Improving Outcomes and System Performance for Complex Children through Qualitative Case Review and Case Dialog

Statement of Problem

Managing quality of care for complex children who traverse multiple public systems, whether it be child welfare, education, juvenile justice, or healthcare, can be a very difficult undertaking.  Given the unique nature of each child who traverses multiple systems, it can be difficult to manage performance of the system as a whole with simple quality metrics or process measures.

To address the need to measure system performance in settings with very complicated and unique child histories, there has been an emerging focus on qualitative tools that would permit a “deep” dive into a subset of cases within a system over regular intervals.  For example, the Quality Service Review (QSR), first used as a result of child welfare lawsuits in Alabama and Utah, has become an alternatives to case record file reviews that did not seem to be producing better outcomes for children and families. 

Qualitative methods – like a case study, interview, or focus group – are one of the best ways of understanding an area where little is known.  The review is particularly helpful for complex clients who require multiple formal (professional) and informal supports involved in their treatment and overall care.  The QSR principally measures family engagement and team functioning to determine whether the child and family are satisfied and the team has the same view and understanding of the care plan. 

PolicyLab seeks to extend the expertise with QSR from its traditional settings in child welfare to education and healthcare, particularly with respect to improving quality of care for the most complex children in each system.  In child welfare, the team is analyzing multiple years of QSR data from the state of Utah to determine which QSR measures are predictive of others.  This review is intended to generate a set of recommendations about the possibility of a shorter tool that will be used by more jurisdictions and agencies serving complex children.  Within the city of Philadelphia, the team has advised the School District and child welfare system in initiating a cross-system QSR to better understand the educational needs of child welfare-involved youth.  In healthcare, the team is seeking to develop a QSR approach to better coordinate the healthcare needs of the most medically complex children.

The team has taken two principal approaches to dissemination of findings with respect to the QSR.  They are currently preparing analyses of the original QSR work from the state of Utah to share with a broad child welfare practice and policy network.  At the same time, the strategy team continues to engage diverse stakeholders in novel applications of the QSR, including within education, behavioral health, and pediatric health systems.

Suggested Citation

The Children's Hospital of Philadelphia, Policy Lab. Improving Outcomes and System Performance for Complex Children through Qualitative Case Review and Case Dialog [Online]. Available at: [Accessed: plug in date accessed here].