The mystery of the insufficient casenotes.

We started Quality Assurance visits last week.  Quality Assurance reviews allow us, in the TOC/OWA administrative office, to give feedback to the service providers about fiscal and programmatic tracking and reporting.  It is, in short, much like an audit but with a friendlier sounding title. 

There are two principal components to a Quality Assurance review: Fiscal review and Program review. The difference between program and fiscal is fairly significant, although they are related and there is a lot of cross-over.  In extremely simplistic terms, the Fiscal part of the Quality Assurance review focuses on the money and how it is tracked and reconciled.  The Program part of the review focuses on the participants and the services and activities they receive, both individually and as a group.  Cross-over occurs because the money, of course, is spent on the participants.

So, for example, during the Quality Assurance review, we talk to the service provider about actual spending versus planned spending and actual numbers of participants versus planned numbers.  We look at a sample of fiscal transactions to make sure the service provider is following appropriate procedures to make sure everything is tracked properly and that transactions reconcile.  As you may be able to tell from that last sentence, I focus on program and not fiscal.  In the program review, we look at a sample of individual files and try to make sure appropriate procedures were followed and that activities and outcomes are properly tracked and explained.  That last bit seems to be the most challenging aspect for everyone involved.

All last week I was out in the field with Jeff and Melissa visiting with a few different regions.  The regions visited are incidental to this discussion, since the "casenote" issue is more universal than just to the specific regions we visited.

Casenotes allow the observer (the auditor, the Quality Assurance reviewer, the DOL, or even another employment councelor that might take over another councelor’s participant load) to follow a participant’s "story."  Good casenotes allow anyone to sit down, look at the file and quickly and easily understand why the participant needs assistance, what kind of assistance, if the participant is actually eligible to receive WIA services, what WIA services are and will be provided and, importantly, why.  Any occasion where money, time and/or energy are expended on a participant a casenote should document in what way and why. 

This is not new.  Explanatory casenotes have been required for years and years.  Any field in which services are provided require casenotes – even if just to remind the provider what happened last time contact with the participant occurred.  Casenotes are going to vary in quality, based, at least in part, on the amount of time the writer has to devote to the casenote, their writing ability and the specific points which they think are salient (which may differ between different councelors as well as with the auditors). 

But, I repeat, casenotes have been required for years.  Not only that, but there is fairly explicit guidance offered by TOC/OWA regarding what needs to be documented in casenotes (on the website here under "Case notes and Caseload").  We even offer templates which would allow a councelor to paste in the participant specific information to insure all the necessary elements are addressed.  Yet, and here is the mystery, casenotes are insufficient at explaining the "story" a lot of the time.  Not all of the time, thank goodness, but plenty of the time.

If you are an employment councelor, these are some of the elements you may wish to consider as you write casenotes (although I recommend following the casenote section of the WSO guide).

• Is the participant eligible?  How do I know this?  (Write out your responses in the casenotes.)
• What is the goal for the participant?  What are the steps to get to this goal?  What kinds of services might help the participant achieve this goal?
• What kind of assistance does the participant need?  Why?  Can we provide the assistance?  How?  If not, why?  Can another agency?
• If I am using WIA funds to pay for something for the participant, how much am I going to spend?  What am I spending it on?  To whom?  How does it help the participant get closer to achieving goals?  If I were an outside viewer, would I think the expense is justifiable?  Why?
• What has the participant achieved?  Is there more that WIA can or needs to offer?

See, it’s just explaining what the employment councelor and the participant are doing and why.  I suppose I don’t actually care if the mystery as to why casenotes are insufficient is answered.  I would be delighted if the point were made moot (through good casenoting).

I’m pretty sure, though, that this blog isn’t going to resolve the matter and that it will continue to be an ongoing discussion.

- Monty

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