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September 2013Vol. 14, No. 7CB's Focus on Continuous Quality Improvement

The Children's Bureau (CB) completed two rounds of Child and Family Services Reviews (CFSRs) in all 50 States, the District of Columbia, and Puerto Rico during Federal fiscal years 2001–2004 and 2007–2010. At the end of the second round of reviews, the Children's Bureau took a step back to consider ways that Federal monitoring of child welfare programs could be improved, building on the basic foundation of the CFSRs—to focus on outcomes and use data to drive systems and practice improvements. While CB is considering how to improve the CFSRs, CB strongly encourages States to continue to strengthen their ability to monitor their own performance and child and family outcomes using continuous quality improvement (CQI) principles.

In August 2012, CB issued Information Memorandum ACYF-CB-IM-12-07 on establishing and maintaining CQI systems. This information memorandum (IM) provides States with CB's current view of a State Quality Assurance(QA)/CQI system framework that is comprehensive and well-functioning in accordance with existing Federal requirements for Quality Assurance (QA (45 CFR 1357.15(u)).The IM outlines five key components of an effective CQI system. They are as follows:

  • A strong foundational administrative structure
  • Quality data collection
  • An effective case record review process
  • Process to analyze and disseminate data
  • Processes to provide feedback to stakeholders/decision-makers and adjust programs and process

The IM also specifies CB's intention to provide consultation and technical assistance to States with the goal of assisting States with implementing well-functioning QA/CQI systems. 

In addition to the IM, on April 10, 2013, CB issued Program Instruction ACYF-CB-PI-13-04 to States on requirements for the fiscal year 2013 Annual Progress and Services Report (APSR). The Program Instruction offered guidance to States on providing a self-assessment of their current QA/CQI system (using the framework outlined in IM-12-07) including any training or technical assistance (T&TA) that the State anticipates needing from CB or any other partners. Using the CQI information provided by States in the APSRs, and supplemented by CB knowledge of State child welfare programs and systems gathered from discussions with the States, CB staff will work collaboratively with States to identify both the strengths in their respective QA/CQI systems, as well as areas that may need further development. 

CB will continue to support States in building and enhancing their QA/CQI systems through various technical assistance resources. For instance, the CFSR Information Portal, maintained by JBS International, Inc., houses the E-Training Platform, a web-based learning system designed to provide pertinent CFSR information. One of the topic-specific sections, the CQI module, provides an introduction and overview of CQI and its benefits. The CQI module will be accessible to all interested persons by mid-September and will include the following five sections: 

  • Defining CQI and Building a CQI Framework
  • Effective Leadership and Creating a Learning Environment
  • Functional Components and Processes of CQI
  • Implementing and Sustaining Systems Change
  • Additional Resources

Another way CB is supporting States in their efforts to enhance their QA/CQI systems is through the Building Child Welfare Capacity for Continuous Quality Improvement Project. The 17-month training project is intended to support child welfare professionals in improving CQI processes and will include an online training program with individual and group-based training opportunities. See the related article, "Building Child Welfare's CQI Capacity" in this issue of CBX.   

For more information on the CFSRs and CQI, please contact Miranda Lynch Thomas at