p case review policy

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HEALTHY FAMILIES MASSACHUSETTS Case Review PolicySeptember 2011

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HEALTHY FAMILIES MASSACHUSETTSPOLICIES & PROCEDURES

CASE REVIEW

As a family-centered model of service delivery, HEALTHY FAMILIES MASSACHUSETTS (HFM)maintains its focus on the strengths, interests, and challenges of the participants throughconsistent review of the home visiting provided. These reviews give supervisors theopportunity to provide time for home visitors to reflect on work with families, to identifyresources for participants, and to ensure accurate documentation of the services provided. Therequirement for participant case review is a minimum of once every four weeks. These reviewsinclude case review in individual reflective supervision, as well as a review of the Participant

Data System (PDS) documentation.

HFM case review frequency policies and procedures are divided into the following sections: Case review in individual supervision, and Case review of documentation.

Attached to this policy are the following appendices: Appendix A: HFM Case Review Case Review Tracking Form Appendix B: HFM Case Review Weekly Supervision Provision Tracking Form

This policy is intended to support:

Thorough familiarity by the supervisor with the caseload of each home visitor in theprogram; Consistent and regular review of documentation of service delivery to each participant

on all service levels;

Assurance that service delivery reflects fidelity to the HFM home visiting model; Consistent review of all participant records (at least every four weeks) for data

completeness, to identify data gaps, and to fill those gaps without unduly burdeninghome visitors or supervisors;

Identification of data system problems in a timely way, such that any data loss is easilyidentifiable and/or correctable; and

A unified approach to ensuring accuracy of participant records that enhances primarily,family satisfaction and success with services, and secondarily, program administration,evaluation, and implementation.

I. CASE REVIEW IN INDIVIDUAL SUPERVISIONCase review is expected to take place in scheduled weekly individual supervision.Supervisors and home visitors should review the case of each participant regardless of levelof service at least every four weeks (NOTE: every four weeks is more often than once per


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month). Case review is expected to cover the following essential elements of the HFMprogram:

Parent-child interaction and parenting skills; Administration, content, and dynamics related to Family Profile as well as progress

toward addressing identified issues;

Health & medical home issues, such as provider visits, birth control, immunizations,and other relevant issues; Participant education & economic status; Goal-setting, Individualized Family Support Plans (IFSP), progress towards goals,

and use of goals to guide service delivery; Child development and child-centered information and acquisition of

developmental skills; Ages and Stages Questionnaire (ASQ) planning, administration and follow-up; Participant development of formal and informal support networks; Service level assignment/changes, family progress, and discussion between home

visitor and participant regarding progress; Thoughtful transitions; Plans for Engagement, Re-engagement, and secondary activities, with special

attention to the use of creative outreach strategies; Inclusion and involvement of fathers/partners; Balance between observations of family circumstance and home visitor intervention

to strengthen participants skills, including parent education through the use ofcurricula;

location of service delivery prioritizing visits in the home, including documentationof reasons for out of home visits;

Referral needs, follow up activities identified, and outcome of the referral; Plans for home visitor next steps regarding work with the participant; and Other relevant issues unique to the familys circumstance.

Not every case review needs to contain all of these elements. However, over the life ofsupervision of each case, there should be regular attention to each of these elements. Theparallel with the philosophy of home visiting is clear: all the important topics are covered,but not every topic, every visit.

Spotlight on Supervision: To complement regular in-depth case review, HFMIT requiresthe use of the Two-Tiered model for case review. This model pairs in-depth review of eachcase at least once every four weeks with a weekly status check-in on every participant foreach caseload. When using the Two-Tiered model, supervisors do not need to document ascase notes the content of status check-ins unless the discussion develops into a more in-

depth case review. See Appendix A for the required form to clearly document this system ofreview. See Appendix B for an example of a form to help document the provision of weeklysupervision.

Case review in individual supervision must be documented in the supervision log,following standards set out in the Guidelines for Creating and Maintaining Supervision


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Logs in HEALTHY FAMILIES MASSACHUSETTS (please see Appendix G of the HFM STAFFSUPERVISION POLICY).

II. CASE REVIEW OF DOCUMENTATIONBest practice regarding case review frequency applies not only to discussion in individual

reflective supervision, but also to the supervisors review of documentation of servicedelivery. Review by the supervisor of PDS documentation is expected to take place at leastevery four weeks. This regular review of documentation provides quality assurance inregards to service delivery, as well as more thorough familiarity by the supervisor with thefamily, their strengths and needs, and the delivery of services.

Case review of PDS documentation includes thorough review of the home visiting record:reading the contents of the record at a minimum of every three to four weeks and approvingthe record via electronic signature and noting content reviewed. Supervisors areencouraged to give feedback to home visitors on the content and structure of theirdocumentation in a timely and effective manner, but to do so during individual reflectivesupervision, rather than writing such feedback in the participants record. This assures thatparticipant records remain focused on the participant, rather than on content directed to theprogram staff member.

Spotlight on Supervision: Supervisors should review PDS and paper file documentationoutside of, and ideally, prior to, the individual supervision session, though direct referenceto the review and/or documentation can be a useful tool in building home visitor skillsduring supervision.

Review of other PDS documentation includes attention to the following: Service Level Assignment; Status reports; IFSP goals and progress towards them; Ages & Stages Questionnaires; Immunizations; Medical visits; and Discharges; Referrals and follow up; and Basic accuracy and consistency of data.

In addition to meeting standards for promising practice, challenges (some technological,some human) with the PDS indicate the need for ongoing monitoring of data entered.Regular review of documentation in the PDS will assist in maintaining data accuracy and

completeness.

Case review is an essential tool for ensuring the provision of high quality home visiting servicesto program participants. For questions regarding this policy, please submit a TechnicalAssistance (TA) ticket via the TA Help Desk at [email protected]


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Appendix A: HFM Case Review policy

September 2009

Individual Case Review Schedule

Home Visitor: ____________________________ Supervisor: ____________________________

Every participants case must be discussed each supervisionfor all service levelsand coded as follows:R = reviewed in detail and documented in both client record and supervision notesS = status of case and plan for the week discussed [No note needed in supervision log]O = case opened C = case closedM = missing (provide reason, such as supervisor vacation; HV vacation; staff illness, unable toreschedule; cancelled, unable to reschedule; etc.)

Please note that weeks where no supervision takes place must be noted here as well this assures that casereview takes place at least once every four weeks, even if supervision does not take place every week. Thereason supervision did not take place canbe documented here (it must be documented somewhere in thesupervision log).

Participant Name

/

/20__


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Appendix B HFM Case ReviewWeekly Supervision Tracking Form

September 2009

Weekly Supervision Tracking Form

Home Visitor_________________________ Assigned Supervisor___________________________

WEEK DATE OFSUPERVISION

TIME COMMENTS SUPINITIALS

Week:Can be week ending or week beginning. Must be consistent across all supervisors within a program.Date of Supervision: Actual supervision date. Remember, individual supervision is to be scheduled and face to

face. If there is a documented reason for it, supervision can be divided into two scheduled sessions, but eachmust last a minimum of 45 minutes.Time: Actual time supervision took place. (E.g. 10:00 -11:30AM). Should be filled in after the fact, not as a placeholder.

Comments: If supervision does not take place, the reason why must be documented here, as well as attempts toreschedule if applicable. Other comments as necessary.Sup Initials:The supervisor who provided that weeks supervision should initial here. There are times whensupervision is provided by someone other than the assigned supervisor (during supervisor leaves lasting longerthan two weeks).

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