Child Start operates Head Start and Early Head Start programs across two counties in Northern California, serving about 1,000 children per year. They joined the very first cohort of the QI Network in early 2020 and have since applied the principles of continuous quality improvement (CQI) to several challenges in their programs.

Child Start’s Executive Director Juan Cisneros has worked in Head Start programs for 25 years, first in Florida for five years, then at Child Start for the past 20 years. Deputy Director Susan Smith has worked in the early care and education field for over 30 years, with the last 21 years at Child Start.

EarlyIntel sat down with Cisneros and Smith over Zoom to find out how they’re using Head Start CQI to break down silos among staff and better serve their communities. The following conversation has been lightly edited for clarity and brevity.

What prompted you to join the QI Network?

Juan Cisneros: I think like many Head Start programs, there’s always that need to look at how we can promote continuous quality improvement. We do a lot around monitoring and self-evaluation, but it’s really about how we take it a step further, how we utilize data in an anticipatory way to support planning but also to correct any issues we may see that need immediate attention.

We’ve been looking for a way to really create a system around it, to make it a formal process. And so when we learned about the QI Network and what it was proposing to do, we found that that was a natural fit of where our needs lay around doing that higher level work.

Have you had your Head Start federal review during the time you’ve been in the QI Network?

Juan Cisneros: This past year, we had our Focus Area 2 and the year before that we had Focus Area 1, and we did great in both. I really think that we can attribute some of that to this work that we were doing with the QI Network because we strengthened our monitoring systems. CQI is now incorporated into our monitoring system. We developed new procedures around that. We have lots of different tools to support us through that. I just feel like overall it’s helped us create a more robust, more comprehensive monitoring system.

Susan Smith: Due to COVID, we were able to expand so we were actually able to bring on the majority of our managers, and I think that prompted us to really think about how data works. It gave managers an opportunity to really articulate how data is utilized within their service areas, and that helped in the conversations when we were preparing for FA1 and FA2.

Anything else that you like about your work with the QI Network?

Juan Cisneros: Yes, it links closely to our design and planning process for subsequent program years. One of our CQI projects initially was to really gauge how we could bring more safety to a particular site because there were some really big issues. Ultimately, the process led us to make a decision that helped us understand what our presence in that community needed to be.

If we weren’t able to stay at that site, what could we do to maintain a presence in that particular community? It helped us think through a data collection process, a mini community needs assessment, and the empathy interviews to really understand where parents and our staff were at with continuing to maintain presence there. That community was just experiencing a lot of violence that we really had no control over. It helped us gather the data we needed to make a really important decision ultimately to leave that center but to maintain some level of presence in that community.

Susan Smith: The QI Network has really supported us in learning and utilizing different tools to collect data, like empathy, empathic interviewing, and process mapping. And then actually put them into practice. Especially that first year when we were working with our coaches, we really were able to hone in on some of those processes. We’ve been able to incorporate some of those processes into our everyday work as well as being able to project and look forward to some of our bigger projects.

The other piece that we’re still exploring is really looking at the Power BI [a Microsoft app that enables data visualization] and using data in that format. We see the potential there, especially being able to see where our data is comparatively to others in the Network. That piece of information has really given us some things to think about. I’m hoping that through this year, we’re able to really look at what we can do with the Power BI and how we can utilize that tool more effectively for our program.

Juan Cisneros: It’s interesting to see how some members of the CQI team really really take these tools seriously. It’s a great resource for them, like the PDSA cycles, aim statements, and Fishbone diagrams. These are core to their approach now moving forward. I think that is because of the coaching we received the first year or year and a half where we were exposed to these tools and we were coached along the way on how to use them.

In addition to safety, what other areas are you using Head Start CQI to work on?

Juan Cisneros: Enrollment has been number one. The other big thing is staff retention. Those two have actually become strategic initiatives for the entire organization. A third initiative right now that the team is using some CQI tools to work through is becoming a trauma and resilience informed organization.

Any promising practices or improvements that you can share?

Juan Cisneros: I like the process for collecting ethnographic data through empathy interviews, because we’re also trained in Design Thinking Strategies at Stanford and that’s that’s big in that process. For me, understanding what the real needs and interests are of the end user so whether it’s our families or our staff, it gives us more important information on how to design for them in mind. It’s user-centered design. That’s really the approach now that a lot of us are taking. It’s stopping before we come up with our own solutions to hear from those who are impacted by the systems or services we offer.

Susan Smith: For me, one of the promising practices is the use of tools like Power BI. The introduction of that data source to us through the Network has been very helpful.

How has being part of the QI Network impacted the way your team works together?

Juan Cisneros: CQI has been ingrained in part of the culture amongst management for sure, how to approach challenges, how to use relevant tools based on the situation. Managers that have participated in CQI have a better understanding of how to look into a challenge or situation. We’re good at identifying trends and monitoring. What we didn’t do as well is taking the next step and putting forth some type of design challenge or test to see that through. CQI has helped our managers do that.

Susan Smith: For me, two things came out. One is moving quickly. I think back to a lot of the coaching that we received was that we need to take action, we need to do something. We like to dive in really deep and not act and I think some of the work that we did with our coaches really have made us think about how we can’t just research it and perfect it. It’s looking at that PDSA cycle and really seeing that process through rather than getting stuck in the planning process.

I think the other thing that this the CQI process had us do was really look at this not in isolation. Creating our team and having our whole team go through it, we chose to have a really wide cross section of managers participate. It wasn’t just like our education staff. We all worked towards a similar project when we were looking at enrollment or we were looking at staffing and so everyone had a different perspective.

That really led us to being able to start breaking down the silos and really working towards being able to have all the different voices at the table. I think that the happy coincidence of being able to go virtually with the QI Network allowed us that. At first we had a very small team that was going to participate. But we were able to bring on other people that gave different perspectives which I thought was really important for us.

What surprised you most about Head Start CQI and what have you learned from this process?

Juan Cisneros: The approach overall is very supportive from coaching to the monthly training to access to Power BI. If you’re taking advantage of the full package, it really is a robust approach. What I like is that we’re given the option of how we want to participate, and so we can make it our own experience. If we can’t participate live for whatever training, we’re part of this platform that allows us access to recordings of the training, so we can always make it up at a later time.

Susan Smith: We’ve restructured quite a bit in our agency and having those resources on the website really allowed us to bring on some new individuals into our team. When they were asking “tell me more about process mapping,” I was able to go in and find clips of some of the trainings and some resources. It’s been a really good help to have all those resources in one area.

More recently, this movement with the training opportunities of how to utilize the data to present to our board or to others has been really helpful as well as showing where we are with trends in the rest of our Head Start world.