Free Order - District Court of Connecticut - Connecticut

Case 2:89-cv-00859-AHN

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Juan F. v. Rell Exit Plan Quarterly Report January 1, 2008 - March 31, 2008 Civil Action No. H-89-859 (AHN) June 16, 2008

Submitted by: DCF Court Monitor's Office 300 Church St~4th Floor Wallingford, Ct 06492 Tel: 203-741-0458 Fax: 203-741-0462 E-Mail: [email protected]

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Table of Contents Juan F. v Rell Exit Plan Quarterly Report January 1, 2008 - March 31, 2008 Section Highlights Juan F. Exit Plan Outcome Measure Overview Chart (January 1, 2008 through March 31, 2008) Outcome Measure 3 & 15 Report (First Quarter 2008) Appendix 1 ­ Rank Scores for Outcome Measure 3 and Outcome Measure 15 ­First Quarter 2008 Juan F. Action Plan Appendix 2 ­ The Department of Children and Families Exit Plan Outcome Measures Summary Report: First Quarter Report (January 1, 2008 ­ March 31, 2008) Page 3 6

7 34

47 69

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Juan F. v Rell Exit Plan Quarterly Report January 1, 2008 - March 31, 2008 · Highlights The Monitor's quarterly review of the Department's efforts in meeting the Exit Plan Outcome Measures during the period of January 1, 2008 through March 31, 2008 indicates that the Department has achieved 16 of the 22 outcome measures. On May 5, 2008, the plaintiffs in the Juan F. case forwarded notification and assertion of non-compliance with two provisions of the Revised Exit Plan of July 1, 2004 (as modified July 11, 2006). Outcome Measure 3 (Treatment Plans) and Outcome Measure 15 (Meeting Children's Needs) were the cited provisions for non-compliance. A Status Conference was convened by Judge Alan H. Nevas on May 21, 2008 and was attended by the Court Monitor and the Juan F. parties. The Court Monitor has set dates for the parties to meet and attempt to negotiate an agreement to remedy the issues cited above. · The Department's performance on Outcome Measure 19 (Residential Reduction) was the best recorded percentage since implementation of the Exit Plan (10.5%). The percentage represents 585 children who are placed in residential facilities. However, while the overall number of children in residential settings has been reduced considerably, the children residing out-of-state are increasing each month as seen in a comparison of the May 2007 rate of 244 children in out-of-state placements versus the May 2008 rate of 294 children in out-of-state placements. The percentage of cases having a Multi-Disciplinary Evaluation (MDE) conducted in a timely manner was 98.7%. This is the highest recorded percentage to date and stands in contrast to the performance four years ago of less than 20% receiving this assessment. Based on the Monitor's review of a 51 case sample (see Monitor's Office Case Review for Outcome Measure 3 and Outcome Measure 15) the Department of Children and Families attained the level of "Appropriate Treatment Plan" in 30 of the 51-case sample or 58.8% and attained the designation of "Needs Met" in 30 of the 51 case sample or 58.8%. The treatment plan findings are an improvement over the Fourth Quarter result of 51.0%. Initiatives undertaken by individual offices appear to be making some incremental improvements in performance on this measure. The specificity and sufficiency of time limited action steps and goals continue to need improvement. Provider input, family engagement, and participation rate by active case participants are still problem areas that require attention. The Court Monitor provides feedback to the Area Offices throughout each quarter. This allows an opportunity for individual Area Offices to better understand specific findings, undertake opportunities for improvement and discuss case specific concerns with Court Monitor.

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The "Needs Met" findings are an improvement over the Fourth Quarter 2007 result of 47.1%. The lack of appropriate foster homes and wait-lists for community-based services, continue to exacerbate system gridlock problems. Discharge delays at emergency departments, group homes, residential treatment facilities, SAFE Homes, STAR programs and other treatment/placement programs continue to occur throughout the system. Many discharge delays are the result of the need for additional therapeutic foster care resources. Specialized treatment for sexually reactive children, pervasive developmentally delayed or mentally retarded (DD/MR) children, and children with assaultive behavior are not readily available. These groups of children are primarily being served by out-of-state providers. Efforts to reframe treatment models by in-state providers are desperately needed to allow children to receive treatment closer to home and with greater family participation. · During the past quarter, the Department has implemented a qualitative review process that is similar to the Federal Child and Family Service Review process (CSFR). These pilot reviews, referred to as "Connecticut Comprehensive Outcomes Reviews" (CCOR) have been conducted in the Bridgeport and Manchester Offices. Additional reviews will occur in the Norwich and New Britain Offices in late June. This integrated review process has tremendous potential to develop into a foundational component of the child welfare quality improvement work. Staff from the Monitor's Office continue to take part in this agencydriven and managed effort. The Monitor's quarterly review of the Department for the period of January 1, 2008 through March 31, 2008 indicates the Department has achieved compliance with the following 16 Outcome Measures: · Commencement of Investigations (97.8%) · Completion of Investigations (91.5%) · Search for Relatives (95.3%) · Repeat Maltreatment (5.7%) · Maltreatment of Children in Out-of-Home Care (0.2%) · Adoption (41.5%) · Transfer of Guardianship (70.4%) · Multiple Placements (91.2%) · Foster Parent Training (100.0%) · Placement within Licensed Capacity (96.4%) · Worker-Child Visitation Out-of-Home Cases (95.9% Monthly/99.1% Quarterly) · Worker-Child Visitation In-Home Cases (90.8%) · Caseload Standards (100.0%) · Residential Reduction (10.5%) · Discharge Measures (92%) · Multi-disciplinary Exams (98.7%)

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The Department has maintained compliance for at least four (4) consecutive quarters1 with each of the 16 of the Outcome Measures reported achieved this quarter. (Measures are shown with designation of the number of consecutive quarters for which the measure was achieved): · Commencement of Investigations (fourteenth consecutive quarter) · Completion of Investigations (fourteenth consecutive quarter) · Search for Relatives (tenth consecutive quarter) · Repeat Maltreatment (fourth consecutive quarter) · Maltreatment of Children in Out-of-Home Care (seventeenth consecutive quarter) · Adoption (sixth consecutive quarter) · Transfer of Guardianship (seventh consecutive quarter) · Multiple Placements (sixteenth consecutive quarter) · Foster Parent Training (sixteenth consecutive quarter) · Placement within Licensed Capacity (seventh consecutive quarter) · Visitation Out-of-Home (tenth consecutive quarter) · Visitation In-Home (tenth consecutive quarter) · Caseload Standards (fifteenth consecutive quarter) · Residential Reduction (eighth consecutive quarter) · Discharge Measures (eleventh consecutive quarter) · Multi-disciplinary Exams (ninth consecutive quarter) The Monitor's quarterly review of the Department for the period of January 1, 2008 through March 31, 2008 indicates that the Department did not achieve compliance with six (6) measures: · Treatment Plans (58.8%) · Reunification (56.5%) · Sibling Placements (86.7%) · Re-Entry (11.0%) · Children's Needs Met (58.8%) · Discharge to DMHAS and DMR (97%)

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The Defendants must be in compliance with all of the outcome measures, and in sustained compliance with all of the outcome measures for at least two consecutive quarters (six-months) prior to asserting compliance and shall maintain compliance through any decision to terminate jurisdiction.

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Juan F. Exit Plan Report Outcome Measure Overview 1Q 2008 (January 1 - March 31, 2008)
Measure Measure 1Q 2004 2Q 2004 3Q 2004 4Q 2004 1Q 2005 2Q 2005 3Q 2005 4Q 2005 1Q 2006 2Q 2006 3Q 2006 4Q 2006 1Q 2007 2Q 2007 3Q 2007 4Q 2007 1Q 2008

1: Investigation >=90% Commencement 2: Investigation Completion 3: Treatment Plans** 4: Search for Relatives* 5: Repeat Maltreatment 6: Maltreatment OOH Care 7: Reunification* 8: Adoption 9: Transfer of Guardianship 10: Sibling Placement* 11: Re-Entry 12: Multiple Placements 13: Foster Parent Training 14: Placement Within Licensed Capacity 15: Needs Met** 16: Worker-Child Visitation (OOH)* 17: Worker-Child Visitation (IH)* 18: Caseload Standards+ 19: Residential Reduction 20: Discharge Measures 21: Discharge to DMHAS and DMR 22: MDE

X

X

X

91.2% 92.5% 95.1% 96.2% 96.1% 96.2% 96.4% 98.7% 95.5% 96.5% 97.1% 97.0% 97.4% 97.8%

>=85% 64.2% 68.8% 83.5% 91.7% 92.6% 92.3% 93.1% 94.2% 94.2% 93.1% 94.2% 93.7% 93.0% 93.7% 94.2% 92.9% 91.5% >=90% >=85% <=7% <=2% >=60% X X X X 10% 93% 17% X X X X X X 54% 41.1% 41.3% 30.3% 30% 51% 58.8%

82% 44.6% 49.2% 65.1% 89.6% 89.9% 93.9% 93.1% 91.4% 92% 93.8% 91.4% 93.6% 95.3%

9.4% 8.9% 9.4% 8.9% 8.2% 8.5% 9.1% 7.4% 6.3% 7.0% 7.9% 7.9% 7.4% 6.3% 6.1% 5.4% 5.7% 0.5% 0.8% 0.9% 0.6% 0.8% 0.7% 0.8% 0.6% 0.4% 0.7% 0.7% 0.2% 0.2% 0.0% 0.3% 0.2% 0.2% X X X X X X 64.2% 61% 66.4% 64.4% 62.5% 61.3% 70.5% 67.9% 65.5% 58.0% 56.5%

>=32% 10.7% 11.1% 29.6% 16.7% 33% 25.2% 34.4% 30.7% 40.0% 36.9% 27% 33.6% 34.5% 40.6% 36.2% 35.5% 41.5% >=70% 62.8% 52.4% 64.6% 63.3% 64.0% 72.8% 64.3% 72.4% 60.7% 63.1% 70.2% 76.4% 78% 88.0% 76.8% 80.8% 70.4% >=95% <=7% >=85% 100% 65% X X X 53% X X X X X X X X X 96% 94% 75% 77% 83% 85.5% 84.9% 79.1% 83.3% 85.2% 86.7%

7.2% 7.6% 6.7% 7.5% 4.3% 8.2% 7.5% 8.5% 9.0% 7.8% 11.0%

95.8% 95.2% 95.5% 96.2% 95.7% 95.8% 96% 96.2% 96.6% 95.6% 95% 96.3% 96.0% 94.4% 92.7% 91.2% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

>=96% 88.3% 92% >=80% >=85% 100% >=85% 53% 72% 87% 39% 57% 86% 98% 40%

93% 95.7% 97% 95.9% 94.8% 96.2% 95.2% 94.5% 96.7% 96.4% 96.8% 97.1% 96.9% 96.8% 96.4% 53% 73% 93% 46% 56% X X X X X X 62% 52.1% 45.3% 51.3% 64% 47.1% 58.8%

81% 77.9% 86.7% 83.3% 85.6% 86.8% 86.5% 92.5% 94.7% 95.1% 94.6% 94.8% 94.6% 95.9% 91% 93.3% 95.7% 92.8% 93.1% 93.1% 90.9% 91.5% 99.0% 99.1% 98.7% 98.7% 98.5% 99.1% 33% 71.2% 81.9% 78.3% 85.6% 86.2% 87.6% 85.7% 89.2% 89% 90.9% 89.4% 89.9% 90.8%

100% 73.1% 100% 100% 100% 100% 100% 99.8% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% <=11% 13.9% 14.3% 14.7% 13.9% 13.7% 12.6% 11.8% 11.6% 11.3% 10.8% 10.9% 11% 10.9% 11% 10.8% 10.9% 10.5% >=85% 100% >=85% 74% 43% 52% 64% 93% 56% 83% 60% X X X X 95% 78% 92% 70% 85% 95% 91% 100% 100% 98% 100% 95% 97% 100% 97% 90% 83% 95% 96% 96% 92% 97%

19% 24.5% 48.9% 44.7% 55.4% 52.1% 58.1% 72.1% 91.1% 89.9% 86% 94.2% 91.1% 96.8% 95.2% 96.4% 98.7%

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Monitor's Office Case Review for Outcome Measure 3 and Outcome Measure 15 Background and Methodology: The Juan F. v Rell Revised Exit Plan and subsequent stipulated agreement reached by the parties and court ordered on July 11, 2006 requires the Monitor's Office to conduct a series of quarterly case reviews to monitor Outcome Measure 3 (Treatment Planning) and Outcome Measure 15 (Needs Met). The implementation of this review began with a pilot sample of 35 cases during the third quarter 2006. During the First Quarter 2008, the Monitor's Office reviewed a total of 51 cases. This quarter's 51-case sample was stratified based upon the distribution of area office caseload on December 1, 2007. Data was extracted for record review from January 1, 2008 through April 10, 2008. The sample incorporates both in-home and out-of-home cases based on the caseload percentages reflected on the date that the sample was determined. Table 1: First Quarter 2008 Sample Required (Based on December 1, 2007 Ongoing Services Caseload)
Area Office Bridgeport Danbury Greater New Haven Hartford Manchester Meriden Middletown New Britain New Haven Metro Norwalk Norwich Stamford Torrington Waterbury Willimantic Statewide Total Caseload 1,048 325 902 1,839 1,246 595 425 1,491 1,465 240 1,099 273 458 1,233 779 13,418 % of AO Cases Identified as In-Home 0.32 0.17 0.27 0.19 0.29 0.35 0.29 0.38 0.32 0.45 0.36 0.37 0.09 0.19 0.30 0.29 In-Home Sample 1 1 1 1 1 1 1 2 2 1 1 1 1 1 1 17 CIP Sample 3 1 2 5 4 1 1 3 3 1 3 1 1 3 2 34 Total Sample 4 2 3 6 5 2 2 5 5 2 4 2 2 4 3 51

This quarter, the methodology individually assigned one DCF staff or Monitor's Review staff to review each case. Within the course of review, each case was subjected to the following methodology. 1. A review of the Case LINK Record documentation for each sample case concentrating on the most recent six months. This includes narratives, treatment planning documentation, investigation protocols, and the provider narratives for any foster care provider during the last six-month period.

Case 2:89-cv-00859-AHN
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2. Attendance/Observation at the Treatment Planning Conference (TPC)/Administrative Case Review (ACR) or Family Conference (FC)2. 3. A subsequent review of the final approved plan conducted fourteen to twenty days following the date identified within the TPC/ACR/FC schedule from which the sample was drawn. The reviewer completed an individual assessment of the treatment plan and needs met outcome measures and filled out the scoring forms for each measure. As referenced in prior reviews, although the criterion for scoring requires consistency in definition and process to ensure validity, no two treatment plans will look alike. Each case has unique circumstances that must be factored into the decision making process. Each reviewer has been provided with direction to evaluate the facts of the case in relationship to the standards and considerations and have a solid basis for justifying the scoring. In situations where a reviewer had difficulty assigning a score, the supervisor would become a sounding board for determining vote in the final designation of scoring. Reviewers could present their opinions and findings to the supervisor to assist them in the overall determination of compliance for OM3 and OM15. If a reviewer indicated that there were areas that did not attain the "very good" or "optimal" level, yet has valid argument for the overall score to be "an appropriate treatment plan" or "needs met" he or she would clearly outline the reasoning for such a determination and submit this for review by the Court Monitor for approval of an override exception. These cases are also available to the Technical Advisory Committee (TAC) for review. During the first quarter, there were nine such cases submitted for consideration/ assistance of supervisory oversight. Included in these cases, were five case requests for override on Outcome Measure 3 and four case requests for override on Outcome Measure 15. All requests were reviewed and seven of the nine received were granted. Examples of rationale for overrides included such items as: · A dental well-care appointment was identified as a service need not provided within six months, but area office had already scheduled the appointment to take place shortly after the ACR (the visit was confirmed). Given the short period of delay (several weeks beyond recommended semi-annual schedule) an override was granted. · DCF consistently provided MH services to parents in the hope of reunification. Providers reported barriers in relation to the parents' cognitive delays that impacted the ability to understand the rationale for treatment or make progress in application to real life situations. The parents were inconsistent in attending and treatment was ineffective. Multiple services were attempted with no success, as the parents were unable to complete the required treatment. Given the ongoing and concerted efforts to engage the parents to achieve completion of the service and given the appropriate case management in legal filings, collateral contacts and visitation, the Monitor deemed that overall DCF was appropriate in meeting the needs in this case. · The treatment plan had conflicting permanency goals cited in the data field vs. assessment text. Given the multiple revisions identified on the DCF-553 and the full set of corrections
Attendance at the family conference is included where possible. In many cases, while there is a treatment plan due, there is not a family conference scheduled during the quarter we are reviewing. To compensate for this, the monitoring of in-home cases includes hard copy documentation from any family conference held within the six month period leading up to the treatment plan due date.
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made within the narrative assessment section that clearly reflected the shared understanding achieved at the ACR, the Monitor determined that the failure to update the one data element did not result in confusion related to overall planning. The override was granted. Multiple legal action steps were discussed at the ACR but were not incorporated into the treatment plan. Upon further review, the Monitor established that all legal filing was done in the period of two weeks between ACR and SWS plan approval and therefore was actually not required going forward. The override was granted.

Sample Demographics The sample consisted of 51 cases distributed among the fifteen area offices. In all the work of 51 Social Workers and 49 Social Work Supervisors was incorporated into the record review. Cases were most recently opened across the range of time from as long ago as July 24, 1997 to one most recently re-opened on December 21, 2007. At the point of review, the data indicates that the majority of cases (96.1%) were open for child protective service reasons. There were 60.8% cases that had at least one prior investigation within their history. Crosstabulation 1: Is there a history of prior investigations? * What is the type of case assignment noted in LINK?
Is there a history of prior investigations? Yes No Total CPS In-Home Family Case
11 6 17

CPS Child In Placement Case
17 15 32

Voluntary Services Child in Placement Case
0 2 2

Total
28 23 51

While 17 cases were in-home cases at the point of selection, there were 35 children that had been in placement during some portion of the six month period reviewed. Of that number, 57.1% were female and 42.9% were male. Ages ranged from one month to17 years and 9 months as of December 31, 2007. Legal status at the point of review was most frequently committed, with 47.1% of the cases identifying the child in placement with this legal status. Thirteen of the cases were inhome cases that had no legal involvement. An additional 11.8% of the cases designated children in placement as TPR status. The table below provides additional information related to legal status for both the In-Home and Child-in-Placement cases.

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Table 2: Legal Status
Legal Status Frequency Percent 24 47.1 Committed (Abused/Neglect/Uncared For) 13 25.5 N/A In-Home CPS case with no legal involvement 6 11.8 TPR/Statutory Parent 3 5.9 Not Committed 2 3.9 Protective Supervision 1 2.0 Order of Temporary Custody 1 2.0 Committed FWSN 1 2.0 DCF Custody - Voluntary Services 51 100.0 Total

In addition to the six children with TPR status, DCF had filed for TPR in an additional four cases. Of the 35 children in out-of-home placement at some point during the quarter, during the quarter, three or 8.6% had documented involvement with the juvenile justice system during the period. Racial and ethnic make-up of this sample population was most frequently identified as White and non-Hispanic. Crosstabulation 2: Race (Child or Family Case Named Individual) * Ethnicity (Child or Family Case3 Named Individual)
Race (Child or Family Case Named Individual) Black/African American White UTD Multiracial (more than one race selected) Total Ethnicity (Child or Family Case Named Individual) Hispanic 0 8 4 0 12 Non-Hispanic 11 24 0 2 37 Unknown 0 1 1 0 2 Total 11 33 5 2 51

In establishing the reason for the most recent case open date identified, reviewers were asked to identify all allegations or voluntary service needs identified at the point of most recent case opening. This was a multiple response question which allowed the reviewers to select more than one response as situations warranted. In total, 157 allegations or issues were identified at the time of report to the Hotline. The data indicates that physical neglect remains the most frequent identified reason for referral. Thirty-seven of the 51 cases had physical neglect included in the concerns identified upon most recent referral to the Hotline. In 33 cases (64.7%) physical neglect was substantiated. This was followed by issues related to Parental Substance Abuse/Mental Health, which was present in 49.0% of the cases reviewed, and Domestic Violence and Emotional Neglect alleged in 29.4% of the cases sampled and substantiated in 17.6% and 15.7% of the cases

Establishes the child's race in CIP cases, but the case named individual (primary parent/guardian) for those cases identified as in-home.

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respectively. The Hotline identified prior DCF involvement in 28 cases transmitted for investigation. Table 3: Reasons for DCF involvement at most recent case opening
Identified Issue/Concern Physical Neglect Parent's Mental Health or Substance Abuse Emotional Neglect Domestic Violence Physical Abuse Abandonment Medical Neglect Sexual Abuse Educational Neglect Emotional Abuse Voluntary Services Referral (VSR) Prior History of Investigations Child's Behaviors Child's Legal Status Became TPR prompting new case opening FWSN Referral Prior History of TPR for parent Total Number of Times Alleged/Identified 37 25 15 15 5 4 3 3 2 2 2 28 7 6 2 1 157 Number Substantiated 33 12 9 8 4 0 1 2 2 1 2 n/a n/a n/a n/a n/a

The reviewers were asked to identify the primary reason for DCF involvement on the date of most recent case opening. As in past quarter's findings, "Physical Neglect" and "Substance Abuse or Mental Health (parent)" remained the most frequently cited reason for involvement with the Department. Table 4: What is the primary reason cited for the most recent case opening?
What is the primary reason cited? Physical Neglect Substance Abuse/Mental Health (parent) TPR prompted new case Emotional Neglect Domestic Violence Physical Abuse Voluntary Services Request (VSR) for medical/mental health/ substance abuse/behavioral health of child (No CPS Issues) Educational Neglect FWSN Referral Medical Neglect Sexual Abuse Total Frequency 22 7 6 4 3 3 2 1 1 1 1 51 Percent 43.1 13.7 11.8 7.8 5.9 5.9 4.0 2.0 2.0 2.0 2.0 100.0

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Of the sample cases, 13.7% designated a "yes" response to the question, "Did the child have behavioral, medical, substance abuse or delinquent behaviors in conjunction with CPS concerns in the home?" In one case, the investigation assessment of the parent identified as alleged perpetrator, incorporated consideration of a prior instance of parental rights having been terminated for a sibling to the identified child. This is the first quarterly review in which the review process collected a large enough sample of cases subject to Structured Decision Making assessments. This relatively new practice of assessment and scoring cases has shown promise in other states that have implemented the protocol. Given the newness of the process, results should not be given great weight at this juncture and are for informational purposes only. SDM scores at investigation were documented for 21 of the cases reviewed.4 Of those completed, SDM overall risk scores were most frequently deemed moderate (47.6%) at the point of investigation. Five cases had risk scores in the high range (23.8%) and six were indicated as low risk (28.6%). In three cases, there was supervisory override of the scoring. At the point of investigation finalization, five situations were deemed "safe", an additional five were deemed "conditionally safe" and 10 were identified as "unsafe". In nine cases, there was a documented safety plan resulting from the safety assessment. In eight cases, there was evidence that services or interventions put into the home during the investigation mitigated safety factors in the home.

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In 30 of the cases, the case opening date pre-dated use of SDM.

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Crosstabulation 3: For cases with Investigations post May 1, 2007 what is the overall scored risk level * What is the safety decision documented prior to finalization of the investigation?
For cases with Investigations post May 1, 2007 what is the overall scored risk level upon Investigation Low Moderate High Total What was the safety decision documented prior to finalization of the investigation? Conditionally Safe Safe Unsafe Total 1 3 2 6 4 1 6 2 0 5 4 4 10 10 5 21

Of the 16 cases that were open at least 90 days from the initial SDM risk assessment, eight cases documented the required 90 day re-assessment. DCF approved permanency goals were identified for all 51 cases reviewed. DCF policy requires concurrent planning when reunification or APPLA are the designated goal. Of the ten situations in which "Reunification" was the permanency goal, there was a required concurrent plan documented in 9 cases (90.0%). The one plan without an approved concurrent plan identified "TPR if there are no viable family resources" as the concurrent plan. Of the six cases with the goal of APPLA, three (50.0%) identified a concurrent goal. In the three cases with no concurrent plan, there was appropriate consideration given to more permanent goals prior to the ACR including rationales and such tasks as referring to LLFT. In one case, the ACR identified a need to establish a more permanent plan for a child in a Department of Developmental Services (DDS) group home who was requesting a family setting. This was not done prior to the finalization of the plan document, but according to the LINK narrative documentation, has been done since that time by the newly assigned SWS. Table 5: What is the child or family's stated goal on the most recent approved treatment plan in place during the period?
Permanency Goal In-Home Goals - Safety/Well Being Issues Adoption Reunification APPLA Transfer of Guardianship LTFC with a Licensed Relative Total Frequency Percent 17 33.3% 12 23.5% 10 19.6% 6 11.8% 4 7.8% 2 3.9% 51 100.0%

Children in placement had various lengths of stay at the point of our review. This ranged from one month to fifteen years. The average length of stay is 854 days, but that is impacted by outliers at the upper range of the scale. To more accurately reflect the population, the median length of stay was calculated and is reported at 370 days. In looking at the length of stay in the current placement on January 1, 2008 there is a range from 14 days to 1498 days, with an average of 439 days with the same provider. To account for the outliers on the upper end of the scale, the median was calculated and is reported at 365 days.

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The following is a crosstab of cases by length of stay as it relates to TPR filing and in relation to the ASFA requirement to file or identify an exception by no later than 15 months into the out of home episode. In all cases in which the child's length of stay and permanency goal required the filing of TPR, it had been done or there was an exception filed and documented in LINK in accordance with ASFA timelines. A review of the seven exceptions found that six of the seven cases appeared to be reasonable given the circumstances at the point of identification and each of those six had been routinely revisited through discussions reflected in narratives and treatment planning documentation.5 Crosstabulation 4: Has child's length of stay exceeded the 15 of the last 22 benchmark set by ASFA? * For child in placement, has TPR been filed?
Has child's length of stay exceeded the 15 of the last 22 benchmark set by ASFA? yes Yes No N/A - In-Home Case (CPS or Voluntary Services) TPR has already been granted Total 1 3 0 For child in placement, has TPR been filed? N/A - child's goal N/A - In-Home Exception and length of Case (CPS or noted in time in care don't Voluntary no require Services) LINK 0 7 1 0 5 0 0 0 10 0 0 18

Total 6 18 18

6 10

0 5

0 7

0 11

0 18

9 51

At the point of review, the children in placement were predominantly in foster care settings. Seventeen children were in DCF non-relative licensed foster homes, five children were in relative foster homes and one child was in a special study home. Two children were living in private provider foster homes in Connecticut. Three children were in group homes. Three children were in in-state residential settings. One child in the sample was living out of state, with a relative foster parent, and one child was living out of state in a residential facility. At the time of review, one child was AWOL.
One case citing an exception of "clinical reasons" in December 2006 did not appear at the time to be a valid exception from the information available in LINK. After entering DCF custody in July 2005 this adolescent had been in a DCF foster placement, two shelter placements, and a therapeutic foster care home. Of further note, this case had a goal identified as Transfer of Guardianship, but there was never an identified relative willing or able to accept this responsibility. Child is now nearing 16 and has been AWOL since January. This adolescent recently failed to show for court related to shoplifting charges. It is believed that she will return to her biological mother (who failed to cooperate with required steps to reunify after physically abusing her) although mother indicates that she is not aware of her location. It was the position of the Department at the onset of the AWOL episode that she required a residential level of care should she surface. The CANS was prepared, but she has continued to remain on AWOL status for close to four months at this juncture. Recent supervisory narratives reflect preparation of revocation of commitment paperwork.
5

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Table 6: Current residence of child on date of LINK review
Current Residence N/A - Biological/Guardian Home (no CIP) In-State DCF Non-Relative Licensed Foster Care In-State DCF Certified/Licensed Relative Foster Care Group Home In-State Residential Facility In-State Private Provider Foster Care Out of State Relative Foster Care Out of State Residential Facility DCF Special Study Foster Home AWOL/Unknown Total Frequency 17 17 5 3 3 2 1 1 1 1 51 Percent 33.3 33.3 9.8 5.9 5.9 3.9 2.0 2.0 2.0 2.0 100.0

Monitor's Findings Regarding Outcome Measure 3 ­ Treatment Plans Outcome Measure 3 requires that, "in at least 90% of the cases, except probate, interstate and subsidy only cases, appropriate treatment plans shall be developed as set forth in the "DCF Court Monitor's 2006 Protocol for Outcome Measures 3 and 15" dated June 29, 2006 and the accompanying "Directional Guide for OM3 and OM15 Reviews" dated June 29, 2006." To date, the full sample of cases reviewed throughout the process indicates an overall compliance with Outcome Measure 3 of 42.6%. The first quarter 2008 case review data indicates that the Department of Children and Families attained the level of "Appropriate Treatment Plan" in 30 of the 51-case sample or 58.8%. This is an improvement over the prior quarter's result of 51.0% appropriate treatment plans, and is the highest achievement in any quarter to date. Table 7: Historical Findings on OM3 Compliance - Third Quarter 2006 to First Quarter 2008 Quarter Sample (n) Percent Appropriate 35 54.3% 3rd Quarter 2006 th 73 41.1% 4 Quarter 2006 75 41.3% 1st Quarter 2007 nd 76 30.3% 2 Quarter 2007 rd 50 32.0% 3 Quarter 2007 51 51.0% 4th Quarter 2007 51 58.8% 1st Quarter 2008 360 42.6% Total to Date

Of the 34 cases with children in placement on date of review, 20 (58.8%) achieved an overall determination of "appropriate treatment plan" during the first quarter 2008. In-Home cases also achieved this designation in 58.8% of the sample for this quarter. The following crosstabulation provides further breakdown to distinguish between voluntary and child protective services cases as well.

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Crosstabulation 5: What is the type of case assignment noted in LINK? *Overall Score for OM3
What is the type of case assignment noted in LINK? CPS InCPS Child Voluntary Home in Services Child Family Case Placement in Placement (IHF) Case (CIP) Case (VSCIP) Total 10 18 2 30 58.8% 7 41.2% 17 100.0% 56.3% 14 43.8% 32 100.0% 100.0% 0 .0% 2 100.0% 58.8% 21 41.2% 51 100.0%

Overall Score for OM3 Appropriate Treatment Plan Not an Appropriate Treatment Plan Total Count % Count % Count %

100.0% of the cases sampled had plans less than 7 months old at the point of review. In one case, the language needs of the biological father were not accommodated via an interpreter or translation of the plan. This plan also had deficit areas that resulted in plan being deemed inappropriate. All of the plans were approved by the SWS. In relationship to the case goal, cases with a goal of LTFC - Relative and Adoption had the highest rate of appropriate treatment plans with 100.0% (2 of 2) and 83.3% (10 of 12) respectively. The lowest rate of appropriate treatment plans were those cases designated as Transfer of Guardianship, in that all four failed to achieve an appropriate treatment plan designation.

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Crosstabulation 6: What is the child or family's stated goal on the most recent approved treatment plan in place during the period? * Overall Score for OM3
What is the child or family's stated goal on the most recent approved treatment plan in place during the period? Overall Score for OM3 Not an Appropriate Appropriate Treatment Treatment Plan Plan Total 4 6 10 40.0% 60.0% 100.0% 13.3% 28.6% 19.6% 10 2 12 83.3% 16.7% 100.0% 33.3% 9.5% 23.5% 0 4 4 .0% 100.0% 100.0% .0% 19.0% 7.8% 2 0 2 100.0% .0% 100.0% 6.7% .0% 3.9% 10 7 17 58.8% 41.2% 100.0% 33.3% 33.3% 33.3% 4 2 6 66.7% 33.3% 100.0% 13.3% 9.5% 11.8% 30 21 51 58.8% 41.2% 100.0% 100.0% 100.0% 100.0%

Reunification

Adoption

Transfer of Guardianship

Long Term Foster Care with a licensed relative In-Home Goals Safety/Well Being Issues

APPLA Total

Count % within goal % within Overall Score for OM3 Count % within goal % within Overall Score for OM3 Count % within goal % within Overall Score for OM3 Count % within goal % within Overall Score for OM3 Count % within goal % within Overall Score for OM3 Count % within goal % within Overall Score for OM3 Count % within goal % within Overall Score for OM3

Greater New Haven, Middletown, Norwalk and the Willimantic Area Offices all achieved 100% compliance with Appropriate Treatment Plans. We note that this is the fifth time the Middletown Office has achieved the measure and has the overall best performance in this regard statewide with 75.0% of its reviewed treatment plans to date being deemed "appropriate treatment plans." See the table below to see the full statewide results for by quarter.

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Crosstabulation 7: Area Office Assignment? * Overall Score for OM3
Number and Percentage of Plans Deemed "Appropriate Treatment Plan" (n=411) Area Office Assignment Bridgeport Danbury Greater New Haven Hartford Manchester Meriden Middletown New Britain New Haven Metro Norwalk Norwich Stamford Torrington Waterbury Willimantic State Total 3Q2006 2 66.7% 0 0.0% 2 66.7% 2 50.0% 2 50.0% 0 0.0% 1 100.0% 1 33.3% 2 50.0% 1 100.0% 2 66.7% 1 100.0% 1 100.0% 1 33.3% 1 50.0% 19 54.3% 4Q2006 0 0.0% 1 50.0% 2 40.0% 5 55.6% 4 57.1% 2 66.7% 3 100.0% 2 25.0% 1 14.3% 0 0.0% 5 83.3% 0 0.0% 2 66.7% 0 0.0% 3 75.0% 30 41.1% 1Q2007 2 33.3% 3 100.0% 2 40.0% 2 22.2% 3 50.0% 1 33.3% 1 33.3% 4 50.0% 3 37.5% 1 50.0% 3 50.0% 0 0.0% 2 66.7% 2 28.6% 2 50.0% 31 41.3% 2Q2007 3 50.0% 0 0.0% 0 0.0% 3 30.0% 3 50.0% 1 33.3% 1 33.3% 0 0.0% 3 37.5% 0 0.0% 3 50.0% 1 50.0% 2 66.7% 1 14.3% 2 50.0% 23 30.3% 3Q2007 2 50.0% 2 100.0% 0 0.0% 0 0.0% 2 40.0% 0 0.0% 2 100.0% 1 20.0% 1 20.0% 2 100.0% 1 25.0% 0 0.0% 2 100.0% 0 0.0% 1 33.3% 16 32.0% 4Q2007 2 50.0% 0 0.0% 1 33.3% 1 20.0% 5 100.0% 2 100.0% 2 100.0% 5 100.0% 2 40.0% 1 50.0% 1 33.3% 0 0.0% 1 50.0% 1 16.7% 2 66.7% 26 51.0% 1Q2008 3 75.0% 1 50.0% 3 100.0% 2 33.3% 4 80.0% 1 50.0% 2 100.0% 3 60.0% 1 20.0% 2 100.0% 2 50.0% 0 0.0% 0 0.0% 3 75.0% 3 100.0% 30 58.8% All 14 42.4% 7 46.7% 10 37.0% 15 31.3% 23 60.5% 7 43.8% 12 75.0% 16 38.1% 13 31.0% 7 53.8% 17 53.1% 2 15.4% 10 62.5% 8 21.6% 14 60.9% 175 42.6%

One final snapshot of the overall scoring for OM 3 is a look at the rate of compliance by crosstabulating Race (Child or Family Case Named Individual) * Overall Score for OM3 and Sex of the child. The highest rate of compliance with Outcome Measure 3 results for CIP cases are those in which the child is a white male child (Four of Nine or 80%). The lowest rate of compliance is achieved in both children in placement and in-home families identified as having "UTD" race. Both these categories had zero compliance with appropriate treatment plans.

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Crosstabulation 8: Overall Score for OM3 * Race (Child or Family Case Named Individual) * sex of child
Overall Score for OM3 Sex of Child Appropriate Treatment Plan 2 4 0 2 8 5 8 13 9 0 9 Not an Appropriate Treatment Plan 1 4 2 0 7 3 4 7 4 3 7

Total 3 8 2 2 15 8 12 20 13 3 16

Male

Race

Female

Race

In-Home Case

Race

Black/African American White UTD Multiracial Total Black/African American White Total White UTD Total

During this quarter, Hispanic children and families seem to fare less well than Non-Hispanic children and families in relation to treatment planning. During the quarter only 16.7% of the 12 cases identified with Hispanic ethnicity had "appropriate" treatment plans, while 73.0% (27 of 37) Non-Hispanic children and families were identified as "appropriate." One of the two cases (50.0%) with Unknown Ethnicity achieved compliance with OM3. We will continue to look at this issue in upcoming quarters. The level of engagement with children, families and providers in the development of the treatment plans, as well as, the content of the plan document itself was captured. Each case had a unique pool of active participants for DCF to collaborate with in the process. The chart below indicates the degree to which identifiable/active case participants were engaged by the social worker and the extent to which active participants attended the TPC/ACR/FC. Percentages reflect the level or degree to which a valid participant was part of the treatment planning efforts across all the cases reviewed.

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Table 8: Participation and Attendance Rates for Active Case Participants
Identified Case Participant Foster Parent Mother Child Other Participants Father Active Service Providers Other DCF Staff Attorney/GAL (Child) Parents' Attorney Percentage with documented Participation/Engagement in Treatment Planning Discussion 77.8% 76.2% 72.2% 55.2% 50.0% 44.9% 37.1% 18.9% 13.3% Percentage Attending the TPC/ACR or Family Conference (when held) 59.3% 63.2% 35.0% 41.4% 34.3% 31.7% 24.2% 8.3% 6.9%

As with prior reviews, this review process continued to look at eight categories of measurement when determining overall appropriateness of the treatment planning (OM3). Scores were based upon the following rank/scale. Optimal Score ­ 5 The reviewer finds evidence of all essential treatment planning efforts for both the standard of compliance and all relevant consideration items (documented on the treatment plan itself). Very Good Score ­ 4 The reviewer finds evidence that essential elements for the standard of compliance are substantially present in the final treatment plan and may be further clarified or expanded on the DCF 553 (where latitude is allowed as specified below) given the review of relevant consideration items. Marginal Score ­ 3 There is an attempt to include the essential elements for compliance but the review finds that substantial elements for compliance as detailed by the Department's protocol are not present. Some relevant considerations have not been incorporated into the process. Poor Score ­ 2 The reviewer finds a failure to incorporate the most essential elements for the standard of compliance detailed in the Department's protocol. The process does not take into account the relevant considerations deemed essential, and the resulting document is in conflict with record review findings and observations during attendance at the ACR. Absent/Adverse Score ­ 1 The reviewer finds no attempt to incorporate the standard for compliance or relevant considerations identified by the Department's protocol. As a result there is no treatment plan less than 7 months old at the point of review or the process has been so poorly performed that it has had an adverse affect on case planning efforts. "Reason for Involvement" and "Present Situation to Date" were most frequently ranked with an Optimal Score. Deficits were most frequently noted in two of the eight categories: "Determination of Goals/Objectives" and "Action Steps to Achieve Goals". The following table provides the scoring for each category for the sample set and the corresponding percentage of cases within the sample that achieved that ranking.

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The following set of three tables provide at a glance, the scores for each of the eight categories of measurement within Outcome Measure 3. The first is the full sample (n=51), the second is the children in out of home placement (CIP) cases (n=34) and the third is the in-home family cases (n=17). For a complete listing of rank scores for Outcome Measure 3 by case, see Appendix 1.

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Table 9: Measurements of Treatment Plan OM 3 ­ Number and Percent of Rank Scores for All Cases Across All Categories of OM3
Category I.1 Reason for DCF Involvement I.2. Identifying Information I.3. Strengths/Needs/Other Issues I.4. Present Situation and Assessment to Date of Review II.1 Determining the Goals/Objectives II.2. Progress6 II.3 Action Steps to Achieving Goals Identified II.4 Planning for Permanency Optimal "5" 43 84.3% 14 27.5% 27 52.9% 29 56.9% 13 25.5% 24 49.0% 5 9.8% 27 52.9% Very Good "4" 7 13.7% 32 62.7% 18 35.3% 16 31.4% 26 51.0 19 38.8% 23 45.1% 19 37.3% Marginal "3" 1 2.0% 5 9.8% 6 11.8% 6 11.8% 11 21.6% 5 10.2% 21 41.2% 5 9.8% Poor "2" 0 0.0% 0 0.0% 0 0.0% 0 0.0% 1 2.0% 1 2.0% 2 3.9% 0 0.0% Adverse/Absent "1" 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0%

Table 10: Measurements of Treatment Plan OM 3 ­ Number and Percent of Rank Scores for Out of Home (CIP) Cases Across All Categories of OM3
Category I.1 Reason for DCF Involvement I.2. Identifying Information I.3. Strengths/Needs/Other Issues I.4. Present Situation and Assessment to Date of Review II.1 Determining the Goals/Objectives II.2. Progress II.3 Action Steps to Achieving Goals Identified II.4 Planning for Permanency Optimal "5" 30 88.2% 6 17.6% 16 47.1% 18 52.9% 9 26.5% 15 44.1% 4 11.8% 15 44.1% Very Good "4" 3 8.8% 25 73.5% 14 41.2% 11 32.4% 14 41.2% 14 41.2% 16 47.1% 14 41.2% Marginal "3" 1 2.9% 3 8.8% 4 11.8% 5 14.7% 10 29.4% 4 11.8% 13 38.2% 5 14.7% Poor "2" 0 0.0% 0 0.0% 0 0.0% 0 0.0% 1 2.9% 1 2.9% 1 2.9% 0 0.0% Adverse/Absent "1" 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0%

6

Two cases were rated "too early to rate" and are therefore excluded from this measurement.

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Table 11: Measurements of Treatment Plan OM 3 ­ Number and Percent of Rank Scores for In-Home Family Cases Across All Categories of OM3
Category I.1 Reason for DCF Involvement I.2. Identifying Information I.3. Strengths/Needs/Other Issues I.4. Present Situation and Assessment to Date of Review II.1 Determining the Goals/Objectives II.2. Progress7 II.3 Action Steps to Achieving Goals Identified II.4 Planning for Permanency Optimal "5" 13 76.5% 8 47.1% 11 64.7% 11 64.7% 4 23.5% 9 60.0% 1 5.9% 12 70.6% Very Good "4" 4 23.5% 7 41.2% 4 23.5% 5 29.4% 12 70.6% 5 33.3% 7 41.2% 5 29.4% Marginal "3" 0 0.0% 2 11.8% 2 11.8% 1 5.9% 1 5.9% 1 6.7% 8 47.1% 0 0.0% Poor "2" 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 1 5.9% 0 0.0% Adverse/Absent "1" 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0%

As in prior quarters the eight categories measured indicate that DCF continues to struggle with assignment of action steps for the case participants in relation to goals and objectives (II.3); identifying the goals and objectives for the coming six month period (II.1).

7

Two In-Home Family cases were rated "too early to rate" and therefore are excluded from this measurement.

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In spite of the difficulties in achieving overall compliance with Outcome Measure 3, the Department has made strides in some areas which can be recognized when looking at average scores over time. While the requirement is for 90% to have an overall passing score on each component rather than achieve a statewide average within the passing range, this quarter, seven of the eight categories had average scores at or above the "very good" rank of 4. The chart of mean averages below is provided as a way to show the trends, not compliance with Outcome Measure 3. Table 12: Mean Averages for Outcome Measure 3 - Treatment Planning (3rd Quarter 2006 - 1st Quarter 2008)
Mean Scores for Categories within Treatment Planning Over Time 3Q2006 4Q2006 1Q2007 2Q2007 3Q2007 4Q2007 Reason For Involvement Identifying Information Strengths, Needs, Other Issues Present Situation And Assessment to Date of Review Determining Goals/Objectives Progress Action Steps for Upcoming 6 Months Planning for Permanency 4.46 3.94 4.27 3.89 4.63 3.96 4.50 3.82 4.66 3.92 4.71 4.16 1Q2008 4.82 4.18

4.09

4.04

4.07

3.93

4.16

4.25

4.41

4.14 3.80 4.00

3.97 3.48 3.91

3.96 3.68 3.87

3.93 3.66 3.86

4.02 3.70 3.82

4.29 3.82 4.31

4.45 4.00 4.35

3.71 4.03

3.44 4.04

3.19 4.13

3.30 4.01

3.40 4.08

3.55 4.24

3.61 4.43

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IV. Monitor's Findings Regarding Outcome Measure 15 ­ Needs Met Outcome Measure 15 requires that, "at least 80% of all families and children shall have all their medical, dental, mental health and other service needs met as set forth in the "DCF Court Monitor's 2006 Protocol for Outcome Measures 3 and 15 dated June 29, 2006, and the accompanying `Directional Guide for OM3 and OM15 Reviews dated June 29, 2006." The case review data indicates that the Department of Children and Families attained the designation of "Needs Met" in 58.8% of the 51-case sample. There is disparity among the area offices when reviewing results for this measure. Crosstabulation 9: What is the social worker's area office assignment? * Overall Score for Outcome Measure 15
What is the social worker's area office assignment? (compliance rate within area sample) Bridgeport (100.0%) Norwalk (100.0%) Norwich (100.0%) Waterbury (100.0%) Greater New Haven (66.7%) Willimantic (66.7%) Manchester (60.0%) New Britain (60.0%) Danbury (50.0%) Meriden (50.0%) Middletown (50.0%) New Haven Metro (40.0%) Hartford (16.7%) Stamford (0.0%) Torrington (0.0%) Total (58.8%) Overall Score for Outcome Measure 15 Needs Met 4 2 4 4 2 2 3 3 1 1 1 2 1 0 0 30 Needs Not Met 0 0 0 0 1 1 2 2 1 1 1 3 5 2 2 20 Total 4 2 4 4 3 3 5 5 2 2 2 5 6 2 2 51

In reviewing the measure from inception of the process in the third quarter 2006, the highest rate of compliance with OM 15 is the Manchester Office which has a rate of 73.7% "needs met" for the 38 cases sampled. This is followed by Torrington at 68.8% within 16 cases reviewed, and the Norwich Office with 65.6% compliance within the 32 cases reviewed. The lowest rate of compliance is within the Stamford Office which shows compliance with needs met in 30.8% of the 13 cases reviewed to date. The statewide average over the course of these reviews is 53.8% achieving a "needs met" designation.

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There is greater variation in relation to needs met across various case types. Of the 17 cases selected as in-home family cases, 7 or 41.2% achieved "needs met" status. Twenty-two of the 32cases with children in placement (68.8%) achieved "needs met" status. This quarter, there were two Voluntary Service children in out of home placement. One achieved the measure and one failed to achieve "needs met" status. Crosstabulation 10: Overall Score for Outcome Measure 15 * What is the type of case assignment noted in LINK?
Overall Score for Outcome Measure 15 What is the type of case assignment noted in LINK? CPS In-Home Family Case (IHF) Needs Met 7 41.2% 22 68.8% 1 50.0% 30 58.8% Needs Not Met 10 58.8% 10 31.3% 1 50.0% 21 41.2% Total 17 100.0% 32 100.0% 2 100.0% 51 100.0%

CPS Child in Placement Case (CIP) Voluntary Services Child in Placement Case (VSCIP) Total

The overall score was also looked at through the filter of the stated permanency goal. Case goals of Long Term Foster Care with a Relative, and Adoption had the best rates of compliance with Outcome Measure 15. In both of the LTFC - Relative situations, needs were met. In 91.2% of Adoption cases, reviewers indicated that needs were met. Reunification and In-Home Family cases had the greatest number of deficits noted, and the lowest rate of achieving needs met, with only 40% and 41.2% of those respective categories achieving the measure. The full breakdown is shown in Crosstabulation 11 below:

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Crosstabulation 11: What is the child or family's stated goal on the most recent approved treatment plan in place during the period? * Overall Score for Outcome Measure 15
What is the child or family's stated goal on the most recent approved treatment plan in place during the period? Overall Score for Outcome Measure 15 Needs Met Reunification
Count % within What is the child or family's stated goal % within Overall Score for Outcome Measure 15 % of Total 4 40.0% 13.3% 7.8% 11 91.7% 36.7% 21.6% 2 50.0% 6.7% 3.9% 2 100.0% 6.7% 3.9% 7 41.2% 23.3% 13.7% 4 66.7% 13.3% 7.8% 30 58.8% 100.0% 58.8%

Needs Not Met
6 60.0% 28.6% 11.8% 1 8.3% 4.8% 2.0% 2 50.0% 9.5% 3.9% 0 .0% .0% .0% 10 58.8% 47.6% 19.6% 2 33.3% 9.5% 3.9% 21 41.2% 100.0% 41.2%

Total
10 100.0% 19.6% 19.6% 12 100.0% 23.5% 23.5% 4 100.0% 7.8% 7.8% 2 100.0% 3.9% 3.9% 17 100.0% 33.3% 33.3% 6 100.0% 11.8% 11.8% 51 100.0% 100.0% 100.0%

Adoption

Count % within What is the child or family's stated goal % within Overall Score for Outcome Measure 15 % of Total

Transfer of Guardianship

Count % within What is the child or family's stated goal % within Overall Score for Outcome Measure 15 % of Total

Long Term Foster Care with a licensed relative In-Home Goals Safety/Well Being Issues APPLA

Count % within What is the child or family's stated goal % within Overall Score for Outcome Measure 15 % of Total Count % within What is the child or family's stated goal % within Overall Score for Outcome Measure 15 % of Total Count % within What is the child or family's stated goal % within Overall Score for Outcome Measure 15 % of Total

All Permanency Goals

Count % within What is the child or family's stated goal % within Overall Score for Outcome Measure 15 % of Total

In total, Outcome Measure 15 looks at twelve categories of measurement to determine the level with which the Department was able to meet the needs of families and children. When looking at passing scores (5 or 4) and those not passing (3 or less) there is a marked difference in performance among the categories ranging from 69.4% to 100.0%. Please note that percentages are based on applicable cases within that category.

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· ·

·

Safety assessments and planning in the in-home cases was markedly improved from prior quarters. While there were concerns noted related to safety of children in placement these were at the marginal level. There were, no adverse or poor scores assessed related to risks/safety in either in-home or placement cases during this review. Mental health, behavioral health, and substance abuse services pose the greatest challenges to meeting the needs of families and children, in that only 69.4% of the cases achieved a passing score related to this category of needs.
# Passing (Scores 4 or 5) 19 100.0% 49 98.0% 32 94.1% 48 94.1% 34 91.9% 32 88.9% 30 88.2% 33 84.6% 42 82.4% 41 80.4% 34 69.4% # Not Passing (Scores 3 or Less) 0 0.0% 1 2.0% 2 5.9% 3 5.9% 3 8.1% 4 11.1% 4 11.8% 6 15.4% 9 17.6% 10 19.6% 13 26.5%

Table 13: Treatment Plan Categories Achieving Passing Status for 1Q 2008
Category Safety ­ In Home (I.1) DCF Case Management ­ Legal Action to Achieve the Permanency Goal During the Prior Six Months (II.2) DCF Case Management ­ Recruitment for Placement Providers to achieve the Permanency Goal during the Prior Six Months (II.3) Medical Needs (III.1) Securing the Permanent Placement ­ Action Plan for the Next Six Months (II.1) Safety ­ Children in Placement (I.2) Child's Current Placement (IV.1) Educational Needs (IV. 2) DCF Case Management ­ Contracting or Providing Services to achieve the Permanency Goal during the Prior Six Months (II.4) Dental Needs (III.2) Mental Health, Behavioral and Substance Abuse Services (III.3)

Table 14 below provides the complete scoring for all cases by each category.

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Table 14: Measurements of Treatment Plan OM 15 ­ Percentage of Rank Scores Attained Across All Categories8
Category I.1 Safety ­ In Home I.2. Safety ­ Children in Placement II.1 Securing the Permanent Placement ­ Action Plan for the Next Six Months II.2. DCF Case Management ­ Legal Action to Achieve the Permanency Goal During the Prior Six Months II.3 DCF Case Management ­ Recruitment for Placement Providers to achieve the Permanency Goal in Prior Six Months II.4. DCF Case Management ­ Contracting or Providing Services to achieve the Permanency Goal in Prior Six Months III.1 Medical Needs III.2 Dental Needs III.3 Mental Health, Behavioral and Substance Abuse Services IV.1 Child's Current Placement IV. 2 Educational Needs # Ranked Optimal "5" 9 47.4% 23 63.9% 21 56.8% 38 76.0% 25 73.5% 24 47.1% 28 54.9% 31 60.8% 14 28.6% 19 55.9% 22 56.4% # Ranked Very Good "4" 10 52.6% 9 25.0% 13 35.1% 11 22.0% 7 20.6% 18 35.3% 20 39.2% 10 19.6% 22 44.9% 11 32.4% 11 28.2% # Ranked Marginal "3" 0 0.0% 4 11.1% 3 8.1% 1 2.0% 1 2.9% 9 17.6% 3 5.9% 6 11.8% 12 24.5% 3 8.8% 5 12.8% # Ranked Poor "2" 0 0.0% 0 0.0% 0 0.0% 0 0.0% 1 2.9% 0 0.0% 0 0.0% 2 3.9% 1 2.0% 1 2.9% 1 2.6% # Ranked Adverse/Absent "1" 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 0 0.0% 2 3.9% 0 0.0% 0 0.0% 0 0.0% N/A To Case

32 15 14 1

17

0

0 0 2 17 12

For a complete listing of rank scores for Outcome Measure 15 by case, see Appendix.
Percentages are based on applicable cases for the individual measure. Those cases marked N/A are excluded from the denominator in each row's calculation of percentage. A number of cases had both in-home and out of home status at some point during the six month period of review.
8

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From an alternate view, the data was analyzed to provide a comparative look at the median for each of the Outcome Measure 15 categories. As with the chart provided for Outcome Measure 3, this is presented as a method to identify trends across time, and is not a reflection of overall compliance with the 80% requirement for Outcome Measure 15 - Needs Met. Table 15: Mean Averages for Outcome Measure 15 - Needs Met (3rd Quarter 2006 - 1st Quarter 2008)
Outcome Measure Needs Met - Median Scores Over Time 3Q2006 4Q2006 1Q2007 2Q2007 4.00 3.75 3.78 4.00 4.43 4.15 4.39 4.36 3Q2007 4.20 4.57 4Q2007 4.00 4.53 1Q2008 4.47 4.53

Safety: In-Home Safety: CIP

Permanency: Securing the Permanent Placement Action Plan for the Next Six Months Permanency: DCF Case Mgmt - Legal Action to Achieve Permanency in Prior Six Months Permanency: DCF Case Mgmt - Recruitment for Placement Providers to Achieve Permanency in Prior Six Months Permanency: DCF Case Mgmt - Contracting or Providing Services to Achieve Permanency during Prior Six Months Well-Being: Medical Well-Being: Dental Well-Being: Mental Health, Behavioral and Substance Abuse Services Well-Being: Child's Current Placement Well Being: Education

4.38

4.22

4.19

4.16

4.53

4.31

4.49

4.29

4.45

4.67

4.67

4.74

4.65

4.74

4.42

4.42

4.20

4.43

4.56

4.47

4.65

4.17 4.31 4.47 4.40 4.48 4.46

4.03 4.34 3.93 4.07 4.30 4.26

3.79 4.28 3.87 3.72 4.23 4.05

4.13 4.22 4.13 3.91 4.21 4.07

4.12 4.34 4.12 4.02 4.37 4.32

3.98 4.25 4.25 3.88 4.14 4.31

4.29 4.49 4.29 4.00 4.41 4.38

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In 37 of the 51 cases, reviewers found evidence of one or more unmet needs during the prior six month period. In some cases, these needs were primary to goal achievement and in others, they were less significant, but still established at the point of the prior treatment plan development or throughout the case narratives. A total of 89 discrete needs were identified across those cases. The largest category of unmet needs is once again in the area of mental health, which accounts for 21.3% of the total identified. Table 16: Unmet Service Needs and Identified Barriers for the 37 Cases Identified with an Unmet Need
Service Need
Adoption Recruitment Adoption Supports (PPSP) Childcare DCF Case Management/Support/Advocacy DCF Case Management/Support/Advocacy DCF Case Management/Support/Advocacy Dental Care - Other Svc or Orthodontic Care Dental Care - Routine Dental Care - Routine Dental Care - Routine Dental Care - Routine Dental Care- Routine Domestic Violence Treatment - Perpetrator Domestic Violence Treatment - Perpetrator Domestic Violence Treatment - Perpetrator Domestic Violence Treatment - Victim Domestic Violence Treatment -Victim Educational Screening/Evaluation Educational Screening/Evaluation Family Preservation Services Family/Marital Counseling Foster Care Support Foster Care Support Foster Parent Training Foster Parent Training Health/Medical Screening Housing Assistance Housing Assistance IEP Programming Individual Counseling - Child Individual Counseling - Child Individual Counseling - Child Individual Counseling - Child Individual Counseling - Parent Individual Counseling - Parent In-Home Parent Education and Support Job Placement/Coaching Job Placement/Coaching Life Skills Training Maintaining Family Ties Medication Management - Child Medication Management - Child

Barrier
No Slots Available Provider Issues (Staffing) Transportation Assessment of identified relative resources not timely Child needs to have Adolescent Worker Assigned. Delay in referrals to ARG Insurance Issue Client Refused Delay in Referral Insurance Issue Wait List UTD Delay in Referral Placed on Wait List Client Refused Delay in Referral/Father subsequently whereabouts unknown Client Refused Provider Issue (Lack of follow through) Delay in Referral Client Refused Client Refused Client Refused Delay in Referral Client Refused No Service Identified UTD Old debt - Supportive Housing will not work with client until old bill is paid back. Placed on Wait List Approval Process Hours of Operation Provider Issues (Staffing) Wait List Client Refused Provider Issues (Staffing) Client Refused Client Refused Multiple service expectations Service Deferred pending completion of another Service Does Not Exist in the Community Delay in Referral Client Refused Insurance Issue

Frequency
1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 1 1 1 2 1 4 1 1 1 1 2 1 2 1 1 1 1 2 1 6 1 1 1 2 1 1 1

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Service Need
Mental Health Screening - Child Mentoring Mentoring Mentoring Mentoring Other Medical Intervention Other Medical Intervention Other Medical Intervention Other Medical Intervention Other OOH Service - Sibling Visitation Other OOH Services - Emergency Housing Other OOH Services - Legal Aide Other OOH Services - School Attendance Parenting Classes Parenting Classes Parenting Classes Problem Sexual Behavior Evaluation Psychological or Psychosexual Evaluation Social Recreational Program (In-Home Family case) Social Recreational Programs (CIP) Substance Abuse Screening - Parent Supervised Visitation SW/Child Visitation SW/Parent Visitation Therapeutic Foster Care

Barrier
Delay in Referral Delay in Referral Client Refused Other - Poor Matching Wait List Communication Issue Delay in ARG evaluation Insurance Issue Delay in Referral UTD Victim's inability to leave batterer UTD Foster Parent unable to get child to school regularly require some in-home support Client Refused Delay in Referral Service Deferred pending completion of another Provider Issues (Staffing) Client Refused Delay in Referral Lack of Communication between OOH provider and DCF Client Refused Client Refused UTD - Not per mandate UTD No Slots Available

Frequency
1 4 2 1 1 1 1 1 2 1 1 1 1 1 1 1 1 1 1 1 4 1 1 1 1

In looking at the barriers identified in aggregate: · The client was the identified barrier for 31 instances identified, · DCF case management issues were identified in 22 of the cases cited (includes deferred services, delayed referrals, internal process, financing). · Lack of resources (wait lists, no service available, no slots, etc.) is identified in ten cases. · Provider issues were identified in six of the cases. · In six cases the reviewer could not establish the barrier (UTD). · In four cases, the barrier was identified as insurance. · In two cases, the DCF determined it appropriate to defer a service in favor of another. · Transportation and the Local School District were each identified on one occasion. SDM Family Strength and Needs Assessment tools were completed for 21 cases. In some instances, those with unmet needs identified through record review, had needs that had been assessed and prioritized on the SDM tool, but were then not incorporated into the development of the prior treatment plan goals and action steps. When looking forward at the current approved treatment planning document for the upcoming six month period, 15 cases (30.6%) had evidence of a service need that was

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Juan F. v Rell Exit Pl