Building Better Systems: Barriers, Engagement, and Perceived Impact of QRIS Quality Improvement Services in Texas

• In Event: QRIS Under Review: Cross-State Lessons for a More Effective System

Abstract

Introduction
Quality improvement (QI) services are critical for building quality in supply and easing transitions for providers (Cannon et al., 2017). In Texas, there is variability in QI service delivery, likely due to the decentralized structure of QRIS administration, limited evidence of how QI approaches support QRIS content areas, and varying community, program, and workforce needs. Our research questions include:

Research Questions
How does variability in QI delivery relate to participation, engagement, and satisfaction? What are the barriers and needed support to improve participation and engagement in QI? How do programs and staff report improvements in relation to QI activities?  

Methods
We followed a Design, Delivery, Receipt, and Response framework based on intervention mapping approaches used by implementation scientists (e.g., Fernandez et al, 2019). We used secondary data analysis, surveys, and focus groups with participants (centers and child care homes) across Texas. Data sources include: (a) online QRIS data applications (assessment-based ratings) and action plans and (b) workforce registry data (e.g., demographics). Action plans (n = 503) were coded to determine quality ratings. Mentor-, director-, and teacher-level surveys included constructs related to QI services (e.g., participation/engagement, satisfaction). Focus groups with QRIS administrators, mentors, and directors covered topics around provider experiences, incentives/rewards, and implementation of Texas QRIS.  

Analytic Techniques. We examined descriptive statistics and frequency distributions for survey responses and used non-parametric tests to examine implementation variability based on star rating and facility type.  

Results
Directors (n = 562) and teachers (n = 211) showed moderate levels of participation and engagement in QI services (e.g., aware of goals/action steps, less frequent mentor meetings). Focus groups indicated mixed satisfaction levels with QI services (e.g., felt positively about mentor, but not amount of contact). Benefits of QI services included director-mentor collaboration and training opportunities for staff.  80% of directors (n = 390-561) perceived QI services to improve program- and classroom-level quality overall. Lower rated programs perceived fewer benefits in certain categories (e.g., teacher-child interactions) compared to higher rated programs (Kruskal-Wallis Test, chi-square = 10.75, p < .05).

Conclusions/Implications
Our study examines specific program components needed to execute high quality QI within QRIS contexts, using generalizable frameworks that can work across states. We focus on QI ingredients specification, fidelity monitoring, and evaluation so other systems create highly specified, well-monitored interventions. An applied set of recommendations for states leveraging QI approaches within QRIS will be shared, including the need for better supporting lower-star-rated programs and family child care providers and using alternate ways to measure program quality (e.g., QI engagement). Study recommendations include ways to better specify QI models so states can install robust performance management to improve quality of practices and effectively coordinate resources to maximize outcomes (The Build Initiative & Child Trends, 2024). Building capacity for applying fidelity monitoring frameworks can also help QRIS administrators specify QI program designs to monitor and mature implementation.

Author

• Cheryl Varghese, University of Texas Health Science Center at Houston
  Presenting Author