CQI Case Review Instructions

Mission 	
The single common mission of continuous quality improvement (CQI) case reviews is to improve the quality of case work provided to children and families.  

Principles
•	Casework quality is complex and relies on multiple factors interacting over time to produce results for families and children.
•	Case reviews are part of the CQI process where casework quality improves over time.  
•	Each level of case review contributes to assessing case work and informing needs for coaching and mentoring, training, policy supports, practice supports, systemic changes, or problem solving. 
•	Each level of case review uniquely contributes to the mission, but no review level is inherently superior to another review level.  

Levels of Review
Level	Purpose	Supports for the purpose	
First-level	First-level reviews identify a caseworker’s strengths and needs for coaching and mentoring.  The FSOS uses the review process to assist their team in improving best practices and quality case work.  	The case review is based on specific expected practices.  It is a guide to practice.  
Data from the team is available to the FSOS for three months to use for tracking trends or team needs.  	
Second-level	Second-level reviews are intended to identify ways to provide coaching and mentoring to supervisors, regional trends that suggest actions needed within the region or with the courts and other community partners, and data to support action planning at the regional level.  	CQI specialists and administrators will have access to their data at any time to identify trends or performance on specific items.  Summary reports are available at any time.  
The Case Review Data in a Glance (DIG) displays quarterly item scores for all regions statewide.  	
Central Office	Central office reviews are intended to help program staff understand state and regional trends that suggest the need for, such as policy changes, training needs, practice supports, or advocacy with courts or other community partners.  Central office reviews include targeted case reviews conducted for specific areas and outcomes where performance needs addressed.  The Kentucky Child and Family Services Review (KY CFSR) is utilized for support and measurement of program improvement plan (PIP) goals, as well as identify trends around safety, permanency, and well-being to assist with the development of statewide and regional action plans, when needed. 	Central office program staff have real-time access to all state data and access to summary and quarterly trend data, including case review data.   	

Process of Review
The TWS-M112 report is generated on or before the fifth of each month.  The cases will be automatically loaded into CQI-CARES (Case Automated Review and Evaluations System) 2.0 for first-level case reviews.  Second-level case reviews are assigned in CQI-CARES 2.0 manually by CQI specialists.  The TWS-M112 will assign peer reviews for first-level within the FSOS program area and region. The case review tool for each case review can be printed from the CQI-CARES 2.0, if desired.  However, the review is complete when the data is entered into CQI-CARES 2.0.  Summary reports will be immediately available to the FSOS to track and monitor trends within their team.

Division of Service Regions’ (DSR) Field Quality Branch process
•	CQI specialists will manually re-assign cases or provide a substitution, as requested, and ensure that the case requested meets the substitution criteria.
•	CQI specialists communicate the CQI case review standards to regional, supervisor, and staff levels monthly.  Each month, CQI specialists will send by email a list of both first and second-level cases by case number only that will be reviewed that current month to the local level.
•	CQI specialists will monitor the completion of first and second-level case reviews on the 26th of each month and notify regional leadership and FSOSes of cases that are not completed.

First-Level Review
•	Each month, FSOSes review four cases/children in CQI-CARES 2.0.  No more than four cases will be reviewed in the CARES system for first-level case reviews.
•	FSOSes begin their reviews and select the elements of the case by the 12th of the month. 
•	FSOSes complete the reviews by the 25th of the month.  CQI specialists will begin monitoring the completion of first-level case reviews on the 26th of each month and notify regional leadership and FSOSes of case reviews that are not completed.  
•	The FSOS coaches and mentors the case managers or the team to discuss strengths, weakness, and any corrective actions by utilizing the Case Review Strengthening and Mentoring form.  This form will be reviewed by the FSOS with the worker and sent to the second-level case reviewer if the case is selected for a second-level review.  

Regional Review
•	Regional reviewers complete no more than 18 reviews per region each month in CQI-CARES 2.0.
•	Regional reviews are completed by the 25th of the month following the TWS-M112 run.  Example:  TWS-M112 is ran for January.  FSOS completes reviews by January 25th.  Regional reviewers’ complete reviews by February 25th.

Central Office Review
•	Cases for the KY CFSR are identified through a different set of criteria to meet federal requirements.  Details on this process and the criteria can be found in the Kentucky Child and Family Services Review Procedures Manual. 
•	Central office targeted case reviews are conducted as needed.  Cases are selected based on the purpose of the targeted review.
CQI Case Review Procedures
The following rules apply to the first and second level-case review process:
•	All cases selected on the randomized TWS-M112 are reviewed.
•	Substitution clause—substitutions may only be accepted for the following reasons:
o	The case was pulled on the previous month’s TWS-M112 (notify your CQI specialist if this occurs);
o	The case pulled is from an investigative team and is currently an incomplete investigation that was given a legitimate extension (past due investigations without extensions will be reviewed);
o	Controlled access cases; 
o	Sealed cases;
o	Cases transferred out of region;
o	Reviewer does not have access to the CARES 2.0 system; or
o	If a rapid response staff is the case manager of a case in TWIST.  If the case is only shared with the rapid response team, the case should still be reviewed at both the first and second-level.
•	Any requests for substitution must be made by the FSOS to their CQI specialist by the 12th of the month.
•	Review the last completed investigative referral if one occurred in the last 12 months.  
•	For OOHC cases, one child will be identified as the target child for purposes of the case review.  All permanency questions will be answered as they relate to that child only.
•	If the TWS-M112 selects a case that is assigned to a vacant FSOS position, the CQI specialist is NOT required to reassign that case review to another FSOS, however, the CQI specialist is required to and un-assign the case(s) from the vacant FSOS.  Vacant FSOS positions include FSOSes that are on leave, extended medical leave, or have transferred to another position outside of the region.  The first-level review will not be completed.  However, if that case is also flagged for a regional review, those reviews will proceed.  CQI specialists should notify regional management if a vacant FSOS case review has been un-assigned and is flagged for a regional review.
•	CQI specialists are no longer required to ask for exemptions for first-level case reviews.  CQI specialists can un-assign these cases in CQI-CARES 2.0.

Period Under Review
The case review instrument is to be used to review the case or child information for the last 12 months.  You will only complete the sections that are applicable to the case or child for the 12 month period.  

Hard Copy Documents for Case Reviews
To the extent possible, FSOS and regional level reviews should be TWIST reviews only, however, additional documentation may be required.

The review process in most regions provides the regional reviewers with access to the hard copy review, and they can answer all the questions on the case review instrument.  Also, this level of review is necessary to produce scores that are reported as part of the federal Annual Progress and Services Report (APSR) and for legislative content.

Central office reviews consist of TWIST reviews and review of hard copy documentation, when needed.  The KY CFSR also consists of interviews with key case participants.  For more information, please refer to the Kentucky Child and Family Services Review Procedures Manual.

Timeline for Completion
The following table refers to actions needed for a single group of cases selected for first and second-level case review.  The reviews will be completed within two months of the pull.  

Month One	Month Two	Action Needed	
6th		The TWS-M112 automatically loads into CQI-CARES 2.0.  	
12th		FSOS initiate reviews.	
12th		FSOS notifies the CQI specialist if any case that meets the substitution criteria.	
25th 		FSOS complete all assigned case reviews.	
	1st week of the month	CQI specialists’ complete assignments for regional reviewers.