QA/CQI for Case Planning- What Case Managers and Officers Can Implement to Obtain Desired Results

1. QA/CQI for Case Planning- What Case Managers and Officers Can Implement to Obtain Desired Results Presented by: Holley Bossell, Jill Herman, and Matt Morris

2. Introductions • Do your agencies currently perform any QA on your case plans? • What does that process look like in your agency? • Are any of you involved in that process? • How do you feel when you are observed by a peer / SME / supervisor?

3. First thing we have to understand: Case planning is a process, that requires adoption of evidence based principles and core correctional practices to truly be effective. Evaluate your agency culture!

4. Understanding Your Agency Culture

5. Core Correctional Practices • Effective Reinforcement • Effective Disapproval • Effective Use of Authority • Cognitive Restructuring • Anti-Criminal Modeling/Structured Skill Building • Problem Solving • Relationship Skills/Motivational Interviewing • Staff members should view themselves as agents of change and support the goals of offender rehabilitation.

6. Examples of relevant evidence based practices: • Well educated and trained staff • Interviewing skills • Assessment (Risk, Need, Responsivity) • Well defined behavior management system • Cognitive Behavioral strategies and interventions • Well defined policies • Routine evaluation and re-evaluation of both offenders and staff • Advancement and completion criteria • Evaluation of program effectiveness

7. Why should we use a standardized assessment tools? • Ensures accuracy. • Leads to improved RNR identification. • Helps ensure the equal treatment of clients with similar RNR factors. • Reduces bias in the case planning process. • Assists if there are legal challenges.

8. Examples of common assessments:

9. It all begins with the Interview Process A bad start=a bad outcome

10. The goal of the interviewing session is to: Gather detailed and accurate information for the assessment and case planning process!

11. Do I have access to and review collateral information? • Review collateral information prior to interview. Sources include: • Presentence Investigations • LEADS/Arrest Records • Prior Supervision Notes • Prison/Institutional Summary Reports • ORAS Information • Information from family, Schools, Employers, etc. • Utilize interview guides, and be familiar with the assessment tool you are using.

12. How do I conduct interviews with offenders? • Welcome & acknowledge client • State your purpose • Be open & relaxed • Minimize distractions

13. How you ask it matters Double-barreled questions Biased questions Jumping to conclusions Open-ended questions Follow-up questions Utilize the interview Guide Close-ended questions

14. How we interview and interact with offenders matters. Does my agency have a process to evaluate staff in these functions? • Nonverbal attending • Eye contact • Facial expressions • Posture • Devoting full attention • Use of encouragers • Provide listening cues

15. Evaluate your interview, assessment process, and service delivery • Have you been trained in interviewing skills, and the assessment tools you are conducting? • Does your agency have policies and/or procedures detailing the assessment process? Minimally this should include timeframes, and descriptions of the process. Have you reviewed them? • Does your agency have policies and/or procedures detailing the process for quality assurance activities? Minimally this should include timeframes, sample sizes, descriptions of the process, and the methods utilized when they discover deficiencies. • Do forms exist that are to be utilized to conduct QA reviews? These should be signed and dated as a record that the review occurred. • Certification documents for staff who complete assessments or conduct QA. • Recommended Practice: Interview observation, Double-Coding, and file review. • Do you utilize the interview guide, are they asking secondary questions, do you utilize the scoring guide?

16. ASSESSMENT AND SERVICE DELIVERY EVALUATION/OBSERVATION FORMS See training packet for sample: • ORAS direct observation forms and process • Group Facilitator observation/evaluation form • Individual Service delivery observation/evaluation form

17. Dosage/Treatment Considerations • Criminogenic treatment/dosage hours are the time spent participating in structured evidence based behavioral interventions which can include individual & group treatment, and case management/supervision sessions that focus on the criminogenic domains. • Case Plans should be developed in a manner that seeks to deliver enough treatment/dosage hours to address the clients risk and need level and extinguish unwanted behavior. • As the risk level of offenders increases, dosage should increase as well. Therefore, higher risk offenders should receive a significantly higher amount of behavioral interventions than lower risk offenders. • It is important to remember, anti-social behavior is developed over the course of a life time, and requires a significant amount of criminogenic treatment hours before positive affects are generally realized.

18. Dosage/Treatment Considerations Continued • Treatment progress and dosage hours should be regularly updated via case notes and case plans to ensure clients are on track with expectations. • Treatment should be individualized to meet the specific risk and need of each client. • Treatment/dosage should should be prioritized. Offenders can become overwhelmed if they are required to work on too many need areas at once. Consider starting with primary risk factors (those criminogenic need areas most likely to impact recidivism). • Criminal Attitude & Behavior Patterns • Peer Associations • Personality (Aggressive, Impulsive, Risk Seeking, etc. Traits that contribute to crime)

19. Addressing overall Risk Level Ideal situation: • All offenders whose overall risk score is moderate or higher would participate in a core Cognitive Behavioral Therapy (CBT) program such as T4C, EQUIP, Tru Thought, Moving On. • The core CBT program would then be supplemented with individual interventions in such a manner so that higher risk offenders are receiving more treatment. DOES YOUR AGENCY HAVE THE ABILITY TO SUPPLY AND VARY DOSAGE?

20. Individual interventions to supplement the core CBT groups. • The Carey Guides include 33 handbooks that help corrections professionals use EBP with their clients. Each Guide contains two to five Tools (worksheets) which are designed for use by offenders—with the assistance of their corrections professional—to understand and address risk factors, triggers, and other conditions that are essential to their success. They are best suited toward a long term case management system. • Carey Guides Include • Anti-Social Thinking Values • Anti-Social Peers • Problem Solving/Deion Making • Social Skills • Anger • Involving the family • Substance Abuser • Sex Offending • Domestic Violence • The Brief Intervention Tools (BITS) were created to help corrections professionals effectively address key skill deficits with offenders in short, structured interventions. The tools can be used as a supplement to the Carey Guides, but are short, situational, and focus on six key skill deficits which can be used immediately. • BITS Tools Include • Decision making • Overcoming automatic responses • Overcoming thinking traps • Problem Solving • thinking traps • who I spend time with

21. Treatment Options Designed to Address Criminogenic Needs

22. Dosage Recommendations: • Suggested levels of dosage per risk level over the period of supervision: • Moderate Risk = 100 to 200 dosage hours • High Risk = 200 to 300 dosage hours • Very High Risk = 300 + dosage hours Guy Bourgon and Barbara Armstrong (2005), Transferring the Principles of Effective Treatment into a “Real World” Setting. Criminal Justice and Behavior, 32:3.

23. Dosage Considerations: • Does my agency have policies and/or procedures detailing how they will address offender treatment based on risk and need? • Does my agency have defined internal program schedules? • Does my agency have data describing outside referral programs. (letters, pamphlets, or/and written descriptions) Is staff aware of their services? • Do we conduct case file audits to ensure staff consistently refers clients to treatment by risk and need. (Copies of case notes, case plans, discharge summaries, reporting schedules, aftercare plans, individual dosage trackers, and/or agency dosage trackers.

24. Consider Tracking Dosage

25. Why should you develop a Case Plan? • Case planning is beneficial because it: • Provides structure and guidance to supervision process. • Helps maintain focus on criminogenic needs. • Helps prioritize goals and objectives. • Documents progress and provides ongoing intervention. • Provides the offender with a concrete guide to his/her expectations.

26. When should you develop a case plan? • Goals and objectives should be developed for any moderate or high risk or need area determined via the assessment process. • They may be developed in other instances if a client is required to complete additional tasks that you need to track. • The point is, to develop a roadmap for the client to follow. He/she should know what they need to do!

27. What Should you prioritize on the Case Plan? Return to your RNR Principle for guidance: Tier I “Big 4” • Criminal History: • Criminal Attitudes values & Behavior Patterns • Peer Associations • Personality (aggressive, Impulsive, risk seeking ect. Traits that contribute to crime) ============================================= Tier II • Education & Employment • Family & Social Support • Substance Abuse • Neighborhood Problems & Leisure

28. What Should you prioritize on the Case Plan? • Higher risk need areas should be prioritized over other areas when at all possible. • Staff should try to address the “Big 4” first. • If there is a need area or responsivity issue, you may need to re-prioritize the clients plan. • Ask for the clients input. • What makes the most sense based on the data? • If you are not able to address all of the offenders need areas in the time they are under your care you will need to make referrals for services when you develop the After Care Plan.

29. What are the components of a Case Plan? • When developing a Case Plan it should contain: • Need Areas (Assessed criminogenic need) • Goals (Broad, long term outcomes with desired behavioral change for the offender) • Objectives (Short term steps to meet the desired goal. What specific / realistic / measurable steps the offender will take to reach that goal. ***Offender must DO something.) • Techniques (How will the provider monitor / assist the offender accomplish the objectives)

30. A Closer look at Goals • Think of a Goal as the “Big lifestyle change.” • States pro-social behavior change. • Does not have to be measurable. • Defined by need area. • Long-term outcomes.

31. GOAL Examples Education, Employment, and Financial Situation Need Area – Education Goal • To possess the necessary level of education required for the career you desire • Improve your literacy skills Need Area– Employment Goal • To develop the skills necessary to seek and maintain employment • Obtain a job that you can maintain • Develop a plan to address both short and long term career options • Work in an industry that you have the skills for and you enjoy

32. Creating S.M.A.R.T. Objectives • Specific: a specific objectives has a much greater chance of being accomplished than a general objective the expectation is known to the offender/client. No gray area. To set a specific objective you must answer the six “W” questions: • Who is involved? • What do I want to accomplish? • Where (identify a location) • When (establish a timeframe) • Which (identify requirements and constraints • Why (specific reasons, purpose or benefits of accomplishing the goal) • Measurable: establish concrete criteria for measuring progress toward the attainment of each objective you set. Ask the following questions: • How much • How many • How will I know when it is accomplished

33. S.M.A.R. T. continued…. • Attainable: Identify goals that are most important to the offender and also something attainable. If important and attainable they will begin to figure out ways to make them come true. Will develop the attitudes, abilities, skills, and financial capacity to reach them. • Realistic: Must be something the person is willing and able to work on. • Timely: Should be grounded within a timeframe. With no timeframe there is no sense of urgency.

34. Objective Examples • Need Area – Education • Objective • List agencies that provide ABE by XX/YY, and bring them to your next appointment. • Provide verification to your case manager that you registered for ABE classes by XX/YY. • Obtain information about financial aid opportunities from an institute of higher learning, and provide it to your case manager by XX/YY. • Complete a Federal Student Aid application, and provide verification to your probation officer by XX/YY. (Make sure work direction is a measurable action)

35. Further Considerations for Case Planning. • Offender Input: Offenders are more likely to accomplish established goals when they are allowed to participate in the process, and are explained how it benefits them. • Overall Risk Score: If an offender’s overall risk score is moderate or high, it is appropriate to develop case plan objectives to directly address their likelihood to commit a future crime. Placement in a CBT Program is appropriate based on an offenders overall risk score alone. • Case Plan Review and Updates: Case Plans should be reviewed regularly with the offender and updated as an objective is accomplished or the offender demonstrates a new need. It is up to each individual program to develop a minimum review schedule. • Case Notes: Client notes should summarize Case Plan progress. • Court ordered/supervision conditions: Such conditions as EM, alcohol/drug testing, curfew can be effective supervision tools, but are unlikely to result in true behavior change if not used in conjunction with sufficient behavioral interventions.

36. Is the client motivated and/or ready for change? • Case Plans are goal oriented and may have multiple objectives or steps will be used to achieve each goal. The amount of steps is often related to the clients motivation to change. • Staff should seriously consider what stage of change or level of motivation the offender is in. (ideally done through an objective assessment such as URICA, CEST, or HIT) • Once stage of change is assessed, the case plan should focus on moving offender through the remaining stages of change. • Officers should use as many interventions/tools as necessary and take as much time as needed to move the offender forward on the stages of change.

37. Responsivity Issues • If responsivity issues (barriers to treatment) were identified, is our agency able to tailor our interventions/programming to best need to the clients needs? • Do we see evidence of this in case plan objectives? • Are our outside referral sources able to accommodate responsivity issues?

38. How does your Behavior Management System (BMS) support your case plan? • Behavioral reinforcement strategies and techniques should be used to encourage offenders to learn new skills and pro-social behaviors. • Punishments/sanctions need to be available to suppress and extinguish anti-social behavior. • Incentives should be available to promote new positive behaviors. Do we have a defined behavior management system? • The case plan should be a fluid document that is adjusted and updated as positive or negative behavior is exhibited.Do we have a process to review for this?

39. Quality Assurance Supervisors or designees should routinely monitor/review the quality of the case planning process. • Does the case plan match the assessments? • Will the case plan help the offender extinguish unwanted behavior? Will it be enough treatment? • Is the case plan SMART? • Has the case plan been updated as the client meets their objectives or exhibits new needs? • Do the case notes indicate offender progress is monitored appropriately? • Is there an aftercare/continuum of care plan based on the assessment results? • Were the QA efforts documented? • Are employees coached if they do not meet expectations?

40. Case file audit/case plan audit considerations: • Does my agency have enough staff to conduct QA or will an effective process require collaboration with outside agencies? • Does my agency have the ability to monitor outside referrals? • Does my agency have an effective training, mentoring, and coaching process so these functions can be effective?

41. Questions? Holley.Bossell@odrc.state.oh.us Matthew.Morris@odrc.state.oh.us Jill.Herman@odrc.state.oh.us