Quality Skills in Doubt

The first paper published from the National Study of Quality Professionals in behavioral health services concludes that many quality professionals don't think they have the skills they need to do their jobs well. The paper, published online (in prepublication format) at the website for the journal, Administration and Policy in Mental Health and Mental Health Services Research, was written by me (Curtis McMillen) and Matt Raffol. It finds that roughly 40% of the employees rated themselves at unskilled at both the research and quality aspects of their jobs. Another 30% found themselves skilled at research, but not knowledgable about quality improvement. Here is the abstract.

Behavioral health agencies have been encouraged to monitor performance and improve service quality. This paper characterizes the workforce charged with these tasks through a national survey of 238 behavioral health quality professionals. A latent class analysis suggests only 30% of these workers report skills in both basic research and quality-specific skills. Respondents wanted to learn a variety of research and data analytic skills. The results call into question the quality of data collected in behavioral health agencies and the conclusions agencies are drawing from their data. Professional school and continuing education programs are needed to prepare this workforce.

skills chart

The paper also provides the first U.S. national glimpse at the quality workforce in behavioral health. The group is a veteran one, with a mean of 20 years working in the social services, over 12 years in a position related to quality assurance or improvement. Only a small portion had a certification in the quality field, but those who possessed such a credential rated themselves higher in skills needed to do the job well.

The paper concludes by calling for training for the quality workforce in the social services. Most of this workforce reports that they currently get their training on the job or through their agencies' accreditors. Existing quality professionals in the social services might want to consider seeking a certification in the quality field.

The paper is behind a pay firewall at the journal. You will likely have to access it from an academic library to get access to the full paper.

Summer training opportunity

In August, the University of Chicago will host a 3.5 day ocanstockphoto5599965(1)n-site training in performance measurement and quality improvement for social service agency staff and faculty members in schools of social work. For seven of those agency-faculty pairs, the training will be free, courtesy of the Center for Health Administration at the University. Plus, these pairs will receive a small budget for consultation and improvement project back at their agencies. Tina Rzepnicki and Curtis McMillen of the university are putting together the training, which will include outstanding faculty from across the country.

Details are here:http://www.qualitysocialservice.com/learning-opportunity/



New Study on Performance Measurement in Social Services

The University of Chicago and Chapin Hall Center for Children at the University of Chicago today announced that they will be funding a new research project to explore performance measurement in private child and family service agencies. The study, Understanding and Improving Performance Measurement Systems in Private Child and Family Service Agencies, will involve case studies of nine agencies. These agencies' performance management efforts will be at varying levels of maturity and functioning. The study aims to better understand the developmental and workforce challenges private child and family service agencies face as they build performance management systems. The project's co- principal investigators are Drs. Nathan Israel of Chapin Hall and Curtis McMillen of the School of Social Service Administration at the University of Chicago.

Dr. Nathan Israel
Dr. Nathaniel Israel

The fund was established to support outstanding research that investigates and leads to new directions in policy and practice aimed at promoting the well-being of vulnerable children, while fostering long-term policy-relevant collaborations between the University and Chapin Hall.

Bob Lloyd Rocks the Whiteboard with Quality Learning

I continue to hear from people that they don't know where they can learn the science of quality in an economical way. It really is here on the web for all of us, not always in an organized way, but the pieces are all here. Today's example comes from quality genius, statistician and all around nice Chicago guy, Robert Lloyd. He has created a series of white board lectures to demonstrate key quality constructs.

lloyd whiteboard lectureAnd they are on the web. For free. And quite good.

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Luna Gale Nails It: The Problem with Case Management


It is a pity that so few people will see Rebecca Gilman's amazing new play, Luna Gale, now showing at the Goodman Theater in Chicago. Mary Beth Fisher is spellbinding in the role of Caroline, a competent, yet ethically challenged veteran foster care worker battling her supervisor, her own demons, burnout and an ill-structured service system to help a young couple addicted to methamphetamine. In a perfect world, the play would be shown around the world, and Mary Beth Fisher would play the character Caroline on a HBO series for the next five years. And we could all have a conversation about our social service systems.

There is a point in the first act when the young couple reports back to Caroline on the services that she has arranged for them. They can't get into the substance abuse treatment they need. The support group for addicted Moms is showing movies. The therapist cancelled. And a young couple trying to stay off drugs is reduced to using 5 Hour Energy Drink as a detox substitute.

When the world discovers troubled families, it often calls on case managers to fix things up. The child welfare, juvenile justice, mental health, homeless services and health care systems all rely to some extent on case managers to hook up clients to the services they need so that their lives can be adequately supported or repaired so that they are no longer be a danger to society or themselves. The case plan on this young couple looks good on paper. But it won't help anyone get better, let alone a desperate young family in acute crisis in need of top-rate help.

Somehow, playwright Gilman has discovered the dirty secret of the social service world. The services that are counted on to turn around a troubled family simply are often simply not up to the task. Last year a young man in trouble described the therapy groups he was asked to attend as "content free." It reminded me of a young person in one of my research studies who was asked to talk about his psychotherapy. "I can't explain to you why this person is not able to help me. But if you met her, "he said, "it would be immediately obvious."  I never met her, but I knew just what he meant.

Our social service clients know when services can't help. Oddly enough, the people who don't know are the people who pay for them and the heads of the agencies that operate them. Our social service systems too often operate without data. Programs and therapy can be "content free" without anyone knowing but the direct service provider and her client. They get away with it because the people who need to know are data free. This is a simplification, of course. Social service programs suffer from a lack of a quality for a variety of reasons, including underfunding. But without the data to show that quality is lacking, we are reduced to hearing that news from some fabulous actors and a socially attuned playwright in one theater in Chicago.

Read a review of the play, Luna Gale, here.

What’s In a Name: Titles for Quality Professionals

Starting today, some of the blog posts on the Quality Social Service website will begin to discuss results from the National Study of Quality Professionals in the social services. Our team at the University of Chicago, with funds from the Center for Health Administration Studies, surveyed 264 quality professionals in social service agencies that serve children, youth and families.

Today, let's talk titles. We learned that there are lots of titles used by quality professionals.

nameplate alteredTheir titles included root terms like: quality, performance, standards, compliance, safety and utilization. Titles often mixed these terms together. People were in charge of both performance and quality or safety and quality or performance and standards.

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Six Things I Learned By Teaching Quality Monitoring and Improvement to Social Work Students

1. Social work students intuitively understood that the social service agencies they loved had quality problems. Every one I know in the social services understands this. But few talk about it.  These students knew the arenas in which their agencies struggled.

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Learning QI Through Wikipedia

Wikipedia-logo-deThere are lots of resources out there for the budding quality professional in the social services to get some quality game. Social service folks are always looking for the cheap way to do things. There is no cheaper way to learn than Wikipedia.

Luckily, our quality brothers and sisters in other fields have been judicious arbiters of the Wikipedia quality space. There are entries related to lots of quality topics. We started a list of quality-related Wikipedia links on our resources page. There are lots of reasons to visit them. If you are truly new to quality, this is not a bad way to get introduced to the wide variety of topics in which quality professions develop expertise. If you know lots, but fear there is much more to know, go exploring. If you want to suggest links you use, peruse our list and help us fill in the blanks.

We provide our beginning list here, below the jump. If you want the most updated list, head to the resources page, where we will update with new entries.

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Teaching Quality Improvement to Social Service Students

pdsa_smallUpdate 2 from my pilot course on Quality Monitoring and Improvement for the Social Services: It was great fun watching social service students catch on to the idea of improvement cycles, charters, and how to know if your change is an improvement. They had not been exposed to PDSA cycles or related topics in their social service careers or in their coursework.


All in all I will call it a success. I will share comments from the course evaluations when I receive them.

The students proposed and worked through very interesting projects, based on work in real social service agencies and healthcare settings. Two proposed projects related to no-show rates. Two proposed projects related to welcoming social service clients to their agencies. I don't think this is accidental. Social service agencies struggle with engagement for a variety of reasons.

Here were the bumps.

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