STATE OF NEVADA - Division of Child and Family Services

meeting with DCFS Information Management Services (IMS) to identify and develop a mechanism for linking the UNITY
system with the quality improvement case review efforts and continuous quality assurance efforts which includes
development, design and deployment of the functionality for sample selection, sample management and case review and
reports. The newly designed tool is modeled after the CFSR tool, and the newly designed system will focus on specific
items and a targeted review process. The tool is expected to be released in September 2010. The final process for
implementation of the new QICR will be formalized after the State meets with PMAG.
The second objective to this item’s goal is that the State will identify a process to increase involvement of stakeholders in
the quality improvement process. This objective has been well implemented in the past fiscal year. There has been a
great deal of work ensuring collaboration with key child welfare stakeholders during development of the Performance
Improvement Plan (PIP). The Statewide PIP Kick-Off meeting occurred on December 2, 2009. During the current PIP
development process, each region met with local stakeholders at least four times minimum through bi-weekly meetings
beginning in mid-December and continuing through February. The Statewide Committee was made up of State-level
stakeholders from DCFS Administration, each of the three child welfare agencies, the Division of Health Care Financing
and Policy, the Division of Health, Children’s Mental Health, Juvenile Justice, the Judiciary, the Court Improvement
Program, educational representatives, foster parent associations, tribal members and more. Approximately 50 key
individuals participated statewide on the Statewide Committee. Overall, nearly 100 individuals took part in this planning
process across the state. Nevada will continue to utilize the collaboration of the key child welfare stakeholders in
implementation of the PIP, and in planning and implementation of a quality improvement framework and system that
includes a clearly defined continuous quality improvement loop.
A third objective under this goal was for the State to examine existing use of QICR reports and Agency Improvement
Plans on the agency level and will develop a process with the agencies to increase the utilization of information at the
caseworker, supervisor and manager/agency level for practice improvements. To ensure that the child welfare system in
Nevada is meeting compliance in all Safety, Permanency, Well-Being and Systemic Outcomes; Nevada is currently
planning a redesign of the existing Quality Improvement Framework and system.
The 2010 PIP development process focused on five key strategies to improve and enhance child welfare practice in
Nevada. These included: Safety practices, connections and relationships, timelines to permanency, child welfare
supervision and service array. Each practice area to be addressed has been examined to see where improvements are
needed to be made as to how data is collected and reported in the Statewide Automated Child Welfare Information
System (SACWIS) or UNITY. Additionally, areas of staff and/or stakeholder training needed were discussed in detail and
were incorporated in the final plan. This plan is currently under review.
A fourth objective under this item is that the State will ensure that statewide policy is reviewed annually and revised as
needed or will ensure that policies are developed and implemented to ensure the inclusion of requirements under this item
based on the policy development and review schedule. Through the use of statewide collaborative policy workgroups, the
Policy Approval Review Team (PART) and DMG, policies are developed and/or revised as new legal language or practice
requires. Policies that have been revised in the past fiscal year are reported throughout the APSR under the section that
applies most closely to the policy topic.
Agency Level Quality Improvement Activities: To assist in preparing for reviews, each child welfare agency engages
in a case review process in order to meet this goal. In the past, this goal was addressed through a quality improvement
case review completed by supervisors in each child welfare agency. Under this review process, every worker had a
minimum of one case reviewed every quarter. These reviews were then forwarded to the State for inclusion in quarterly
quality improvement reports. Due to budget restrictions this process has been made optional to the agencies. That is, the
agency can choose to follow this process, or could opt to engage in an alternative process to meet the goal.
WCDSS continues to use this process. They report that as a result of this process case reviews conducted by
supervisors are high. They do indicate, however, that the case reviews tended to be better suited to permanency and
long-term cases than to those in the investigative unit. WCDSS also engages in an internal case review process. In this
process, the WCDSS Program Specialist examines the reviews for internal consistency and data collection specific to
child safety and risk. The Department has internal audits within specific division, such as eligibility; contractors engaged
in reviewing the functions of certain areas such as Independent Living; and Independent Service Provider contracts who
report to upper management. Case specific QA occurs in the Child and Family Team Meeting process, which includes
meetings with team members from outside of the agency and a facilitator. The meetings occur at numerous points in time
in the life of the case, including required milestones that encompass areas such as safety planning, case planning, diligent
search and placement planning. Facilitators collect data for outcome measurements and trends for reports to
management for system improvement and policy recommendations. Child fatalities are staffed in two separate
Nevada APSR – SFY 2010
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