6000. ACCOUNTABILITY AND QUALITY ASSURANCE
The Children's Administration (CA) has a system of accountability wherein all levels of the organization have a role in assuring that services are provided to the clients of CA in compliance with policy and statute. The Office of Quality Assurance and Training has primary responsibility for statewide quality assurance reviews and oversight.
All Children's Administration staff are expected to perform in compliance with the CA Case Services Policy Manual, Appendix C, Shared Decision-Making.
CA shall demonstrate continuous quality improvement in services to children and families within legislatively determined parameters. CA Quality Improvement focuses on:
- Data Driven Decisions: Service quality improvements are determined through the use of annual measurements of established regional performance benchmarks. Benchmarks are established in the areas of child safety, permanency, and child and family wellbeing.
- Customer Defined Services: Within legislatively determined parameters, child and family needs determine what services are arranged or provided for by the Children's Administration. Clients are regularly surveyed to measure the accessibility and usefulness of services and the responsiveness and competence of agency staff.
- Quality Management: The success of CA managers is regularly measured against improvements in quality results.
- Employee Involvement: CA engages in an open, inclusive, information-based decision-making process where employees are afforded the opportunity to contribute to decision in areas of expertise. CA delegates decision making as deep into the organization as possible.
Division of Children and Family Services (DCFS) Regional Administrators and Division of Licensed Resources (DLR) Regional Managers work together to provide their respective services in a manner which will best meet client outcomes and serve the best interests of the children and families served by Children's Administration.
- DCFS Regional Administrators establish systems and procedures designed to achieve regional expectations discussed in chapter 2000, section 2310, and to improve client outcomes.
- Regional Administrators are responsible for service delivery, management of regional personnel, implementation of all CA policy, oversight of practice, and compliance with CA manual requirements.
- DCFS Area Managers are expected to review one case per unit supervised per month.
- Area Managers report to the Regional Administrators on a monthly basis regarding the status of the monthly reviews and the quality of the records reviewed.
- The Area Manager meets with each supervisor on a monthly basis to review casework supervision and practice.
- The Area Manager monitors achievement toward CA goals and strategies through tracking benchmarks, regional expectations, or other performance measures.
CA social work supervisors are expected to monitor services and expenditures authorized by their staff.
- Monthly Case Review Consultation
- Supervisors will be available to social workers regularly during the month for case consultation.
- Supervisors will meet with each case-carrying social worker monthly to complete a 100 percent case review consultation. The detail and thoroughness of each case review will vary from case to case as determined by the social worker and the supervisor. All cases will be reviewed to the mutual satisfaction of both the supervisor and the social worker.
- The supervisor documents monthly case reviews. The form of documentation may include:
- Notes on Service Episode Record (SER)/Narrative for the client
- Supervisors discuss case closures with the social workers during the monthly case review consultation. The supervisors use the following case review guidelines for assessing closure:
- Legal action has been terminated.
- All appropriate Social Service Payment System (SSPS) authorizations have been closed.
- The risk to the child is sufficiently low to justify closure.
- Further intervention is not warranted.
- DLR Regional Managers establish systems and procedures designed to improve the health and safety of children in out-of-home care and to monitor and license placement and child care resources in compliance with CA policies and applicable federal and state statutes, and quality assurance as described in this chapter, section 6100.
- The Supervisory staff will schedule a conference with each worker at least once a month.
- The details and thoroughness of each case review will vary from case to case as determined by the social worker and supervisor.
- Supervisors will be available on an as-needed-basis to workers regularly during the month for case consultation on issues of:
- health and safety of children;
- placement; and
- resource decisions.
- Office of Foster Care Licensing (OFCL) Regional Managers establish systems and procedures designed to achieve the implementation of WAC minimum licensing requirements, oversee and conduct group care and family foster home health, and safety reviews in compliance with CA policies and applicable federal and state statutes, and quality assurance as described in this chapter, section 6100.
- The following is a guide for monthly meetings between supervisor and worker:
- Facility Incident Reports:
- Discuss all new and outstanding reports;
- Find out if all CAMIS licensing/incident Report Modules are up to date, and if not, what are the barriers and the plan for addressing the barriers.
- Health & Safety Concerns:
- Is any additional support needed to particular homes?
- Are any additional monitoring calls, visits and/or evaluations needed to determine quality home environment?
- Are there revocations or denials to be reviewed and considered?
- Health and Safety Reviews
- How many Health and Safety reviews have been conducted this month?
- What were the concerns, and did any child report not feeling safe?
- Was there a case in which there was serious professional disagreement, including disagreement by the foster parents(s), regarding:
- risk of death,;
- serious injury;
- out-of-home placement of a child; or
- child's return home as a result of a decision to leave a child in the home or to return the child to the home.
- Licensing/ Re-licensing
- Is there a backlog of applications over 90 days or pending re-licenses?
- Is there a backlog of Criminal History Background and FBI Clearance - average wait for licensing?
- Is there a plan for catching up on any backlog?
- Morale & Training needs
- Are there any problems or other issues of concern?
- Are there plans for employee development?
- . Supervisors will read 100% of files when the home is licensed/re-licensed to review for:
- any health and safety concerns;
- to track both individual worker and unit practice patterns;
- record maintenance and written work.
- Supervisors will read 100% of incident reports to review for risk factors and to track for completeness and closures within a timely manner.
- Supervisors will document monthly case reviews. Forms of documentation may include:
- Pull a CAMIS list of cases & "com tics";
- Case lists in Word with conference notes entered; or
- Notes on Service Episode Record (SER) Narrative for the client; or
- Notes in the worker's file; and
- A log of cases discussed.
- Supervisors must audit, with documentation, a minimum of one case per worker per month for audit compliance in addition to those reviewed for licensing/relicensing.
- The supervisor will retain the audit review instrument in a Supervisor's desk to be used as a method to identify areas of training needs, clarification of policy, and practice issues for the individual workers and for the unit.
- Supervisors are expected to monitor services and expenditures authorized by their staff.
- Regional managers will review three records per month that the first line supervisor has reviewed, in addition to meeting the above requirements for the licensors they directly supervise.
- The CPS Facility Investigation Section Manager establishes systems and procedures designed to implement facility investigations in accordance with the standards outlined in chapter 5000, section 5300, of this manual.
- Supervisors review 100% of case closures and transfers.
- Supervisors will complete a case file audit of at least one open case per month per worker.
- Under the direction of the division director, program and policy development, managers assist field staff in the coordination and monitoring of programs for compliance with statutes, regulations, and policies to maintain program integrity and evaluate program effectiveness.
- Program and policy development managers monitor headquarters-based contracts for compliance and participate in quality assurance activities in conjunction with field staff and the Division of Management Services.
- Office of Quality Assurance and Training (OQAT) managers monitor service delivery to improve the quality of DCFS and DLR programs and support compliance with law and policy. OQAT provides technical assistance to field and program managers when developing systems for internal improvements in social work practice or for internal evaluation.
- OQAT develops tools to evaluate casework and to identify practice improvements that increase statewide consistency and reliability in the achievement of child welfare outcomes. OQAT develops and implements systematic reviews of child welfare cases and improves the use of data management in the assessment of performance. OQAT provides technical assistance on specific practice issues and cases, conducts program reviews, and identifies child welfare "best practices."
Under the direction of the division director, Management Services staff coordinates statewide contract and accountability functions to support field and headquarters operations in conjunction with the Divisions of Program and Policy Development, Licensed Resources, and Children and Family Services.
- Operations Support managers develop and implement data collection, data reporting, and accountability mechanisms including regional performance expectations, quarterly reporting systems, and client-based outcome measures. The managers provide feedback to regions regarding their performance.
- Operations Support works with the Division of Program and Policy Development, DLR, and the Office of Children's Administration Research (OCAR) to plan and implement policies, procedures, and systems that achieve CA program implementation in compliance with policies, applicable federal and state statutes, and quality assurance, as described in this chapter, section 6100.
- The Office of Children's Administration Research (OCAR) conducts research, implements surveys, and provides data collection and evaluation in support of CA quality improvement activities.
- OCAR works with the Division of Program and Policy Development, DLR, and Operations Support to develop policies, procedures, and systems that achieve CA program implementation in compliance with policies, applicable federal and state statutes, and quality assurance, as described in this chapter, section 6100.
The CA Assistant Secretary conducts reviews quarterly in each region, reviewing the performance of the regions on established performance measures and regional expectations. Regional Administrators and Regional Managers shall report required information using the designated format.
OQAT reviews programs at the request of Area Managers, Regional Administrators, Division Directors, and the Assistant Secretary. OQAT may provide technical assistance, upon request, to regions in completing their own program reviews.
- An analysis of strengths and weaknesses of the program;
- Implications to statewide structure, services, or training needs;
- An evaluation of performance on client-based outcome measures concerning child safety, permanency planning, and child and family health and well-being; and
- Recommendations for practice and management improvements in areas identified as problematic.
Regional Administrators shall establish a system of regular performance review for major program areas such as Child Protective Services, Child Welfare Services, and Family Reconciliation Services. Each region shall have a biennial review plan that is updated annually. Program reviews shall be conducted on a schedule to be determined by the Assistant Secretary or Regional Administrator. Program reviews shall be conducted by a team of knowledgeable staff and community representatives, and shall include:
- An analysis of strengths and weaknesses of the program;
- An evaluation of performance on client-based outcome measures concerning child safety, permanency planning, and child and family health and well-being;
- Recommendations for practice and management improvements in areas identified as problematic; and
- Quarterly reporting on implementation of recommendations until completed.
- The Director, DLR, shall regularly review the performance of division operations, including an evaluation of progress on strategic planning goals, objectives, and strategies and client-based performance measures utilized in bench-marking and CA performance reports.
- The Director shall establish a system of regular performance review for major program areas such as Foster Care Licensing, Child Day Care Licensing, and Child Abuse and Neglect Investigations. Each office/section shall have a biennial plan which is updated annually. The reviews will be conducted consistent with the requirements for DCFS in section 6330, above.
Operations Support maintains a system for the quarterly collection and reporting of data on performance measures related to program operations, client-outcomes, and policy compliance as directed by the Assistant Secretary, who reviews regional performance information with each regional management team during quarterly reviews.
- Benchmarking is the process of continuously comparing one's own performance against the best. The Divisions of Program and Policy Development, Management Services, and Licensed Resources collaborated on the identification of permanency planning, child safety, and child and family health and well-being performance measures for CA bench-marking.
- Regional Administrators and Managers are responsible for establishing and progressing towards performance targets on bench-marked measures at the regional, area, and office level.
Operations Support is responsible for collecting and reporting progress on client-based child safety, child and family health and well-being, and permanency planning outcome measures associated with the CA budget.
- The Criminal History Record Inquiry (CHRI) Unit is subject to a Washington State Patrol (WSP) system audit every two years.
- While previous audits have been limited to the CHRI Unit's terminal site at headquarters, the audit may include field offices, licensers, social workers, etc.
- The Federal Bureau of Investigation (FBI) may, at its discretion, audit the CHRI Unit.
- The DSHS Management Services Administration's Operations Review and Consultation Services section is available, upon request by the Assistant Secretary, to conduct special audits of and consultations on Administration operations as well of Administration contractors.
- Audits and consultations may include assessment of program performance as well as fiscal management, as requested by the Administration. Directors, Regional Administrators, and Office Chiefs present requests for these services, through the Director of Management Services, to the Operations Review and Consultation Services section.
CA has identified the importance of continuously improving services, outcomes, and resource management for its clients, customers, and citizens.
- Executive Order 97-03 requires every state agency to develop and implement a program to improve the quality, efficiency, and effectiveness of the public services it provides through quality improvement, business process redesign, employee involvement, and other quality improvement techniques.
- Agencies are required to use the tools of strategic business planning and performance measurement to establish their priorities and measure their progress toward their stated goals. Each agency must develop performance measures to assess customer satisfaction, progress toward accomplishing outcomes specified in agency budgets per RCW 43.88.090 and necessary to provide feedback on the impact of quality improvement, employee involvement, and management improvement initiatives.
- Executive Order 97-03 requires every agency to have a steering committee comprised of appropriate senior management, mid-management, front line staff, and support staff organizations.
- DSHS has established one agency-wide Quality Leadership Council chaired by the DSHS Secretary and Deputy Secretary. Each DSHS administration has established a Quality Steering Committee.
- The CA Quality Steering Committee (QSC) complies with Executive Order 97-03, including representatives of the employees' union. The QSC includes management, front line, and support staff. The Federation of State Employees appoints the participants from classes included in the bargaining unit.
- The purpose of the QSC is to work in partnership with the regions, headquarters, quality improvement teams, employees, providers, suppliers, and the community. The QSC providers support for implementation of continuous improvement consistent with CA's mission to protect and serve children. To this end, the QSC develops and implements infrastructure, projects, and processes which:
- Ensure awareness and communication of philosophies, strategies, information, and results related to the improvement initiatives at all levels;
- Provide tools, expertise, resources, and training to support the pursuit of innovative improvement initiatives;
- Provide recognition and reward for individuals, teams, and regions that achieve results;
- Recognize and respect diversity;
- Mentor, motivate, encourage, and empower people who pursue, support, and demonstrate continuous improvement;
- Focus on implementation for results while fostering innovation;
- Eliminate barriers to empowerment and staff/management partnership;
- Promote cross-functional and statewide performance improvement; and
- Minimize oversight and non-productive interference with delivery processes.
- Members of the CA Quality Assurance Steering Committee may sponsor, lead, or facilitate Quality Improvement Teams. Teams are expected to have a firm commitment to quality improvement and a willingness to participate in finding new ways of doing things. Team members are required to receive training in quality improvement processes.
- Every Quality Assurance Team will establish a charter that documents ground rules and clarifies roles and responsibilities. The major elements of the charter are:
- Team structure and operation;
- What teams can work on;
- What teams cannot work on;
- Support structure roles; and
- Expectations for specific groups (managers, supervisors, employees).