CQI Program Manual

Continuous Quality Improvement Program Manual • Case Sample List: The case sample results will include the entire list of eligible (and randomized) cases from all Human Service Zones, DJS, and Tribal Child Welfare Agencies. • Key Case Participants (KCP): Ensuring that all of the relevant participants of the case are available for interviews is critical for a successful review process. If a KCP is unavailable, another person to speak to their perspective can be explored. • Case Elimination: The state will follow the case elimination criteria as found in chapter 4 of the federal CFSR Procedures Manual and chapter 6 of the ND QA Case Review Procedures Manual. Case Review Preparations A thorough preparation for the QA Case Review is intended to increase understanding and engagement in the review as a meaningful process. The case preparation video and CFSTC website will be provided to the agencies four weeks prior to the review event. Quality Assurance Support Staff will mail KCP confirmation letters one week prior to the review week. Finally, agencies will upload the file and case narrative documents onto their agency’s private channel in the Department’s Microsoft Teams one week prior to the case review week. Additional agency resources to support successful implementation of the case review process include: • Letters to Key Case Participants • Access to case file and case narrative documents • Access to Microsoft Teams Completing the QA Case Review Process Cases are reviewed for approximately 13 weeks & each case is reviewed for a full week. Key case review activities include:  Initial case review overview meeting/webinar  Reviewing the case  Case related interviews  Completing the OSRI  Interrater reliability  Determination of substantial conformity with outcomes  First level Quality Assurance  Preliminary Results Meeting  Second level Quality Assurance  Debriefing  Finalizing OSRI Results Resources and use of the Onsite Case Review Instrument (OSRI) A full understanding of what occurred that affected child and family outcomes in a particular case is paramount through the review process. It is critical to obtain information from various sources before making determinations about safety, permanency, and well-being outcomes. The information received March 31, 2021 Page 48

Continuous Quality Improvement Program Manual from child welfare case files and key case participant interviews is captured using the Onsite Review Instrument (OSRI) on the Online Monitoring System (OMS). FRAME A variety of information can be generated on a case from the FRAME data system. Access to FRAME will be strictly for QA Case Review functions. As FRAME’s documentation is not all-encompassing, the agency will also provide additional case records. Agency Case Records All agency case records will be made available to the QA Case Review Team during the review. The QA Manager and Quality Assurance Unit will coordinate with the local agency to clarify which records will be needed and for what time frame. Possible records would include child protection services files, in-home services case files, foster care case management files, medical records, AASK Adoption files, DJS case management files, and Tribal child welfare files. Files needed for a case will be clarified during the case preparation activities. Local agencies will utilize the Microsoft Teams site to upload the necessary case file documentation. Other arrangements may be made with the QA Manager when needed to accommodate a different method of obtaining the agency case record. Case Preparation Documents To round out the case file information, each case selected for review will have case preparation documents completed. Each case summary shall have a genogram included. The genogram can be a copy from the existing record or can be completed using the suggested Case Review Genogram reference. The Case Narrative Summary is to be completed by the current or last caseworker assigned by the agency. If that caseworker is no longer available, the supervisor shall complete the form to the best of their ability. The preparation documents will be reviewed in more detail in Chapter 7- Case Review Preparations. The following documents are to be completed and provided with the agency file as applicable to the case. • CPS Case Narrative-SFN 993 • Foster Care Case Narrative-SFN 995 • In Home Services Case Narrative-SFN 996 • Foster Care Supervisory Questionnaire-SFN 997 • In Home Supervisory Questionnaire-SFN 998 • Adoption Summary-SFN 992 • Genogram March 31, 2021 Page 49

Continuous Quality Improvement Program Manual Use of Online Monitoring System (OMS) North Dakota will utilize the OMS as the resource to document and retain information for all QA Case Review case file reviews. The OMS can be accessed at: https://www.cfsrportal.org.acf.hhs.gov. A complete User’s Guide is available on the OMS website. The QA Manager will be the gatekeeper for access to the OMS. The QA Manager determines who should have access to each of North Dakota’s three OMS sites: • ND CFSR (the site/database capturing federal CFSR data), • ND CQI (the site/database capturing state QA Case Review data), and • Training (the site/database capturing training related data). QA Case Review workforce members will receive account access information before their certification training. They will be expected to keep their accounts current throughout their involvement with the QA Case Review. A cell phone number will be needed for multi-authentication to access OMS. Also, all OMS users accept the OMS Rules of Behavior and User Agreement the first time they log into the OMS. Users will also need to periodically accept user agreements in the CFSR Information Portal and OMS. Users will receive agreement prompts on the Portal and OMS no more frequently than every 60 days. OMS Reports The OMS is accessible online to authorized users on any platform with minimum system specifications, including personal computers, networked computers, tablets, and other mobile devices. OMS provides authorized users access to a comprehensive system for case-level review data entry, automated rating calculations, Stakeholder interview documentations, and reports. • Basic OSRI reports include case-level data, site-level data, and state-level data • Basic Stakeholder Interview Guide (SIG) reports include interview-level data and state-level data Ensuring data quality of case review results The Review Team shares responsibility for ensuring that ratings are accurate and consistent through comprehensive and informed review of cases and two quality assurance levels. Reviewers must gather, analyze, and reconcile available information to rate each relevant item appropriately through reviewing the case file and interviewing key case participants. Reviewers must read all instrument instructions and definitions to understand what the questions are asking and what is being assessed by each item. Reviewers should use their professional judgment in identifying and resolving conflicting information. Support and guidance on how to rate cases can be obtained through the support and guidance of the Quality Assurance team. In reviewing each case, Reviewers need to focus broadly on the child welfare system as it works in concert with its partners, like the courts, law enforcement, and service providers. It is important to identify how the system supported or prevented positive outcomes for the children and family in the case being March 31, 2021 Page 50

Continuous Quality Improvement Program Manual reviewed. Additionally, it is important to determine who in the family should be considered to inform the instrument items, with an awareness of the case type. If Review Teams have questions, they shall utilize their QA Case Review resources. Then if questions persist, the FLQA can join the discussion. QA Leads will ask appropriate follow-up questions that will help prompt the Review Teams to consider whether the case achieved best practice standards that are presented in the OSRI. The QA Leads will use the OSRI Quality Assurance Guide as a resource for the discussion with Reviewers. This guide is located on the CFSR Portal under CFSR Round 3 Resources. All cases reviewed undergo a Second Level QA (SLQA). SLQA is provided by the QA Manager or their designee. SLQA ensures that the cases reviewed are accurate, consistent, and adhere to the guidance provided for use of the OSRI. These activities are intended to ensure the integrity of the completed instruments, the information contained therein, and the accuracy of the ratings so the data can be relied upon to inform program and practice improvement. SLQA is in addition to QA activities that are the foundational work between Review Teams and the QA Lead to ensure initial completion of the instrument for an individual case. SLQA will provide their feedback of outstanding areas of need to the Review Team in QA notes. Designated SLQA Leads will seek clarification from FLQA and Reviewers as needed. During any PIP related monitoring periods between ND and the Children’s Bureau (CB), a negotiated percentage of QA Case Review OSRIs will be identified for secondary oversight. Secondary Oversight (SO) is provided by the Children’s Bureau two to three weeks after the case review week. This is an important QA function and will help all partners gain insight into any trends in ratings or changes in ratings across the review period, and National consistency. SO will provide their feedback to the QA Manager. Once all of the SO notes have been addressed and completed, the OSRI will be finalized and approved. Through the QA Case Reviews, Reviewers will be working with sensitive and personal information. Children, youth, and families involved in the Case Reviews have a right to the privacy of their records and confidential information. However, at times, concerning information may come to light during the Case Review, and this section will assist the worker in taking the necessary steps. Consult with the QA Manager as needed. Conflict of Interest A conflict of interest is defined as a circumstance in which a Reviewer’s or QA Lead’s personal interests or direct professional involvement with a case and case participants materially affect the individual's objectivity or capacity to serve in carrying out their duties of the QA Case Review. Any individual having a conflict-of-interest shall report the conflict to their QA Manager, and the QA Manager shall immediately re-assign the case. The QA Manager shall ensure that any individuals with a conflict-of- interest will not participate in any team that affects cases' ratings. All individuals participating in a QA Case Review shall sign a Conflict-of-Interest Statement for each case reviewed attesting that he/she has: March 31, 2021 Page 51

Continuous Quality Improvement Program Manual • Never been directly or indirectly involved in casework activities related to this case or any of the family participants in this case. • Not participated in decisions related to this case or any of the family participants in this case. • No personal interest in this case or any of the family participants in this case. • No direct professional involvement with the case or family participants in this case under review. A Conflict-of-Interest form will be required for each case reviewed. The QA Manager will resolve any questions or concerns about when a conflict of interest arises. If any of the staff feel they might be biased by what they have heard through their work, they will disclose that to the QA Manager so that it could be discussed whether someone else should be assigned to a case. Confidentiality An ever-present condition of the QA Case Review workforce is the safeguarding of client-related information. All participants of the QA Case Review workforce are expected to be extremely careful in handling client information so that unwarranted and potentially illegal disclosures are avoided. Disclosure of identifying information in a client’s record to individuals or entities outside the QA Case Review Team is prohibited except as authorized by law. Disclosure of identifying information within the QA Case Review Team is on a \"need to know\" basis to facilitate the case file review process. All federal and state regulations regarding the confidentiality of case information apply to the QA Case Review. North Dakota Century Code (NDCC) contains specific statutes impacting the confidentiality of certain information in files reviewed during the QA Case Review process. For example, NDCC 50.25.1-11 prohibits the release of the identity of a child protection reporter except under isolated circumstances. QA Case Review Workforce members must take precautions not to inadvertently release such information. Likewise, NDCC 14-15.16 addresses the release of confidential information related to adoptions. There are state and federal penalties for the unauthorized disclosure of confidential information. Also, violations of confidentiality will be investigated, and if warranted, appropriate disciplinary action taken. All QA Case Review Workforce members shall sign a Confidentiality Statement at each review event to acknowledge their understanding of child welfare records and information confidentiality. Workforce members will take all precautions to protect against unintended disclosure of confidential information during their interviews with key case participants. Child Safety Concerns There may be times when during the course of the case file review and/or key participant interviews, the Reviewers become concerned regarding a child’s safety. Reviewer’s first contact is generally with their First Level Quality Assurance Lead to determine the appropriate level of response. It is important for the March 31, 2021 Page 52

Continuous Quality Improvement Program Manual FLQA to help the Reviewers determine when there is a safety concern and to follow the state’s protocol to report it. This response would also satisfy the Mandated Reporter requirement. The FLQA will be responsible for informing the QA Manager of the situation. “Flagging” Cases When the Review Team uncovers a concern during the review, the FLQA will enter a separate general QA note in the OSRI. The subject line will identify which color flag is being used and the narrative will provide a brief description of the reason and action taken. • Red Flags – representing real concerns of practice and safety management in which the QA Unit needs to have a conversation with the agency prior to the end of the review week. May result in filing a child maltreatment report. • Pink Flags – representing portions of practice within the case that was concerning and worthy of further analysis but not necessarily requiring agency discussions prior to the PRM/end of the review week. May or may not result in filing of a child maltreatment report. • Yellow Flags – representing employee performance concerns that were noted – may or may not have been a specific safety issue yet warrants agency management attention. QA unit will bring those concerns to the agency supervisor/Director/CFS Field Services Specialist's attention. If the concern involves an employee licensed by a state board and the concerns involve possible infractions of the licensing rules, the Reviewers will staff with FLQA and SLQA. Reviewers will be supported in ensuring the situation is also appropriately reported. Reviewers’ Safety Case Reviewers will conduct case interviews as a team and mainly by phone; therefore, concerns regarding their personal safety will not likely arise. If there is a safety or risk concern in contacting a key case participant, an interview will not be required. If a case Reviewer feels unsafe, he/she will immediately report any concerns to the QA Manager. If an immediate safety concern arises, he/she will dial 911. Inter-Rater Reliability The QA Unit strives to have inter-rater reliability in the QA Case Reviews. This means that no matter which Reviewer or Review Team is assigned the case, that another Reviewer or Review Team would arrive at the same rating in the OSRI. Dissemination and use of case review data as part of CQI activities The QA Unit seeks to provide timely feedback to statewide partners regarding the results of the QA Case Reviews. Results and trends will be shared with the state and local agencies every six months and these items will help guide CQI efforts. March 31, 2021 Page 53

Continuous Quality Improvement Program Manual QA Case Review results and trends will capture statewide, Cross-Zonal, and local agency performance. Results may further be broken down by case type (foster care or in-home services). Specific reports currently available include: • APSR/CFSP: Detailed updates regarding the case record review process for all Child and Family Outcomes and Systemic Factors is reported in the Child and Family Services Plan and the Annual Progress and Services Report. This information can be accessed at http://www.nd.gov/DHS/info/pubs/family.html. • Case Rating Summary & Complete OSRI: Local agencies and the involved CFS Field Service Specialist(s) receive a copy of the completed OSRI and a Case Rating Summary once the case review is finalized. • State Rating Summary: This report gives an aggregated summary of state performance for an entire review. The report provides both an individual and combined count of ratings for each item and outcome, as well as individual and combined percentages. Users may filter by case type, case status, site, case review month, PUR start date, reason for agency involvement, and by cases that have been designated for PIP monitoring. The report is shared with the state and local agencies following each measurement period. • Supplemental State Rating Summary: This report includes the data from the State Rating Summary, presented with statewide and case type trends. It also includes summary information on Strengths and Challenges noted during the measurement period for Safety, Permanency, and Well-Being outcomes. The report is shared with the state and local agencies following each measurement period. • CFSR PIP Items at a Glance: This report tracks the progress for PIP tracked items in accordance with the state’s PIP Measurement Plan. The report is shared with the state and local agencies following each measurement period. The QA Unit is working collaboratively with the Children and Family Services Division in the development of a defined CQI process. Decisions regarding additional report formats, schedules, etc. is yet to be determined. March 31, 2021 Page 54

Continuous Quality Improvement Program Manual VIII. KEY PERFORMANCE MEASURES FOR CQI Purpose: The North Dakota CQI process will focus on the continual generation, use, and reinforcement around a set of key performance measures and outcomes that are in alignment with the agency’s vision, strategic priorities, and Federal requirements. Measures will be updated as needed as well as the establishment of performance baselines and benchmarks to be utilized as a primary driver for all Department CQI activities. Key Performance Indicators will also be reviewed annually as part of the Child and Family Services Planning process. The use of Key Performance Indicators will serve several purposes in supporting the Department in implementing an effective CQI process, including: • Strengthening the engagement and communication with agency staff, stakeholders, youth, and families as to progress in meeting child welfare system priorities • Targeting effective services for potential expansion • Developing and justifying agency budget decision-making • Preparing for long term agency planning • Retaining and increasing agency funding • Supporting efficient and effective service utilization • Improving the accurate identification of service needs • Strengthening system capacity to accurately measure the overall effectiveness and efficiency of the North Dakota child welfare system The use of qualitative case review data (OSRI) in particular serves several additional purposes as it relates to the CQI process, including: • Informing the quality and effectiveness in the delivery of services to North Dakota children and families including but not limited to such services as: developmental, educational, physical, dental, mental health, behavioral health services, domestic violence, substance abuse, and others • Identifying best practices that may improve the delivery of services to children and families • Identifying systemic barriers in the delivery of service to children and families • Understanding how case policy and practice impacts the assessment and delivery of services • Informing the Department’s state office and legislature on child welfare system needs and opportunities for improvement Stakeholder data also contributes to the North Dakota CQI process by: • Measuring the satisfaction and effectiveness of child welfare system service delivery as experienced by North Dakota children and families • Informing the Department’s state office on whether to modify or establish new memorandums of understanding with contracted agencies, vendors, or other third parties to improve collaboration March 31, 2021 Page 55

Continuous Quality Improvement Program Manual • Identifying areas of improvement, highlighting best practices, and areas of opportunities Connection of KPI’s to North Dakota Strategic Priorities North Dakota’s vision is to invest in prevention and early intervention efforts; ensure all North Dakotans have timely access to behavioral health services; expand outpatient and community-based services; enhance and streamline the system of care for children and youth, and ensure the safety, permanency and well-being of children and families. To realize this vision, North Dakota has targeted key performance indicators to tell a data story to support their principles and values. Key performance indicators reflected in this manual will be reviewed and updated on a regular basis as part of the CQI process and annual CFSP planning. Additional KPI’s can be added by the State CQI Council or Cross- Zonal Teams. Data Reporting Quantitative Data: The CQI Administrator is responsible for extracting and analyzing the quantitative data from management information systems regarding designated KPI’s on relevant safety, permanency, and well-being items. Data is validated and reported on the Department’s website. This report is provided to the local county agency of individual findings. A state summary report is posted annually on the Department website. Qualitative Data: The QA Reviewer as a part of the Case Review Unit is responsible for the CFSR/OSRI randomized sample pulled prior to end of current review event. Data is collected weekly for 12 weeks in 6-month period. Cases are selected twice a year (every six months). The CFSR/OSRI Report summarizes the review event which contains 65 cases combined from two review periods of 33 and 32 cases. Data is validated and reported on the Department’s website. The complete OSRI instrument is provided to the local agency on individual findings for their case 1-2 weeks after the case is finalized by the QA Unit. The state summary report is posted annually on the Department website. March 31, 2021 Page 56

Continuous Quality Improvement Program Manual North Dakota Key Performance Indicators for Child Safety National National Performance Data Indicators (Source: NCANDS) Performance Recurrence of maltreatment within 6 months 9.67 victimizations Maltreatment in foster care Round 3 CFSR Items (Source: Case Review Data) 9.5% Item 1: Timeliness of initiating investigations of reports of child maltreatment ND Target Item 2: Services to child(ren) in the home and preventing removal or reentry PIP Goal Item 3: Risk and safety assessment and management 82% 30% 54% North Dakota Key Performance Indicators for Permanency National Performance Data Indicators (Source: AFCARS) National Performance Permanency in 12 months for children entering foster care 42.7% Permanency in 12 months for children in care 12-23 months 45.% Permanency in 12 months for children in care 24 months or more 31.8% Re-entry to foster care in 12 months 8.1% Placement stability 4.44 moves Round 3 CFSR Items (Source: Case Review Data) ND Target PIP Goal Item 4: Stability of foster care placement 81% Item 5: Permanency goal of child 64% Item 6: Achieving reunification, guardianship, adoption, or other planned permanency 21% living arrangement Item 7: Placement with siblings ~ March 31, 2021 Page 57

Item 8: Visiting with parents and siblings in foster care Continuous Quality Improvement Program Manual Item 9: Preserving connections Item 10: Relative placement ~ Item 11: Relationship of child in care with parents ~ ~ ~ North Dakota Key Performance Indicators for Child and Family Well-Being ND Target Round 3 CFSR Items (Source: Case Review Data) PIP Goal Item 12: Needs and services of child, parent, and foster parents 52% Item 13: Child and family involvement in case planning 54% Item 14: Caseworker visits with child 62% Item 15: Caseworker visits with parents 43% Item 16: Educational needs of the child Item 17: Physical health of the child ~ Item 18: Mental/Behavioral health of the child ~ ~ March 31, 2021 Page 58

Continuous Quality Improvement Program Manual APPENDIX (Currently under development) March 31, 2021 Page 59

CQI CYCLE SCENARIOS Consider the two scenarios, both relating to what appears to be declining compliance with monthly caseworker Scenarios A and B. Same Results contacts with children in substitute care. • Both units have had a monthly compliance rate Units A and B monthly compliance rate: 70−75% for 6 months Agency’ s performance goal: 95% between 70 and 75% for the past 6 months. • The agency’s established performance goal, however, Findings Regarding Unit A is 95%. Scenario 1: Unit A • The performance of these two units is having a • A recent trend, not long term • Positive performance in other areas profound impact on the region’s performance and is • MIS data and case record review now also starting to impact statewide performance. • The issue was in fact recently brought to the attention – Monthly contacts and ongoing of the agency’s Director by their regional Federal supervision occur, but data not partners who have also noticed this drop in entered timely performance. • The agency director has asked for an explanation. – Some staff not using proper data entry codes A closer look by the Agency’s CQI Team, using monthly MIS (i.e., SACWIS) trend reports as well as qualitative case file review data, reveals the following information. Let’s start with Unit A: • Compliance in this area on Unit A began to dip 6 months ago (previous compliance had been steady at over 90%). • The unit has a relatively new and inexperienced, though committed, supervisor. • Two of the unit’s seven caseworkers retired in the past year and one has been on an extended medical leave of absence, leaving the unit with three new caseworkers. • While MIS (SACWIS) data suggests unit compliance is currently at 75%, a review of case entry notes in unit case files clearly shows that actual monthly caseworker child contact is close to meeting the 95% benchmark. • The data are simply being entered several weeks late into SACWIS. • The newer staff are also not consistently using the proper drop down fields in SACWIS when they enter their contact notes suggesting a training issue for both the staff and supervisor. This information indicates issues of timeliness and accuracy. Page 60

Comparison of Unit A and Unit B Now let’s look at Unit B. • Compliance in this area has been low on Unit B in • Unit A: Overall good case practice, documentation, and comparison to the rest of the region for several years training issue with little change. • The current supervisor on the unit is experienced but • Unit B: Poor case practice, lack newly assigned. of consistent supervision • He has; however, a history of mediocre performance that goes back to his prior unit assignments within the Findings Regarding Unit B agency. • The unit has been staffed appropriately and caseloads Scenario 1: Unit B have also been at an acceptable level by agency • A more pervasive, long -term standards. • There is a mix of newer and more experienced issue caseworkers on the unit and the unit was without a • Performance on supervisor for 9 months prior to the current supervisor being assigned. permanency goals generally • A review of MIS data indicates few children are being lower than average seen on a monthly basis by their assigned caseworker. • Monthly contacts and • A review of case file documentation (case notes) supervision do not occur corroborates this finding and there’s very little consistently documentation of on-going case supervision. Here the issues are entirely different. In the case of Unit A: • The quality of the data is most directly impacted by the three new caseworkers on the unit. • The overall case practice is good, rather it appears to be a documentation and training issue. • The supervisor also impacts data quality by not being aware of the delay of data entry and use of inaccurate MIS data fields by some of her casework staff. • Ultimately, the data are an inaccurate reflection of the case practice occurring in this area but perhaps easily correctable. With Unit B: • There appears to be a more challenging case practice issue which is further impacted by a lack of consistent supervision. • The data unfortunately displays an accurate portrait of the poor practice currently taking place on the unit. • This can be a more intractable issue, one that goes beyond the mechanics of simple data quality. Both are equally important; however, as the agency isn’t achieving its established performance benchmark in this area which has an impact on the children and families the agency is there to serve. Page 61

CQI ACTION PLANNING WORKSHEET Clear Fields The worksheet on the following pages is to be used to guide your team’s activity and document progress towards implementation of a solution(s). CQI TEAM INFORMATION Project Lead Name Mailing Address City State Zip Code Telephone Email Team Members Involved Partner Represented Project Start Date Attach additional sheets, if needed. Anticipated Completion Date Actual Completion Date Page 62

I. IDENTIFY AND UNDERSTAND THE PROBLEM What is the identified problem (Problem Statement)? Who is impacted/target population? Why is it occurring? What is the long-term goal/outcome to be achieved? How do you know this is the problem? What evidence did you use to identify the Problem and Root Cause? What was your process to identify the Root Cause? Include supporting documentation such as Why-Why Diagram or other tool used. What data will you need and what is its sources? What data gaps, if any, exist? Page 63

II. RESEARCH THE SOLUTION What is already known about how to solve the identified problem? What more can be learned about solutions from your own data? What are the needs of the target population? What process did you use to identify the solution? What is the chosen solution to the identified problem? Page 64

III. DEVELOP A THEORY OF CHANGE Use “Change and Implementation in Practice: Theory of Change” as a guide. Include your completed Theory of Change below. Page 65

IV. ADAPT OR DEVELOP THE SOLUTION Will the identified solution use an existing practice, or will one need to be developed? ☐ Existing ☐ To be Developed Is the solution an evidence-based practice? ☐ Yes ☐ No Name of EBP If EBP, will the practice require modification to implement? ☐ Yes ☐ No (If Yes, explain modification) If developing a new process, include your action plan below (attach additional sheets, as needed). Page 66

V. IMPLEMENT THE SOLUTION Project Launch Date Location of Project (check all that apply) ☐ Statewide ☐ Cross-Zonal CQI Team Area (Identify) ☐ Human Service Zone(s) (Identify) ☐ County (Identify) ☐ Vendor Agency (Identify) How will fidelity to the model be monitored/evaluated? Include any performance measures that will be used. Attach additional sheets, as needed. Page 67

VI. MONITOR AND ASSESS THE SOLUTION Identify the performance indicators that will be used to monitor and assess the impact of the chosen solution. Attach additional sheets as needed. Performance Indicator 1 Data Source Frequency of Data Collection ☐ Monthly ☐ Quarterly ☐ Semi-Annually ☐ Annually ☐ Other (specify) Performance Indicator 2 Data Source Frequency of Data Collection ☐ Monthly ☐ Quarterly ☐ Semi-Annually ☐ Annually ☐ Other (specify) Performance Indicator 3 Data Source Frequency of Data Collection ☐ Monthly ☐ Quarterly ☐ Semi-Annually ☐ Annually ☐ Other (specify) Performance Indicator 4 Data Source Frequency of Data Collection ☐ Monthly ☐ Quarterly ☐ Semi-Annually ☐ Annually ☐ Other (specify) Page 68

CQI PROJECT STATUS REPORT Use this form to report on the activities completed since the start of the project/last update. Attach additional sheets, as needed. Project Name Project Lead Name Project Start Date Report covers the period to Is this the final report? ☐ Yes ☐ No Project Completion Date Which step of the CQI Cycle are you in? ☐ 1. Identify and Understand the Problem ☐ 2. Research the Solution ☐ 3. Develop a Theory of Change ☐ 4. Adapt of Develop the Solution ☐ 5. Implement the Solution. ☐ 6. Monitor and Assess the Solution What is the problem statement? Has this changed since the last report? ☐ Yes ☐ No What is the Long-term Outcome? Has this changed since the last report? ☐ Yes ☐ No Describe the activities/progress on strategies since the last report Describe additional problems and data gaps that have been identified since the last report What additional resources are needed? Additional comments Attach performance indicator data, if available. Attach additional sheets, as needed. Clear Fields Page 69