Quality Service Review Overview ~ Improving Results for Children and Families

Quality Service Review (QSR) is part of the Department of Human Services ongoing commitment to improve the quality of our services to children and their families. QSR is a structured process of client interviews and focus group meetings that examine key functions of the child welfare system in an attempt to determine the benefits it provides to children and their families.

QSR focuses on two  areas: the status of the individual child and family related to safety, permanency and well-being; and the quality of system performance in terms of best practice standards and how well the system is meeting the needs of the clients it serves.

Quality Service Reviews involve an intensive examination of a selected number of cases in a County or Cluster. A team of trained professionals review individual case record and conduct a series of in-depth interviews to determine how well the system is performing for a particular child.  The process receives input from the child and family and key persons and service providers involved in the child?s life.  Additionally, QSR invites Community Stakeholders to participate in interviews or focus groups to discuss system performance.  The results of each review are combined into a report that provides information about how well the system is functioning on behalf of children and families and recommendations for local practice development. This information is also used to support learning, practice enhancement and system change.

The QSR process is helping to create the capacity for self-evaluation, and position the Department for the new federal Child and Family Service Review process, which is based on a similar model.  As we move forward QSR, combined with useful, readily available administrative data and a structured case reading process, will provide a mechanism for continuous quality improvement and a spring board for practice development and system change.

Updated:  4/12/06

Introduction

Quality Service Review (QSR) is part of the Department of Human Services ongoing commitment to improve practice and reach better outcomes for children and their families. Since 2000, Iowa has completed weeklong reviews in 15 local areas focusing on over 200 cases.  In 2006, reviews will be held in the Sioux City Service Area in August and in the Cedar Rapids Service Area in October.  

QSR is a structured case review method that provides both a qualitative and quantitative look at child welfare practice.  QSR is used in a number of states to examine key functions of the child welfare system, identify client outcomes and the particular elements of practice that contribute ? or are needed ? to produce positive results.  QSR focuses on two areas: 1) status of the individual child and family related to safety, permanency and well-being; and 2) system performance in terms of best practice standards and how well the system is meeting the needs of the clients it serves. 

The process uses a combination of case record reviews, in-depth personal interviews and focus group meetings to determine how well the system is performing for a particular child.

The QSR process involves an intensive examination of a selected number of cases ? usually 10 to 12 - in a selected area.   For each case reviewed, a team of 2 trained professionals is assigned to read the case record and conduct a series of in-depth interviews with the child and family, service providers and other key persons involved in the life of the identified child. 

Additionally, QSR invites Community Stakeholders and child welfare practice partners to participate focus group meetings focusing on system performance. The results of each review are combined into a report that provides information about how well the system is functioning on behalf of children and families and recommendations for local practice development.  This information is also used at the state level support learning, practice enhancement and as a compliment to Quality Assurance activates.  QSR activities are also part of the CFSR PIP that was approved in August 2004.

Review Sites

Since April 2000, QSRs have been conducted in the following sites: 

Current Projects

Family Team Decision Making Quality Service Review

In December 2004, the Division of Behavioral, Developmental and Protective Services (BDPS) received a grant from the Center for Community Partnership in Child Welfare to study the effectiveness of the implementation of the Family Team Decision Making (FTDM) in daily practice.   The results of this study are included in the final report dated April 6, 2006.

Through this grant, DHS was funded to:

?          Study the effectiveness of the implementation of FTDM

?          Evaluate the effectiveness of meetings in the areas of

o        Family engagement

o        Developing a plan of action

o        Implementing change strategies that assist the family with real change

?          Develop a summary report with recommendations for practice development to ?round out? the FTDM Tool Kit

?          Develop a curriculum for staff related to these findings

The FTDM study was developed in conjunction with statewide implementation of family team meetings and is linked to CFSR PIP strategies for practice improvement and the CPPC roll out.  The study process was conducted in conjunction with research being conducted by a University of Iowa MSW student.   The study involved 30 cases selected from 6 of the 8 Service Areas.  Reviews were conducted using a modified child welfare Protocol focusing on the family team meeting process. 

Lessons learned as a result of this exploratory study along with baseline qualitative information about results and outcomes of family team meetings will be shared with staff and child welfare partners around the state as part of a consistent, learning focused process.  It is anticipated that the project will strengthen connections between evaluation of the outcomes of family team meetings and the desire to insure quality and consistent practice.