Improving Child Well-Being Through Continuous Quality Improvement

victor flangoVictor E. Flango, Executive Director, Program Resource Development, National Center for State Courts

Summary: The author explains the continuous-quality approach and how it allows states to evaluate intervention efforts of courts and agencies and improve services based upon outcomes.


The Fostering Connections to Success and Increasing Adoptions Act of 2008[1] makes it clear that courts, treatment providers and educators share with child welfare agencies responsibility for improving the lives of maltreated children, although they each play very different roles. When intervention is necessary, success is most likely when all involved coordinate their efforts on behalf of children and families.

A continuous-quality approach allows states to determine the impact they are having on children and families. It uses assessment, feedback, and information to improve services proactively, by continuously evaluating processes and outcomes.[2] After a shared vision is agreed upon, and safety, permanency and well-being of children are defined operationally, the next step is to determine the impact on the lives of children. We do this by using outcome measures to establish a baseline from which to measure the success of improvement efforts, as well as to identify areas where improvements are necessary. In the absence of measurement, perceptions about collective impact may be based on anecdotes and personal accounts, and thus may not present an accurate picture of the work of courts handling dependency cases.

In January 2009, the National Resource Center on Legal and Judicial Issues, composed of the ABA Center on Children and the Law, the National Center for State Courts (NCSC) and the National Council of Juvenile and Family Court Judges, released Toolkit for Court Performance Measurement in Child Abuse and Neglect Cases[3], which proposed 30 court measures in the areas of safety, permanency, due process and timeliness.

At that time it was deemed premature to address well-being measures as well. Well-being refers to a child’s current and future welfare, including physical and mental health needs, as well as educational needs. Given that courts have the responsibility to ensure that the state is providing proper care to children in its custody, courts need to consider whether these children are receiving a quality education and are physically and emotionally healthy. In October of 2010, NCSC, in partnership with Casey Family Programs, began work on educational well-being outcome measures.

The focus group on educational well-being comprised distinguished representatives from child welfare agencies, educational and research institutions, the advocacy community and the courts.[4] Its mission was (1) to identify education performance measures and the data elements needed to produce the measures, and (2) identify strategies to overcome obstacles to sharing data among courts, child welfare agencies and schools.

The group produced a proposed set of key education performance measures designed to improve the educational outcomes for children involved in the foster care system. These measures have been released, and several states and local jurisdictions are in the process of field testing the measures.[5]

The following year, under the auspices of the National Resource Center on Legal and Judicial Issues, the National Center for State Courts convened a focus group to address measures of physical and emotional well-being. The group considered performance measures in the areas of physical health, mental health, maintenance of permanent relationships, transition to adulthood, and enhanced family capacity. The focus group’s members are all distinguished experts from child welfare agencies, the courts and research institutions.[6] A total of 18 suggested measures were recommended for consideration, with 5 listed as key measures.

The work of both focus groups provided an excellent foundation for the mission of developing court-related well-being outcome measures for children in foster care. The next step in this project has been to vet these measures to before a larger audience.[7] Other experts and stakeholders are reviewing and evaluating the measures for practicality and usefulness. They are also providing recommendations on how best to improve collaboration and facilitate the exchange of data required to produce the measures. Currently, the well-being measures are being pilot tested to determine how well they work in practice and what obstacles arise when a way to measure well-being is instituted. The interest and positive feedback that this work on court-related well-being measures has received from the court community has been very encouraging.

All of the efforts to create and test valid performance measures will be for naught if these measures are not used to change practice, evaluate the effectiveness of the changed practices, and then perhaps make more changes. That is the philosophy behind continuous quality improvement.

Author biography:

Victor Eugene Flango is the executive director of Program Resource Development at the National Center for State Courts. In this position, he generates support for National Center research, education and technical assistance projects. Before assuming this position in 2005, Flango was the vice president of the National Center’s Research and Technology Division for 10 years. He is the author of more than 100 publications, including seven monographs, 17 articles, and one website dealing with child welfare issues. Flango has delivered more than 100 presentations and served on many national, regional, state and local panels for professional and academic audiences.

[1] Fostering Connections to Success and Increasing Adoptions Act of 2008, Pub. L. No. 110-351, 122 Stat. 3949 (2008).

[2] Bickman, L. & Nosser, K. , “Meeting the Challenges in the Delivery of Child and Adolescent Mental Health2 Services in the Next Millennium: The Continuous Quality Improvement Approach,” 8 Applied and Preventive Psychology 247-255.

[3] Available at 

[4] Focus Group members were Ms. Kate Burdick, Zubrow Fellow, Juvenile Law Center; Dr. Gretchen Cusick, Chapin Hall; Hon. Robert R. Hofmann, Associate Judge, Child Protection Court of the Hill Country, Mason County, Texas; Michelle L. Lustig, MSW, Ed.D., Coordinator, San Diego County Office of Education; Ms. Kathleen McNaught, Assistant Director, ABA Center on Children and the Law; Mr. Ronald M. Ozga, Governor's Office of Information Technology, Colorado Department of Human Services; Ms. Regina Schaefer, Director, Education Unit, New York City Children’s Service. Their invaluable contribution to this effort is gratefully acknowledged.

[5] The education measures can be found in Nora E. Sydow & Victor E. Flango, Educational Well-Being: Court Outcome Measures for Children in Foster Care, 50 Family Court Review, 455-466 (2012). See also, Victor E. Flango & Nora Sydow, Educational Well-Being: Court Outcome Measures for Children in Foster Care. Future Trends in State Courts. (National Center for State Courts, 2010), available a

[6] Focus Group members are Ms. Sarah Fox, CIP Training Specialist, New Hampshire Court Improvement Project; Ms. Sandi Metcalf, Director of Juvenile Services, 20th Judicial Circuit Court, Grand Haven, Michigan; Hon. Robert R. Hofmann, Associate Judge, Child Protection Court of the Hill Country, Mason County, Texas; Ms. Sandra Moore, Administrator, Office of Children and Families in the Court, Pennsylvania; Mr. Ronald M. Ozga, Governor’s Office of Information Technology, Colorado Dept. of Human Services; Ms. Sonya Tafoya, Senior Research Analyst, AOC Center for Families, Children and the Courts, California. Staff representatives to the project include Dr. Victor Eugene Flango, National Center for State Courts; Ms. Lisa Portune, Consultant; Ms. Nora Sydow, National Center for State Courts; Ms. Deborah Saunders, National Center for State Courts; Mr. Scott Trowbridge, ABA Center on Children and the Law; and Dr. Alicia Summers, National Council of Juvenile and Family Court Judges. Their invaluable contribution to the project is gratefully acknowledged. The authors would also like to acknowledge the contribution of Ms. Eva Klain, ABA Center on Children and the Law, for her invaluable review of this manuscript.

[7] The National Resource Center on Legal and Judicial Issues hosted a live video webcast on May 17, 2012 that included a panel of experts discussing these new measures. An archive of the webcast can be viewed here.

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