Currently, the Federal Government and most State and local child welfare systems use a combination of quantitative and qualitative approaches in identifying what is working well and what needs attention. Of particular interest is the increasing use of QCR methods, which involve "real-time" assessments, including interviews and, in some applications, structured feedback with case team members, workers, and supervisors. This is the first report to examine how QCRs are used in the field, whether the current QCR approaches help systems improve outcomes, and how the process can be improved. The report presents lessons derived from interviews with child-welfare managers in multiple jurisdictions, experts in the field, and a review of various source materials. It also draws on the study team's experience in implementing and conducting QSR in a variety of jurisdictions. The lessons learned pertain to core elements of an effective QCR process, key implementation factors, and an action agenda. The QCR methods studied include the two most frequently used QCR tools in child welfare systems. One tool is the Quality Service Review (QSR), which was initially developed for State mental health quality assurance systems in the early 1990s. The second tool is the Child and Family Service Reviews (CFSRs), a Federal monitoring tool first used in 2000. In addition, this study included observations of ChildStat, an emerging approach to child welfare quality improvement. Participants and experts agreed that maintaining a robust QCR process that adds value to child welfare systems requires a considerable investment in organizational capacity, whether the chosen approach is a QSR or a CFSR. 3 tables and appended project approach and methodology, survey themes, and data-collection protocols