St. Louis County Public Health and Human ServicesFoster Care

System Changes: Moving Into the Future

AGENDA Overview Systems/Considerations Casey Family Programs – Breakthrough Series

Collaborative (BSC) BSC – Basics BSC – Premises BSC – Methodology/Improvements/Tests/PDSA’s Spread Minnesota Framework References

Overview On any given day, approximately 350

St. Louis County children are in out-of-home placement.

About 320 are in foster care

Overview Purpose of foster care:

Provide temporary or long-term primary care for children who have been maltreated, experienced family problems, or who have special needs;

Provide a planned, goal directed service to children and their families;

Assist the department in its permanency planning efforts

An Appreciation of Systems…

Child welfare systems are increasingly identifying the need for more flexibility regarding…

how they allocate financial resources; the design of a more thorough array of

supports and services that truly respond to the real needs of families and children;

how they respond to families; how they make decisions about

placement; how they factor in considerations of race,

culture, identity and the many forms of diversity found in our society.

For Your Consideration… We sell many “systems” improvement

efforts on the basis of improved outcomes for families and children.

Yet, the substance of systems improvement is really about the day-to-day work and experiences of administrators, supervisors, and workers.

We tend not to frame the conversation around the benefits for the individuals responsible for creating the improvements.

For Your Consideration…

Individuals most familiar with the needs of families, and the demands of the work, are often left out of the conversation about what is working well and what really needs improvement.

The BSC Model for Improvement is designed to center the improvement process in the daily experiences and realities of the individuals most connected to the work.

Casey Family Programs: Breakthrough Series Collaborative (BSC)

December 2000: Casey Family Programs - Seattle, Wash. – joined with the Institute for Healthcare Improvement (IHI) & Associates in Process Improvement (API) to learn the Breakthrough Series Collaborative (BSC) methodology;

2001-2002: Casey National BSC on Recruitment and retention in foster care

2005 & 2006: Minnesota BSC

Basics Quality improvement method; Existing program or framework; Core team of key actors; Identify and test new strategies or

ideas for best practice ; in key domains;

Allows the team to make dramatic changes in focused areas over short periods of time

BSC Premises There is a gap between knowledge

or theory and practice; BSC uses existing knowledge based on what has worked – apply to system needs

There is a significant variation in practice in the field; some agencies do well, whereas others not = room for improvement

BSC Premises All improvement requires change, but not

all changes lead to improvement; measurement critical – small tests of change done to allow for rapid implementation – track to see impact;

“Every system perfectly designed to achieve the results it gets”; systems need fixing – not the people within the system

Basic Components of Improvement Developing a Change

Examination vs. innovation… or both? Change requires action

Testing a Change Trial and learning process Modifications may be made over time Discard change efforts when necessary Cycles of learning… continuous feedback

Implementing a Change Balance between demonstration and consensus-

building

Testing Changes: What Is a PDSA?

PLAN• Determine

objective, questions, &

predictions• Create plan to

test idea (who, what, where, when, how?)

ACT• Make

adjustments• Ensure that the

next cycle reflects the learnings

DO• Carry out the plan• Document problems

and unexpected results

• Begin analysis of data

STUDY• Complete analysis

of data• Compare data to

predictions• Summarize what

was learned

Adapted from © 2001 Institute for Healthcare Improvement

1

23

4 Generation of a

Good Idea

SMALL!!!Don’t Forget

To Study!

Adjust and Do Again

Supporting Improvement Methods Using data

Recognizing and making sense of patterns of variation

Appreciation for a rapid action orientation to change Developing a change Testing a change Implementing a change

Working with people Understanding motivation is critical in obtaining

cooperation to sustain improvements.

Progression of ChangesTesting

Implementation in pilot site

Spread

P

S

A D

P

S

A D

P

S

A D

Spread Moves the changes into new areas of the

jurisdiction or beyond

Requires that a change has been tested and has

been shown successful in pilot site

Uses a new set of strategies (e.g., key message

and messengers identified, etc.)

P

SA D

SA D

P

S

A D

Testing Implementation in pilot site

Spread

The Life Cycle of a “Best Practice”

Innovation

Best Practice

Promising Practice

Emerging Practice

Smooth out the Bumps

Work out the Details

The needs of the field are always changing.

SomeBest Practices

No Longer Effective

Now What?

“Evidence Based” Practice

Minnesota BSC Framework for Foster Care Recruitment

Retention

Ensuring Voice Birth Parent Foster Parent Child

Using the Minnesota Framework

Barriers or Stick Points

Strategies to Overcome

Generate Ideas – PDSA’s

Measurement

Small Group Exericse

Breakout and discuss

Generate an idea

References MN BSC: Recruitment and Retention –

Presentation by Lori Lutz – Consultant for Casey Family Programs.

Handouts – Minnesota State Department of Human Services

Langley, Gerald, J., Nolan, Kevin M., Norman, Clifford L., & Provost, Lloyd P. (1996). The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. Jossey-Bass: A Wiley Company: San Francisco, CA.