Improving the Quality of Professionals’ Visits with Children, Youth, Caregivers, and Providers – Agency Examples

Overview

Adams County sought to improve the quality of caseworker visits with families and ultimately improve family’s outcomes. To this end, the PDSA Team implemented a prep checklist to better prepare for home visits and used the tool when meeting with families. Also, a to-do list with carbon paper was used in meetings to document actions the family and/or worker agreed to take, and copies were left with both the family and worker to improve accountability. Finally, the team implemented a new process they termed “Enhanced Assistance Tasks (EATs). Here the worker identifies some of the to-do tasks that should be completed in the family visit and uses visit time to assist the family in completing those tasks.

The tool

The Tool may be viewed and downloaded here:

Adams Visit Checklist and To-Do List

Improvements

As a result of the project, the team noted that the checklist led to better documentation of what was discussed in the visit. The prep sheet and to-do list also assisted in reminding workers to address safety concerns, family goals and tasks necessary to comply with expectations. One worker noted that while they spent 7 minutes tailoring the prep sheet to the specific family prior to use, the use of the prep sheet ensured they covered every topic in the family visit. While more time is spent prepping for the visits and more time is spent meeting with families, the team is saving time in the long run through covering all topics and not needing to schedule additional meetings or follow up with additional phone calls.

PDSA Team members stated that when they use the to-do list and EATs process, the family was held accountable for their participation in services, such as finding housing. Working through the to-do items with families also helped better identify where families were at in the change process, and specifically which families were motivated to make changes. The process also showed the progress of obtaining and maintaining services along with the struggles the family had where the worker was able to step in and assist. For example, a worker may help with phone calls and communication with service providers to work towards the family goals. In another example, the EATs process helped one worker identify a family member’s struggle with literacy which was previously unknown. Identifying this barrier led to the worker better understanding additional supports this family needed.

Barriers Overcome

Adams County discovered the preparation sheet was not applicable to all case types. Also, using a new tool was initially a challenge as workers have their own processes. Last, the EATS process was not helpful with after-hours visits as it is often not possible to contact providers at these times.

Overview

Prior to beginning the PDSA Collaborative, La Crosse County felt that documentation was inconsistent with requirements outlined in the Department of Children and Family’s Ongoing Service Standards. The county also felt that their current documentation process did not clarify if next steps or tasks decided upon in family meetings were followed up on.

Over the fall of 2020 and spring of 2021, La Crosse County created a structured case note template to be used for all face-to-face interactions with case participants. The county’s goal in using the structured case note was to encourage concise and focused case notes, as well as to allow for easy tracking of action steps that were or were not taken by clients and the county social workers. The structured case note was revised over multiple weeks through use of the tool, revision, and ultimately unit adoption. The workers also measured the effectiveness of the process through utilizing a point system to determine whether the tasks were completed by the workers or if they were not.

Tool

The La Crosse County structured case note may be viewed and downloaded here:

Face to Face Case Note Template

Improvements

Workers found that this structure helped focus their case notes on relevant details from visits and cut out some of the ‘noise’ that occurs in a typical visit. Workers also felt this was faster as they were able to begin their case notes in that structure during meetings and then more easily translate those into their fully formed case notes once they adjusted to the structure. Workers also had an easier time remembering what all parties had agreed to accomplish by the next meeting and following up on those.

Barriers Overcome

In utilizing the structured case note process, workers needed to shift from documenting the case notes chronologically, and to instead fit discussion items into themes. This required additional analytical work by the social workers. Overall though, the investment of time and analysis was important and led to improved quality of the case notes, only the important points were documented, and the action steps were more specific. Workers generally felt that the structure kept them on track and made it easier for them to follow up with clients about tasks they had agreed to accomplish. This also provided accountability for the workers, since they knew it would easily be identifiable if they did not accomplish an action step assigned to them.

Overview

Ozaukee County identified three practice areas to improve through using the PDSA Collaborative process. First, the collaborative members wanted to address their varied documentation styles between workers. The agency felt that the documentation did not always include all required information for face-to-face contacts, including documentation of adequate engagement and sufficient quality of visits. Second, the team also identified a need to give families more transparency in what to expect in visits, to help the families follow through on tasks from meetings, and to make the content of visits more purposeful and planned. Last, there was a desire to reduce a workers’ feelings of being overwhelmed due to documentation requirements.

The PDSA Collaborative team created a case note template and a tear-away sheet to provide families with a list of items to do after each meeting. The tools were taken to visits, shared with families, and was used to guide documentation after the visit. One worker also looked into if documentation could be made even more efficient by using handwriting-to-text technology. To this end, the worker uploaded their case note template to the Samsung Galaxy S6 Lite tablet, and handwritten notes entered onto the tablet converted to text that was able to be copy and pasted into eWiSACWIS.

Tool

The Tool may be viewed and downloaded here:

Case Note Template and Tear-away sheet

Improvements

As a result of the project, PDSA team members felt that:

• Case notes were easier to write as well as more consistent.
• Case notes included all necessary information.
• Case note documentation turnaround was faster.
• Permanency plan and case plan documentation time was reduced because the information was easier to find.

In addition to the benefits seen by the team members, the agency felt that families seemed to like the transparency this structure for visits/notes provides. The families appreciated the to-do list provided at the end of visits. Also, the tool holds both workers and families more accountable to accomplishing tasks and making progress between meetings. Team members felt a reduction in being overwhelmed by documentation requirements specific to case notes and permanency plans.

The use of the tablet that enables handwriting-to-text casenote writing was also found to be successful for the worker. This system allows the worker to stay on top of notes and the technology was user-friendly to learn.

Barriers

The team found that the tool works best when it is formatted to the family’s specific goals, and workers need to spend time personalizing the tool for each family.

Overview

Trempealeau County’s PDSA Collaborative goal was to improve documentation. Prior to the work in the PDSA Collaborative, workers found it time consuming and difficult to go through past case notes to gather all information needed for their current casework, and specifically for court documents. The team created a simple template to document what had or had not been done in the case, such as the dates of contact, drug tests, and other important events that occurred each month.

The template created is essentially a log that condenses all case management contacts, drug testing, etc., into one user-friendly spreadsheet that can easily be referenced when needed. The log was based off information needed in court to give updates to the Judge. Likewise, it is also helpful in case transition meetings to inform the new worker of the work that has been completed in the case.

The tool

The tool may be viewed and downloaded here:

Case Management Log

Client Contact Summary Sheet

Improvements

Due to Trempealeau County’s court calendar, not enough data has been able to be gathered to determine the effectiveness of this tool, as of the end of the Collaborative in April 2022. The team does hypothesize that they will be able to save time overall in preparing for court documents. The team also theorized that clients and caseworkers will be better able to track progress (or lack thereof) throughout the life of the case. Likewise, the team feels that if the family is transitioned to a new worker, the log will likely help the new worker understand past contacts made, progress made, etc.

Barriers Identified

Trempealeau County identified that it does take time to document and update the case management log in addition to regular case noting, and this process must be worked into regular case work. Likewise, the PDSA Team noted that as multiple people sometimes work on one case, the team needed to save the log to a location that could be accessed by all necessary people.

Overview

Washington County joined the PDSA Collaborative motivated to improve their data collection and better document their case notes. The county had identified inconsistencies in what information was being captured and were concerned as to the risk of missing important case information. The county also sought to streamline their case notes, ensure all important documentation was being collected, and remove unnecessary details cluttering the note. To solve these issues, the county created two case note templates – one for their social workers, and the other for the Family Support Assistants.

Tool

The Washington County structured case note contact checklist may be viewed and downloaded here:

Case Worker Contact Checklist

Family Support Assistants Contact Checklist

Improvements

Washington County participants found that there was an initial investment of time in learning this process. However, throughout the case the participants found it saved time and made it easier to find and track information – specifically court documents and Permanency Plans. It was also easier to follow up with subsequent visits. Family Support Assistants reported that the notes assisted them with easily identifying the quality of a visit, and for better ease of seeing change cycles for meetings with social workers. Team members also preferred structured notes over the narrative style in most situations. Finally, workers also found that the template took less time than they initially thought it would.

Barriers Overcome

As stated, there was an initial additional time investment, but users of the new system did overall find time savings once the tool was comfortable. Additionally, when rolling the tool out to workers not on the original PDSA Collaborative Team, there was some trepidation as not all were in a position to take on a new task. The process was made easier through having joint team meetings with the other ongoing unit to explain the template prior to use. A survey was also used to gather feedback on the tool and improve its functionality. Through the feedback the tool was made more functional and less time consuming. Use of the tool is also an expectation of the workers in the unit.

Overview

Waukesha County’s PDSA Collaborative goal was to implement a comprehensive change that would move families to permanency quicker. In doing this, the PDSA Collaborative members sought to improve communication and understanding of and follow up on goals necessary to achieve permanency. The county strived to build trusting relationships and engage families by developing a practice for structured client contacts which focused on safety and permanence. An action planning tool was created and implemented during client related contacts – including family team meetings, home visits, and staffings. The tool reflected the needs, goals, action steps and timelines for team members. A few different versions of the form were created to utilize in different settings.

After the tool was created, it was introduced and used in contacts with families. The PDSA Collaborative members reviewed who used the form, where, and how frequently. Barriers were identified and discussed during weekly PDSA check-ins with the team. A survey was also developed to determine the usefulness and satisfaction of using the action planning form in contacts with families.

The tool was shared with other ongoing teams, other workers have shadowed use of the action plan and other workers have used the action plan in their work with families.

Tool

The Waukesha County Action Planning Tool may be viewed and downloaded here:

Action Planning Tool – 1

Action Planning Tool – 2

Action Planning Tool – 3

Improvements

As a result of the project, team members felt more comfortable and confident in the roles and steps towards meeting case goals and achieving safety, permanency and well-being. Social workers increased rapport and understanding of the family’s needs and families felt they were heard to a greater extent. Workers appreciate that they know if the families follow up on expectations set in meetings and families appreciate having a better understanding of the steps they need to follow. Everyone feels meetings are more organized and they have a better understanding of where the case is in the process. The Action Planning Tool has helped increase transparency with families, improved accountability with all case participants and provided a clear path towards permanency.

Worker Testimony in using the Action Plan

A family began receiving child welfare services in 2017 and there was a transition in social workers in 2019. There were many challenges in working with the family. One of the primary identified barriers was the issue of communication and planning. Through the implementation of the action planning tool in family team meetings, a reunification is pending court approval. The action planning tool was very helpful in being able to move the case to a shared goal of permanency for two children. The tool provided a clear way to define the specific goals which related to child safety and then concise actions steps were developed for all team members. This was effective in improving transparency and communication between the social worker, family, relative caregivers and providers. The action steps were tied directly to items that impacted the safety of the children. This increased awareness of safety within the family team. The action planning tool allowed the parent and team members to follow up sooner, address barriers earlier and track progress often. The parent was asked to participate in the optional survey after each family team meeting. The parent felt very strongly that the action planning tool increased her understanding of each task and that it helped her make progress on her family goals. It is my belief in working with this family and being part of the PSDA collaborative team that this case is an example of how we created goals that were family centered which resulted in reunification for this family.

Overview
Through work in the PDSA Collaborative, Wood County sought to find a more time efficient and effective way to document their meetings with families, to simplify documentation, and to improve consistency between workers. The county attempted multiple different processes, and ultimately adopted and tweaked the structured case note created by Vilas County. In Spring 2021, the PDSA Collaborative team asked the entire Wood County Ongoing Unit, including those outside of the original PDSA team, to implement the new structure, termed the Visitation Preparation and Summary Sheet.

Improvements
First, workers noted time efficiency and savings. The workers found they saved approximately 5-10 minutes per case note through using the Visitation Preparation and Summary Sheet. Workers were able to be more focused at visits which in turn made the time in homes more efficient.

Additionally, workers noted an improvement in overall effectiveness and thoroughness of notes resulting in better response, decision making and understanding of the case when needed to be accessed by another worker. This was specifically noted by workers needing to access a case during an on-call response, decision making at Access when a new report is received, and when a different worker or supervisor needs to cover the case unexpectedly during an absence. The content of these notes was also more helpful to new workers accessing the case during a Termination of Parental Rights, when the new worker found that better information was captured and organized within the case note.

Finally, there was also the downstream effect of improved team morale, great teamwork, and creative brainstorming. New workers were trained on this process and found it helpful as they had been unsure with what they needed to cover at each meeting.

Barriers Overcome
As stated, the team went through multiple different tools before deciding upon the one linked below. Also, through use of the chosen tool, it was found that some of the areas covered in the tool were excessive for every meeting, leading to workers at times skipping over unnecessary sections. Rolling out the tool to the non-PDSA Collaborative Ongoing Unit took time, but were assisted through using the Unit Meeting Flyer to help explain the process, available in the hyperlink below. Questions were encouraged, and conversations helped explain the process and clarify expectations. In late Spring, additional meetings were held to further revise the tool prior to adoption.

Tool
The Wood County Visitation Preparation and Summary Sheet, as well as the Wood County Unit Meeting Flyer may be viewed and downloaded here:

Wood County Visitation Preparation and Summary Sheet

Wood County Unit Meeting Flyer