Using Structured Case Reviews to Strengthen Kin Placement Stability

Authors: Lynda Blancato, Emma Cregg
Contributor: Sara Israelsen-Hartley

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A young boy works on the computer with an adult relative.
Working through the case review process has been good for our staff. It has helped us slow down and be more intentional in thinking about what our kin caregivers need. We know how important kin are for kids, and we are committed to all the ways we can make our kin placements more stable. Marvin Green
Regional Administrator, Los Angeles County Department of Children and Family Services

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The Government Performance Lab (GPL) has supported many child welfare agency leaders as they work to increase placements with kin. These leaders often rely on data dashboards to identify positive trends or areas to improve. However, these data may not always be detailed enough to identify why a trend is happening nor how an agency could address it. In these cases, it can be helpful to review individual case details in a more structured way.

The GPL has helped agencies across the country conduct structured case reviews to identify opportunities to improve kin placement rates and set up those placements to be stable and supportive. Through this approach, managers systematically review a sample of cases guided by a driving question. Even reviewing a small number of cases can help teams elevate themes and identify actionable next steps to improve outcomes for children and their kin caregivers.

In this publication, we outline five steps for conducting a structured case review: ask, gather, review, synthesize, and design. We explain each step and what it might look like for agency leaders and their teams. We also share downloadable resources that child welfare agency managers and continuous quality improvement (CQI) staff can use in this process.

Step 1: Ask a driving question

To begin, identify a specific outcome that will improve the experience of children and families you serve. Perhaps you want to increase the stability of kin placements so fewer children experience placement disruptions, or you would like to improve the home inspection process for kin to avoid delays in placement. Identifying this outcome will help define the driving question for the structured case review process.

Having a clear, action-oriented driving question will help elevate the most relevant root causes or conditions preventing that outcome and prompt ideas for actionable next steps. A driving question will help you avoid becoming mired in case context and instead help you focus on the details that matter most for influencing a specific goal.

A driving question can be broad (e.g., “What steps can we take to reduce the number of placement disruptions that occur when children are placed with kin?”) or more narrow (e.g., “How can we more swiftly address barriers kin face in the home inspection process?”). No matter the scope, the question should always focus on a specific challenge that your agency staff have influence over improving.

EXAMPLE

In reviewing the agency’s monthly placement report, a manager noticed that placements with kin were much more stable than placements in other settings. However, a number of kin placements — many for teens in care — were disrupting in the first three months. The manager had several theories about what might be happening but could not pinpoint which factor might be most common across disruptions.

The manager decided to do a structured case review with staff guided by the overarching question: “What can we do to reduce kin placement disruptions for teens in care?”

This case review process created a light-bulb moment for me. We are so focused on supporting a child’s needs that we don’t always talk with caregivers about their own needs separate from a child’s, but of course they have them. This process has given me new ideas for small things we can be doing to better support our caregivers. Michael Brady
Assistant Regional Administrator, Los Angeles County Department of Children and Family Services

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Step 2: Gather cases to review

Next, gather a small set of cases to review that can help elevate insights around the challenge. Take a systematic approach to selecting cases. This can help you build a more representative sample and avoid overweighting the most recent or most memorable cases.

When setting a target number of cases for review, be mindful of the amount of time this will take staff. Between 10 and 20 cases is a good target number for review; even as few as five cases can help illuminate themes and prompt ideas for next steps. When possible, choose to review cases from the past year. Staff may remember more details about these cases and they will likely better reflect current agency processes and policies.

EXAMPLE

The manager set a target of reviewing 15 cases where teens placed with kin experienced placement disruptions. Looking at the past six months of placement data, the CQI analyst identified 27 cases that fit this criteria. The manager selected the 15 most recent cases for review, which included at least one case from each of the local areas within the region and represented a variety of teen and caregiver characteristics and needs.

A teenage boy embraces an older family member.

Step 3: Review case information

Consider which questions about each case will help you uncover the most relevant factors as well as the most meaningful opportunities to improve future case outcomes.

The next page shows several questions from a Kin Placement Disruption Case Review Worksheet. The downloadable Word document can be customized to your jurisdiction’s specific context and needs. There are multiple ways to gather the needed case information:

  • Set up 30-minute conversations with the supervisor and/or case manager for each case.
  • Email the worksheet to staff to complete independently for their cases. CQI analysts may help by gathering initial details for each case from the case management system.

EXAMPLE

The manager downloaded the Kin Placement Disruption Case Review template and asked the CQI analyst to populate basic case information for each of the 15 cases they had selected. The manager then sent an email with the worksheet to each of the associated case workers and supervisors:

“Our agency is working to identify high-impact opportunities to strengthen placements with kinship caregivers. To better understand the underlying drivers of placement disruptions, we’re selected a handful of recent case examples to review, discuss, and learn from together.

You supported one of the cases that we have selected to review and discuss as a team: [case name or details].

We will be using the attached template to guide our learning and next steps. [CQI analyst] has already added some case details. Please answer the remaining questions and email this worksheet to me by [date]. We are eager to hear your reflections and ideas to develop new ways to prevent disruptions and better support children and their kin caregivers.

If you have any additional questions, please let me know.

Thank you!”

Case workers completed the remaining questions over the next two weeks and returned the form to the manager.

Kin Placement Disruption Case Review Worksheet

This worksheet contains questions to help managers conduct a structured case review to identify trends and potential action steps that could help reduce the likelihood of disruption in future kin placements.

Download the Worksheet

Included questions:

  • What challenges did the kin caregiver face over the course of this placement?
  • What types of supports or resources did the child(ren) or kin caregiver use during the placement?
  • What were the primary reasons the placement changed?
  • At any point in the placement, did the caregiver reach out to agency staff about a need that the agency could not meet? Please describe.
  • Thinking back, is there anything that might have been done early on to better support the caregiver and prevent the placement from disrupting?
  • If you had a magic wand, what resources or services would you have liked to provide the caregiver to support this placement better and sooner?
Kids walking to school.

Step 4: Synthesize for action and impact

Carefully review the completed worksheets and notes for each case. You might want to gather a small team to help review the information, potentially including CQI analysts and other managers in that process.

The Case Review Synthesis Worksheet

This worksheet can help you unpack your findings to identify high-level trends and potential areas for further action.

Download the Synthesis Worksheet

As you review your notes, ask yourself the following questions:

  • Did anything surprise you about these cases?
  • Was there anything you were expecting to see that did not come up?
  • What patterns or trends emerged across cases?
  • What common factors made it difficult for caregivers to sustain placement?

EXAMPLE

The manager brought together a group of CQI analysts and managers to review the information and reflections captured about each of the 15 recent cases. In discussion, two major patterns and themes emerged: First, many teens were not accessing behavioral or mental health services, or received supports only after challenges emerged in placements. Second, caregivers felt overwhelmed and did not always have a network to turn to for support. Caregivers also felt they lacked training around caring for youth who have experienced trauma.

Step 5: Design next steps for implementation

Even after reviewing only a small number of cases, it is likely you identified themes or generated ideas for new strategies your team could test to improve outcomes for children and their caregivers. After reviewing your findings, assemble a team of managers, supervisors, front line staff, and other specialized staff to brainstorm next steps, including what changes your team could implement to help answer your driving question.

Continue using the synthesis worksheet to discuss questions such as:

  • What potential changes could have the biggest impact on improving outcomes for children and caregivers in kin placements?
  • Which of these potential changes will you prioritize first for implementation?
  • Who will need to be involved to design and test these ideas?
  • What will look different for staff and caregivers if these changes are implemented?
  • How can we embed solutions into existing processes so they can be sustained long-term?
  • How will we communicate to our full team about why we are implementing this change and their role in the next steps?
  • How will we know if the change is having the desired impact? Who will monitor it? What metrics will we use?

EXAMPLE

The manager convened a group of supervisors, front line staff, the CQI analyst and resource coordinator to discuss the case review and brainstorm answers to their driving question: “What can we do to reduce kin placement disruptions for teens in care?” The team identified two solutions to try:

1. Increase access to mental health services for teens. The agency vowed to re-launch regularly monthly meetings with the director of children’s services at the local mental health provider to strengthen collaboration and streamline access to services. The group wanted to see more teens quickly connected with youth peer support specialists who could help them navigate resources and strengthen engagement in services.

2. Strengthen support for caregivers. The agency decided to work with the local family resource center to start a new kin caregiver peer support group. The agency also decided to start a new monthly touchpoint with caregivers. During these “30-day calls,” resource coordinator staff would call caregivers to check in on how they were doing and share information about peer groups and other resources.

A Black woman in a wheelchair enjoys a walk outdoors with family members.

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