Using Outcome Measurement to Promote Continuous Quality Improvement for Children in Foster Care

Abstract

Continuous Quality Improvement is the term used to measure progress toward achieving safety, permanency, and well-being for children in foster care. This report highlights the results of a 2014 survey conducted by the National Resource Center on Legal and Judicial Issues asking states to identify how they are using performance measures to improve the lives of children in care, which measures are being used, whether the newly-created well-being measures are being integrated into the original set of court performance measures, and how performance measures are being used to support Continuous Quality Improvement. Although there is much more to do, the number of performance measures being used, the number of states sharing data between courts and child welfare agencies, and the number of documented examples of improvement in lives of abuse and neglected children are all encouraging signs. "Continuous quality improvement is the complete process of identifying, describing, and analyzing strengths and problems and then testing, implementing, learning from, and revising solutions." U.S. Department of Health and Human Services, Children's BureauThe Continuous Quality Improvement (CQI) process begins with identifying specific desired outcomes. In child welfare, those desired outcomes of safety, permanency, and well-being of every child in foster care were enshrined in the Adoption and Safe Families Act of 1997. But how is progress towards goal achievement measured? Outcome

Continuous Quality Improvement Processes in Child Protection: A Systematic Literature Review

“…One further study highlighted the importance of case data collection, progress reporting, and data management strategies (Antle et al, 2012). Data sharing between courts was an indicator of improved practice in aspects of child protection decision making, in the study reported by Flango et al (2015).…”

“…It is a process that focuses on the systematic collection and review of performance data "…that allows an agency to monitor, understand, and improve, on an ongoing basis, all aspects of service delivery and documentation" (Baker & Charvat, 2008, p. 336). Performance measurement and statistical evaluation are important tools of CQI systems, concentrating the organisational focus on implementing strategies, testing outcomes, learning from results and revising solutions (Flango, Gatowski & Sydow, 2015). Successful CQI implementation relies on an organisational philosophy and culture that supports continuous learning and is committed to the proactive, ongoing improvement of the organisation and the services it delivers.…”

“…All the studies (n=8) stated that the aim of applying CQI measures was to improve organisational processes and six also described the establishment of measures to determine this improvement (Antle, Christensen, van Zyl & Barbee, 2012;Cash et al, 2012;Flango et al, 2015;Lambert, Richards & Merrill, 2015;Lawrence, Rosanbaum & Dodge, 2011;van Zyl et al, 2014). Collaborative team work in identifying issues and applying CQI processes (a core feature of Shortell et al's definition) was highlighted as a feature in six (Antle et al, 2012;Flango et al, 2015;Glisson et al, 2006;Holden et al, 2010;Lambert et al, 2015;Lawrence et al, 2011) and a focus on key stakeholders and their involvement was clearly identified by three of the eight papers, namely Cash et al (2012), Holden et al (2010) and Lawrence et al (2011). However, while the articles claimed to have applied CQI strategies, very few (n=3) explicitly described the methodology of applying these strategies to…”

“…Glisson et al, 2006;Lawrence et al, 2011). Consistently applying CQI processes was found to contribute to the identification of training needs and to the dissemination of resources to where they were most needed in two studies (Flango et al, 2015;Lawrence et al, 2011). Three studies identified that specific training enhanced the commitment of staff to program fidelity thus contributing to improved outcomes for children and families (Glisson et al, 2006;Holden et al, 2010;Lambert et al, 2015).…”

“…Van Zyl et al (2014), moreover, highlighted that working with the nuclear family was not enough; engagement needed to include the extended family. Additionally, community stakeholder involvement was found to be crucial in the implementation and design of child protection intervention programs in six of the eight studies (Cash et al, 2012;Flango et al, 2015;Glisson et al, 2006;Lambert et al, 2015;Lawrence et al, 2011;van Zyl et al, 2014).…”