quality standards for group care · 2017-09-06 · quality standards for group care shamra...
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QualityStandardsforGroupCare
ShamraBoel-Studt,Ph.D.,MSW,FloridaStateUniversityCollegeofSocialWorkKenBender,MS,BoysTownXiomaraTurner,MSW,FloridaDepartmentofChildrenandFamiliesHuiHuang,Ph.D.,MSW,FloridaInternationalUniversitySchoolofSocialWork
ChildProtectionSummitAugust31,2017
FocusingonQualityinResidentialCare
QualityResidentialCareisNeededQualityMatters– “Allresidentialprogramsarenotcreated,ormanagedequally.Theresultscorrespond”(Barth,2005).Qualityisacombinationof:
• Structure• Processes• Experiences• Outcomes
Sowhatisqualityresidentialcare?
HighQualityResidentialCareReviewofconsensusforresidentialperformancestandards
• Serviceplanning• Safe,abusefreeenvironment• Maintainpositivepeergroupculture• Familyandculture• Leastrestrictiveenvironment• Programelements• Education,skills,&outcomes• Aftercare
QualityResidentialGroupCareinFlorida
MovingfromTheorytoPractice• Late2015,strongpushinFloridatoeliminategroupcare
programs• BoysTownandotherlike-model,qualityproviderswere
abletochangetheconversationfromeliminating groupcaretoquality groupcare
• Abletochangefocusby– Creatingpositivemediacoverage– PersuadingpolicymakersattheFloridaDepartmentofChildrenandFamilies(DCF)
– InfluencingtheFloridastatelegislature 6
Howwedidit,andactionstaken…• Leveragedexistingallianceswithlike-mindedproviders• FloridaCoalitionforChildren(FCC;provideradvocacy
group)ResidentialCommitteeChair• UsedFCCChairpositontodeliverandempower
statewidegrouphomeprovidersonmessaging• Developedmaterialsandmessaging– Outcomesincommon(onepager)– WhyQualityResidentialCareisGoodforAmerica’sAt-RiskKids:ABoysTownInitiative
Howwedidit,andactionstaken• MetwithDCFleadership
– Sharedconcernwithqualityhomes,resultinginaworkgrouptodevelopqualitystandards(changedtheconversation)
– ChairedtheGroupCareQualityStandardsWorkgroup– Educatedoncommunityinvestment(donors,boardmembers,localbusiness)
• 3agencieswroteopeds andmetwitheditorialboardsinourareas,had6articlespublished
• Metwithreporterwritingnegativearticlesoutofthecapital,tourof2ofthegrouphomeprovidersfacilities
• Metwithlegislatorsandstartedthediscussiononquality:educatingthemondifferentiators,modelsofcare,andcomparisonstofostercare
Whatmadethedifference?• Outcomesandonepager
− Helpedwitheducation/Notmuchinfluenceonthelegislators/Hadimpactonpolicymakers(legislativestaff)andDCFstaff
• Mediacoverage− Impactonlegislators,communitydonors(FCCConferenceLegislator
Panel)• Unifiedmessage
− Impactonlegislators,policymakers,detractors• Developmentofthestandards
− Impactonpolicymakers,legislators,detractors,providers
DevelopmentofCareQualityStandardsforResidentialGroupCareinFlorida
Purpose• TheGroupCareQualityStandardsWorkgroupwasestablishedbythe
DepartmentofChildrenandFamiliesandtheFloridaCoalitionforChildrentodevelopasetofqualitystandardsforDepartmentlicensedresidentialgrouphomes.
Responsibilities• Analyzeresearchsurroundingqualitystandardsforresidentialgroup
caresettings.• Establishasetofcorequalitystandardscommontoresidentialcare
settings.
CoreQualityStandardsforGroupCareEightQualityDomains• Assessment,Admission,&ServicePlanning• Positive,SafeLivingEnvironment• Monitor&ReportProblems• Family,Culture,&Spirituality• Professional&CompetentStaff• ProgramElements• Education,Skills,&PositiveOutcomes• Pre-Discharge/Post-DischargeProcessesLinktoQualityStandardsforGroupCareBooklet:http://www.dcf.state.fl.us/programs/foster-care/group-care/docs/1507-255%20Quality%20Standards%20for%20Residential%20Group%20Care%20Booklet.pdf
Wherewearenow…• Standardscompletedandaccepted• 2016legislativesessionlanguage,billkilledlastdayofsession.
• 2017legislativesession,languagewrittenandsignedintostatute- HB1121lines2036– 2100.
• Dissentionandoppositionnowthatitisstatute
MeasuringQualityinFlorida’sResidentialGroupHomes
GroupCareQualityStandardsAssessmentPurpose• TheFloridaDepartmentofChildrenandFamiliesengagedtheFlorida
InstituteforChildWelfaretodevelopandvalidateanassessmenttooltomeasure,document,andfacilitatequalityservicesinFlorida’sDCFlicensedgrouphomes
Objectives• Designandvalidateanassessmenttomeasurethecorequality
standardsasdefinedbytheGroupCareQualityStandardsWorkgroup• Developsystemforimplementingtheassessmentaspartof
Department’sre-licensureprocess
ProjectTimeline
Project Handoff from DCF to FICW
December 2015
Draft Scale & Implementation
ProtocolJanuary 2016 –
August 2016
Test PilotNovember 2016-
January 2017
Field TestFebruary-July 2017
Data Analysis/Finalization
of ToolJuly-September 2017
Statewide Roll-OutDecember 2017
Year One ValidationJanuary 2018-March
2019
Year Two ValidationJanuary 2019-March
2020
ProjectTeamCollaborationiskey!• FloridaInstituteforChildWelfare• FloridaDepartmentofChildrenandFamilies• GroupCareQualityStandardsWorkgroup• FloridaCoalitionforChildrenResidentialCommittee• BoysTownNationalResearchInstitute• Formerfosteryouth• Childadvocates• Childwelfarescholars• Community-basedcareagencies
DevelopmentoftheQualityAssessmentGuidelines• Flexible/allowsindividualizedapproaches• Equitable• Informedbymultiplekeystakeholders• Complementsandexpandsuponlicensingcriteria/
integratedintolicensingprocess• Reliable/validmeasure(psychometrics)• Implementationscience/Developmentalevaluation
frameworks
StepsinDevelopment1. Distill&operationalizestandards(Nov.– Feb.)2. Crosswalkstandardswithstatelicensingcode(Feb.– March)3. Selectionofprioritystandards(survey)(April– May)4. Draftofassessmenttool(June)5. Developimplementationplan(July)6. Contentvalidationreview(July)7. Finalizepilotassessmenttool(Aug.)8. ApprovalfromDCFLeadership
Consult
ReviewRevise
AssessmentToolOverviewMulti-dimensional• Subscalesmeasureeightpracticedomains;Itemsmeasurestandardswithineach
domainsThreetypesofItems• Structural– Measuresinfrastructureofcaresetting(e.g.,staffing,policies,resources)
– E.g.,Theprogramhaspoliciesandproceduresforsupervisingyouthandrespondingwhenayouth’sactionsthreatenthesafetyofother.
• Process– Measuresextenttowhichprovidersconsistentlyprovideservicesthatfollowrecommendedguidelines– E.g.,Acomprehensiveassessment(includingpre-admissionandfollow-up
assessmentsasneeded)arecompletedforallyouthwithin30daysofadmission.• Experiential – Measuresexperiencesofconsumersandproviderswiththecaresetting
– E.g.,Igetalothelpfromstaff.
AssessmentToolOverview
Triangulationofdatasources• Self-report,documentreview,observation,&interviews• Multi-informant– ServiceProviders– Youth– LicensingSpecialists
Time-oriented- Assessmentofpracticesandconditionsingrouphomewithinpast12monthsOn-line– Qualtrics
PilotStudyPurpose- EvaluatefeasibilityofimplementationplanandperformpreliminarypsychometricanalysesofqualitymeasureSample/Setting – 10grouphomes,oneserviceregion• 94assessmentformscompleted
– 56serviceproviders,27youth,11licensingspecialists– Responserates- 100%directors,directcareworkers,licensing,casemanagers&youth;70%placementspecialists
ImplementationData• Weekly/biweeklytriagecallswithlicensingteams• Post-pilotdebriefingwithallparticipants
ReliabilityofSelf-ReportForms
Note.Alpha>.70=Acceptable;SEM=StandardErrorofMeasurement
LessonsLearned– Whatwentwell?• Participantsupportforassessment&willingnesstoengage
inprocess• Feasible/manageabletocomplete• Itemsgenerallyviewedasrelevant;easytocomprehend• Reliabilityacrossmostsubscalesoftheyouthandprovider
formswereacceptable- excellentrange• Preliminaryfindingssupportfeasibilityofimplementing
qualityassessmentwithinstatelicensingsystem;Establishpromisingfoundationforassessmentandinsighttoguidenextphaseofdevelopment
LessonsLearned–Whatchallengeswereencountered?
FieldTestPurpose: Evaluateassessmentintworegionsusinglargersample;Collectdatatofurtherdevelopassessment,implementationprocedures,andstatewidetrainingTimeline:March- July2017Sample/Setting– 34grouphomes• NER=19(55.9%),CR=15(44.1%);Grouphomes=28,Shelters=6Completedassessmentforms=299• 34licensing,115groupcareproviders,72casemanager/placement,78
youthTriagecalls– NER=3;CR=3Sitevisits– ConductedinMay(NER)andJune(CR)
FieldTest- PreliminaryResultsEmergingthemesthatwereconsistentwithtestpilot:• Support/willingnesstoparticipate• Fewissueswithimplementation• Mostrespondentscompletedformsuponrequest• Needforadditionalguidanceonsampling– who
shouldbecompletingforms?– Issueswithproviderscompletingmultipleformsfordifferent
homesthatarepartofsameprogram
FieldTest– PreliminaryResultsNeedtodefinesometermsandprovideadditionalguidanceonhowtorate• 6.1.Levelofcareismatchedtoyouths’needswithasfew
restrictionsaspossible• 1.4.Youthareinvolvedintheadmissions processViewsonfeasibilityofcertainstandards• Familyinvolvement
‒ 1.5.Familiesareinvolvedincreatingserviceplans• 8.7.Theprogramfollows-upwithyouthandtheircaregivers
tomonitorpost-dischargeoutcomes.
FieldTest– PreliminaryResults
Differencesinpracticesofgrouphomesacrossregions-sometimesrelatedtorequirementsofleadagencies• 3.6.Theprogramusessurveystoassessconsumersatisfaction• 6.18.Staffworkwithapsychiatristtomanageyouth
medicationsDifferencesinapplicabilityofsomestandardsforemergencyshelters• 1.12.Serviceplansincludeclearlydefined,measureablegoals.• 7.1.Theprogramensuresyouthreceiveon-goingeducational
assessmentstodeterminetheireducationalneeds
FieldTest– PreliminaryResults
Topicstospendmoretimeonduringtraining:‒ Trauma-informedcare‒ Evidence-basedpractice‒ Guidance/providingmoreexamplesofhowtorateitems
• Offerweb-basedtraining
FieldTest• Additionalanalysesinprogress– participantfeedback,
reliability,andvalidity• Preliminaryresultsprovideguidanceon:
‒ Itemrevisions‒ Adjustmentstosampling‒ Training
• Supportrelevancy/applicabilityofmajorityofstandardstoqualitygroupcarepracticeandembeddingassessmentintoDCFrelicensing
GroupCareQualityAssessmentTool–Demonstration
NextStepsPre-ImplementationActivities(July– October2017)• Dataanalysis– refinetoolandassessmentprocess• Developstatetrainingandtechnicalsupportprotocol• Finalizeplansforstatewideroll-out&validationstudyStatewideRoll-out(December2017)• Orientation,training,andon-goingtechnicalsupportacrossallsixregionsFirstYearAssessmentToolValidation(January2018– March2019)• FullyearofdatacollectionusingassessmentdatafromallDepartment
licensedgrouphomesthroughoutthestateConveneWorkgroup/AdvisoryBoard(October2017)• Developqualityaccountabilitysystem
ResourcesBoysTownAdvocacyExternalResourceDocument
Thompson,R.W.,Huefner,J.C.,Daly,D.L.,&Davis,J.L.(2014).WhyisQualityResidentialCareGoodforAmerica’sAt-RiskKids:ABoysTownInitiative.BoysTown,NE:FatherFlanagan’sBoys’Home(http://www.boystown.org/documents/quality-care/why-quality-care.pdf)
FloridaInstituteforChildWelfareQualityStandardsforResidentialGroupCareProjectBriefsandReports(http://ficw.fsu.edu/technical-assistance-training)Boel-Studt,S.M.(2015).ImprovingtheQualityofResidentialGroupCare:AReviewofCurrentTrends,EmpiricalEvidence,andRecommendations.TechnicalReport.FloridaInstituteforChildWelfare(http://ficw.fsu.edu/sites/g/files/imported/storage/original/application/d274e89564cd47d4b98ee14f68817127.pdf)
ContactInformationShamra Boel-Studt, PhD, MSWFlorida State University & Affiliate Of the Florida Institute for Child [email protected]
Xiomara Turner, MSWFlorida Department of Children and Families [email protected]
Ken Bender, MS Boys [email protected]
Hui Huang, PhD, MSWFlorida International University & Affiliate of the Florida Institute for Child [email protected]
Thankyouforyourparticipation!