Quality Improvement

Programs vary widely in how much data they collect and track about the services provided to children in their care. At the request of the Cabinet for Health and Family Services (CHFS), CRP collects Quality Improvement (QI) data, primarily from information programs provide to CRP as part of the level of care assignment process. This data serves as an ongoing source of information about the treatment and services programs provide to children in Kentucky. Issues are identified to bring attention to individual service and documentation concerns and to highlight patterns that programs may not be aware of, in order to encourage discussion of service or documentation changes that may need to be made. CRP provides general summaries of this information to CHFS, which principally uses the data to look at broad patterns and to identify system-level areas for improvement in services (for example, increasing the provision of family therapy). CRP may also provide information regarding significant child-specific issues to CHFS separately for any necessary follow up to improve services for that child. The overall goal of this collaborative data collection effort is to improve children’s experiences while in placement.


QI DEFINITIONS

QI data is collected in various categories related to safety, services, and documentation.  The specific category definitions are listed below.

Safety

Child or others were reported to have been harmed or were at significant risk of being harmed due to apparent inadequate risk management or caregiver action.

Physical Management (Phys Mgmt)

Physical managements were reported that were numerous (once weekly or more), resulted in significant injury to the child or others, or for which the documentation was insufficient to explain the rationale for the management.

Placement Stability (Stability)

Child exhibits a pattern of multiple placement moves within an agency, or program staff actions have delayed the placement process or resulted in an additional or unplanned placement for child.

Child Progress (Progress)

Child is not making progress, is not moving through a program’s phase/level system, or does not have a clear plan for discharge, and there is no indication that this issue is being addressed. Child appears to be in need of different or additional services, or an alternate placement more matched to the child’s needs.

Intervention

There were questions regarding whether the interventions reported to correct address or prevent behaviors were therapeutic, given child’s developmental level, mental health issues, or other factors.

Service Need Not Addressed (Svcs - Tx)

Child has a service need (e.g., mental health, medical, specialized assessment, interpreter) and insufficient services to address that need have been reported.

Mental Health Services - Number (MH Svcs - #)

Child with a LOC of 3 or higher was reported to have received fewer than the number of individual counseling sessions required by the PCC agreement and/or received fewer than one (1) in-house individual counseling session each month while being provided individual counseling services from an outside agency.

Mental Health Services - Provider (MH Svcs - Prov)

Child with a LOC of 3 or higher was reported to have received therapy from someone not considered a qualified professional as identified by the PCC agreement or no credentials were identified for the service provider.

Family Counseling Services (Family Tx)

No family counseling services involving family members or other adults identified by the child’s permanency goal were reported to have been provided, and a sufficient rationale for the lack of services was not documented.

Psychiatric Treatment (Psychiatric Tx)

No psychiatric services were reported although the child had been recommended to receive psychiatric treatment or had other clear psychiatric needs.

Substance Abuse Treatment (Sub Ab Tx)

Insufficient substance abuse services were reported to have been provided when substance abuse was listed as a concern, child’s behavior was indicative of substance abuse, child had a substance abuse related diagnosis, or substance abuse treatment had been recommended.

Documentation: No Mental Health Diagnosis (No MH Dx)

Reports indicated that child had mental health issues, was receiving psychotropic medications, and/or was seeing a therapist, and no formal diagnosis was provided on the ALP, on an attached treatment plan, or on an assessment/evaluation completed by the program.   

Documentation: Incongruent Information (Incongruent Info)

Program submitted conflicting information about a child.

Other

Covers any area for quality improvement that has not been identified in another category.


ACCESSING QI ISSUES

QI information for programs is available to select staff on CRP’s web application. Staff accessibility is determined by each agency. To access program QI information, staff need user access. Contact Tye Reece, CRP Quality Assurance Coordinator, [email protected] to arrange this. We encourage programs to review QI information on a regular basis. Please note PCCs/PCPs are not required to submit a plan of correction or follow up in other ways with CRP when QI issues are identified.  Programs can decide how to use QI information most effectively.