultural differences. Culturally competent, diverse staff will ensure that all clients have access to receive and benefit from the necessary services. Any differences in outcomes for populations of races, religions, ethnicity, gender, physical disability, or other characteristics will be identified and addressed. Integration - interagency planning, resource sharing and service delivery will be linked across the system of care network providers. Through a shared philosophy, coordinated intake, service planning, case management and continuity of service provision, the system of care will appear seamless to the individuals and families served. 4

5 Effective and Efficient children, their families and the community expect quality services, effective service outcomes and responsible, transparent, and accountable use of public and private funds; providers and families will be held accountable for results. Normalcy - Children will be encouraged to participate in age appropriate activities that stimulate physical, social and emotional development. Services received by children will be within the least restrictive environment that is appropriate for their needs and safety requirements. Community-Engaged Local planning, management and decision making is the foundation of community based care. Partnerships with stakeholders will ensure that resources are allocated to meet the unique needs of the community. Ongoing assessment and identification of service needs will guide the prioritization process. Permanency Driven the Children s Network of Southwest Florida will always strive for safe reunification of children with their families; however, if reunification is not possible, an alternate permanency plan for children and adolescents who are in out-of-home care will be developed in a timely fashion. Goal priorities will be: adoption, permanent guardianship of a dependent child, placement with a fit and willing relative, another planned permanent living arrangement, or independent living. Strength Based Interventions with families will be centered on individual strengths, goal oriented and solution focused. 5

6 QUALITY ASSURANCE PROCESSES Children s Network promotes a corporate culture of continuous quality improvement utilizing a total quality management framework. The agency s organizational structure is designed to include quality assurance functions in all departments and has a dedicated Quality Management team that performs standardized case reviews and executes other related duties to achieve outcomes aligned with statutory, accreditation, and contractual requirements. The Programs Department evaluates Foster Care Recruitment, Retention, Licensing and Relicensing, monitors Exit Interviews, conducts Foster Parent Surveys, and tracks ICPC home studies. The Contract Unit performs programmatic oversight through monitoring of all contracted providers and participates in policy development and dissemination throughout the network. The Utilization Department analyzes service accessibility and efficacy, facilitates linkage to providers within and beyond the circuit, and assures smooth case transfer from Child Protection Investigation to the subcontracted Case Management Organizations (CMO). The Staff Development Department equips Children s Network and CMO staff, stakeholders and community partners with knowledge of best practices in child welfare. Additionally, that Department completes secondary file reviews of all candidates recommended for certification through the Florida Certification Board. The Fiscal and Revenue Maximization Units conduct audits to maintain vigilant fiduciary responsibility in the expenditures of State, Federal, and local funds as well as grants. The 6

7 Executive Administrative Assistant records and processes all Client Relations matters effectuating timely resolution and customer satisfaction to the extent possible. Children s Network system-wide approach to performance and quality improvement is designed on Deming s Plan-Do-Check-Act Model PLAN: Establish the objectives and processes necessary to deliver results in accordance with the expected target or goals. By establishing output expectations, the completeness and accuracy is also a part of the targeted improvement. DO: Implement the plan, execute the process. Collect data for analysis in the following "CHECK" and "ACT" steps. CHECK: Study the actual results measured and collected in "DO" and compare against the expected results from the "PLAN" to ascertain any differences. Look for deviation in implementation from the plan and also look for the appropriateness and completeness of the plan to enable implementation. ACT: Implementing performance improvement activities to overcome barriers to quality services and remediate noted deficiency. Conduct follow up to assess effectiveness and sustainability. Reinitiate the cycle if interventions are found to be ineffective. This approach includes Program Planning, Implementation, Monitoring and Modification as required, ensuring that processes are sound and comprehensive. Agency, provider, stakeholder and case management specific strategic planning takes place to address monitoring results, implement law changes, assess the effectiveness of policies and procedures, and identification of additional resources to meet the needs of children and families in the community. QUALITY ASSURANCE, CQI & STAFF RESOURCES The Quality Management Department consists of members with varied areas of expertise and specialization providing a broad knowledgeable base and perspective that is essential to evaluate and address the complex needs of children, families and the system of care. The Quality Management Department is comprised of: 1 Director and an Administrative Assistant 1 Supervisor 7

8 2 ½ FTE Quality Management Specialists 1 QA/QI Specialist 3 Permanency Specialists 1 Adoption Specialist 1 Independent Living Specialist for youth in OOH care ages Independent Living Specialist for young adults formerly in foster care All Children s Network Quality Management staff have either received QA Reviewer certification through the Department of Children and Families (DCF) or participated in local training and peer reviews to gain proficiency in the monitoring process while awaiting availability of the DCF certification training. (This excludes the Imaging Specialist and Administrative Assistant as neither performs case file reviews so are not certified). Select Quality Management staff Director, Supervisor and QM Specialists - provide training to the Case Management Organizations Quality Assurance, local management and Supervisory staff to assure their understanding and working knowledge of the standards incorporated in the review instruments utilized to evaluate case management practices especially when they are amended. Information is disseminated upwards, downwards and across at various meetings and utilizing a variety of mediums to ensure awareness. The subcontracted Case Management Organizations are allocated staff positions to perform quality assurance functions. These personnel are experienced child welfare professionals who maintain certification through the Florida Certification Board, have / is able to successfully complete(d) the DCF QA Reviewer Certification training and work collaboratively with the lead agency to develop and implement improvement plan. They perform internal case reviews to provide coaching, mentoring and technical support to front line staff to drive favorable case outcomes and promote critical thinking. As appropriate, CMO Quality Assurance staff serves as peer reviewers alongside Children s Network reviewers. DATA COLLECTION, ANALYSIS AND INTERNAL REPORTING Children s Network encourages utilizing data to identify individual and systemic areas of strength as well of those in need of improvement. Analytic and systemic planning is essential to performance management therefore the continuous quality improvement process is multitiered, data driven and inclusive of stakeholders participation in decision making. Performance is evaluated, shared and/or addressed at various points and times including: Daily: Exit Interviews completed when a child is leaving a licensed facility and the placement duration was at least 60 days. Staff has the discretion to complete the interview regardless of length of staff to assess child safety and well-being. Any noted concern is communicated to the Licensing entity and the Programs Department for follow up as necessary. Incident Reports all critical and reportable incidents are reviewed daily by Senior Management, Quality Management, Contracts and Utilization Management staff. A monthly trend analysis is reported at the CMO Team Meeting and trends pertaining to other subcontracted are communicated via the Contract Manager. The Quality Management 8

9 staff enters applicable incidents in DCF s Incident Reporting and Analysis System (IRAS) so that entity is provided notification. Prevention of Sexual Abuse Safety Plans are monitored daily by the Placement Unit, and weekly by the Programs Department. A monthly random sample is reviewed by Quality Management staff to assess child safety and regulatory compliance as completion of the plan at the time of placement has been identified as an area to improve. Permanency Staffings This meeting is facilitated by the Children s Network Permanency Specialist and is attended by Parents, Out of Home Caregivers, Guardian ad Litems, Attorney ad Litems, Parent s counsel, Children s Legal Services, Case Manager, Case Manager Supervisor, the child when appropriate and treatment providers. This forum provides the opportunity to gain valuable information about parental engagement, service provision, and collaboration and to gain stakeholders insightful feedback on the system of care from a firsthand experience. Noted trends are addressed during the monthly CMO team meetings. Weekly: Data and Scorecard Meetings Data Meetings that include both CBC and CMOs Leadership and QM/QA staff occur weekly. Data is derived from FSFN ad Hoc reports and is drilled down to the child level to synthesis the information provided and assure its integrity. Workgroups are formed to address areas that emerge as concerns. Scorecard performance is posted on the DCF s website so is available to the community at large. The same is disseminated to the CMOs and is addressed at various stakeholder meetings. Well Being Management Reports (medical, dental, psychotropic medication) An executive level report is generated from FSFN weekly that provides relevant information pertaining to timeliness of key well-being services to children. Each week the CMOs reports on the status of each child that is approaching or is beyond a required timeframe. Close watch of these measures have resulted in identification of service gaps as well as improvement in timely service delivery. Children s Network is developing a Psychotropic Coordinator s position that will provide technical guidance to CMO staff and work directly with practitioners who prescribe psychotropic medication to streamline the process. It is expected this will reduce the time it s taking to obtain a completed medical report and therefore the appropriate authorization for dispensation of the medication. Administrative Reports (Imaging, ID verification etc.) Also disseminated weekly, the CBC gives priority to ensuring that children s photos are updated as required, and birth verification is secured. These are tracked weekly. Reunification Staffings Attended by the Children s Network Permanency Specialist, Parents, Out of Home Caregivers, Guardian ad Litems, Attorney ad Litems, Parent s counsel, Children s Legal Services, Case Manager, Case Manager Supervisor, and is chaired by the CMO Program Director whose involvement ensures child safety remains the central point of discussion. Emerging patterns are presented at the CMO Team Meeting, Directors Meeting and Supervisor s Quarterly as applicable. 9

10 Semi Monthly: Supervisory Review Report Timely and appropriate case management supervisory guidance is perhaps one of the most critical elements in child welfare. In addition to obtaining results from the case file reviews, Children s Network maintains a close watch on the timeliness of completion of Supervisory reviews. A FSFN Business Objects report is generated and disseminated twice monthly that identifies compliance with completing a supervisory review every 90 days. Information is provided per unit, and the raw data of each child is included. This allows assessment of trends between units and provides the opportunity for staff to shares time management and staff development ideas. Family Functioning Assessment ongoing / Progress Update Report /Family Assessments - A FSFN ad hoc report and a FSFB BOE report serve as the repositories of information pertaining to timeliness in completing the family assessment (aka FFA-O). The intent is to equip Supervisory staff with management information pertaining to cases assigned to their units to ensure children and their families are assessed timely, objectively and services can be initiated timely. With the recent roll out of the new practice model, concerted effort will be needed to ensure cases are converted to the FFA-O at critical junctures. Monthly : Judicial Brown Bag Meetings Led by the Judiciary, these meetings focus on educating the various stakeholders (Judiciary, CLS, GALP, Parent s Attorneys, CBC, CMO, community providers,) involved in court supervised cases to address barriers, improve services and strategize interventions. Legislative updates are typically reviewed along with the plans for roll out. Provider Contract Team Meetings Children s Network Contract staff, and presentative of the Children s Network applicable Department responsible for oversight meet with the provider to discuss their performance outcome to date, allocation of resources, accountability, challenges and successes. This ensures on going communication and clear understanding. DCF Team Meetings Facilitated by the DCF Contract Manager and attended by DCF Regional and Local leadership, CBC and CLS leadership, this meeting focuses on the CBC s programmatic performance and administrative outcomes. Florida Youth Shine Meeting Engagement of former and current foster youth to obtain essential feedback on what is working well and improvements needed to adequately meet the unique needs of this segment of our population. Youth are taught advocacy skills, leadership, presentational skills and to become change agents. A Children s Network staff serves as a Mentor along with a licensed foster parent and members of youth/young adult focused mentor agency. Corrective Action Plan validation Each month Children s Network staff reviews a random sample of cases meeting the criteria of a determined corrective action plan to assess progress within that area. Aggregate data is compiled, analyzed and shared with the 10

11 respective agencies. As necessary modifications are made until the plan is successfully accomplished. Quality Parenting Meeting The Foster and Adoptive Parent Association executive team participates in monthly meetings with the CBC s CEO, Program s Director and the CMO Program Director(s) to plan interventions, services, address concerns and focus on recruitment and retention efforts. The foster parents aid in development of performance improvement goals and are members of a variety of performance improvement workgroups such as the one focused on transition planning. CMO Directors Meeting Involves CBC and CMO Management staff, DCF Contract Manager, CBC Contract Manager and other guests. Performance and Scorecard outcomes are reviewed, training needs are addressed, and systemic factors are presented. CFSRs Case file reviews conducted on a quarterly basis that provide insight into case management practices related to child safety, permanency and well-being. Outcomes are communicated via several venues and is critical in training needs, service gaps, systemic factors and also improvement. Rapid Safety Feedback Reviews Targeted reviews of children aged 0-4 who remain in their parent (s) custody with an in-home safety plan. The review looks at recent case practices in key areas that impact child safety. Consultations assist in providing coaching for front line staff with noted action steps to ensure timely attention to address matters that if left unattended pose the potential to endanger the child. Individual and cumulative outcomes are provided to the CMOs and DCF has access to the completed tool and aggregate outcomes as the tools are maintained in the DCF operated portal. Bi-Monthly: Board Meetings The governing body provides its long range and short term goals for the agency that is derived from local and state initiatives, stakeholder feedback, contract performance and external audits. The CEO and COO provide updates on the agency s programmatic outcomes and present needs related to staff and infrastructure to remain viable in an evolving system. Quarterly: CMO Supervisor Meeting CMO Supervisory staff participates in quarterly meetings where quality assurance review outcomes and trend analysis is disseminated and discussed. Statewide QA Managers Meeting The Quality Management Director attends quarterly meetings with DCF and other CBCs and Sheriff s departments to collaborate on federal and statewide quality assurance and continuous improvement activities. DCF Regional Meeting Strategic planning, performance review, policy and procedural updates and community development matters are addressed herein. 11

12 Adoption Meeting one on one meeting with the Supervisor and Case Manager to discuss efforts to achieve adoption finalization for children for whom TPR has been achieved. There are two contracted performance measures associated with adoptions (adoptions within 24 months the latest removal and the cumulative finalization goal by June 30) necessitating close monitoring and evaluation of performance to ensure achievement of both. IL Reviews and Meeting The Independent Living Specialist generates several reports from FSFN and BOE pertaining to key components of the Independent Living program to ensure service delivery and court oversight is achieved timely. These include referral for IL services, credit checks, Special JR at 17 and 17 ½ and applicable transition plans. For young adults receiving services, the IL Specialist selects a random number of youth and utilizes DCF s COU tool to ascertain if the young adult is receiving the appropriate case management services and oversight. Outcomes are discussed at the provider s unit meeting and during the team meeting. Model Court Meeting All Judiciary from the five counties within the circuit are invited to participate along with key representatives from DCF, CBC, CLS, Defense Counsel, Regional Counsel, and GALP. Strategic goals are identified and workgroups formed with participation from the aforementioned stakeholders. Alliance Meetings The Florida Statute authorizes the community alliance to oversee provision of child welfare. Meetings are attended by DCF, the GALP, Judiciary, and various stakeholders. The Lead Agency s performance is reviewed, and the Alliances assist in identifying and developing Annually: Community Forums In addition to routine contacts made to the agency via , telephone calls, and trackers/complaints, stakeholders have the opportunity to share input on the system of care relevant to its performance, community engagement, etc. at forums designed to specifically elicit their assessment. Children s Network updates the community on its progress, challenges and strategic vision. Information obtained is carefully considered and incorporated in strategic planning for the upcoming year. Contract Provider Monitoring Annual monitoring of provider agencies is conducted. As applicable, Quality Management staff with specialization in the focus area participates in the reviews. Written reports are completed that focus on trend and prior outcomes are generated and provided. DCF Contract Oversight Unit Monitoring / DCF Child Placing Licensing Monitoring identifies the agencies compliance with statutory or administrative code regulations. The results of which are communicated in a written report to the agency which is shared with service providers who have an impact on the outcomes. As needed improvement plans are developed, monitored and the outcomes reported to DCF. 12

13 Fiscal Monitoring - CNSWFL is evaluated by an independent, certified accounting agency on an annual basis to assess its business practices related to financial management. The report generated from this review is provided to the Board and DCF. CASE REVIEWS In accordance with the approved Statewide QA/QI model, in each quarter of the fiscal year the Children s Network will conduct a minimum of ten Rapid Safety Reviews, eighteen CFSR case reviews and two CFSR case reviews with interviews that will utilize the Stakeholder Interview. Reviewers will utilize the statewide evaluation instruments located in the DCF QA Portal, and CFSR Florida portal. If a decision is made to discard a randomly selected case file from the sample list under the allowable discard criteria, the rationale must be documented and the decision must be approved by the Children s Network of Southwest Florida Quality Management Director. Following completion of the reviews, a case consultation will be conducted with the Case Manager, Supervisor, and CMO Quality Assurance staff. This provides timely feedback and promotes modeling and applying critical thinking skills to address identified case practices. As needed, managerial staff at the CMO will be requested to participate. A group debrief consisting of the review teams, Children s Network management and Quality Management staff, CMO management staff and QA staff, and the DCF Contractor will occur each month. This provides the forum to evaluate systemic strengths as well as opportunities and the group develops initiatives to improve practice. Each completed review instrument is provided to the assigned CMO Case Manager, Supervisor and QA staff. As necessary, time sensitive action steps are identified which must be reported upon on a weekly basis until satisfactorily resolved. Written reports analyzing practice trends and comparing outcome from previous reviews is shared at the CMO Director s Meeting, Quarterly Supervisor s Meeting and review outcomes are readily accessible to DCF in the respective portals. An annual report of practice trends is provided to DCF. Below is a Quality Assurance review schedule: Quarter 1: Date July 13-15, 2015 July 24, 2015 th August August 21 st September September 25 th September 28th -30th Review Type / Event Rapid Safety Reviews Rapid Safety Group Debrief CFSR CFSR Group Debrief CFSR CFSR Group Debrief CFSR in depth 13

14 Quarter 2: Date October 12 th 14th 2015 October 23 rd, 2015 November 2 nd 4 th, 2015 November 13th December 7 th 9 th, 2015 December 11 th, 2015 *December 15 th 17 th, 2015 Review Type / Event CFSR CFSR Group Debrief CFSR CFSR Group Debrief Rapid Safety Reviews Rapid Safety Debrief CFSR in depth Quarter 3: Date January 11 th 13 th, 2016 January 22 nd, 2016 February 8 th -10 th, 2016 February 19 th, 2016 March 7 th 9 th, 2016 March 18 th, 2016 *March 29th -31 st, 2016 Review Type / Event Rapid Safety Reviews Rapid Safety Group Debrief CFSR CFSR Group Debrief CFSR CFSR Group Debrief CFSR in depth Quarter 4: Date April 11 th 13th April 22 nd, 2016 April 25 th 27 th May 9 th -11 th, 2016 May 20 th, 2016 June 13th-15 th, 2016 June 24 th, 2016 April 25 Review Type / Event Rapid Safety Reviews Rapid Safety Group Debrief CFSR in depth (federal review case) CFSR (federal review case) plus other reviews CFSR Group Debrief CFSR (2 federal review cases) plus other reviews CFSR Group Debrief CFSR in depth If a critical life, health or safety threat to the child or adult is identified in the course of a case review or interview the following actions will be taken: The reviewer will immediately notify the CMOs assigned Quality Assurance staff who is responsible for ensuring the Case Manager and Supervisor are immediately engaged. Depending on the severity and urgency of the matter, Children s Network Quality Management Director or designee and the CMO s Program Director will also be notified by the reviewer. A Request for Action will be entered in FSFN. If the concern is related to a contracted provider a copy of the RFA will be submitted to the 14

15 Utilization Management Director and the provider as appropriate. The Reviewer will identify the actions needed to remediate the concern and maintain contact to assure action has been taken to address the issue. Once the safety level is sufficient reduced, if there are still procedural outcomes to be addressed the reviewer will inform the Children s Network Lead QM staff who will continue monitoring the case through completion of all tasks. All actions related to the case will be documented in the FSFN record. EXECUTIVE MANAGEMENT AND DCF DISCRETIONARY REVIEWS The Secretary of DCF or other executive staff may determine a review of a particular process or topic is needed, or may require a statewide or localized special project be conducted throughout the year. This activity will likely require specially designed review tools and other protocols depending on the subject matter. Discretionary reviews may also be assigned by Regional Directors or the Children s Network management team for local purposes. These reviews will include high profile cases. Request for special reviews will be directed to the Children s Network of Southwest Florida s Chief Operating Officer who will direct the request to the appropriate member of the Children s Network Quality Management team. 15

16 Initiatives to Improve Practice: In January 2015, Circuit 20 began officially rolled out of the Child Welfare Practice Model (previously known as Safety Methodology / Transformation). Workgroups were developed to ensure open communication and collaboration amongst the partnering agencies. The continuous quality improvement process identified improvement delayed service initiation was impacting permanency. This lead to the judiciary asking parents at shelter if they will accept services which would be included in the shelter order. Further, the CBC began assigning case managers as secondary prior to case transfer so that parents can be assisted with referrals. Other planned interventions for the fiscal year: Conversion of existing cases to the new practice model at critical junctures. Participation in the Statewide Policy Workgroup for Case Management services. Hired a Nurse Coordinator to assist with enrollment and provide technical guidance for children enrolled in the Integrated Health Plan. Creation of a Psychotropic Medication Coordinator. Creation of a Benefits Coordinator to assist with application and appropriate utilization of third party benefits for children in out of home care. Centralize ICPC home studies to one unit. Expansion of ABC visitation program. Rocket Docket Project conduct staffings with CMO and CLS to identify and address barriers to timely permanency particularly reunification within 12 months. Incorporate therapeutic providers in Licensing meeting to address recruitment and the growing numbers of children requiring such placements. Develop a streamlined system to improve timeliness of diligent searches. Explore implementing Adoption Overlay services (in Lee county) to expedite finalizations. 16