Department of Health and Family Services
Division of Children and Family Services
                    DCFS Memo Series 2005 - 08 /Action
                      September 14, 2005

                            Re:    CONTINUOUS QUALITY
                                     IMPROVEMENT (CQI)


To:  Area Administrators/Human Services Area Coordinators
Bureau Directors
County Departments of Community Programs Directors
County Departments of Developmental Disabilities Services Directors
County Departments of Human Services Directors
County Departments of Social Services Directors
Licensing Chiefs/Section Chiefs
Tribal Chairpersons/Human Services Facilitators
Director of State Courts
From: Burnie Bridge

Document Summary

The purpose of this memo is to inform you of the development and implementation of the new Division of Children and Family Services (DCFS) Continuous Quality Improvement (CQI) program and to obtain input from counties concerning the timing of their participation in the formal county CQI review cycle.


In response to the federal Child and Family Services Review (CFSR), Wisconsin is required to develop a statewide quality assurance program. Therefore, the development and implementation of a quality assurance program for child welfare is a prominent Action Step in our CFSR Program Enhancement Plan (PEP).

CFSR Review vs. Quality Service Review (QSR)
As part of the implementation process for the CQI program, Wisconsin needed to evaluate whether to adopt the CFSR or QSR (Quality Service Review) as its case review protocol. Between May 1st and July 30th, 2005, case reviewers were trained in and utilized the CFSR case review in three counties. This is the same protocol that was applied during the federal onsite review in August 2003. In June 2005, the QSR was "field tested" at the La Crosse DHS. The federal CFSR case review instrument originated from the Quality Services Review (QSR) protocol, which was designed and first utilized in Alabama during the 1990's, when Alabama was under a court settlement agreement. It is currently being utilized in 14 states and is considered a highly effective instrument in enhancing case practice. Input was solicited from La Crosse staff and the case reviewers involved in the CFSR & QSR reviews and presented to the CQI Committee which, on June 28, 2005, adopted the QSR case review instrument for Wisconsin.

Piloting the CQI Protocol and QSR Tool
The DCFS and the CQI Committee have finalized the pilot county review protocol and are completing technical revisions to the QSR case review instrument to make it Wisconsin specific. The county review protocol and Wisconsin QSR tool will be piloted in Pierce and Washington Counties in September 2005, with final revisions completed by October 31, 2005. Pilot counties will be considered to have already been reviewed for the first round of the formal statewide county review cycle that begins in November 2005.

The Children's Court Initiative (CCI) Project
The CQI county reviews will be conducted in partnership with the Children's Court Initiative, which is a review of how a county's court conducts activities associated with Child in Need of Protection or Services (CHIPS) cases, including Termination of Parental Rights (TPR) Cases. The intent is that a joint review will provide the agency and court with findings that can enhance and improve their interaction, resulting in better outcomes for children and families in their county. Due to the joint review process, County Director consultation with the circuit court is suggested when volunteering a specific time for their county to participate in the formal review cycle. The Director of State Courts Office will contact circuit courts individually once the CQI review schedule is established.

Formal Statewide County CQI Review Cycle
On November 1, 2005, the formal CQI review cycle will begin, as indicated in the PEP. Given the current resources of the CQI Team, measured against the tasks and activities required to perform a quality review, the total number of possible county reviews will be limited to 16 per year. The criteria for determining which counties will be reviewed and when are based on the following tenets:

  • The safety, permanence, and well being of all children and families in Wisconsin are of equal importance to all of us, regardless of the county in which they reside.

  • We must demonstrate movement toward achieving the performance standards of the CFSR, or absorb fiscal consequences.

After considerable discussion, the statewide CQI Committee recommended and DCFS adopted the following schedule for CQI reviews of the 71 counties (Milwaukee is already being reviewed pursuant to the Jeanine B. Settlement Agreement requirements):

  • The 18 counties with the largest child populations are reviewed every three years (i.e., 6 counties per year).

  • The remaining 53 counties are reviewed every 5 years (i.e., 10 to 11 counties per year).

Since 72% of Wisconsin's children reside in its 19 largest counties (including Milwaukee County), the recommended schedule ensures the counties they reside in will receive a qualitative CQI review no less frequently than once every 3 years.

The CQI Committee also recommended and DCFS adopted the following criteria in determining which counties will be selected for review:

  • Divide the group of 53 counties into two groups, i.e., counties with mid-size and small child populations.

  • When selecting the 16 counties that will be reviewed each year from each of the 3 groups (i.e. large, mid-size and small counties), select a proportionate number from each of the five DCFS regions, when feasible.

  • Give priority to those counties which volunteer and indicate an intention to adopt a CQI program or develop and implement a countywide Program Enhancement Plan.

County Director's who would like to volunteer a specific time for their county to participate in the formal review cycle are asked to indicate the best time on the attached form and return it by October 14, 2005. We cannot guarantee that we will be able to abide by your request since we need to conduct approximately 16 reviews per year, but we will take your request into consideration. Counties that do not return the form will be assigned review times in accordance with the above criteria.

Continuous Quality Improvement Manager
P.O. Box 8916
Madison, WI 53708-8916
Phone: 608-264-8525

Volunteer County Participation in CQI Review form (PDF, 9 kb)

cc: County CPS Supervisors


The Department of Children and Families, protecting children, strengthening families, building communities.