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Quality of Care

Quality of care measures are designed to monitor the quality of care for each residential service provider. Indicators to track quality of care can be generated by the Quality Inspections, Serious Occurrence reports and exit surveys of young people leaving a facility.

Safety

Safety is a core priority for all residential services. Serious Occurrence reports track many Indicators of safety, including rates of injury, physical or sexual abuse by peers or caregivers, and running away.

Data Source

Timeframe for reporting

Examples from other jurisdictions

Serious Occurrence Reports

Within one year

Proportion of children in care who are abused or neglected (U.S Department of Health and Human Services, 2014: See Measure 2.1)

Children in care who were the subject of a substantiation (Australian Government, 2015: See Box 15.11)

The number of children reported missing for more than 24 hours (UK Government, 2015: See Paragraph 65)

Fatalities of Children in Care (British Columbia, 2015a)

Program Coherence: Does the program match its stated objectives?

As part of the Concept Statements that will be required to accompany all licenses, service providers will be asked to describe their program objectives at the program and the client level. Service providers will also be asked to provide evidence relative to measurable indicators related to each program and client-level output and outcome. The quality of care inspectors will assess the extent to which the program elements are indeed in place to meet the stated program objectives, on the basis of their review of the residence’s program schedule, staff background and training, and interviews with residents and staff. These assessments can be summarized in the form of simple Likert scale ratings for each element, producing a composite overall score.

Data Source

Timeframe for reporting

Examples from other jurisdictions

Quality Inspection Reports

Within two years

OFSTED Inspection Reports (UK Government, 2016 & UK Government, 2015: See Paragraphs 151-161)

Staff Qualifications, Experience and Stability

Indicators of the quality of staff that could be easily reported during inspection visits include (1) the proportion of full-time, part-time and relief staff with above minimum required human services credentials, (2) the median years of staff experience working with young people, (3) the median years working in the specific residential setting (turnover rate), (4) the proportion of staffing hours covered by full-time staff; and (5) staff satisfaction with their work environment.

Data Source

Timeframe for reporting

Examples from other jurisdictions

Quality Inspection Reports

Within two years

See AACRC Framework (2009)

Staff Development

Quality inspections should include information about (1) the amount of on-going training provided, documenting separately in-house and external training, (2) the frequency of supervision, and (3) the qualification of supervisors.

Data Source

Timeframe for reporting

Examples from other jurisdictions

Quality Inspection Reports

Within two years

Evidence of local arrangements for all carers of looked-after children and young people to receive ongoing high-quality core training and support packages that equip them to provide warm, nurturing care (NICE UK, 2013: See Quality Statement 1)

School Attendance, Vocational Training and Employment

For school aged young people, supporting daily attendance at school, or vocational training or employment, is a minimum expectation for quality care. The proportion of young people in Section 23 classrooms is also important context information to track. This indicator does not assess the quality of education or training nor educational outcomes.

Data Source

Timeframe for reporting

Examples from other jurisdictions

Reviewer reports

Within two years

Age-Appropriate Grade of Children and Youth in Care (British Columbia, 2015b: See Performance Indicators 5.16, 5.21, 5.26)

Percentage of looked after children achieving level 2 or above (Math, Reading & Writing, and Attainment Gap) (UK Government, 2014: See Chart 1 and Chart 6)

Restrictiveness

The restrictiveness of different settings will vary on the basis of the quality of staff, of supervision, of programming and the types of young people in the setting. A range of indicators can be tracked to reflect the restrictiveness of a specific setting, these include the use of restraints, psychotropics, isolation, one-on-one shadowing and police interventions.

Data Source

Timeframe for reporting

Examples from other jurisdictions

Serious Occurrence Reports and Reviewer Reports

Within two years

Use of psychotropic medication among youth in foster care (California Child Welfare Indicators Project, 2016: See Measure 5a.1)

Family Support

For young people for whom family contact is appropriate, the extent to which a facility supports family contact can be tracked by documenting the number of days of contact, differentiating between home visits, face to face visits and other contact (phone, skype, etc.).

Data Source

Timeframe for reporting

Examples from other jurisdictions

Reviewer reports

Within three years

N/A

Youth Perception of Quality of Care

The Quality Inspectorate should have a simple web-based or app-based survey that all young people are asked to complete when they leave a residential setting. This should include their perceptions of the following:

  1. Youth feel safe and respected

  2. Youth feel staff / foster-kinship parents care about them as individuals and are interested in their future

  3. Youth develop or maintain healthy friendships with youth in the community

  4. Youth’s unique educational needs are being met

  5. Staff / foster parent(s) actively support and encourage connection to family, community, culture and sexual identity, spiritual needs

  6. There is a consistent adult in the youth’s life who cares about them

  7. A range of athletic, cultural, and social activities are organized and youth’s individual hobbies, sports or artistic interests are supported

  8. Someone spends regular time with youth to help them understand and cope with sad or bad things that have happened to them

  9. Young people are asked to participate in decisions about their care and about the daily activities in the residential setting

Data Source

Timeframe for reporting

Examples from other jurisdictions

New exit survey (build on new YJ survey)

Implement survey within one year, report publicly within two

Quality of the caregiver and youth relationship (Ontario Looking After Children study)

Client satisfaction (Australian Government, 2015: Under development, see Box 15.7 & 15.8)

Looked-after children and young people experience warm, nurturing care (NICE UK, 2013: See Quality Statement 1)