Training Matters


Vol. 14, No. 1 • October 2012

In Pursuit of Better Outcomes: Putting CQI in North Carolina's Child Welfare Toolbox

In recent years, the federal Children’s Bureau and many practitioners have embraced the concept of using outcome measurement to help child welfare agencies make a difference in families’ lives.

At the same time, there has been a growing awareness that in order to help families in the most effective and sustainable way, we need to apply strategies and tools that have not always been seen as part of the traditional social work toolbox.

Continuous Quality Improvement is one of the most important of these “non-traditional” social work tools.

What is it?
CQI, simply put, is “an ongoing process by which an agency makes decisions and evaluates its progress” (Watson, 2005).

In an outcomes-focused agency, staff and community partners use a standard model to analyze data, develop goals and action steps, and track progress. The figure below depicts the 4-step CQI process model North Carolina has adopted.

North Carolina's CQI Model

REAP (Reaching for Accountability and Excellence in Practice) is our state’s model for creating an achievement-focused child welfare system. REAP includes a CQI approach done in partnership with DSS staff, community partners, and the families receiving services.

Quick Profile of REAP

Mission: Create achievement-focused child welfare culture that includes . . .

  • Sharing accountability for reaching core achievements
  • A data-driven, results-oriented CQI approach
  • Engaging partners to assess community’s needs and build on its strengths
  • Continuously improving achievements using best practices, technical assistance, and training

Current REAP Pilot Counties: Craven, Cumberland, Hoke, Pender, Pitt, Scot-land, Union, Wilson

Key Components

  • Focus on a set of core child welfare achievements (outcomes)
  • Counties track progress on outcomes using monthly data report
  • County Self-Assessment: A new approach to the biannual review
  • County Achievement Plan: Developed with community partners; includes actions steps to improve selected outcomes
  • Division of Social Services provides technical assistance and support based on county achievements and self-assessment

Focus on Implementation
Moving an entire system towards a new approach takes time and a clear focus on supporting change. REAP has looked to the field of implementation science for guidance. Implementation is defined as a specified set of activities designed to put into practice an activity or program of known dimensions (NIRN, 2012).

Years of research tell us that there are specific implementation drivers that determine whether a new model will be successfully adopted and make a difference in agency outcomes (Fixsen et al., 2009). Staff training and supervision, leadership, and effective community partnerships are all implementation drivers.

Promoting a “Learning Culture” in Pilot Counties
The NC Division of Social Services offers REAP pilot counties an array of training opportunities. The trainings are designed to bolster an agency’s capacity to assess and build implementation drivers at the local level.

For example, agency leadership and culture are critical factors in successful change efforts. In particular, agencies with a “learning culture” are most likely to be successful in implementing new approaches. A learning culture is one which values curiosity and critical thinking, and which empowers all staff—management to front-line workers—to be leaders and innovators.

Implementation science also tells us that to improve outcomes, front-line staff must develop new skills and approaches (Fixsen et al., 2009). That’s why supervisors are a key intervention point for CQI efforts—they’re the ones responsible for continually assessing and developing workers’ skills.

To support supervisors and REAP implementation, in pilot counties North Carolina is focusing on building coaching skills and other supervisory competencies.

CQI and the CFSR
The Children’s Bureau sees CQI as a critical component for each state’s child welfare system. According to a recent Information Memorandum, the next round of Child and Family Services Reviews is likely to include an assessment of each state’s CQI system.

Fortunately, because of REAP, North Carolina is well positioned to show progress in this area. With training and support from federal, state, and county resources, even data-shy child welfare practitioners can add CQI to their toolkit for helping families.

Fixsen, D. L., et al. (2009). Core implementation components. Research on Social Work Practice, 19(5), 531-540.

National Implementation Research Network. (2012). Implementation defined. Chapel Hill, NC: FPG Child Development Institute, UNC-CH.

Watson, P. (2005). Using CQI to improve child welfare practice: A framework for implementation. Portland, ME: Casey Family Programs and NCROI.

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