Performance and Quality Improvement

PlanThe Bair Foundation

Print out handout:

TBF PQI Information Packet (T-04)

Assess, evaluate and improve service delivery

To have input from all levels of staff within the organization – this means your input is very important

To ensuring that quality of care is being met

Problem identification and resolution

Utilizing stakeholder input to evaluate service needs

To improve outcomes

Provide accountability to all levels of management

Purpose of the PQI Process:

Meet M

onthly M

eet Quarterly

Meet Sem

i annually

Mee

t Mon

thly

Mee

t Ann

ually

National PQI Advisory Committee (AC)

Dir. of Program Standards, NET, Board Member, Service delivery staff, External Stakeholders (6-8

members)

State & Regional PQI Teams (SRT’s) State Director,

Regional Director, Dir. of Program Standards

National Executive Team (NET) CEO, Executive Vice-

President

Local Office PQI Teams (LOT’s)

QI Manager, DSS, ID, SSW’s, secretaries, foster parents

The Bair Foundation Board of Directors

Performance & Quality Improvement Flow Chart

Local Office Teams: LOT’s

Comprised of staff members (this mean you) that represent the various programs within the office along with stakeholder

representation

Meeting quarterly in conjunction with your office records review.

Review of growth, compliance and quality of care issues identified on the score card for each program your office provides services in.

Develop a Performance Improvement Plan (PIP) to address performance standards on the scorecard that are not being met.

The PIP must include measurable steps with identified timeframes and responsible parties to address outcome measures that are not being met according to the scorecard.

Generating meeting minutes for PQI notebooks and SRT

Scorecard and the PIP (if applicable) will be completed at local level and sent to the Director of Program Standards and State/Regional Director within 7 days of the meeting.

Duties of the Local Office Teams

State and Regional Teams (SRT’s):

The State Director will serve as chairperson of the SRT. Membership of the committee is composed of The Dir. of Program

Standards, Regional director if applicable, and the Executive Team.

Monthly meetings to be held on the second week of the month.

Review all Scorecards and Performance Improvement Plans (PIP) from the Local Offices that received a quarterly records review in the previous month.

Prior to the SRT meeting the state/regional director must approve all PIPs for offices that are being reviewed.

Evaluate and prepare a monthly score card for offices that received reviews.

Monthly results from SRT meetings disseminated to the AC Chairperson for tabulation of semi-annual performance and improvement scorecard.

Duties of the State and Regional Teams

National Executive Team (NET) It is comprised of the Chief Executive Office and the Executive Vice president.

Monthly meetings

Participate on Advisory Committee Semi annually

Review quarterly scorecards generated by SRT’s

Provide oversight to the SRT’s

Establish and review Management Scorecard

Management Scorecard to be completed quarterly with results disseminated to AC.

Duties of the National Executive Team

The National PQI Advisory Committee

The Director of Program Standards serves as the chairperson of this committee. The committee will be composed of 6-8 individuals who represent

the various service areas and geographic areas served by the agency. The National Executive Team and Director of Program Standards will be standing

members of the AC. The other members will serve staggered two year terms. Members are nominated by their supervisors or from members of the agencies

management team and approved by the National Executive team.

Meet semi annually (every 6 months)

Review the semi-annual reports generated by SRT’s

Review accumulative score cards for each program nationally (For example, this means that foster care in all states will be evaluated on one scorecard in an aggregated form)

Review PQI Plan annually.

Review annual program evaluation.

Prepare, review and approve the Annual Report to be forwarded to the Board of Directors.

Duties of the Advisory Committee

Program Outcomes

Each program will have their own designated scorecard which will be reviewed for outcome achievement.

Documentation will be noted on each performance measure on the scorecard.

Performance Improvement Plans will be developed for all measures not meeting criteria noted in the Performance Measure section.

During this section, you will work with the scorecards designated for each program serviced out of your office.

You will find the scorecards for all programs located on the portal under General Employee resources>Performance and Quality Improvement.

Example of Blank Scorecard(We will review the Foster Care Scorecard

for training purposes but all scorecards and PIP’s will follow the some process for

completion.)

Example of a Filled Out Scorecard

PIP Performance Improvement Plan

Performance Improvement Plan

Name of Office:______________

Name of Program:_____________________

Goal:__________________________

If you did not meet the Goal answer the following questions: 1.Why was the goal not met? (Define obstacles. List reasons why the established goal was not met.) *If an outcome is not met due to lack of accountability or follow-up, it is important to take ownership by documenting what occurred in this section. Without ownership change will not happen. 2. Develop a plan to meet your goal and overcome obstacles. (must be measurable with target dates)

*You will answer the questions who (who will be responsible), what (what will be accomplished) and when (when will it be done). 3. How are you going to monitor your plan on a weekly basis? (What is your check system to ensure goals are being met?)

*Here you will ask how (how you will make it happen). 4. If weekly goals are not being met what adjustments need to be made in order to meet the goal?

Performance Improvement Plan

Name of Office: Somewhere Warm

Name of Program: Foster Care

Goal: G-1 less restrictive

If you did not meet the Goal, answer the following questions: 1. Why was the goal not met? (Define obstacles. List reasons why the established goal was not met.) There were 4 children who ran away and did not return. There were also 3 disruptions due to aggressive behavior with families who are new to foster care. Because the children required being in a home with no other foster children, we were unable to move them within network. 2. Develop a plan to meet your goal and overcome obstacles. (must be measurable with target dates) Children will not run away from care next quarter:

1. Children who have a history of running will have a safety plan at placement that includes strict supervision and bed checks

2. Placement worker will research the child’s history with the referral agency to identify triggers for this child and to identify if the child is running from the home or from school. This information will be incorporated in the development of the safety plan. If the child is running from school then SSW will meet with the school and incorporate actions they will take to keep the child safe in the initial safety plan.

3. Placement worker will talk with the child to discuss his/her reasons for running and make the child a part of the safety plan development.

4. The safety plan will be monitored weekly in supervision of the SSW and during weekly contact with the family. Adjustments to the plan will be made as needed.

Placements in newly certified families will not disrupt during the next quarter

1. At placement the worker will meet with the foster family, the child, and any other member of the team available to discuss behaviors the child has had in the past and develop a specific plan of intervention.

2. All interventions included in the plan will be role played with the parent. 3. Weekly visits will occur for the first 60 days of a new placement. 4. The new family will be given the phone number of a tenured foster parent as a mentor prior to

placements occurring. The office has already identified families willing to be on a call list for new families. 3. How are you going to monitor your plan on a weekly basis? (What is your check system to ensure goals are being met?) Through supervision with the placement staff and the SSW, progress on the safety plans, and support to new foster families. Visitation to new families will be tracked on the log nag for the child placed in the home. Safety plans for children who run will be addressed in supervision with the SSW 4. If weekly goals are not being met what adjustments need to be made in order to meet the goal?

Performance Improvement Plan

Name of Office: Somewhere Warm

Name of Program: Foster Care

Goal: G-2 Increase Placements

If you did not meet the Goal, answer the following questions: 1. Why was the goal not met? (Define obstacles. List reasons why the established goal was not met.) 90% of our referrals are for older children and our families are resistant to take older placements. We currently have 8 openings and none are for older children. 2. Develop a plan to meet your goal and overcome obstacles. (must be measurable with target dates) Plan to increase teen beds

1. 5 families will become a teen home within the next 30 days DSS will meet with current families with openings to cast the vision for older children within the

next 2 weeks. Placement worker will identify family’s strengths that will meet the need of the child being

referred Placement worker will put supports in place for the family to address concerns prior to

placement. 2. An additional 8 families will become teen homes over the next 90 days. This will include new families

certified. ID will stress teen homes in GSP A teen who has been adopted by the Smith family will complete a teen roundtable by February

15th Mrs. Smith and ID will co-train a training session on dealing with teens in foster care by February

25th. Dr. Scott has agreed to do training on avoiding control battles on March 10th. This is an area of

development for all families. Dr. Scott has agreed to keep the training focused on older children. 3. How are you going to monitor your plan on a weekly basis? (What is your check system to ensure goals are being met?) Families deciding to open their home to teens that are currently certified will have an addendum to the HS completed to increase the age range. This will be monitored weekly during supervision with the ID New families being certified who are willing to take teens will have teen home checked on the marketing report. Additional families deciding to take teens based on the efforts listed above will be tracked for the next 90 days and their decision to increase age range will be documented in their file. 4. If weekly goals are not being met what adjustments need to be made in order to meet the goal?

Performance Improvement Plan

Name of Office: Somewhere Warm

Name of Program: Foster Care

Goal: G-3 Referral Increase

If you did not meet the Goal, answer the following questions: 1. Why was the goal not met? (Define obstacles. List reasons why the established goal was not met.) Referrals were not placed at the projected goal of 80% because of the lack of teen homes as stated on the growth goal. 2. Develop a plan to meet your goal and overcome obstacles. (must be measurable with target dates) All families certified the remainder of the fiscal year will be teen homes.

Teen families will present at the GSP New families willing to take teens will be partnered with tenured families who are caring for teens for

support 8 additional families who will take teens will be certified this fiscal year.

3. How are you going to monitor your plan on a weekly basis? (What is your check system to ensure goals are being met?) This will be tracked weekly during supervision with the ID. All families in the process will be evaluated for their ability and willingness to take a teen child. Obstacles will be identified and addressed weekly. Monthly, the marketing report will document progress. 4. If weekly goals are not being met what adjustments need to be made in order to meet the goal?

Performance Improvement Plan

Name of office: somewhere warm

Name of program: foster care

Goal: C-1 Child Files

If you did not meet the Goal, answer the following questions: 1. Why was the goal not met? (Define obstacles. List reasons why the established goal was not met.) Out of the 47 deficiencies there were 2 areas of concern. The majority of the deficiencies were due to late medicals and dentals. The remaining deficiencies were because of late outcomes. I have been allowing staff to tell me medicals and dentals are done we are just waiting for the forms. Now I am requiring them to give me the scheduled date. Out comes were not a focus for me. 2. Develop a plan to meet your goal and overcome obstacles. (must be measurable with target dates) Medicals and dentals will be completed on time over the next quarter Medicals and dentals due in February, March, and April will be done prior to the due date

On January 15th SSW’s will be trained on the expectation of medicals and dentals completed prior to the due date.

During weekly supervision the SSW will have the schedule of when medicals and dentals will be completed for the ones due within 30 days. The supervisor and the SSW will identify families who need extra reminders in order to meet the expectation. Action steps will be developed for the worker to do with the family to ensure completion.

The worker will show up to supervision with the medical and dental in hand no later than 5 days after the scheduled appointment.

All outcomes will be done prior to the ISP this next quarter On January 15th staff will be trained on how to use outcomes to develop an ISP. The workers will also be

trained on the outcomes report and it will be stressed that the progress of their children on the report is a reflection of their work. They will be instructed to bring outcomes to supervision for all ISP meetings that will occur the following week.

During supervision the worker and the supervisor will look at the outcomes and do a rough draft of the ISP.

Once the ISP meeting is held the worker and the supervisor will evaluate the process to help the worker identify the usefulness of the outcomes tool.

3. How are you going to monitor your plan on a weekly basis? (What is your check system to ensure goals are being met?) During weekly supervision the outcomes will be reviewed prior to conducting any ISP’s the following week. The nags will document outcomes are completed on time. 4. If weekly goals are not being met, what adjustments need to be made in order to meet the goal?

Performance Improvement Plan

Name of Office: Somewhere Warm

Name of Program: Foster Care

Goal: C-2 Family Files

If you did not meet, the Goal answer the following questions: 1. Why was the goal not met? (Define obstacles. List reasons why the established goal was not met.) There were 6 deficiencies in the family files due to one family not completing the annual requirements timely. There were 4 foster parents late at getting CPR training. I have allowed families to be out of compliance because we are not being pro active with training. 2. Develop a plan to meet your goal and overcome obstacles. (must be measurable with target dates) The families will be up to date by March 15th.

SSW will talk with the families to get them scheduled for upcoming CPR/first aid and restraint training by January 15th

CPR/first aid training will be done February 2 Restraint training will be done February 12 SSW will obtain the following annual requirements from the families by February 10th

1. Annual driving questionnaire 2. Copy of insurance card 3. Annual manual training

If the foster parents refuse to meet the above deadlines, the home will be recommended for closure. Foster parent training will be completed on time

Foster family secretary will send a quarterly schedule of trainings to families monthly. SSW will give the training nag to families monthly and document the trainings they will attend in their

monthly foster home review. Trainings will be offered monthly in support group Family training will be monitored weekly in supervision.

3. How are you going to monitor your plan on a weekly basis? (What is your check system to ensure goals are being met?) The family nag will be monitored weekly in supervision. All obstacles to completing the above requirements will be addressed weekly and documented on a supervision note. During staff meetings the training needs of families will be discussed to the team can address concerns together and brainstorm solutions for families struggling with meeting the training requirements. 4. If weekly goals are not being met what adjustments need to be made in order to meet the goal?

Performance Improvement Plan

Name of Office: Somewhere Warm

Name of Program: Foster Care

Goal: Q-2 Behavior Indicators

If you did not meet the Goal, answer the following questions: 1. Why was the goal not met? (Define obstacles. List reasons why the established goal was not met.) One behavioral indicator did not show improvement over time. This indicator is physical aggression. The difficulty of children placed is intense and families are having a very difficult time de-escalating a potentially volatile situation. 2. Develop a plan to meet your goal and overcome obstacles. (must be measurable with target dates) Physical aggression indicator will improve over the next two quarters

Training for SSW will occur on January 30th on identifying behavior in a child that will lead to aggression. The training will also include practical steps. The worker must help the care giver avoid control battles.

In supervision the week after the training, SSW’s will work with the supervisor to identify children who are aggressive or have the potential of becoming aggressive on their case load. A specific intervention plan will be developed in supervision with action steps that will be monitored by the supervisor weekly.

The DSS will assess any incident involving physical aggression by going to the foster home with the worker to make sure interventions and resolution steps identified are appropriate.

3. How are you going to monitor your plan on a weekly basis? (What is your check system to ensure goals are being met?) The DSS will monitor weekly in supervision and after any incident involving physical aggression. 4. If weekly goals are not being met what adjustments need to be made in order to meet the goal?

Performance Improvement Plan

Name of office: Somewhere Warm

Name of program: Foster care

Goal: Q-4 Critical Incident

If you did not meet the Goal, answer the following questions: 1. Why was the goal not met? (Define obstacles. List reasons why the established goal was not met.) The critical incidents are occurring in more than 15% of the population. The children running away and the incidents involving physical aggression are the reason for this occurring. Both have been addressed on other plans. 2. Develop a plan to meet your goal and overcome obstacles. (must be measurable with target dates) Children will not run away from care next quarter:

1. Children who have a history of running will have a safety plan at placement that includes strict supervision and bed checks

2. Placement worker will research the child’s history with the referral agency to identify triggers for this child and to identify if the child is running from the home or from school. This information will be incorporated in the development of the safety plan. If the child is running from school then SSW will meet with the school and incorporate actions they will take to keep the child safe in the initial safety plan.

3. Placement worker will talk with the child to discuss his/her reasons for running and make the child a part of the safety plan development.

4. The safety plan will be monitored weekly in supervision of the SSW and during weekly contact with the family. Adjustments to the plan will be made as needed.

Physical aggression indicator will improve over the next two quarters

Training for SSW will occur on January 30th on identifying behavior in a child that will lead to aggression. The training will also include practical steps. The worker must help the care giver avoid control battles.

In supervision the week after the training, SSW’s will work with the supervisor to identify children who are aggressive or have the potential of becoming aggressive on their case load. A specific intervention plan will be developed in supervision with action steps that will be monitored by the supervisor weekly.

The DSS will assess any incident involving physical aggression by going to the foster home with the worker to make sure interventions and resolution steps identified are appropriate.

3. How are you going to monitor your plan on a weekly basis? (What is your check system to ensure goals are being met?) The DSS will monitor weekly in supervision and after any incident involving physical aggression. Safety plans for children are monitored weekly. 4. If weekly goals are not being met what adjustments need to be made in order to meet the goal?

At the PQI meeting the QI Manager will complete minutes of the meeting according to the document on the next slide.

All present at the meeting are required to sign.

Local Office Team PQI Review (Review of _______________)

(Quarter meeting in conjunction with records review)

Office: __________________________ Date:___________________ Program:_________________________ Stakeholder involvement: I. Review of Previous Meeting Minutes to ensure accuracy: II. Old Business (Document progress of goals from plan for Performance Improvement

Plans.):

III. New Business (attach scorecards for all programs office provides services):

Review of quarterly information on program scorecards. Recommendations Attendees: Name Title Date

State and Regional Team Scorecards

Once the SRT’s review program scorecards, the state/regional director with the Dir. of Program Standards will complete the SRT Scorecard.

Two quarter of the SRT scorecards will be compiled for a semi-annual report to the Advisory Committee.

SRT Summary Score Card

State:__________________________________________________

State Director:___________________________________________

Date of SRT Meeting:_____________________________________

Instructions – To be complete on all offices being reviewed in the previous month.

Office/Program Reviewed

Date of meeting

Performance measure requiring Performance Improvement Plan

Results Last quarter

Results This quarter

Performance Improvement Plan Approved Y/N If not approved, Recommendations

At the PQI meeting the Dir. Of Program Standards will complete minutes of the meeting according to the document on the next slide.

All present at the meeting are required to sign.

“Without change there is no innovation, creativity, or incentive for

improvement. Those who initiate change will have a better opportunity

to manage the change that is inevitable.”

William Pollard