Section 3: Continuous Quality Improvement (CQI) in Child Welfare

Continuous quality improvement (CQI) is an evidence-based system used by many industries and agencies.  It can be simply defined as a data-driven process that employs specific values and tools for setting goals, planning, and implementing and measuring change.  The ultimate goal of CQI is to enable organizations to improve their overall performance on an ongoing basis.

Long entrenched in Japan, Western Europe, and the United States, CQI has served as a fundamental building block of manufacturing, health care, and other industries whose implementation of CQI decades ago led to dramatic improvements in efficiency, worker satisfaction, and customer service (Sollecito and Johnson, 2012). As a systematic, informed process that mirrors other sectors, however, CQI is still a developing field for the Nation’s child welfare programs.

The 1994 Amendments to the Social Security Act (SSA) authorized the Children’s Bureau, under Health and Human Services, to ensure substantial conformity with the State plan requirements of titles IV-B and IV-E of the SSA. Existing regulations of the Child and Family Services Plan (CFSP) require States to describe the quality assurance (QA) systems they have in place that “regularly assess the quality of services under the CFSP and assure that there will be measures to address identified problems.”

During both rounds of the Child and Family Services Reviews (CFSR), the Children’s Bureau found that the majority of States met basic requirements for QA systems that evaluated the quality of their services at the time of the review; however, the Program Improvement Plan phase revealed that many State QA systems needed extensive expansion and refinements to adequately assess and measure service and practice improvements, specifically with regard to CFSR outcomes and systemic issues, on an ongoing basis. Thus, a major intent of the CFSRs has been to illuminate and help States enhance their ability to monitor, self-evaluate, and improve their practices and programs.

Although States and jurisdictions have made efforts to improve the quality of their child welfare services for many years, some have found it challenging to implement comprehensive reform, sustain changes made, and effectively monitor practice. With the CFSRs as a major catalyst, and as States become more informed about implementation science and evidence-based practices, an understanding has grown that changes in practice must be implemented and measured, on a continual basis, through a formalized, comprehensive, agency-wide system.

The Children’s Bureau is committed to supporting States in achieving improved outcomes for families and children, and to that end is promoting sound, comprehensive CQI systems in States' child welfare agencies. The Children’s Bureau supports the quality improvement efforts of these agencies by providing information through online publications, trainings, and technical assistance and support services.

  • Note: Information Memorandum 12-07, published by the Children’s Bureau, specifically provides information on establishing and maintaining CQI systems in State child welfare agencies. It is available online at LINK.

The essence of CQI is an organization-wide, systematic focus on better meeting the needs of the recipients of the agency’s services. A comprehensive, well-integrated CQI program, diffused into all facets of a child welfare agency, offers an exciting approach for more effective responses to demands that agencies work more efficiently, use resources more wisely, and achieve more positive outcomes.

Module Structure

This e-training module is designed to provide an introduction and overview of CQI and its benefits. The first section, Defining CQI and Building a CQI Framework, provides a discussion of several key elements that “set the stage” or complement an agency’s ability to implement a strong CQI system.

The second section, Effective Leadership and Creating a Learning Environment, deals with leadership qualities, attitudes, and activities that are key to the implementation of a successful, agency-wide CQI program. Additionally, the section discusses the necessary features of an effective learning environment.

The third section, Functional Components and Processes of CQI, describes the five key components of an effective CQI system. These include:

  1. A strong foundational administrative structure
  2. Quality data collection
  3. An effective QA case record review process
  4. Effective data analysis and data dissemination procedures
  5. Procedures to enable feedback to stakeholders and decision-makers and adjustment of programs and process

The fourth section, Implementing Systems Change, covers the involvement of internal and external stakeholders in creating change, assessment of needs/goals, selecting intervention strategies, developing an implementation plan, implementing innovations, and sustaining the change.

The final section of the module provides Additional Resources for further study of numerous aspects of leadership, systems building, and of the CQI process. The listing for each resource provides a summary and Web link.