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Vol. 27, No. 2
July 2024
Regional Meetings Support CQI Implementation
According to the Child Welfare Information Gateway, "continuous quality improvement (CQI) systems areframeworks for defining and examining strengths and problems and then testing, improving, and learning from solutions on an ongoing basis".
Although North Carolina has been focusing on CQI for years, understanding how CQI applies to day-to-day work has remained challenging for many. The bottom line is we all want to improve outcomes for children and families in the child welfare system. Implementing CQI is a way to do this effectively.
While most agencies are engaging in CQI in some way, Goal 4 of North Carolina's CFSP ("implement continuous quality improvement") is aimed at universal implementation at all levels - workers, supervisors, agencies, regions, and the state. Structures are already in place to accomplish this goal, including a Statewide CQI Lead, Holly McNeill. Over the last two years, Holly has worked to establish quarterly regional CQI meetings to build CQI capacity in all regions and improve practice.
Regional CQI meetings began in October 2022 and are held in each region once a quarter. Meetings are led by Holly and supported by the regional child welfare specialists. The initial goals of these meetings were to encourage a regional identity, educate county staff on the CQI cycle, and establish a baseline understanding about using data, including what data is available, how to access it, and how to use it and disseminate it to support practice improvement.
Holly feels these initial goals have been met and that she has seen a change over time in how counties are using meetings effectively. "Teams who attend the regional CQI meetings no longer see CQI as an event, but as a process that they are engaged in all the time," Holly says. Her hope is that when teams leave these meetings they talk to leadership, staff, and community partners about what they have learned and take at least one step to implement changes that will lead to improvement.
What happens during a regional CQI meeting?
Each county is responsible for sending a team ready to discuss the identified topic for the quarter. The topic is chosen based on statewide data, issues related to the CFSP goals, and priorities for where the state needs to improve outcomes. Since starting regional meetings, teams have addressed repeat maltreatment, placement stability, quality visits, domestic violence, assessment of safety and risk, kinship placement, and DEIA (diversity, equity, inclusion, and accessibility).
Counties bring data that reflects how they are performing in each identified area. They review it before the meeting to identify the root causes of a problem, discuss possible solutions, and create an action plan for implementing change. Counties learn from each other's experiences, share ideas and strategies, and develop a support network for future resources.
What are some highlights from the meetings so far?
Holly says, "First of all, I think post-COVID, there was a real need for counties to talk to each other again and open lines of communication. It has been great to see counties learning to use each other as resources and be creative about working together."
Another success has been around data quality. "We have done a good job helping counties see where data errors come from. We have seen an impact on the quality of data we are getting now, especially in placement stability." In addition, Holly thinks there has been an increase in comfort with data in general. "Teams have a better understanding of data as a tool and are more willing to look honestly at data in order to understand the problem and make changes."
In addition, Holly was encouraged when community partners attended quarterly CQI meetings. "When we addressed domestic violence, community partners came and had valuable discussions with county staff about how to support families in their region. It really showed how we must work together to solve complex issues families face."
Where do we go from here?
Counties typically send CQI or quality assurance staff and supervisors to regional meetings. In some cases, program managers and administrators also attend. While this is a good start, it keeps CQI at the upper levels of agency awareness. Holly believes that "CQI needs to be all-inclusive and not just top-down." To bring CQI to all levels, Holly would like more individuals with lived experience, community partners, and line staff to attend. "If we are going to address complex problems, we need to have a diverse set of views on the root cause as well as creative ideas for problem-solving."
Holly hopes line staff will become more involved in the CQI process. There are many ways to bring the CQI model to the work we do every day. Supervisors can use CQI when looking at documentation issues, staffing, and personnel needs. Workers can use CQI when looking at their caseloads or even on one case. Holly says supervisors can encourage workers to review their data: "How often are you seeing kids? How often are you seeing families? Are we doing what we set out to do?" Looking at data more often would help workers see the root causes of ongoing challenges and find better solutions.
If you are interested in learning more about CQI or attending regional meetings, talk to your supervisor, program manager, or CQI staff to find out about the next scheduled meeting.
For those planning to attend regional CQI meetings, Holly says it is important to prepare in advance. "Look at data and know what is going on in your county that is relevant to the topic, but most importantly come prepared to take action and create a plan to move forward."
Key Questions to Guide the CQI Process
Collect: Identify the problem
- What is the problem I want to solve?
- What factors contribute to this problem?
- What is the root cause?
Create: Research/decide on my solution
- What have we tried? What strategies have been shown to make a difference?
- Will it meet the needs of our target population?
- Will it fit with our agency?
- Do we have the capacity to implement it?
Change: Implement/try my solution
- How will I put the solution into practice?
- What will help me make sure the new practice is used correctly?
- What are some common challenges when trying new practices?
Check: Evaluate my solution
- How will I know if my solution is working?
- What should I do if nothing is improving?
- What are the next steps if things are working?