Quality Improvement Committee

Quality Improvement will be a continual, collaborative, proactive effort to examine and evaluate program and service delivery to ensure that our programs and agency achieves the desired results and is maintaining a high standard of service. The Quality Improvement Committee has the responsibility to provide an ongoing, comprehensive quality improvement program at Travelers Aid Society of Los Angeles. The Committee, the Management Team, and the Board of Directors will review the Quality Improvement Plan discussed below annually.

The Committee is small enough to facilitate active discussion and timely decisions. The standing Quality Improvement Committee consists of at least one Board Member and two Staff Members: the Executive Director and the Director of Social Services. There is also at least one standing position on the Quality Improvement Committee for another Agency staff member. Staff members will rotate through the Committee on a biannual basis. The current members of the Quality Improvement Committee are listed in Attachment 1. Other Agency staff members and the contracted Evaluation Consultant may be involved at various times. Meetings are held at least quarterly, but may be called monthly.

Under the direction of the Quality Improvement Committee, work groups will examine a variety of topics that will assist with advancing the Agency's knowledge about functions, programs, services, and processes that may be improved. Attachments 2 and 3 identify some of the activities that the Quality Improvement Committee oversees. The Quality Improvement Committee will monitor progress at scheduled presentations, and recommendations will be made as appropriate. A plan of corrective action will be developed to address any program/area quality deficiency or to improve on the established effectiveness demonstrated by each indicator that is identified. The attached form (attachment 4) will be used as a template for summarizing quality improvement studies and projects.

Once the community needs assessment is completed, an ad hoc committee will convene every three years to review and modify the Agency's mission statement, if necessary, and the strategic plan. During this process, the committee will evaluate the strengths and weaknesses of the Agency and determine the Agency's needs in realizing its mission. Although the core of the committee will consist of at least two Board Members and two staff members including the Executive Director, members of the Management Team will be consulted in developing the strategic plan.

Short-Term Planning
In order to be effective, the long-term/strategic plan must be supported by a short-term (one year) plan. Each year the staff from each program/area will assist the corresponding manager in reviewing and establishing the programmatic goals and objectives. The manager and staff will identify outcomes and indicators that will assist in evaluating whether the programmatic goals and objectives were reached. Although the staff and the managers will be the primary driving force in defining the goals, the Teen Canteen Advisory Committee and LAX Lead Volunteers may have a place in assisting with this process. (Attachments 6 and 7 are tools that may be used to assist the managers in directing the discussion with his/her staff regarding identifying short-term goals and objectives. Attachment 8 identifies the current client outcome goals.) The program/area manager will report on progress towards meeting the goals on his/her monthly report to the Executive Director.

Program indicators are objective, measurable references of whether a program is fulfilling the intended purpose or outcome. Measurable quality indicators are intended to address the questions of how well and how effectively services are being provided. The Quality Improvement Committee approves indicators, objectives, and goals that are measured. Indicators assist the Quality Improvement Committee, as well of each of the program and service areas, with its ongoing review of important functions and processes. If at all possible, a standardized tool that has been developed by the lead person or by an outside source should be used to measure outcomes.

By developing a set of indicators specific to each program, establishing a measurable minimum standard for each indicator, and conducting an assessment on the extent to which each indicator is met, the Agency can assess the quality of services being delivered. This information, used along with the results from other quality improvement studies conducted in each service and program area, assist the Agency in improving its programs and services.

The individual who oversees a specific program and Agency service area develops procedures that apply to his/her area of concentration. Once the procedures are drafted, the draft needs to be approved by the Executive Director and the Administrative Director. The Agency's Board of Directors must approve all policies. Each manager must maintain a current copy of the policies and procedures that affect his/her specific area(s) of concentration. In addition, the administrative staff (Administrative Director and/or the Business Office Manager) will maintain a master copy of all of the agency policies.

As the policies and procedures are implemented, staff, volunteer, and client input is essential to making the written policy and procedure applicable and appropriate to the service and program being conducted. Policies and procedures can be reviewed and modified as needed, based on Board, staff, volunteer, and client feedback.

Staff Qualifications, Training, and Evaluation

Case management services are essential at Travelers Aid Society of Los Angeles. Staff and volunteers are knowledgeable of local resources, and the staff is able to determine the appropriateness of services for each client. The Executive Director, the Administrative Director, and the Board of Directors evaluate at least annually the distribution of staff and financial resources based on service center needs and current financial resources.

The Coordinator of Social Services, the Teen Canteen Coordinator, the Case Managers, and the Volunteer Director must have a minimum of a Bachelors degree from an accredited college. The Executive Director and the Director of Social Services must have a Masters degree from an accredited college. After the initial six months of employment, each individual is evaluated on his/her performance annually, and establishes performance and personal growth goals in collaboration with his/her supervisor.

The Peer Educators have lived on the streets, been homeless or at risk of homelessness, or lived in a shelter, themselves. Not only do the peer educators serve as role models, but also as links between the Teen Canteen clients and staff. The Peer Educators must attend a HIV/AIDS training and a STD training as soon as possible after they begin working with Teen Canteen. Since the peer educator position has historically been a short-term (six months to one year), the Program Coordinator reviews their performance once every six months, after the initial three-month probation period.

All staff has the opportunity and are encouraged to participate in on-going training. Employees who have a role in providing direct service to the clients are provided training in at least non-violent crisis intervention, sensitivity awareness, tuberculosis, CPR and first aid, and health-related/communicable disease prevention. Staff training needs are evaluated at least annually and implemented accordingly.

Furthermore, any partnering entity is evaluated annually to determine if the relationship is beneficial to Travelers Aid Society of Los Angeles. Any outside agency that enters into a partnership with TASLA will have a written service agreement that outlines the services that will be provided, deliverables, and areas of accountability. The TASLA manager overseeing the collaborating agency or person will monitor the quality and quantity of services provided.

Agency Stakeholders and Feedback Mechanisms

In order to provide the best possible service, the Agency takes into account and consults various individuals and groups of individuals on an ongoing basis. These stakeholders include: clients, staff, funders, the Advisory Committees (Teen Canteen and LAX), the Board of Directors, volunteers, community/neighbors, and other agency "friends." Attachment 9 identifies some of the ways that each stakeholder group is involved in the quality improvement process.

Client Feedback
Client feedback refers to both a method used for evaluation and how information feeds back into services. Feedback from current, or past clients, or participants, can be valuable when evaluating the effectiveness and the quality of the program and/or service. In addition to helping identify sound outcomes, client feedback enhances the credibility of the evaluation effort. Information from client feedback will be used to modify existing services and to create new services when appropriate. On an ongoing basis, TASLA obtains input from clients about services and programs so that we can improve services and meet the needs of our client population. Agency-wide, clients complete a satisfaction survey biannually to evaluate the case management services that they received and the environment where they are served.

At Teen Canteen, staff obtains feedback from clients in at least three ways. First, the case managers obtain direct feedback by conducting client meetings quarterly to determine clients' needs and overall satisfaction with the services provided. Secondly, there is a suggestion box located in an accessible area in the client "dayroom." The case managers review suggestions on a bimonthly basis. Thirdly, clients participate in an anonymous written satisfaction survey (attachment 10) conducted twice a year. The Director of Social Services, the Program Coordinator, and the Teen Canteen Coordinator will monitor clients' satisfaction with the services and report any changes to the Quality Improvement Committee and the Teen Canteen Advisory Committee. Finally, the Agency asks at least two clients to participate in the Teen Canteen Advisory Committee that meets a minimum of once a quarter. In addition to the clients, the Advisory Committee consists of staff members, peer educators, and concerned community members. A list of current members can be found in attachment 1.

Furthermore, workshop participants may complete a brief evaluation form (attachment 11) for any program that they participate in at Teen Canteen. In addition, a few questions on the workshop post-test and on the workshop follow-up (attachment 12) focus on evaluating the "For Love or Money" workshops. This feedback helps inform program staff about clients' overall satisfaction with the workshop, the areas that were good, as well as areas that may need improvement. The Program Coordinator will monitor clients' satisfaction with the workshops and report changes to the Quality Improvement Committee. In addition, Teen Canteen clients, the Peer Educators, and the Case Managers will participate in a focus group discussion and key informant interviews at least once a year. These sessions are conducted and summarized by the Evaluation Consultant. The focus groups will address issues of overall Teen Canteen services and the "For Love or Money" program activities. The Evaluation Consultant will present a summary of the discussions and the resulting recommendations to the Quality Improvement Committee. Based on the information obtained and the recommendations made, the Program Coordinator and the Director of Social Services will make appropriate changes.

Volunteer Feedback
Volunteers provide invaluable assistance to the many people they contact. They are in a unique position to provide feedback about the agency, as well as the services that they directly provide to clients. Volunteers participate in a survey conducted by the Volunteer Director at least once a year. The Volunteer Director also convenes monthly meetings with the Lead Volunteers, who serve as our TASLAX Advisory Committee, as well as informal meetings with all volunteers. All of these venues provide avenues for feedback about the volunteers' satisfaction with the program and with their delivery of services. Depending on the outcome of the information gathered, the Quality Improvement Committee, with the assistance of the Volunteer Director, will make appropriate recommendations and changes in the Volunteer program.

Staff Feedback
The staff has an important role in quality improvement projects/studies: they are an important source of information to the Quality Improvement Committee; and, they are responsible for implementing any changes or corrective actions that may result from a quality improvement project/study. Staff is instrumental in providing the actual services that fulfill the Agency's mission. Staff provides ongoing and constant feedback about service delivery in two ways. First, each area/program meets on a regular basis to discuss procedures, program goals, and client/programmatic issues. Staff is involved in developing their area's yearly plan, selecting and monitoring outcomes and indicators. The Case Management staff, including the Director of Social Services and the Coordinator of Social Services, conducts a utilization review of all of the clients' files at least once a year, even though it may be distributed throughout the year. Ideally, the person who reviews the client's file should not be involved with the case. Utilization reviews of the client's file should at least include a review of the service plan to evaluate implementation and appropriateness of service. Any supervision or case review should be clearly documented. In addition, individuals who are no longer receiving services should have a written "discharge plan" that indicates the reason for termination of services and follow-through that will allow for appropriate continuity of care. Findings from the utilization review will assist with standardizing form completion; making any necessary changes in the forms that the Agency uses for client interaction and tracking; and, revising procedures as necessary.

Furthermore, the staff is involved with ongoing and new quality improvement studies and projects. One example of this is a staff satisfaction survey (attachment 14) that is conducted once a year. One of the responsibilities of the Agency Safety Committee is to evaluate and make recommendations for improving the safety of staff work environments. Evaluating the work environment also enhances client confidentiality and staff productivity. In addition, at least two staff members have a standing seat on the Quality Improvement Committee.

TASLA Board of Directors
The Agency Board of Directors oversees the overall governance and direction of the Agency. The Board of Directors provides direction by reviewing and redefining the Agency mission and values. At least two members participate in the long-term/strategic planning committee, with the general Board approving it. And, depending on the scope of coverage of policies and procedures, the Agency's Board of Directors must approve the policy. As a quality improvement effort, the Board of Directors engages in reviewing not only its own effectiveness, but also its relationship with the Executive Director and other partnering agencies including legal counsel. At least one Board Member has standing seat on the Quality Improvement Committee. Annually, the general Board reviews and approves the Quality Improvement Plan as discussed in this document.

Community Input
Community members participate in Advisory Committees that assist with identifying service outcomes and indicators, as well as programmatic short-term plans. The primary objectives of the Teen Canteen Advisory Committee includes a forum to obtain feedback on current Teen Canteen programs and services which includes "For Love or Money;" to identify gaps in services that Teen Canteen can address; to identify new programs that may be offered to clients; and, to identify additional program resources, including volunteer recruitment. A list of current members is listed in attachment 1.

In addition, we survey the community and other local agencies once every three years in an attempt to identify services and gaps in services.

Funder Input
We maintain ongoing communication with funders to assess our compliance with contractual or grant agreements. We also implement changes based on feedback obtained from program and agency audits.

Only staff can access client-related information on the database. The client database is password protected. As the client database is being implemented, the case managers as the primary users of the database will keep a log of exceptions and/or problems and/or suggested inclusions that will then be incorporated into the design of the database. The database will centralize client information and facilitate aggregate client demographic information. It will also provide information regarding the services that the client identifies that he/she needs and which ones they have used. In addition, all Agency computers have the most up-to-date anti-virus program installed and is updated at least once per month.

Risk Management

The Administrative Director oversees Agency compliance with legal requirements as these apply to building and equipment, as well as to client and staff safety. Based on the Agency confidentiality policy, any information that directly pertains to clients, be it for outside research purposes or presentations to the wider community, will protect the clients' confidentiality.

The Administrative Director monitors client, staff, and volunteer grievances, incidents, and accidents for patterns. As grievances, incidents, and/or accidents occur, appropriate corrective action is recommended to prevent future events. Reports discussing these areas are made to the Quality Improvement Committee as needed.

The Agency Safety Committee meets at least quarterly to discuss areas of concern related to workplace, staff, client, and volunteer safety concerns. The Safety Committee may also address environmental risks, incidents, and accidents and make appropriate recommendations. Based on pertinent information, resources, and recommendations, appropriate changes are made.

Quality Improvement Scope of Activities

Attachments 2 and 3 identify some of the activities that the Quality Improvement Committee oversees. Below is a brief list and overview of some of these activities.

· Quality Improvement Plan review annually

· Long-term/Strategic planning and Community Needs Assessment conducted once every three years

· Annual short-term planning and review, including identifying goals, objectives, outcomes, and indicators

· Teen Canteen Advisory Committee and LAX Advisory Committee/Lead Volunteers each conducted at least quarterly

· Client feedback:

o Client meetings conducted quarterly
o Written Satisfaction Surveys (attachment 10) conducted bi-annually
o Workshop Evaluation Forms (attachment 11) conducted after each workshop
o "For Love or Money" workshop post-tests and follow-up forms (attachment 12)
o Suggestion Box reviewed by staff twice a month
o Focus Groups conducted at least once a year by the contracted Evaluation Consultant

· Peer Educator feedback is ongoing and will also be solicited during key informant interviews with the subcontracted Evaluation Team.

· Program Coordinator routinely monitors "For Love or Money" workshops and peer educator individual sessions

· Case Conferences are conducted at least bimonthly based on the individual client's need. Through this process, staff may identify additional service needs and ways to address those needs. Each active client is discussed at least once a quarter.

· Client Case File Review is conducted at least once a year. The Coordinator of Social Services, the Teen Canteen Coordinator, and/or the Director of Social Services will use the standardized utilization review form (attachment 15) to evaluate the completeness of the client's file.

· Volunteer and Staff feedback is ongoing. Volunteer Survey (attachment 13) and Staff Survey (attachment 14) conducted annually.

· Risk Management is ongoing, but reported as needed.