for Organizational Improvement
A service of the Children's Bureau, US Department of Health and Human Services
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Developing and piloting qualitative case review systems (Winter, 2003)
I am writing from a rural county in northern Minnesota where I have been working with the Minnesota Department of Human Services' External Review team. These committed state reviewers have traveled throughout Minnesota since 1998 to conduct county child welfare reviews, and the current process combines extensive case file reviews with staff and stakeholder interviews. However, this week we are using the federal Child and Family Services Review (CFSR) process and instruments to experiment with a more qualitative and outcome-focused approach to reviewing child welfare cases. Each team of state and county or tribal staff reviews two case files extensively and then interviews some of the key people involved in each case, including social workers, parents, children, foster parents and other key providers.
As a result of an increased focus on outcomes and the implementation of the CFSR process in the past few years, a number of states and counties have begun to explore or implement qualitative case reviews. My recent experience in Minnesota and other states highlights a range of key issues QA staff should consider in developing and piloting qualitative case review systems:
- Consider using the CFSR instruments and process as the foundation for your first pilot review, and then modify them based on the needs of your state.
- Explain the goals of the pilot process clearly to the local office/county that will be reviewed and set realistic expectations for results (e.g., format and timeliness of final report).
- Include state QA and other staff, staff from other counties or local areas, and external stakeholders on the review team.
- Designate a lead person from the county who will take responsibility for critical logistics such as scheduling and sequencing interviews with key case participants.
- Randomly select cases for review and oversample initially since many cases may not be included once local staff check the specifics and attempt to set up interviews with key case participants.
- Designate a site leader who will train the review team, conduct entrance and exit conferences, and lead daily case debriefings as teams complete case reviews.
- Provide training to all membersof the review team on the process and instruments before the review.
- Include county data illustrating performance on national standards and any additional state standards that may apply in the review process.
- Provide avenues for county and stakeholder input through a county self-assessment before the review and/or interviews with key county staff and external stakeholders during the review.
- Conduct an entrance conference to orient local staff and review team.
- Conduct an exit conference to provide immediate feedback to local staff and stakeholders at the conclusion of the review.
- Revise the review process and instruments based on pilot.
While these points summarize some broad issues, the Resource Center has developed and collected more detailed information and examples that would help any state, county or other organization develop and pilot a qualitative review process similar to the CFSR. Please get in touch anytime by telephone or email if you have questions or need more information.
Peter Watson
207-228-8330
Other QI Corner Topics:
The Critical Role of Stakeholders
in Continuous Quality Improvement (CQI) (Fall, 2005)
Quality Improvement T/TA Planned for 2005
(Spring 2005)
Use Your PIP to Help Transform
QA to QI (Winter, 2004)
Child Welfare Leadership and Quality Assurance
(Spring, 2003)
