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Library: Policy

340:75-18-1. Purpose of Continuous Quality Improvement

Revised 7-1-13

     The Continuous Quality Improvement (CQI) program and activities assist and promote the development of program excellence for the safety, permanence, and well-being of children and families served by Oklahoma Department of Human Services (OKDHS).

  • (1) Assessing and ensuring contractor compliance.  OKDHS conducts performance reviews of providers of child welfare (CW) services by implementing the terms and requirements of the provider's contract with OKDHS and assessing the contractor's performance on an annual basis.  The providers assessed include:

    • (A) therapeutic foster care;

    • (B) psychiatric acute and residential treatment centers;

    • (C) group homes;

    • (D) specialized community homes;

    • (E) residential maternity and infant homes; and

    • (F) intensive treatment services.

  • (2) Evaluating achievement of outcomes for children and families.  An annual Child and Family Services Review (CFSR) is conducted by the CQI program to review the performance of each OKDHS human services center.  • 1

    • (A) Desired outcomes include:

      • (i) children are first and foremost protected from abuse and neglect;

      • (ii) children are safely maintained in their own homes, when possible and appropriate;

      • (iii) children have permanency and stability in their living situations;

      • (iv) continuity of family relationships and connections is preserved for children;

      • (v) the person responsible for the child (PRFC) has enhanced capacity to provide for their children's needs;

      • (vi) children receive appropriate services to meet their educational needs; and

      • (vii) children receive adequate services to meet their physical and mental health needs.

    • (B) Systemic factors identified as essential to effective service provision are reviewed such as the:

      • (i) Statewide Automated Child Welfare Information System (SACWIS system), commonly known as KIDS;

      • (ii) Child Welfare Services (CWS) case review system;

      • (iii) training for (CWS) staff and providers;

      • (iv) availability of services and resources;

      • (v) OKDHS response to the community;

      • (vi) quality assurance system; and

      • (vii) foster and adoptive home recruitment and approval process.

  • (3) Providing ongoing support and training.  The training model is designed to provide time-intensive, small group, or one-on-one guidance to CWS staff to enhance child welfare practice as outlined by the Child Welfare Services practice standards and the Child Welfare Services practice model.

Instructions to Staff 340:75-18-1

Revised 7-1-13


1.Child and Family Service Review (CFSR) protocol.

(1) CFSR review team.The CFSR is conducted by two to four teams of child welfare (CW) staff and community stakeholders in the designated district or districts.Prior to participation in reviews, staff and stakeholders complete training regarding the CFSR process.Stakeholders sign commitments agreeing to keep confidential the information made available to them during the CFSR.Each team consists of:

(A) a Child Welfare Services (CWS) Continuous Quality Improvement (CQI) Program Unit representative, who serves as the leader of the site review;

(B) a CW specialist or supervisor who is not affiliated with a site under review;

(C) a third party identified by the deputy director for the region; and

(D) at least one volunteer stakeholder, not employed or contracted by OKDHS.

(i) The participating district director or designee ensures that a background check is completed on each stakeholder, unless the stakeholder is employed in law enforcement, prior to the stakeholder's involvement in the CFSR.

(ii) The background check includes a criminal records check through Oklahoma State Bureau of Investigation (OSBI) and review of Child Abuse and Neglect Information System.

(2) CFSR schedule.

(A) Prior to the beginning of each calendar year, Continuous Quality Improvement (CQI) CFSR team members produce an annual schedule that projects the date for a CFSR at each site in the state for the year.

(B) CFSRs occur quarterly within each region, allowing each site to participate in a review at least once per year, except in rare instances when an exception is granted.

(i) When exceptional circumstances exist, the district director contacts the deputy director for the region to request permission to obtain an adjustment in the schedule.

(ii) When the district director is granted permission to obtain an adjustment, the district director convenes a meeting or conference call with the Regional CQI coordinator and CQI programs manager to discuss rescheduling options.

(iii) The CQI Program Unit CFSR team makes efforts to honor the request without compromising the CFSR yearly review schedule.

(iv) When the CFSR review cannot be rescheduled within the same quarter, the current year's review is cancelled and the CFSR schedule resumes the next year.

(3) Stratified random sample.Each CFSR includes a stratified random sample of approximately six children in each of the three-to-four participating counties.

(A) CQI Program Unit CFSR team members notify district staff of each child identified for inclusion in a CFSR at least one month prior to the CFSR.

(B) The OKDHS site coordinator, identified by the district director, contacts the person responsible for the child (PRFC) for each child and discusses the opportunity to participate in the CFSR.

(4) Preparation for CFSR.

(A) At least one CQI Program Unit CFSR team member is assigned to each area to:

(i) assist in planning for quality improvement;

(ii) facilitate staff and stakeholder participation; and

(iii) approximately one month before the CFSR, train designated area staff and stakeholders in CFSR interview, record review, and standard application procedures.

(B) Each CFSR site leader visits with the participating district director or designee at the initiation of the CFSR to:

(i) explain procedures;

(ii) confirm arrangements; and

(iii) schedule an exit conference.

(5) CFSR assessment procedures.

(A) Outcome performance is assessed on-site through:

(i) review of CWS case records; and

(ii) observations and interviews with:

(I) school-age children;

(II) parents or PRFCs;

(III) CWS staff;

(IV) placement providers; and

(V) other persons with a significant role in a child's life.

(B) CQI Program Unit CFSR team members collaborate with each team member daily during the CFSR to assure the findings made by the team member is consistent with performance criteria for each outcome and systemic factor;

(C) Systemic factors performance is assessed through individual and group interviews of internal and external stakeholders arranged by district staff.

(6) CFSR results.

(A) Findings are generated for each child indicating whether each outcome is:

(i) substantially achieved;

(ii) partially achieved;

(iii) not achieved; or

(iv) not applicable.

(B) Findings for systemic factors are aggregated to achieve findings of:

(i) strength;

(ii) partially achieved; or

(iii) area needing improvement.

(C) The CQI Program Unit CFSR team:

(i) shares the CFSR findings with designated CWS staff at each site that describe performance related to each outcome and systemic factor, and the significant or ongoing departures from service quality expectations;

(ii) recognizes and commends the site's areas of strength:

(I) with the participating district director during the district exit conference at the conclusion of the district review; and

(II) with the regional director or designee during the area exit; and

(iii) reports immediately to relevant authorities, including the district director, deputy director for the region, and CWS director, findings of significant non-compliance with civil rights, rules, or laws.

(7) Continuous quality improvement plan.The CFSR team assists each local OKDHS office, when requested, develop a plan to address the most critical challenges in CW service delivery identified during the CFSR.

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