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CQIR ANNUAL REPORT 2013 FLORIDA REGION ANALYSIS

Report Snapshot
Florida region served 3,178 clients in FY13. 90% of Florida Outcome Goals were met. The Florida Region Compliance & Quality rating on Peer Record Reviews was 76%. For the past three years, Florida scored an A in overall client.

REPORT PREPARED BY KIMBERLY D. CLARK CQIR SYSTEMS ANALYST PLEASE DIRECT INQUIRIES TO: KCLARK@ONEHOPEUNITED.ORG

Table of Contents
Letter from the Editors ..............................................................................................................................2

CQIR Team & Highlights ...........................................................................................................................3

Florida Leadership ....................................................................................................................................5

Executive Summary ..................................................................................................................................6

Clients Served ..........................................................................................................................................8

Outcome Management..............................................................................................................................9

Peer Record Reviews .............................................................................................................................11

Client Satisfaction ...................................................................................................................................16

Incident Reports ......................................................................................................................................17

Office Systems Reviews .........................................................................................................................18

Supervisory Systems Reviews ................................................................................................................19

Priority Reviews ......................................................................................................................................20

Employee Recognition ............................................................................................................................21

Quality Improvement Teams ...................................................................................................................22

Appendix .................................................................................................................................................23 Appendix A: Circuit 9 Highlights ..........................................................................................................23 Appendix B: Circuit 10 Highlights ........................................................................................................26 Appendix C: Circuit 13 Highlights ........................................................................................................28
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Letter from the Editors

October 19, 2013 To Our Readers: This is our 13th year of providing the Continuous Quality Improvement and Research (CQIR) annual report on the agencys outcomes and other quality improvement activities and results. The CQIR team takes great pride in preparing and presenting this report to you, our valued stakeholders. In Fiscal Year 2013, the CQIR team has adopted a Risk Management orientation in the processes and functions we facilitate. This shift was made at the request of staff so that we could ensure that we are spotting and addressing small problems before they become larger problems. Therefore, this type of orientation is meant to be proactive rather than reactive in order to alleviate risks and ideally prevent them before they occur. With this orientation, the CQIR team has begun using a new Risk Management report during Quality Improvement Teams (QITs). This type of approach requires participation at all levels; therefore, during this process, all staff (from direct service staff to program and agency leadership) are looking at current CQIR data to identify areas for improvement and develop action plans to meet and/or exceed best practice. Staff members have reported that this approach is better for them as they are able to see the data from their programs more regularly and develop solutions to areas of concern. In the human services field, organizations are constantly being asked to, do more with less while at the same time being asked to perform at higher levels than ever before. In these economic times many programs are being scaled back or eliminated for not reaching outcomes and targets set by funders. Now more than ever, One Hope United needs to look at each program, even those that consistently perform at high levels, and use creativity, research, and innovation to become even better. Each and every program can improve upon something. If One Hope United becomes stagnant, we will fall behind. Ultimately, at the end of the day, this constant attention to data and program improvement is for the clients we serve. By asking ourselves, what can we do even better we are investing our time and energy into making sure that our clients become healthy and productive adults when they leave One Hope United. In the next year, the CQIR team will spend time developing methods to learn what happens to our clients after leaving services in order to see what sticks from our service and genuinely changes lives. This work will help us ensure that One Hope United is here for our future clients. We hope that you find this report informative and that you will let us know what you think and how we could make the report better in the future. Thank you for your support.
Kimberly D. Clark CQIR Systems Analyst Fotena A. Zirps, PhD Executive Vice President

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Continuous Quality Improvement & Research Team


To support direct service providers and ensure best practice quality of service throughout the agency, the Continuous Quality Improvement and Research (CQIR) team at One Hope United guides the organization in 14 core tasks (PQI Standards) that are aligned with internal OHU principles and external accreditation standards. Dr. Fotena Zirps Executive Vice President Tina McLeod Assistant to the EVP Florida Region Hudelson Region Northern Region Research Team Ruann Barrack Senior Vice President Ryan Counihan CQI Technician Jeffrey Honaker CQI Director Katurah Roby CQI Coordinator Ron Culbertson CQI Coordinator Linda Weiss CQI Medicaid Coordinator Stan Grimes CQI Coordinator Elizabeth Hopkins CQI Medicaid Coordinator Jackie Schedin CQI Coordinator Special thanks to Katrina Brewsaugh of the CQIR team who left in FY13. Information presented in the Florida region annual report is organized by these CQI Core Tasks: Outcome Management Peer Record Reviews Client Satisfaction Incident Reports Office Reviews Supervisory Reviews Priority Reviews Employee Recognition Quality Improvement Teams Sarah Tunning Director of Research Kimberly Clark Systems Analyst

The CQIR Team achieved the following accomplishments in FY13. Accomplishments have been categorized in line with the OHU promises of Innovation, Collaboration, Leadership, Results, and Hope. Innovation The CQIR team has been utilizing Survey Monkey technology to enter Incident Reports, Office Reviews, and Supervisory Reviews which has made the data entry process more efficient. A pilot for utilizing Survey Monkey for Peer Record Reviews is planned for FY14 using Tablet technology. The CQIR team has taken a Risk Management focus which included a pilot and a full implementation of the OHU Risk Management Report in Local, Service, and Regional Quality Improvement Teams. Under the direction of Fotena Zirps, PhD. and Sarah Tunning; Ruann Barack, Jeffrey Honaker and Kimberly Clark are members of Team Data which is looking at the current and future data needs of the organization in alignment with the agencys strategic plan. In addition, there are many members from Operations (including the Team Excellence Outcomes committee) and IT that are collaborating on this project.
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Peer Record Review Training has been developed and placed on the Essential Learning Website.

Collaboration Stan Grimes, Jackie Schedin, and Elizabeth Hopkins have all participated as volunteers with the Council on Accreditation to re-accredit 3 organizations. In collaboration with the Department of Children and Family Services, all Illinois OHU CQIR staff have access to SACWIS which will assist with electronic review of case files. The CQIR team participated in a WorkSmart training facilitated by Larry Kujovich from Executive Partners. Jackie Schedin was a presenter at a CANS training in collaboration with the Casey Foundation. Linda Weiss and Elizabeth Hopkins continued to collaborate to ensure consistency across Regions with the Medicaid Rule Changes. This included monthly meetings with program leaders to ensure all involved participated in the process of change. Jackie Schedin and Ron Culbertson collaborated with operations in the Northern and Hudelson Regions in revising the Intact Operating Procedures for the Agency Operating Manual based upon Rule changes. The group also collaborated in the revision of the Intact Quality Review Tool. Linda Weiss worked with operations in the revision of the SASS Model for service delivery to achieve a team approach to provide more efficient and effective service delivery. Ron Culbertson provided technical assistance with Missouri Leadership to assist the Missouri office in maintaining their Licensing as a Child Placement Agency. Leadership Linda Weiss from Hudelson and Elizabeth Hopkins from Northern have led the process of implementing the new Medicaid Rule to ensure all Medicaid programs are in compliance. They have also consolidated forms to one Mental Health Assessment and two Individualized Treatment Plans so that there is more consistency amongst the Northern and Hudelson regions. Stan Grimes, Jeffrey Honaker, and Kimberly Clark are participants in the 2013 Leadership Academy facilitated by CEO Bill Gillis and Executive Vice President Fotena Zirps PhD. Ruann Barack was awarded the Promise Award for Leadership. Jackie Schedin was awarded a STAR Award for exemplary service during the 4th quarter of FY13. Results The CQIR team in Florida has launched a weekly data reporting process that takes a proactive stance in addressing programmatic concerns. The Medicaid Team in Hudelson achieved a 97% rating and Northern achieved a 94% rating (a 19 point increase) on their Post Payment Reviews for FY13 services. The CQIR team participated in a CQI Capacity Assessment administered by the Department of Children and Family Services and received a 19 out of 20 rating. The assessment focused on Foster Care Programs in Illinois. Members of the CQIR team completed a Program Evaluation of the Circle of Hope program in Springfield, MO. Members of the CQIR Team completed a 100% file review of the Tampa program. Hope Katurah Roby joined the CQIR team in Tampa, FL. Sarah Tunning has taken on the Director of Research role for the Federation.
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Florida Leadership
The Florida Region is divided into three Circuits (Circuit 9 Orlando, Circuit 10 Sebring/Wauchula, and Circuit 13 Tampa). The region is led by an Executive Director and a Senior Vice President. Additionally, each Circuit has a Director of Programs (DOP).

Barbara Moss Executive Director

Neika Berry Senior Vice President Circuit 9 (Orlando) Brigitte Brown DOP Circuit 10 (Sebring/Wauchula) Michelle Ramirez DOP C13 (Tampa) LaSonja Houston DOP

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Executive Summary
This year, OHU programs in the Florida region served 3,178 clients and families an 8.4% increase from last year. The Compliance & Quality of service documentation overall was 76%. The efforts of Florida programs overall resulted in 90% of all outcome goals being met.

OUTCOME MANAGEMENT

PEER RECORD REVIEWS

Across all programs, 90% of Outcome goals were Out of 444 files reviewed in FY13, the Florida met in FY13. region Compliance & Quality rating on service documentation was at 76%. CLIENT SATISFACTION INCIDENT REPORTS

Florida region Overall satisfaction score has In the Florida region, the number of incidents remained above 4.50 (A) for the past three years. increased 25% across most incident types. Incidents classified as Other and Medical/Psychiatric incidents had the largest increases, up by over 274% and 94%, respectively, from FY12 to FY13. OFFICE REVIEWS SUPERVISORY REVIEWS PRIORITY REVIEWS

In the Florida region, 89% of Office Reviews and There were 3 priority reviews conducted in FY13: 1 Level III, 1 Level II and 1 Case Consultation. 78% of Supervisory reviews were compliant. EMPLOYEE RECOGNITION QUALITY IMPROVEMENT TEAMS

There were 36 STAR awards and 2 GALAXY There was an average QIT attendance rate of 94% awards distributed this year. in the Florida region.

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In reviewing each area assessed in this report, the following actions are recommended in FY14 based on Outcomes, Peer Record Reviews, Office Reviews, and Supervisory Reviews in FY13. Circuit Reviewed Risk Management Topics for FY14 QITs: Recommended Areas to Develop Action Plans Circuit 9 did not achieve the outcome of children remaining reunified for a period of 6 months without re-entry into foster care; it was within 3% of the outcome. Adoptions finalized within 24 months of the latest removal did not reach its target; it was within 18%. Circuit 9 Family Preservation programs did not achieve the 90% target on peer record reviews in Intake (86%), Assessment (86%), Service Delivery (83%), and Closing (38%). Circuit 9 Placement programs did not achieve the 90% target on peer record reviews in Intake (78%), Assessment (86%), Treatment Planning (87%), Service Delivery (86%), and Closing (0%). The Office Review in Circuit 9 did not achieve the 90% target, which is mainly attributed to the office moving locations. Circuit 10 did not achieve the outcome of children remaining reunified for a period of 6 months without re-entry into foster care; it was within 11% of the target. Children experiencing no more than two placement settings within 12 months did not reach its target; it was within 3%. Circuit 10 Family Preservation programs did not achieve the 90% target on peer record reviews in Intake (81%), Assessment (85%), Treatment Planning (77%), Service Delivery (80%), and Closing (50%). Circuit 10 Placement programs did not achieve the 90% target on peer record reviews in Intake (69%), Assessment (85%), Treatment Planning (79%), Service Delivery (78%), and Closing (45%). The Office Reviews in Circuit 10 did not achieve the 90% target, it was within 1%. Circuit 13 did not achieve 5 of its outcomes. No substantiated reports of abuse or neglect while in out of home care, children will remain reunified for a period of 6 months without re-entry into foster care, and children were not removed with 12 months of a prior reunification (re-entry) were within 1% of the target. Adoptions finalized within 24 months of the latest removal was within 3% of the target and sibling visitation was within 6% of the target. Circuit 13 Family Preservation programs did not achieve the 90% target on peer record reviews in Intake (68%), Assessment (76%), Treatment Planning (65%), Service Delivery (67%), and Closing (20%). Circuit 13 Placement programs did not achieve the 90% target on peer record reviews in Intake (68%), Assessment (69%), Treatment Planning (73%), Service Delivery (65%), and Closing (29%). The Supervisory Reviews in Circuit 13 did not achieve the 90% target, they were within 50%.

Circuit 9

Circuit 10

Circuit 13

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Clients Served
In fiscal year 2013, One Hope United served 3,128 clients and families in the Florida Region an increase of 8.4% from FY12. The increase can be attributed to the programs in C13 which operated the entire fiscal year. (In FY12 the C13 program only operated for the last half of the fiscal year).

# of Clients Served by Fiscal Year


Counseling Family Preservation Placement C131 TOTAL FY13 N/A 932 2,246 N/A 3,178 FY12 N/A 573 1,686 673 2,932 FY11 109 809 1,863 N/A 2,781

Clients Served: Florida


29%

71%

Family Preservation

Placement

The Placement programs continue to be the largest source of clients for the Florida Region, accounting for 71% of their client population. Family Preservation programs account for 29% of the client population.

Clients Served: By Circuit

36% 20%

44%

C9

C10

C13

Circuit 9 continues to serve the most clients in the Florida region accounting for 44% of clients served. Circuit 13 serves 36% of Floridas clients and Circuit 10 serves 20%.
C13 began services in FY12. In this year client numbers could not be separated by Program Category. In FY13 client numbers were tracked by Program Category and are accounted for in the Family Preservation and Placement rows. Page 8 of 29
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Outcome Management
An outcome or accomplishment can be defined as the result of efforts or outputs (interventions by an individual or team) within an agency that have value to the goals of the agency. Outcome CQIR monitors contract and agency goals are important to establish because they outcome goals established by federal provide purpose for the work with children and and state standards and OHU values. families and should tie either directly or indirectly to the mission of the agency. Additionally, outcome goals create a culture of accountability and also provide an evaluation of Child Welfare Measures (referring to a clients safety, permanency and well-being). CQIR monitors contract and agency outcome goals established by federal and state standards and OHU values. Outcome Goal Achievement: Florida Region

FY13
OVERALL TOTAL Safety Permanency Well-Being 90% 100% 86% 100%

FY12
90% 100% 83% 100%

FY11
80% 100% 67% 100%

This year, the Florida region achieved 90% of its outcome goals. The Florida region holds itself to ten outcome goals. Two outcome goals pertain to Family Preservation programs and the remaining 8 outcome goals refer to Placement programs. Below is an analysis of how each Circuit performed. Outcome Goal Achievement: By Circuit
Circuit 9 Safety Permanency Well-Being TOTAL % Achieved 100% (2/2) 71% (5/7) 100% (1/1) 80% (8/10) Circuit 10 Safety Permanency Well-Being TOTAL % Achieved 100% (2/2) 71% (5/7) 100% (1/1) 80% (8/10) Circuit 13 Safety Permanency Well-Being TOTAL % Achieved 50% (1/2) 57% (4/7) 0% (0/1) 50% (5/10)

SAFETY ACHIEVEMENT Outcome Goals 1. No Substantiated abuse or neglect while in out of home care. 2. Children not abused or neglected during inhome services. Target 99% 95% C9 99% 98% C10 99% 98% C13 98% 98% Region 99% 98%

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PERMANENCY ACHIEVEMENT Outcome Goals 1. Children reunified within 12 months of the latest removal. 2. Children will achieve permanency within 24 months of latest removal. 3. Children will remain reunified for a period of 6 months without re-entry into foster care. 4. Children were not removed within 12 months of a prior reunification (re-entry). 5. Adoptions finalized within 24 months of the latest removal. 6. No more than two placement setting within 12 months. 7. Children served in Family Preservation will remain intact during services. WELL-BEING ACHIEVEMENT Outcome Goals 1. Sibling Visitation: There will be documented visitations occurring for children separated in out of home care. Target 50% C9 97% C10 87% C13 44% Region 77% Target 46% 32% 91% 91% 32% 85% 95% C9 81% 80% 88% 93% 14% 89% 98% C10 64% 94% 80% 96% 83% 82% 99% C13 61% 49% 90% 90% 29% 85% 99% Region 68% 70% 88% 91% 36% 86% 99%

Circuit 9 achieved 80% of its outcome goals. The outcome goal pertaining to children remaining reunified for a period of 6 months without re-entry into foster care was within 3% of meeting the target. The outcome referring to adoptions finalized in 6 months was more than 10% away from the target. Circuit 10 achieved 80% of its outcome goals. The outcome pertaining to clients having no more than two placement settings within 12 months was within 3% of meeting the target. The outcome referring to children remaining reunified for a period of 6 months without re-entry into foster care was more than 10% away from the target. Circuit 13 achieved 50% of its outcome goals. All outcome goals that did not achieve the target were within 1%-6% of achieving the target.

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Peer Record Reviews


A Peer Record Review is the process by which CQIR internally examines records in depth for timely completion of required activities (a Compliance Review) and for quality of services (a Quality Review). COA standards require OHU to randomly select a sample of records to review for all programs. COA standards require OHU to CQI Coordinators conduct file reviews for each randomly select a sample of records to program every quarter and the results are communicated via a report for each review review for all programs. date, as well as a Risk Management report that rolls up all units by program category in a particular circuit. For the annual report, peer reviews are looked at for the fiscal year beginning July 1st, 2012 through June 30th, 2013. The program categories reviewed for the Florida Region in this report are: Family Preservation, and Placement. # of Florida Region File Reviews by Quarter PRR Review Tool Q1 Q2 Q3 Compliance & Quality Family Preservation In-Home 36 22 22 Placement Adoption 5 4 4 Placement Foster Care 83 76 89 TOTAL 124 102 115

Q4 30 5 68 103

TOTAL 110 18 316 444

In FY13, 444 files were reviewed across Family Preservation (110) and Placement (334) Programs. There are 3 tools utilized in the Florida region that assess Compliance & Quality. Results were combined across all tools to produce the following graph which looks at overall Region performance. The goal for each phase of client services is 90%, represented by the black dashed line on the chart below. The purple solid line represents how each phase of client services scored cross-regionally.

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Compliance & Quality - Florida Region


100% 80% 60% 40% 20% 0% Intake Region Target Cross-Region 73% 90% 90% Assessment 78% 90% 85% Treatment Plan 79% 90% 84% Service Delivery 75% 90% 84%

Closing 38% 90% 83%

Overall 76% 90% 86%

In FY13, the Florida region achieved a 76% Compliance & Quality rating on service documentation. All areas measured were below the agencys 90% target. Closing (38%) is significantly below the agencys target. Closing decreased significantly from FY12 where it scored 84%. It is recommended that supervisors pay close attention to Closing activities to ensure that documentation is completed. It may also be useful to review more closed files to see whether this is a larger trend than seen in the Record Review process. (Only 8% of the 444 files reviewed was a closed record). Compliance & Quality performance for the Florida region was also analyzed by Program Category and by Circuit to produce the following three graphs. Further analysis can be found in Appendices A-C. Compliance & Quality: Program Category
100% 80% 60% 40% 20% 0%
Intake Family Preservation Placement Target 79% 71% 90% Assessment 83% 77% 90% Treatment Plan 80% 79% 90% Service Delivery 78% 74% 90%

Closing 38% 39% 90%

Overall 80% 75% 90%

Family Preservation programs are performing slightly better than Placement programs; however, no areas are achieving the 90% target on Compliance & Quality measures. Across all phases of client services Family Preservation achieved an 80% Compliance & Quality rating and Placement achieved a
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75% Compliance & Quality rating. With the exception of Closing, all areas are performing similarly to as they did in FY12. Compliance & Quality: Family Preservation by Circuit
100% 80% 60% 40% 20% 0% Intake C9 C10 C13 Target Cross Regionally 86% 81% 68% 90% 85% Assessment 86% 85% 76% 90% 85% Treatment Plan 90% 77% 65% 90% 82% Service Delivery 83% 80% 67% 90% 89% Closing 38% 50% 20% 90% 75% Overall 86% 81% 70% 90% 85%

Family Preservation programs in Circuit 9 (86%) are outperforming Circuits 10 (81%) and 13 (70%) as well as the Cross Regional rate (85%); however, they are below the 90% target (-4%). Circuit 10 is within 9% of the target, whereas Circuit 13 is within 20% of the target. Circuit 9 is achieving the 90% target in Treatment Planning. Compliance & Quality: Placement by Circuit
100% 80% 60% 40% 20% 0% Intake C9 C10 C13 Target Cross Regionally 78% 69% 68% 90% 83% Assessment 86% 85% 69% 90% 79% Treatment Plan 87% 79% 73% 90% 80% Service Delivery 86% 78% 65% 90% 76% Closing 0% 45% 29% 90% 47% Overall 85% 79% 69% 90% 79%

Placement programs in Circuit 9 (85%) are outperforming Circuits 10 (79%) and 13 (69%) as well as the Cross Regional rate (79%). Circuit 10 is meeting the Cross Regional rate. Across all Circuits no phases of client services are achieving the 90% target. To improve in FY14, programs should focus on the areas missed most on reviews throughout the year. Below is a full item analysis for each review conducted in FY13 by program category. The percentage indicates the percent of files in compliance. The number in parentheses at the end of each statement indicates the number missed out of the total for each review, excluding those items marked N/A.
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Family Preservation Intake (79%) Are the Release of Information Forms current (within checked timeframes) for correspondence with ALL entities outside of the agency? (44/109) Is the Clients Rights and Responsibilities (current within 1 year) receipt in the record & signed by all clients involved in the service? (41/108) Assessment (83%) Was the Initial Family Assessment completed within 15 business days of intake staffing? (50/98) Has the Family Assessment been updated every 6 months? (41/73) Treatment Plan (80%) Is the current Service/Treatment Plan/Case Plan signed and dated by the client, parent/guardian, caseworker and supervisor? (39/86) Is the current copy of the case plan in the record? (31/105) Service Delivery (78%) Is there current dental records for the child(ren) contained in the file if medical concerns are the reasons for service involvement? (24/42) Closing (46%) Does the record contain a case closure letter to the family regarding additional resources for continued assistance? (15/21) Placement Intake (71%) Is the Clients Rights and Responsibilities (current within 1 year) receipt in the record & signed by all clients involved in the service? (181/300) Are the Release of Information Forms current (within checked timeframes) for correspondence with ALL entities outside of the agency? (167/307) Assessment (77%) Was the Initial Family Assessment completed within 15 business days of intake staffing? (159/275) Has the Family Assessment been updated every 6 months? (128/220) Were recommended services of the Comprehensive Behavioral Health Assessment initiated within 30 days of the report completion date? (97/214) Is the Comprehensive Behavioral Health Assessment in the record? (91/281) Treatment Plan (79%) Is the current Service/Treatment Plan/Case Plan signed and dated by the client, parent/guardian, caseworker and supervisor? (118/241) Is the current copy of the case plan in the record? (85/299) Service Delivery (74%) Is there documentation in FSFN that the Case Manager visited or attempted face to face contact with biological parents every 30 days when the goal of the case was reunification? o For Mother? (94/233) o For Father? (104/199) Closing (39%) Does the record contain a case closure letter to the family regarding additional resources for continued assistance? (9/13)
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During fiscal year 2013 there were 42 case managers and supervisors who assisted in reviewing 444 files as a part of the CQI peer record review process. These champions of quality serve as an integral part of the continual process of assessing the quality of our files, providing feedback on how to improve, and ensuring that plans of correction are being completed on time. Florida C10

C9 Lauren Prekop Melanie Rivera MaryAnn Miller Dhaima Chin Elliot Vegas Brandy Davis April Campbell Shawna Sweetman Natheena Soto Miguelina Jorge Carmen Lott Carissa Arena Emily Gustafson Ebonie Hopkins Laurie Stern Yolanda Walker Vanessa Hyden Bernadine West

C13

Barbara Hester Monica Sanders Darby Barwick Veronica Bell Andre Davis Becka Kampman Muriah Davis Deuth Ayana Alexander Danielle Day Robin Sherwood Ashley Vaughn Jeannine Powell Pam Evans

Candace Fraser Anna Beyea Justin Wilkins Nyla Williams Laurie Vincent Amy Clarke Kristy Swift Anne Marie Johnson Myra Singleton Renante Demezier Stacey Singleton

Total Reviewers: 42 Thank you for your time, efforts, and commitment to quality service delivery.

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Client Satisfaction
CQIR conducts an annual Client Satisfaction Survey to monitor OHU clients impressions of Client Satisfaction Surveys monitor the services provided. After all surveys have clients impressions of the services OHU been received, region and program reports are compiled to provide stakeholders with a provides. Consumer Report Card that compares their program to the programs in their program category and to regions as a whole. Please contact Sarah Tunning, Director of Research for One Hope United, for a report card on any program or region.

Overall OHU Client Satisfaction: Florida Region


5.00 4.80 4.60 4.40 4.20 4.00 3.80 C9 C10 C13-OHU C13-Transfer

C9 FY13 FY12 FY11

C10

C13-OHU

C13-Transfer

4.64 (N=259) 4.64 (N=302) 4.57 (N=248)

4.67 (N=162) 4.76 (N=196) 4.62 (N=138)

4.40 (N=201) 4.81 (N=69) N/A

N/A 4.37 (N=218) N/A

In the Florida region, C9, and C10 scored in the fine tuning (A) range. C13 scored in the needs improvement (B) range. Overall client satisfaction in C9 remained unchanged in FY13; whereas C10 experienced a slight decrease. In FY12, C13 separated client surveys due to the inheritance of cases from a different Case Management Organization. In FY13, this was not the case. Although there was decrease in Overall Client Satisfaction in FY13, a true comparison cannot be made. 2013 4.57 (N=622) 2012 4.61 (N=785) 2011 4.59 (N=435)

In the Florida region, overall client satisfaction with OHU has remained above 4.50 (A) for the past three years. This year, there were 622 surveys returned for Florida Region, a 20.76% decrease from the 785 surveys collected in 2012.
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Incident Reports
An incident is any occurrence that may have the potential for increased risk for our clients and the liability of our agency. Reportable incidents also include situations that raise risk to staff or Incident reports track situations that may agency property, such as a theft or natural have the potential for increased risk for our disaster. CQIR provides monthly reports on incident trends and correlations. Annually, clients and the liability of our agency. this report rolls up data for the fiscal year and presents incident trends by region and circuit over three fiscal years.

Incident Types by Year: Florida Region Programs


600 500 400 300 200 100 0

FY13

FY12

FY11

In the Florida region, there was a 25% increase in the number of incident types in FY13 compared to FY12. There were five incident categories that increased from FY12: Incidents classified as Other increased by 274% Medical/Psychiatric related incidents increased by 94%. Client Injuries increased by 50%. Hospitalizations increased by 42%. Abuse and neglect increased by 7%. Circuits 9 and 10 both saw decreases in the number of incident types in FY13 compared to FY12, 15.9% and 6.7% respectively. Circuit 13 experienced a 415% increase primarily attributed to being in full operation the entire fiscal year. Further information on Incident Reports can be found in Appendices A-C.

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Office Systems Reviews


The Office Systems Review is a process to determine if an office is meeting agency standards. This includes professional appearance, staff response to answering telephone calls, maintaining client confidentiality and safety and risk management. CQIR coordinators conduct OHU office systems reviews annually. Office Systems Complinace : Florida Region
100%

80%

86%

89%

91%

89%

60%

40%

20%

0% C9 C10 C13 Region

Four Office Systems Reviews were conducted in the Florida Region (1 in both C9 and C13 and 2 in C10). As a region, 89% of all office system reviews were compliant an 8% decrease from FY12. Circuits 9 and 10 were just below the agencys 90% target (represented by the black dashed line) whereas C13 slightly exceeded the target. The items that were missed most on Office Systems Reviews were: The agencys Mission and Values statements are posted in the reception area. Safety evacuation plans are visibly posted in the office. The office is convenient to public transportation.

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Supervisory Systems Reviews


On an annual basis CQIR conducts an assessment of supervision provided by each direct service supervisor in the organization. The review uses a standardized form and involves a check of a number of supervision tasks. Although there are several items addressed, there is a concentration on the frequency of supervision and quality documentation of supervisory activities. Supervisory Systems Compliance: Florida Region
100%

100% 93%
80%

78%
60%

40%

40%
20%

0% C9 C10 C13 Region

Fifteen Supervisory Systems Reviews were completed in the Florida Region (C9 = 6, C10 = 4, C13 = 5). As a region, supervisors were 78% compliant with items measured a 13% decrease from FY12. Circuits 9 and 10 were above the agencys 90% target (represented by the black dashed line) with C9 achieving 100% compliance. Circuit 13 is significantly below the target, achieving a 40% compliance rating. The items that were missed most on Supervisory Systems Reviews were: Individual supervision occurs. The supervisor maintains supervision notes. It is possible to determine the purpose and outcome of the supervisory meetings documented.

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Priority Reviews
A priority review is a process that examines the quality of services provided to a client or family and compliance with program policies and procedures. There are three levels of Priority review is a process that examines priority reviews: The Level 1 Priority the quality of services provided to a client or Review also called a case consultation family. is voluntary and can be conducted on any case upon the request of the supervisor. The Level 2 Priority Review is conducted in the event of a serious injury to a client or a crime. Level 3 Priority Reviews are held when there is a client death, suicide attempt or felony. # Priority Reviews in FY13 Case Program Category Level 2 Level 3 Consultations Family Preservation 0 0 0 Placement 1 1 1 TOTAL 1 1 1

TOTAL 0 3 3

There were 3 priority reviews conducted in FY13 (down 6 from FY12). The decrease in Priority Reviews in the Florida region can be attributed to a decrease in Case Consultations and Level 2 reviews. Case Consultations are preventative in nature and are meant to be used as a method to share thoughts and ideas about a case that may be challenging. Florida conducted 5 less Case Consultations in FY13. There was one Level 2 Priority Reviews in FY13 (down 1 from FY12). The review was conducted due to the medical neglect of a youth in placement by their caregiver, which resulted in a permanent injury. There was one Level 3 Priority Review in FY13 (no change from FY12). This review was due to the death of a client while at an outside providers child care facility. Below are some highlights of lessons learned throughout the year:

In cases of medical neglect, it is important that supervisors have an ongoing discussion with case managers to address any medical concerns during monthly supervision. Collateral contacts with service providers are vital in monitoring client progress and following up if concerns are identified. Medical neglect cases warrant an increased level of vigilance to make certain that medical needs are addressed. We make assumptions that licensed providers, in this case, child care, are consistently meeting licensing requirements. When visiting such providers, we should focus our attention on seeing where the child sleeps, feeding log, etc. Possibly enlist the assistance of lead agencies in this effort for extra oversight. Possibly interviewing a new child care provider prior to placing the child in the service and determine the quality and licensing compliance.

A complete list of lessons learned from reviews can be found by contacting a member of the CQIR team.
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Employee Recognition
Two methods of awarding staff excellence are supported by CQIR. The first is the STAR Award for individual excellence, and the second is the GALAXY Award for team excellence. The awards recognize staff that have gone above and beyond normal work duties, exhibited exemplary performance and done their job under circumstances that are out of the ordinary. There were 36 Star awards and 2 Galaxy awards distributed in the Florida region this year. In FY13 we were proud to recognize these Florida employees with a STAR Award. Quarter 1 Myra Singleton Program Specialist (Tampa, FL) Amanda Boley Family Support Specialist (Tampa, FL) Stacey Singleton Permanency Specialist (Tampa, FL) Christina Doty Office Manager (Tampa, FL) Melissa Gabriel Office Manager (Tampa, FL) Quarter 2 Amanda Birge Case Manager (Sebring/Wauchula, FL) Daniel Cook Life Coach (Sebring/Wauchula, FL) Rebecca Kampan Case Manager (Sebring/Wauchula, FL) Bobbie Colvin Family Support Worker (Sebring/Wauchula, FL) Beverly Mitchell Case Manager (Orlando, FL) Dhaima Chin Family Case Manager (Orlando, FL) Vanessa Hayden-Johnson Family Case Manager (Orlando, FL) Lucie Memorie Case Manager (Orlando, FL) Alan Blackmon-Case Manager (Orlando, FL) Brandy Davis Family Case Manager (Orlando, FL) Lauren Prekop Case Manager (Orlando, FL) Lauren Loffert Case Manager (Orlando, FL) April Campbell Family Case Manager (Orlando, FL) Fiona Simmons Records Management Specialist (Orlando, FL) Ebonie Hopkins Supervisor (Orlando, FL) Yolanda Walker Supervisor (Orlando, FL) Laurie Stern Supervisory (Orlando, FL) Ferdinand Medina Family Support Worker (Orlando, FL) Jennifer Carmin Case Manager (Orlando, FL) Emily Gustafson Case Manager (Orlando, FL) Jolene Palazzo Business Manager (Orlando, FL) Quarter 3 Mileidy Daniel Case Manager (Orlando, FL) Therese Hartwell Family Case Manager (Orlando, FL) Shawna Lambert Supervisor (Sebring, FL) Claudia Gonzalez Adoption Specialist (Tampa, FL) Ana Cruz Case Manger I (Wauchula, FL) Lindsay Bass Case Manager (Wauchula, FL) Robin Sherwood Lead Case Manager (Wachula, FL) Nancy Baker-Guerin Case Manager I (Wachula, FL) Quarter 4 Courtney Hall Family Case Manager (Sebring, FL) Natheena Soto Family Case Manager (Orlando, FL)

The following teams were presented with a GALAXY Award this year. Quarter 2 OHU Licensing Team (Orlando, FL Quarter 3 C10 Leadership Team (Sebring/Wauchula, FL)
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Quality Improvement Teams


Everyone in the agency participates in at least one Quality Improvement Team (QIT). This allows each employee the power to implement improvement within their own QIT. The QIT is focused on improving the quality of service at the local level using data, effective problem solving and action planning. Across the agency, there was an overall attendance rate of 96% in FY13. The attendance rate for the Florida region was 94%. The following local, service center and regional Quality Improvement Teams were assembled three times this year in the Florida region. QIT Names Sassy Soldiers Stellar Seven Elite 6 Advocates Unit 206 The A Team Team Terrific Mighty Helpers Everyday Heroes Unit 853 The A Team Best & Brightest Team Focus Perfect Stars OHU Angles Rescue Rangers Excellence Trackers Q2 Quality Queens Improvement Seekers Quality Avengers Mighty Women of Quality

Local

Service Center Regional

C9 Supervisors Super Sups C10 Supervisors No Worries C13 Supervisors Quality Angels Hopes Heroes

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Appendix A: Circuit 9 Highlights


Peer Record Reviews are shown below by Program Category with a break-down by Unit. Compliance & Quality: Family Preservation - Circuit 9
100% 80% 60% 40% 20% 0% Intake Unit 201 Unit 202 Unit 204 Unit 205 Unit 206 Target All Programs 73% 85% 82% 100% 87% 90% 86% Assessment 84% 79% 91% 83% 93% 90% 86%

Treatment Plan 81% 93% 88% 94% 90% 90% 90%

Service Delivery 83% 86% 76% 79% 86% 90% 83%

Closing 33% 33% 33% 38% 100% 90% 38%

Overall 80% 84% 86% 88% 90% 90% 86%

Overall, Family Preservation programs in Circuit 9 achieved an overall Compliance & Quality rating of 86%. Treatment Planning is the only area measured that achieved the target. Unit 206 is the only Unit that achieved an overall Compliance & Quality rating that met the agencys target. Assessment, Treatment Planning, and Closing achieved the target. Unit 205 was within 2% of the target, achieving an overall Compliance & Quality rating of 88%. Intake and Treatment Planning both exceeded the agencys target. Unit 204 was within 4% of the agencys target, achieving an overall Compliance & Quality rating of 86%. Assessment achieved the agencys target. Unit 202 achieved an overall Compliance & Quality rating of 84%, with Treatment Planning exceeding the agencys target. Unit 201 achieved an overall Compliance & Quality rating of 80%.

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Compliance & Quality: Placement - Circuit 9


100% 80% 60% 40% 20% 0% Intake Unit 201 Unit 202 Unit 204 Unit 205 Unit 206 Adoption 209 Target All Programs 78% 74% 70% 86% 80% 71% 90% 78% Assessment 83% 78% 85% 87% 95% 78% 90% 86%

Treatment Plan 82% 90% 86% 85% 92% 86% 90% 87%

Service Delivery 83% 83% 85% 85% 93% 84% 90% 86%

Closing

Overall 82% 82% 83% 86% 91% 82% 90% 85%

0%

90% 0%

Overall, Placement programs in Circuit 9 achieved an overall Compliance & Quality rating of 85%. Unit 206 is the only Unit that exceeded the agencys target with an overall Compliance & Quality rating of 91%. Assessment, Treatment Planning, and Closing all exceeded the target. Unit 205 was within 4% of the target, achieving an overall Compliance & Quality rating of 86%. Unit 204 was within 7% of the agencys target, achieving an overall Compliance & Quality rating of 83%. Units 201, 202, and Adoption 209 all achieved an overall Compliance & Quality rating of 82%. Incident Reports by incident type are reported below for Circuit 9. Incident Types: Circuit 9
250 200 150 100 50 0

FY13

FY12

FY11

In Circuit 9 there was a 15.9% decrease in the number of incident types in FY13 compared to FY12. Over the past three fiscal years the number of incidents have decreased by over 15% each year. There were significant decreases in six incident categories.
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Education related incidents decreased by 100%. Client injuries decreased by 66.7%. Criminal Acts decreased by 59%. Sexually Problematic Behaviors decreased by 46.2% Abuse and neglect decreased by 41.3%. Behavioral issues decreased by 28.6%. There were large increases in 2 incident categories. Incidents classified as Other increased by over 200%. Medical/Psychiatric injuries increased by 18.8%.

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Appendix B: Circuit 10 Highlights


Peer Record Reviews are shown below by Program Category with a break-down by Unit. Compliance & Quality: Family Preservation - Circuit 10
100% 80% 60% 40% 20% 0% Intake Unit 849 Unit 853 Unit 854 Unit 855 Target All Programs 83% 88% 81% 73% 90% 81% Assessment 69% 85% 93% 90% 90% 85% Treatment Plan 86% 86% 81% 57% 90% 77% Service Delivery 64% 90% 82% 86% 90% 80% Closing 100% 25% 33% 100% 90% 50% Overall 75% 85% 84% 78% 90% 81%

Overall, Family Preservation programs in Circuit 10 achieved an overall Compliance & Quality rating of 81%. Unit 853 achieved an 85% overall Compliance & Quality rating, with Service Delivery meeting the agencys target. Unit 854 achieved an overall Compliance & Quality rating of 85%, with Assessment exceeding the agencys target. Unit 855 achieved an overall Compliance & Quality rating of 78%, with Assessment meeting the agencys target and Closing receiving a 100% on Compliance & Quality items. Unit 849 achieved an overall Compliance and Quality rating of 75%, with Closing receiving 100% on Compliance & Quality items.

Compliance & Quality: Placement - Circuit 10


100% 80% 60% 40% 20% 0% Intake Unit 121 Unit 849 Unit 853 Unit 854 Unit 855 Target All Programs 92% 67% 61% 68% 68% 90% 69% Assessment 85% 85% 92% 79% 84% 90% 85% Treatment Plan 91% 89% 77% 70% 67% 90% 79% Service Delivery 91% 83% 76% 70% 75% 90% 78% Closing 75% 80% 0% 50% 0% 90% 45% Overall 90% 82% 80% 72% 75% 90% 79% Page 26 of 29

Overall, Placement programs in Circuit 10 achieved an overall Compliance & Quality rating of 79%. Unit 121 is the only Unit to meet the agencys target with an overall Compliance & Quality rating of 90%. Intake, Treatment Planning, and Service Delivery exceeded the agencys target. Unit 849 achieved an 82% overall Compliance & Quality rating. Unit 853 achieved an overall Compliance & Quality rating of 80%, with Assessment exceeding the agencys target. Unit 855 achieved an overall Compliance & Quality rating of 75%. Unit 854 achieved an overall Compliance and Quality rating of 72%. Incident Reports by incident type are reported below for Circuit 10. Incident Reports: Circuit 10
75 50 25 0

FY13

FY12

FY11

In Circuit 10 there was a 6.7% decrease in the number of incident types in FY13 compared to FY12. There were large decreases in 4 incident categories. Deaths decreased by 100%. Medical/Psychiatric incidents decreased by 26.7%. Criminal Acts decreased by 21.9%. Abuse and Neglect decreased by 14.5%. There were large increases in 4 incident categories. Client injuries increased by 200%. Education related incidents increased by 150%. Hospitalizations increased by 50%. Incidents classified as Other increased by 50%.

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Appendix C: Circuit 13 Highlights


Peer Record Reviews are shown below by Program Category with a break-down by Unit. Compliance & Quality: Family Preservation - Circuit 13
100% 80% 60% 40% 20% 0% Intake Unit 640 Unit 650 Unit 660 Unit 720 Unit 910 Target All Programs 61% 70% 73% 63% 72% 90% 68% Assessment 72% 82% 86% 64% 75% 90% 76%

Treatment Plan 66% 56% 63% 73% 72% 90% 65%

Service Delivery 64% 69% 72% 70% 58% 90% 67%

Closing 0% 50% 0% 25% 90% 20%

Overall 66% 71% 74% 66% 70% 90% 70%

Overall, Family Preservation programs in Circuit 13 achieved an overall Compliance & Quality rating of 70%. Unit 660 achieved the highest rating with an overall Compliance & Quality rating of 74%, followed by Unit 650 (71%), Unit 910 (70%), and Units 640 and 910 (66%). Compliance & Quality: Placement - Circuit 13
100% 80% 60% 40% 20% 0% Intake Unit 640 Unit 650 Unit 660 Unit 720 Unit 910 Target All Programs 64% 70% 71% 75% 61% 90% 68% Assessment 67% 74% 71% 65% 64% 90% 69%

Treatment Plan 64% 80% 76% 75% 68% 90% 73%

Service Delivery 66% 67% 66% 66% 61% 90% 65%

Closing

Overall 66% 73% 70% 69% 63% 90% 69%

0% 0% 50% 90% 29%

Overall, Placement programs in Circuit 13 achieved an overall Compliance & Quality rating of 69%. Unit 650 achieved the highest rating with an overall Compliance & Quality rating of 73%, followed by Unit 660 (70%), Unit 720 (69%), Unit 640 (66%), and Unit 910 (63%).

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Incident Reports by incident type are reported below for Circuit 13.

Incident Reports: Circuit 13


90 80 70 60 50 40 30 20 10 0

FY13

FY12

In Circuit 13 there was an increase in the number of all incident types in FY13 compared to FY12. This increase is due to the fact that C13 was not operational until the second half of the fiscal year and Incident Reporting to CQIR did not begin until the 4th quarter of FY12. A more detailed year to year analysis will be completed in FY14 when there are 2 complete fiscal years of data available.

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