QA/CQI for Case Planning- What Managers Can Implement to ...

QA/CQI for Case Planning- What Managers Can Implement to ...

QA/CQI for Case Planning- What Managers Can Implement to Obtain Desired Results PRESENTED BY: HOLLEY BOSSELL, MATT MORRIS, & AMY STUDEBAKER Introductions When we think about QA/CQI from a managers perspective, what does it mean to you? First thing we have to understand: Case planning is a process, that requires adoption of evidence based principles and core correctional practices to truly be effective. Evaluate your agency culture!

Understanding Your Agency Culture Treatment/Rehabilitation Enforcement/ Punishment Core Correctional Practices Effective Reinforcement Effective Disapproval Effective Use of Authority Cognitive Restructuring

Anti-Criminal Modeling/Structured Skill Building Problem Solving Relationship Skills/Motivational Interviewing Staff members should view themselves as agents of change and support the goals of offender rehabilitation. Examples of relevant evidence based practices: Well educated and trained staff Interviewing skills Assessment (Risk, Need, Responsivity) Well defined behavior management system

Cognitive Behavioral strategies and interventions Well defined policies Routine evaluation and re-evaluation of both offenders and staff Advancement and completion criteria Evaluation of program effectiveness If external providers are utilized, how familiar are you with their services? Evaluate the resources and programming available to your agency

Do they adequately address criminogenic needs? Do they adhere to evidence based principles? Do they utilize cognitive behavioral based strategies and interventions? Does my agency have a positive working relationship with these organizations? (Good communication, familiarity with services, receive progress reports of offender progress) What do our offenders say about these places Why should we use a standardized assessment tools?

Ensures accuracy. Leads to improved RNR identification. Helps ensure the equal treatment of clients with similar RNR factors. Reduces bias in the case planning process. Assists if there are legal challenges. Examples of common assessments: Ohio Risk Assessment System (ORAS) Overall Risk Assessment

Used to assess the chance of committing a new offense. It red flags risk levels in specific domains. Need Assessments & Screening Tools Utilized to further assess need areas that are rated problematic per the ORAS or other collateral information. Assesses Criminogenic Need Areas Substance Abuse ) TCU Drug Screen (TCU-DS) Substance Abuse Subtle Screening Inventory (SASSI) Diagnostic and Statistical Manual of Mental Disorders V, (DSM) Criminal Attitudes TCU Criminal Thinking Scales (TCU-CTS) Family Relational Inquiry Tool Sex Offenders Static-99 Responsivity Assessments Utilized to further assess barriers to treatment. Not all clients respond the same way. Outcomes generally improve when accommodations are made to minimize the effects of barriers.

Many additional assessments are available if needed. Motivation/Treatment Readiness University of Rhode Island Change Assessment (URICA) TCU Client Evaluation of Self and Treatment (CEST) Mental Health/Personality Minnesota Multiphasic Personality Inventory (MMPI-2) Education Adult Basic Learning Examination (ABLE) Evaluate your Agencys assessment expectations Does your agency have the ability to conduct or refer out for a wide array of assessments to identity an offenders individual needs or barriers? Does your agency have policies and/or procedures for assessment protocol? Does your agency staff understand and receive the results of:

ORAS Risk Assessments. Need assessments or letters from community. partners detailing the findings of the assessments. Responsivity Assessments or letters from community partners detailing the findings of the assessments. It all begins with the Interview Process A bad start=a bad outcome ORAS Score Quality Assurance 1 in 4 ORAS assessments had

the WRONG risk level. Peers & Criminal Attitudes was the most problematic area. Source: University of Cincinnati Corrections Institute ORAS Quality Assurance Source: University of Cincinnati Corrections Institute The goal of the interviewing session is to: Gather detailed and accurate information for the assessment and case planning process! Does my staff have access to, and review collateral information?

Review collateral information prior to interview. Sources include: Presentence Investigations LEADS/Arrest Records Prior Supervision Notes Prison/Institutional Summary Reports ORAS Information

Information from family, Schools, Employers, etc. Utilize interview guides, and be familiar with the assessment tool you are using. How does my agency conduct interviews with offenders? Welcome & acknowledge client State your purpose Be open & relaxed

Minimize distractions How you ask it matters Open-ended questions Follow-up questions Utilize the interview Guide Close-ended questions Double-barreled questions Biased questions Jumping to conclusions Reflective Listening, Summarizing, and Affirmations Reflective listening: A statement of understanding that is expressed through: Repeating Rephrasing

Paraphrasing Reflection of feeling Summarizing: Examining what has been said and communicating it back to the offender. A good technique to transition between sections of an assessment. Good way to end meeting. Affirmations: Are compliments or statements of appreciation and understanding. Types of affirmations: Thanks for coming on time today! Ive enjoyed talking with you today and getting to know you a bit! That must have been very difficult for you! I think that it is great that you want to do something about the problem! What does our agency Interviews and interactions look like? VS. Patient Rushing

Open-minded Both Parties Tired Working Together Adversarial Usually a Leader Someone Loses

How we interview and interact with offenders matters. Does my agency have a process to evaluate staff in these functions? Nonverbal attending Eye contact Facial expressions Posture Devoting full attention

Use of encouragers Provide listening cues Evaluate your Agencys interview, assessment process, and service delivery Have agency staff been trained in interviewing skills, and the assessment tools they are conducting? Do policies and/or procedures detailing the assessment process exit? Minimally this should include timeframes, and descriptions of the process. Do policies and/or procedures detailing the process for quality assurance activities exit? Minimally this should include timeframes, sample sizes, descriptions of the process, and the methods utilized when they discover deficiencies.

Do forms exist that are to be utilized to conduct QA reviews. These should be signed and dated as a record that the review occurred. Certification documents for staff who complete assessments or conduct QA. Recommended Practice: Interview observation, Double-Coding, and file review. Do staff utilize the interview guide, are they asking secondary questions, do they utilize the scoring guide? ASSESSMENT AND SERVICE DELIVERY EVALUATION/OBSERVATION FORMS

ORAS direct observation forms and process Group Facilitator observation/evaluation form Individual Service delivery observation/evaluation form Dosage/Treatment Considerations Criminogenic treatment/dosage hours are the time spent participating in structured evidence based behavioral interventions which can include individual & group treatment, and case management/supervision sessions that focus on the criminogenic domains. Case Plans should be developed in a manner that seeks to deliver enough treatment/dosage hours to address the clients risk and need level and extinguish

unwanted behavior. As the risk level of offenders increases, dosage should increase as well. Therefore, higher risk offenders should receive a significantly higher amount of behavioral interventions than lower risk offenders. It is important to remember, anti-social behavior is developed over the course of a life time, and requires a significant amount of criminogenic treatment hours before positive affects are generally realized. Dosage/Treatment Considerations Continued Treatment progress and dosage hours should be regularly updated via case notes and case plans to ensure clients are on track with expectations. Treatment should be individualized to meet the specific risk and need of each client.

Treatment/dosage should should be prioritized. Offenders can become overwhelmed if they are required to work on too many need areas at once. Consider starting with primary risk factors (those criminogenic need areas most likely to impact recidivism). Criminal Attitude & Behavior Patterns Peer Associations Personality (Aggressive, Impulsive, Risk Seeking, etc. Traits that contribute to crime) Addressing overall Risk Level Ideal situation:

All offenders whose overall risk score is moderate or higher would participate in a core Cognitive Behavioral Therapy (CBT) program such as T4C, EQUIP, Tru Thought, Moving On. The core CBT program would then be supplemented with individual interventions in such a manner so that higher risk offenders are receiving more treatment. DOES YOUR AGENCY HAVE THE ABILITY TO SUPPLY AND VARY DOSAGE? Individual interventions to supplement the core CBT groups. The Carey Guides include 33 handbooks that help corrections professionals use EBP with their clients. Each Guide contains two to five Tools (worksheets) which are designed for use by offenderswith the assistance of their corrections professionalto understand and address risk factors, triggers, and other conditions that are essential to their success. They are best suited toward a long term case

management system. Carey Guides Include Anti-Social Thinking Values The Brief Intervention Tools (BITS) were created to help corrections professionals effectively address key skill deficits with offenders in short, structured interventions. The tools can be used as a supplement to the Carey Guides, but are short, situational, and focus on six key skill deficits which can be used immediately. BITS Tools Include

DECISION MAKING OVERCOMING AUTOMATIC RESPONSES Anti-Social Peers Problem Solving/Deion Making Social Skills Anger

OVERCOMING THINKING TRAPS Involving the family PROBLEM SOLVING Substance Abuser THINKING TRAPS Sex Offending

WHO I SPEND TIME WITH Domestic Violence Treatment Options Designed to Address Criminogenic Needs ORAS Domains Examples of Appropriate Referrals & Tools Criminal History Static Domain. Criminal History can not be changed. Peer Associations Referrals to CBT Programming (T4C, EQUIP, Tru Thought, Moving On), Individual interventions/tools via Carey Guides, & EPICs. Criminal Attitudes/Behavior Problems

Referrals to CBT Programming (T4C, EQUIP, Tru Thought, Moving On), Individual interventions/tools via Carey Guides, & EPICs. Substance Abuse Referrals for Substance Abuse Programming, Referrals to CBT Programming (T4C, EQUIP, Tru Thought, Moving On), Individual interventions/tools via Carey Guides, & EPICs. Education/Employment/Financial Situation Referrals for GED Classes, Employment classes, Job Referral Sources, Mock Interviews, Finance Workshops, Individual interventions/tools via Carey Guides, & EPICs. Neighborhood Problems Referrals for Housing Assistance, Individual interventions/tools via Carey Guides, & EPICs. Family and Social Support

Referrals for Family Counseling, Individual interventions/tools via Carey Guides, & EPICs. Dosage Recommendations: Suggested levels of dosage per risk level over the period of supervision: Moderate Risk = 100 to 200 dosage hours High Risk = 200 to 300 dosage hours Very High Risk =

300 + dosage hours Guy Bourgon and Barbara Armstrong (2005), Transferring the Principles of Effective Treatment into a Real World Setting. Criminal Justice and Behavior, 32:3. Dosage Considerations: Does my agency have policies and/or procedures detailing how they will address offender treatment based on risk and need? Does my agency have defined internal program schedules? Does my agency have data describing outside referral programs. (letters, pamphlets, or/and written descriptions) Is staff aware of their services? Do we conduct case file audits to ensure staff consistently refers clients to treatment by risk and need. (Copies of case

notes, case plans, discharge summaries, reporting schedules, aftercare plans, individual dosage trackers, and/or agency dosage trackers. Consider Tracking Dosage Why should you develop a Case Plan? Case planning is beneficial because it: Provides structure and guidance to supervision process. Helps maintain focus on criminogenic needs. Helps prioritize goals and objectives.

Documents progress and provides ongoing intervention. Provides the offender with a concrete guide to his/her expectations. When should you develop a case plan? Goals and objectives should be developed for any moderate or high risk or need area determined via the assessment process. They may be developed in other instances if a client is required to complete additional tasks that you need to track. The point is, to develop a roadmap for the client to follow. He/she

should know what they need to do! What Should you prioritize on the Case Plan? Return to your RNR Principle for guidance: Tier I Big 4 Criminal History: Criminal Attitudes values & Behavior Patterns Peer Associations Personality (aggressive, Impulsive, risk seeking ect. Traits that contribute to crime) ============================================= Tier II

Education & Employment Family & Social Support Substance Abuse Neighborhood Problems & Leisure What Should you prioritize on the Case Plan? Higher risk need areas should be prioritized over other areas when at all possible. Staff should try to address the Big 4 first.

If there is a need area or responsivity issue, you may need to re-prioritize the clients plan. Ask for the clients input. What makes the most sense based on the data? If you are not able to address all of the offenders need areas in the time they are under your care you will need to make referrals for services when you develop the After Care Plan. What are the components of a Case Plan? When

developing a Case Plan it should contain: Need Areas (Assessed criminogenic need) Goals (Long term outcomes with desired behavioral change) Objectives (Short term steps to meet the desired goal) Techniques (How will the provider monitor the objectives) A Closer look at Goals Think of a Goal as the Big lifestyle change. States pro-social behavior change. Does not have to be measurable. Defined by need area. Long-term outcomes.

GOAL Suggestions Education, Employment, and Financial Situation Need Area Education Goal To possess the necessary level of education required for the career you desire Improve your literacy skills Need Area Employment Goal To develop the skills necessary to seek and maintain employment Obtain a job that you can maintain

Develop a plan to address both short and long term career options Work in an industry that you have the skills for and you enjoy Creating S.M.A.R.T. Objectives Specific: a specific objectives has a much greater chance of being accomplished than a general objective To set a specific objective you must answer the six W questions: Who is involved? What do I want to accomplish? Where (identify a location)

When (establish a timeframe) Which (identify requirements and constraints Why (specific reasons, purpose or benefits of accomplishing the goal) Measurable: establish concrete criteria for measuring progress toward the attainment of each objective you set. Ask the following questions: How much How many

How will I know when it is accomplished S.M.A.R. T. continued. Attainable: Identify goals that are most important to the offender and also something attainable. If important and attainable they will begin to figure out ways to make them come true. Will develop the attitudes, abilities, skills, and financial capacity to reach them. Realistic: Timely: Must be something the person is willing and able to work on. Should be grounded within a timeframe. there is no sense of urgency. With no timeframe Objective Suggestions

Need Area Education Objective List agencies that provide ABE by XX/YY, and bring them to your next appointment. Provide verification to your case manager that you registered for ABE classes by XX/YY. Obtain information about financial aid opportunities from an institute of higher learning, and provide it to your case manager by XX/YY.

Complete a Federal Student Aid application, and provide verification to your probation officer by XX/YY. (Make sure work direction is a measurable action) Further Considerations for Case Planning. Offender Input: Offenders are more likely to accomplish established goals when they are allowed to participate in the process, and are explained how it benefits them. Overall Risk Score: If an offenders overall risk score is moderate or high, it is appropriate to develop case plan objectives to directly address their likelihood to commit a future crime. Placement in a CBT Program is appropriate based on an offenders overall risk score alone. Case Plan Review and Updates: Case Plans should be reviewed regularly with the offender and updated as an objective is accomplished or the offender demonstrates a new need. It is up to each individual program to develop a minimum review schedule.

Case Notes: Client notes should summarize Case Plan progress. Court ordered/supervision conditions: Such conditions as EM, alcohol/drug testing, curfew can be effective supervision tools, but are unlikely to result in true behavior change if not used in conjunction with sufficient behavioral interventions. Is the client motivated and/or ready for change? Case Plans are goal oriented and may have multiple objectives or steps will be used to achieve each goal. The amount of steps is often related to the clients motivation to change. Staff should seriously consider what stage of change or level of motivation the offender is in. (ideally done through an objective assessment such as URICA, CEST, or HIT) Once

stage of change is assessed, the case plan should focus on moving offender through the remaining stages of change. Officers should use as many interventions/tools as necessary and take as much time as needed to move the offender forward on the stages of change. Responsivity Issues If responsivity issues (barriers to treatment) were identified, is our agency able to tailor our interventions/programming to best need to the clients needs? Do we see evidence of this in case plan objectives? Are our outside referral sources able to accommodate responsivity issues?

How does your Behavior Management System (BMS) support your case plan? Behavioral reinforcement strategies and techniques should be used to encourage offenders to learn new skills and pro-social behaviors. Punishments/sanctions need to be available to suppress and extinguish anti-social behavior. Incentives should be available to promote new positive behaviors. Do we have a defined behavior management system? The case plan should be a fluid document that is adjusted and updated as positive or negative behavior is exhibited. Do we have a process to review for this?

Quality Assurance Supervisors or designees should routinely monitor/review the quality of the case planning process. Does the case plan match the assessments? Will the case plan help the offender extinguish unwanted behavior? Will it be enough treatment? Is the case plan SMART? Has the case plan been updated as the client meets their objectives or exhibits new needs? Do the case notes indicate offender progress is monitored appropriately?

Is there an aftercare/continuum of care plan based on the assessment results? Were the QA efforts documented? Are employees coached if they do not meet expectations? Case file audit/case plan audit considerations: Does my agency have policies and/or procedures detailing the process for quality assurance activities. Minimally this should include timeframes, sample sizes, descriptions of the process, and the methods utilized when they discover deficiencies.

Does my agency have forms utilized to conduct QA reviews? These should be signed and dated as a record that the review occurred. Does my agency have staff who are proficient enough in services to effectively conduct QA functions? Does my agency have enough staff to conduct QA or will an effective process require collaboration with outside agencies? Does my agency have the ability to monitor outside referrals? Does my agency have an effective training, mentoring, and coaching process so these functions can be effective? Questions?

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