Quality assurance of Inter-services interfaces concerning care of children at risk

1. Ministry of Health Quality Assurance division Department of Social Work Quality assurance of Inter-services interfaces concerning care of children at risk

2. Background: Recurrent failure in continuity of treatment and lack of inter and intra-services coordination. Children and their families do not receive the appropriate care (fall between the cracks).

3. Program’s Aim & objectives: • Aim: • To ensure continuity and coordination of inter-services cooperation for children at risk and their families. • Objectives: • Wording, establishing and cementing of quality standards concerning the inter-services interfaces. • Developing a monitoring mechanism for the evaluation of interfaces quality.

4. Means of operation: “The quality assurance survey”

5. Guiding principles: • Quality assurance: an ongoing, cyclical and spiral process (definition of quality – measurement – obtaining conclusions – implementation and so on). • Quality standards based on field workers’ assessment. • Clients are an important and reliable source for assessing the current situation and for defining standards of quality. • Standards of quality: concise, applicable, and acceptable. • Confidentiality is mandatory.

6. The program’s Two layers: • National comity – supported by ministerial C.E.O.S, and heads of civil and public services, a forum of key personnel was appointed. • A local (municipality of Bat-Yam) – representatives of community organizations and services.

7. The Bat-Yam Pilot- process description: • Step I – making acquaintances, mapping of interfaces, and illuminating loci of discussion. • Step II – In depth Analysis of Services and interfaces: • Think tanks summoned according to organizational membership. • Within the client group.

8. Drawbacks: Informal oral reports, written but incomplete, and not systematic reports. Difficulty in achieving an immediate respond in emergencies. No feedback. Standards formulation: Standard reporting form signed by the principle. In cases of emergencies – a phone call in addition to written report. An emergency phone # is recorded on the answering machine of the social services department. The social services department distributes the emergency contact protocols. The receiving service confirms the arrival of a report with a forwarding contact information. Analyzing an event – defining obstacles – formulizing quality standards:

9. Step III – consolidation of quality assessment tool. • Step IV – creating Infrastructure For the Survey: • Substantial preparation - recruitment of front line workers and initiating assimilation of standards. • Procedural preparationtowards survey performance

10. Step V - performance of survey Survey duration – approximately 7 weeks. 168 surveyors. 55 survey teams. 75 units surveyed. The survey constructed process is in the absolute responsibility of the chairperson of the survey team.

11. Intermediate Gain • Special forms. • Intra-organizational protocols. • Team’s knowledge improvement. • multidisciplinary team. • Initiating & activating joint plans. • Cooperating around selected cases.

12. Step VI – data analysis and processing of findings The process of data analysis is not finished, here are a few preliminary findings: • A mean total grade of the services. • A mean grade of the services in “organizational arrangement” chapter. • A mean total grade and a mean grade in three chapters (“staff’s proficiency”, “organizational arrangement”, “activity procedures”) in a service of 8 organizational units.

13. A mean total grade of 10 services

14. A mean grade of 7 services in “organizational arrangement”

15. Tool’s Mean Unit Unit Unit Unit Unit Unit Unit Unit Chapters 8 7 6 5 4 3 2 1 Staff’s 97 . 66 100 100 100 100 100 100 93 . 75 87 . 5 proficiency Organizational 62 . 81 60 60 62 . 5 50 80 60 50 80 arrangements Activities by 70 . 8 4 94 . 44 94 . 44 72 . 22 86 . 11 55 . 6 55 . 56 46 . 88 61 . 46 procedures Total 74 . 83 86 . 11 86 . 11 76 . 47 79 . 17 72 . 22 66 . 67 A service with 8 organizational units 58 . 82 73 . 04

16. Future activity • Data analysis, processing of findings, interpretation and summarization. • Feedback to the services. • Documentation of the process, formulation of a manual, and accompanying the assimilation process in the city of Bat-Yam. • Distributing and accompanying the implementation of the model in three urban authorities.