FCI: From Stories to Hypotheses Part 3/4


Facilitated Collaborative Inquiry: From Stories to Hypothesis Part 3/4

by Stephen Shimshock, PhD
Director of Systems-Data and Reporting, Casey Family Programs

This post is part three of a four-part series on Facilitated Collaborative Inquiry (FCI). In the previous post (Using Data to Show Differences in Outcomes) we examined ways to identify subgroups of youth that may not be having the same outcomes as others. The example given in the previous post was somewhat simplistic (youth with five or more actionable items in the behavioral, life functioning and risk domains as identified using the CANS at baseline). In an implementation of FCI you would likely explore a variety of potential variables. However, we will continue with the previous example in this post to keep things consistent. In this phase of FCI we explore how to engage staff, through the use of stories, to unpack what they think could be causing the differences in outcomes for youth. Establishing a measurement baseline and a working understanding of what may be causing the differences in outcomes is the foundation from which staff can then set a goal for improvement.

In the previous post the entry cohort data showed that youth with five or more actionable items in the behavior, life functioning and risk domains at intake were less likely to achieve permanency than those youth with four or fewer actionable items. Only 38 percent of the youth with five or more actionable items achieved permanency after two years. This outcome establishes a baseline from which staff can then set improvement goals. Once the baseline is established, the staff then work together to understand why our system is struggling to serve this population of youth. Axiom two from the previous post states, “Those that exit teach us about the quality and efficiency of our system.” To look for patterns and causes we engage the social workers of cases that have closed in a “story session.” This is based on a belief that those closest to the challenges are in the best position to describe the challenges and find solutions.

The closed cases are methodically examined through stories and the collection of data about those stories. It is beyond the scope of this post to go into detail about the story collection process. However, we follow a similar process to Anecdote Circles[i] and many of the practices found in the book Working with Stories by Cynthia Kurtz.[ii] We typically do this work at an office level, so the youth we are exploring are only from that one office. This is a group process involving all staff in that office. A story collection session is conducted in about two hours, during which we collect 25-35 stories. As mentioned earlier, after each story is told the social worker (who told the story) completes a short (7-10) set of scaling questions about the story. In addition, those listening to the stories are writing on sticky notes when they hear a theme about a person, process or tool/form that resonates with them. As you can imagine, after two hours there are a lot of sticky notes collected in addition to the stories themselves. The staff then spend another one to two hours arranging all the sticky notes into clusters that make sense to them. They provide descriptive names for their clusters and then assign a cluster to each story told during the story collection session.

You may wonder how we can collect 25-35 stories in only two hours. The stories are told in response to “story eliciting questions.” These questions are typically crafted in advance with the guidance of the staff. The questions focus on specific events within a case rather than an open-ended case history. Here is an example of a story eliciting question from a recent FCI session: “Recall a time when a case took a surprising turn (either positive or negative); what, specifically, surprised you?” As you can see, these questions focus social workers on a specific experience and result in short (1- to 3-minute) stories or anecdotes. These can be very revealing and often highlight issues that may not be present in the data collected through the case management system.

In most FCI implementations, using data to find the differences in outcomes, engaging staff in unpacking the data with stories, and developing a working theory/hypothesis about the differences in outcomes is completed in one-and-a-half-day sessions. Most of the work is done on day one. In the evening of day one a small group synthesizes all of the information into what we call the “Opportunity Summary.” This report summarizes the opportunity/gap, establishes a baseline, provides charts that show patterns in the story data and also identifies the youth currently open that meet the criteria of the youth under study. The opportunity summary is used during a guided discussion with the staff to help facilitate the development of one or more hypotheses. The hypotheses can then be tested over time with new youth that meet the same criteria.

If, for example, we found an office had 40 youth currently open with five or more actionable items, we could say, “If we do nothing different than we are doing today, based on past performance, only 38 percent, approximately 15 out of the 40 youth currently in care, will find a permanent home.” This is often a palpable and powerful moment. We are not just looking at the “number” of youth but rather we are looking at the names of those youth. At this point, the staff are encouraged to set a goal in the “X to Y by When” format. In this example an office may state: “We want to increase permanency for youth who enter our program with five or more actionable items from 38 percent to 50 percent in the next 18 months.” At times this part of the process can be very challenging if staff are not used to working with goals or they fear not accomplishing the goal will reflect poorly on them.

It is worth emphasizing at this point that all through the FCI process we ensure staff that this is not a “got-you” process. This is a learning process. We have intentionally separated this process from other performance initiatives. In fact, in our organization, FCI is currently optional. Making it optional helps ease the anxiety of getting it “right or wrong.” In addition, as an administrator of FCI, it provides me with instant feedback of whether or not the process is helpful (people tend to stop doing things that are not helpful if they don’t “have” to do it). We want our offices to feel a sense of ownership of the process, and we want them to have some flexibility in how they implement it into their own unique office culture.

This takes us to the third and longest phase of FCI: implementing strategies and monitoring progress. The office now has an identified population of youth whose outcomes need improving, they have a baseline from which they can measure progress, and they will have one or more hypotheses about the causes of the difference in outcomes. Now, they can begin testing their hypotheses on specific cases. The office is encouraged to set up a “cadence of accountability,”[iii] a set of regularly scheduled meetings (typically around 15-30 minutes) where they can talk about what has worked, what has not, and what they are going to try next. Offices are allowed flexibility in how they accomplish this aspect of the work. To help support our offices, we hold monthly and quarterly check-ins where we can provide some structure to documenting their progress.

Overall progress is monitored through a “scorecard” that shows an office progress on their lag measure. While there are some suggested ways offices can track lead measures, we encourage offices to set up methods that best fit their own office culture. During this phase of FCI the facilitator serves as a consultant to the office, providing support and coaching as needed.

In the final post, we will talk about how we summarize the lessons learned from an FCI session and how staff identify their next opportunity. We will talk about the summary report and ideas for how we hope this can grow into a body of knowledge for child welfare professionals. Direct service staff are constantly busy tending to many youth and families and managing administrative work. If FCI is implemented as an “add-on” initiative it will likely fail. FCI needs to be integrated into their existing work. It is about rigorously examining cases to find those cases that would benefit the most from some focused attention. It provides visibility to the most venerable cases and encourages staff to critically think through solutions.

 

References

[i] Callahan, S., Rixon, A., & Schenk, M. (2006, October 19). The Ultimate Guide to Anecdote Circles. Retrieved July 15, 2017, from http://www.anecdote.com/pdfs/papers/Ultimate_Guide_to_ACs_v1.0.pdf

[ii] Kurtz, C. F. (2014). Working with Stories in Your Community Or Organization: Participatory Narrative Inquiry (3rd ed.). (n.p.): Author.

[iii] McChesney, C., Covey, S., & Huling, J. (2016). The 4 disciplines of execution: achieving your wildly important goals. New York: Free Press.

 

For more information on FCI please contact Stephen Shimshock, Director of System, Data and Reporting at Casey Family Programs 206-216-4178 (sshimshock@casey.org)

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2 thoughts on “FCI: From Stories to Hypotheses Part 3/4

  1. This is such a great description of how to actually do outcomes management as a regular part of systems management. The “Cadence of Accountability” is especially essential — setting up an outcomes system that isn’t reviewed accomplishes little. It is necessary to set up a regular review process. This is very nicely laid out in this work.

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