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 October 1, 2007 - December 31, 2007 Civil Action No. H-89-859 (AHN) March 31, 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]

Case 2:89-cv-00859-AHN

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Juan F. v Rell Exit Plan Quarterly Report March 31, 2008

____________________________________

Table of Contents Juan F. v Rell Exit Plan Quarterly Report October 1, 2007 - December 31, 2007 Page Highlights 3 October 1, 2007 through December 31, 2007 Exit Plan Outcome Measure Overview Chart Outcome Measure 3 & 15 Report (Fourth Quarter) Appendix 1 ­ Rank Scores for Outcome Measure 3 and Outcome Measure 15 ­Fourth Quarter 2007 Juan F. Action Plan Appendix 2 ­ The Department's Exit Plan Outcome Measures Summary Report Fourth Quarter Report October 1, 2007 ­ December 31, 2007 7

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47 70

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Juan F. v Rell Exit Plan Quarterly Report March 31, 2008

____________________________________ Juan F. v Rell Exit Plan Quarterly Report October 1, 2007 - December 31, 2007 · Highlights The Monitor's quarterly review of the Department's efforts in meeting the Exit Plan Outcome Measures during the period of October 1, 2007 through December 31, 2007 indicates that the Department achieved 16 of the 22 measures. For the third consecutive quarter, the Department has met the goal for Repeat Maltreatment (Outcome Measure 5). The recorded percentage of 5.4% cases in which repeat maltreatment occurred is the best performance by the Department since implementation of the Exit Plan. 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, pages 8 through 46), The Department of Children and Families attained the level of "Appropriate Treatment Plan" in 26 of the 51-case sample or 51.0% and attained the designation of "Needs Met" in 24 of the 51 case sample or 47.1%. The treatment plan findings are an improvement over the 4th Quarter result of 30.0% appropriate plans and it is the first time since the pilot review that the Department has achieved over 50% compliance with this measure. Initiatives undertaken by individual offices had a positive impact on the quality of their treatment plans. There was a noticeable improvement demonstrated for offices that employed concentrated efforts. Sufficiency of specific and time limited action steps and goals remained an area needing improvement. Provider input was rarely incorporated into treatment plans diminishing the quality of planning and service provision efforts. Some offices utilized the regularly supplied feedback by the Court Monitor's Office on individual cases to undertake discussions within their offices and with Court Monitor staff. This provides a forum to better understand and clarify specific circumstances and take advantage of opportunities for improvement. The lack of appropriate foster homes and wait-lists for community services, contribute to system gridlock that exists throughout the treatment and service array. Discharge delays at emergency departments, group homes, residential treatment centers, SAFE Homes, STAR/Shelters and other treatment placement services occur throughout the system. Additional foster and adoptive homes, especially therapeutic homes are needed. Specialized residential treatment for sexually reactive children, pervasive developmentally delayed/ mentally retarded (DD/MR) children and assaultive children are not readily available. While the Department has met the residential reduction standard (Outcome Measure 19), recent data indicates that the out-of-state residential population are increasing.

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Juan F. v Rell Exit Plan Quarterly Report March 31, 2008

____________________________________ The findings reported for this quarter and impacting service provision are similar to information contained in the recently released " Juan F. Court Monitor's Review of Children in Overstay Status (>60Days) within Temporary Congregate Care Placement Settings and Juan F. Court Monitor's Review of Adolescents in Temporary Placement- Old Shelter Model Facilities". · The Monitor's Office will next review a series of children including cohorts of pre and post Termination of Parental Rights (TPR) legal status. This permanency review will include children that have the non- preferred goal of Another Planned Permanent Living Arrangement (APPLA), children with the goal of Reunification that are well beyond one year in placement, and children with goal of adoption where barriers exist to finalizing the adoption. The recent report "Juan F. Court Monitor's Review of Children in Overstay Status (>60Days) within Temporary Congregate Care Placement Settings and Juan F. Court Monitor's Review of Adolescents in Temporary Placement- Old Shelter Model Facilities " found that as of October 2007, 144 children/youth were in placement beyond 60 days in a temporary placement setting. A review of the same cohort 90 days later found that 59 of the 144 children remained in temporary settings with length of stay beyond 120 days. Beginning March 24, 2008, the Department is implementing a pilot that will utilize an approach similar to the Federal Child and Family Service Review process. This qualitative review will initially examine Bridgeport case practice through a sample of cases and later this spring the Manchester and Norwich offices will also participate in this review. Staff from the DCF Court Monitor's Office will take part in this agencydriven effort. The establishment of a rolling, qualitative review process that involves each of the area offices is an important foundation component to ensure continued review and the identification of both areas of strength and opportunities for improvement.

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Juan F. v Rell Exit Plan Quarterly Report March 31, 2008

____________________________________ · The Monitor's quarterly review of the Department for the period of October 1, 2007 through December 31, 2007 indicates the Department has achieved compliance with the following 16 Outcome Measures: · · · · · · · · · · · · · · · · Commencement of Investigations (97.4%) Completion of Investigations (92.9%) Search for Relatives (93.6%) Repeat Maltreatment (5.4%) Maltreatment of Children in Out-of-Home Care (0.2%) Adoption (35.5%) Transfer of Guardianship (80.8%) Multiple Placements (92.7%) Foster Parent Training (100.0%) Placement within Licensed Capacity (96.8%) Worker-Child Visitation Out-of-Home Cases (94.6% Monthly/ 98.5% Quarterly) Worker-Child Visitation In-Home Cases (89.9%) Caseload Standards (100.0%) Residential Reduction (10.8%) Discharge Measures (96%)
Multi-disciplinary Exams (96.4%)

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Juan F. v Rell Exit Plan Quarterly Report March 31, 2008

____________________________________ · The Department has maintained compliance for at least two (2) consecutive quarters1 with 16 of the Outcome Measures. (Measures are shown with designation of the number of consecutive quarters for which the measure was achieved): · · · · · · · · · · · · · · · · · Commencement of Investigations (thirteenth consecutive quarter) Completion of Investigations (thirteenth consecutive quarter) Search for Relatives (ninth consecutive quarter) Repeat Maltreatment (third consecutive quarter) Maltreatment of Children in Out-of-Home Care (sixteenth consecutive quarter) Adoption (fifth consecutive quarter) Transfer of Guardianship (sixth consecutive quarter) Multiple Placements (fifteenth consecutive quarter) Foster Parent Training (fifteenth consecutive quarter) Placement within Licensed Capacity (sixth consecutive quarter) Visitation Out-of-Home (ninth consecutive quarter) Visitation In-Home (ninth consecutive quarter) Caseload Standards (fourteenth consecutive quarter) Residential Reduction (seventh consecutive quarter) Discharge Measures (tenth consecutive quarter) Multi-disciplinary Exams (eighth consecutive quarter)

The Monitor's quarterly review of the Department for the period of October 1, 2007 through December 31, 2007 indicates that the Department did not achieve compliance with six (6) measures: · · · · · · Treatment Plans (51%) Reunification (58%) Sibling Placements (81.39%) Re-Entry (7.8%) Children's Needs Met (47.1%) Discharge to DMHAS and DMR (95%)

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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. v Rell Exit Plan Quarterly Report March 31, 2008

____________________________________
4Q October 1 - December 31, 2007 Exit Plan Report

Outcome Measure Overview
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

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

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%

>=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% >=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%

82% 44.6% 49.2% 65.1% 89.6% 89.9% 93.9% 93.1% 91.4% 92% 93.8% 91.4% 93.6% 5.4% 0.2%

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% 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% 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%

>=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% >=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% >=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% 81.3 7.8%

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

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% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

14: Placement Within Licensed >=96% 88.3% 92% Capacity 15: Needs Met** >=80% 16: WorkerChild Visitation (OOH)* 17: WorkerChild Visitation (IH)* 18: Caseload Standards+ 19: Residential Reduction 20: Discharge Measures >=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%

53% 73% 93% 46%

56%

X

X

X

X

X

X

62% 52.1% 45.3% 51.3% 64% 47.1%

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

100% 73.1% 100% 100% 100% 100% 100% 99.8% 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% 10.8%* >=85% 74% 52% 93% 83% X X 95% 92% 85% 91% 100% 100% 98% 100% 95% 96%

21: Discharge to DMHAS and 100% DMR 22: MDE >=85%

43%

64%

56%

60%

X

X

78%

70%

95%

97% 100% 97%

90%

83%

95%

95%

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%

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Juan F. v Rell Exit Plan Quarterly Report March 31, 2008

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Monitor's Office Case Review for Outcome Measure 3 and Outcome Measure 15 I. Background and Methodology: The Juan F. v Rell Revised Exit Plan and the 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 Fourth Quarter 2007, 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 September 1, 2007. Data was extracted for the record review from September 27th through January 15, 2008. The sample incorporates both in-home and out-of-home cases based on the overall statewide percentage reflected on the date that the sample was determined. Table 1: Fourth Quarter Sample Required, Based on September 1, 2007 Caseload Universe
Area Office Total Caseload % of State Caseload % of In-Home Cases within in AO Caseload 15.6% 9.8% 13.1% 19.7% 15.2% 15.7% 13.3% 15.0% 17.6% 3.9% 14.3% 12.0% 7.6% 13.1% 10.9% In-Home Sample OOH Sample Total Sample

Bridgeport Danbury Greater New Haven Hartford Manchester Meriden Middletown New Britain New Haven Metro Norwalk Norwich Stamford Torrington Waterbury Willimantic Grand Total

1,165 316 925 1,862 1,256 581 414 1,458 1,512 232 1,095 276 461 1,260 798 13,611

8.6% 2.3% 6.8% 13.7% 9.2% 4.3% 3.0% 10.7% 11.1% 1.7% 8.0% 2.0% 3.4% 9.3% 5.9% 100.0%

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 17

3 1 2 4 4 1 1 4 4 1 2 1 1 5 2 34

4 2 3 5 5 2 2 5 5 2 3 2 2 6 3 51

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Juan F. v Rell Exit Plan Quarterly Report March 31, 2008

____________________________________ This quarter, the methodology individually assigned one DCF staff or Monitor's Review staff to review each case. Within the course of seven to twelve hours, 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. 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 or 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 a valid argument existed 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 (TAC) for review.

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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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Juan F. v Rell Exit Plan Quarterly Report March 31, 2008

____________________________________ During the fourth quarter, there were 14 such cases submitted for consideration/assistance of supervisory oversight. Included in these cases, were five cases requesting an override of Outcome Measure 3 and five cases requesting an override for Outcome Measure 15. All requests were deemed valid and resulted in the approval of an override to allow a passing score. The additional four cases were counseled for appropriate scoring and did not require additional override consideration. Sample Demographics The sample consisted of 51 cases distributed among the fifteen area offices. The work of 51 Social Workers and 42 Social Work Supervisors' work was incorporated into the record review. Cases were most recently opened across the range of time from as long ago as November 15, 1997 to most recently, October 17, 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: What is the type of case assignment noted in LINK? * Is there a history of prior investigations?
What is the type of case assignment noted in LINK? CPS In-Home Family Case (IHF) CPS Child in Placement Case (CIP) Voluntary Services In-Home Family Case (VSIHF) Voluntary Services Child in Placement Case (VSCIP) Total Is there a history of prior investigations? Yes 11 19 0 1 31 No 3 16 1 0 20 Total 14 35 1 1 51

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Juan F. v Rell Exit Plan Quarterly Report March 31, 2008

____________________________________ Of the 36 children that had been in placement during the period, 52.8% were female and 47.2% were male. Ages ranged from 16 months to 17 years and 10 months as of December 31, 2007. Legal status was most frequently committed, with 55.6% of the children in placement having this designation. An additional 27.8% of the children in placement were TPR. The table below provides additional information related to legal status for both the In-Home and Child-in-Placement cases. Table 2: Legal Status
Legal Status Frequency Percent 20 39.2 Committed 10 19.6 TPR/Statutory Parent 8 15.7 N/A - In-Home CPS case with no legal involvement 5 9.8 Not Committed 4 7.8 Protective Supervision 2 3.9 Order of Temporary Custody 1 2.0 Dually Committed 1 2.0 N/A - In-Home Voluntary Service Case 51 100.0 Total

Of the 36 children in out-of-home placement at some point during the quarter, five or 13.9% 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 Case Named Individual)
Ethnicity (Child or Family Case Named Individual) Hispanic 1 3 2 1 7 Non-Hispanic 12 25 0 6 43 Unknown 1 0 0 0 1 Total 14 28 2 7 51

Race (Child or Family Case Named Individual) Black/African American White UTD Multiracial (more than one race selected) Total

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Juan F. v Rell Exit Plan Quarterly Report March 31, 2008

____________________________________ In establishing the reason for the most recent "case open date", 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, 165 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-four of the 51 cases had physical neglect included in the concerns identified upon most recent referral to the Hotline. In 24 cases, physical neglect was substantiated. This was followed by issues related to Parental Substance Abuse/ Mental Health, which was present in 23.5% of the cases reviewed, and Emotional Neglect cited in 13.7% of the cases sampled. The Hotline accurately identified prior DCF involvement for the 31 cases reviewed. Table 3: Reasons for DCF involvement at most recent case opening
Identified Issue/Concern Abandonment Domestic Violence Educational Neglect Emotional Abuse Emotional Neglect Medical Neglect Physical Abuse Physical Neglect Sexual Abuse Parent's Mental Health or Substance Abuse Voluntary Services Referral (VSR) Child's Behaviors Prior History of Investigations Number of Times Identified 4 8 4 2 9 4 6 34 5 20 8 14 31 Number Substantiated 3 2 3 1 7 3 3 24 2 12 n/a n/a n/a

In sifting through the multiply cited reasons for involvement, reviewers were asked to identify the primary reason for DCF involvement on the date of most recent case opening. Not surprisingly, "Physical Neglect" and "parental substance abuse or mental health" were most often identified.

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Juan F. v Rell Exit Plan Quarterly Report March 31, 2008

____________________________________ Table 4: What is the primary reason cited for the most recent case opening?
Cause for DCF involvement upon most recent case opening Physical Neglect Substance Abuse/Mental Health (Parent) Child's TPR Voluntary Services Request (VSR) FWSN Child with behavioral, medical, substance abuse or... etc Abandonment Physical Abuse Medical Neglect Domestic Violence History of prior investigations Emotional Abuse Educational Neglect Total Frequency 12 9 8 4 3 3 3 2 2 2 1 1 1 51 Percent 23.5 17.6 15.7 7.8 5.9 5.9 5.9 3.9 3.9 3.9 2.0 2.0 2.0 100.0

Twenty-seven and one half percent of the sample cases 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 this review sample, none of the parents had a prior history of termination of their parental rights. DCF approved permanency/case goals were identified for all 51 cases reviewed. DCF policy requires concurrent planning when reunification or APPLA are the designated. Of the 13 situations in which "Reunification" was the permanency goal, there was a concurrent plan documented in 11 cases (84.6%). Of the twelve cases with the goal of APPLA, nine (75.0%) identified a concurrent goal; however three of these were another APPLA designation. 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 Reunification APPLA Adoption Transfer of Guardianship Total Frequency Percent 15 29.4% 13 25.5% 12 23.5% 8 15.7% 3 5.9% 51 100.0%

Children in placement had various lengths of stay at the point of our review, ranging from less than two months to fifteen years. Below is a crosstab of cases by length of stay relating to TPR filing and in relation to the Adoption and Safe Families Act (ASFA) requirement to file or identify an exception by no later than 15 months into the out of home episode. In only one case in which the child's length of stay and permanency goal

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Juan F. v Rell Exit Plan Quarterly Report March 31, 2008

____________________________________ required the filing of TPR, had it not been done nor was an exception noted in LINK in accordance with ASFA timelines. Crosstabulation 3: 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?
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 no yes no N/A - Exception noted in LINK N/A - child's goal and length of time in care don't require N/A - In-Home Case (CPS or Voluntary Services) Total 1 1 9 2 0 0 2 1 8 0 N/A - In-Home Case (CPS or Voluntary Services) 0 0 0 0 15 15 N/A - TPR has already been filed or granted 11 0 0 0 0 11 Total 12 3 10 10 15 50

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At the point of review, the children in placement were predominantly in foster care settings. Ten children were in DCF licensed foster homes, five children were in relative foster homes and one child was in a special study home. Seven children were living in private provider foster homes in Connecticut. Two children were in group homes, and one child was in a Safe Home. Four children were in in-state residential settings and two were in in-state hospital settings. Three children were on a trial home visit with their biological parent/guardian. One was living in the home of a family friend informally (no license) at the point of review. Only one child in the sample was living out-of-state, and this was a placement with a relative foster parent. Table 6: Current residence of child on date of LINK review
Residence Frequency Percent 13 25.4 In-home family case (no placement) 3 5.9 Home of biological parent, adoptive parent or legal guardian 1 2.0 Child residing with Mother in Drug Treatment Facility 10 19.6 In-State non-relative licensed DCF foster care 7 13.7 In-State private provider foster care 5 9.8 In-State certified/licensed relative DCF foster care 4 7.8 In-State residential setting 2 3.9 Group Home 2 3.9 In-State hospital setting 1 2.0 Living with friends (informal arrangement) 1 2.0 Out-of-State Relative foster care 1 2.0 Safe Home 1 2.0 Special Study 51 100.0 Total

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Juan F. v Rell Exit Plan Quarterly Report March 31, 2008

____________________________________ II. 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." The fourth quarter case review data indicates that the Department of Children and Families attained the level of "Appropriate Treatment Plan" in 26 of the 51-case sample or 51.0%. This is an improvement over the prior quarter's result of 30.0% appropriate treatment plans, and it is the first time since the pilot review that the Department has achieved over 50% compliance with the measure. Table 7: Historical Findings on OM3 Compliance - Third Quarter 2006 to Fourth Quarter 2007 Quarter Sample (n) Percent Appropriate rd 35 54.3% 3 Quarter 2006 73 41.1% 4th Quarter 2006 75 41.3% 1st Quarter 2007 nd 76 30.3% 2 Quarter 2007 50 32.0% 3rd Quarter 2007 th 51 51.0% 4 Quarter 2007 360 40.3% Total to Date

Of the 36 cases with children in placement, eighteen, or 50.0% achieved an overall determination of "appropriate treatment plan" during the fourth quarter 2007. The average-to-date percentage since the beginning of this review process shows that 41.2% of the child-in-placement cases achieved appropriate treatment plan status. In-Home cases reviewed during the fourth quarter 2007 achieved "appropriate treatment plan" status in 53.3% of the cases. Since the beginning of this review process, the average-to-date percentage of in-home cases deemed appropriate is 38.2% (100 in-home family cases). While improvement is still needed, specifically related to goals, action steps and progress, this quarter's Treatment Plan results show improvement over earlier quarters. The following crosstabulation provides further breakdown to distinguish between voluntary and child protective services cases as well.

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Juan F. v Rell Exit Plan Quarterly Report March 31, 2008

____________________________________ Crosstabulation 4: What is the type of case assignment noted in LINK? * Overall Score for OM3
Overall Score for OM3 Not an Appropriate Appropriate Treatment Treatment Plan Plan 8 6 57.1% 42.9% 18 17 51.4% 48.5% 0 1 0.0% 100.0% 0 1 0.0% 100.0% 26 25 51.0% 49.0%

What is the type of case assignment noted in LINK? CPS In-Home Family Case (IHF) CPS Child in Placement Case (CIP) Voluntary Services In-Home Family Case (VSIHF) Voluntary Services Child in Placement Case (VSCIP) Total

Total 14 100.0% 35 100.0% 1 100.0% 1 100.0% 51 100.0%

100.0% of the cases sampled during the fourth quarter 2007 had plans less than 7 months old at the point of review. One of the plans not passing (2.0%) did not have social work supervisory approval. This plan had one or more sections with less than a "very good" rating and would have been deemed inappropriate regardless of approval status. All cases had documentation that families' language needs were met. In relationship to the case goal, cases with a goal of transfer of guardianship or adoption had the highest rate of "appropriate treatment plan" with 66.7% and 62.5%, respectively. The lowest rate of "appropriate treatment plans" were those cases designated as APPLA. Only 33.3% achieved an "appropriate treatment plan" designation. Crosstabulation 5: 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? Reunification Adoption Transfer of Guardianship In-Home Goals - Safety/Well Being Issues APPLA Total Overall Score for OM3 Not an Appropriate Appropriate Treatment Plan Treatment Plan 7 6 53.8% 46.2% 5 3 62.5% 37.5% 2 1 66.7% 33.3% 8 7 53.3% 47.7% 4 8 33.3% 66.7% 26 25 51.0% 49.0%

Total 13 100.0% 8 100.0% 3 100.0% 15 100.0% 12 100.0% 51 100.0%

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____________________________________ Manchester, Meriden, Middletown and New Britain Area Offices all achieved 100% compliance with Appropriate Treatment Plans. See the table below to see the full statewide results for the fourth quarter 2007. Crosstabulation 6: What is the social worker's area office assignment? * Overall Score for OM3
Overall Score for OM3 Not an Appropriate Appropriate Treatment Plan Treatment Plan 5 0 100.0% 0.0% 2 0 100.0% 0.0% 2 0 100.0% 0.0% 5 0 100.0% 0.0% 2 1 66.7% 33.3% 2 2 50.0% 50.0% 1 1 50.0% 50.0% 1 1 50.0% 50.0% 2 3 40.0% 60.0% 1 2 33.3% 66.7% 1 2 33.3% 66.7% 1 4 20.0% 80.0% 1 5 16.7% 83.3% 0 2 0.0% 100.0% 0 2 0.0% 100.0% 26 25 51.0% 49.0%

What is the social worker's area office assignment? Manchester Meriden Middletown New Britain Willimantic Bridgeport Norwalk Torrington New Haven Metro Greater New Haven Norwich Hartford Waterbury Danbury Stamford Total

Total 5 100.0% 2 100.0% 2 100.0% 5 100.0% 3 100.0% 4 100.0% 2 100.0% 2 100.0% 5 100.0% 3 100.0% 3 100.0% 5 100.0% 6 100.0% 2 100.0% 2 100.0% 51 100.0%

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____________________________________ Since the inception of the review process, the highest rate of compliance exists within the Middletown Office, which has 71.4% of all treatment plans meeting the requirement. This is followed by Manchester at 57.6%, Willimantic at 55.0% and Norwich at 53.6%. Lowest rates of compliance across all reviews to date are Waterbury at 15.2% and Stamford at 18.2%. The level of engagement with children, families and providers in both the development of the treatment plan, as well as, the content of the plan document 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. Attendance rates seemed to have slipped slightly when compared to prior quarter reviews. Reviewers most often noted a failure to invite adolescents and fathers to meetings, and the overall lack of engagement with the children's and parents' attorneys. There is also a noted concern regarding the participation of adolescents within their adolescent planning conferences prior to the ACR. It is unclear how often this is a documentation issue related to issues with the form imported into LINK, or whether adolescents are actually not present for meetings related to the identification of their strengths, needs, and life skills planning efforts. Table 8: Participation and Attendance Rates for Active Case Participants within the Sample Set
Identified Case Participant Foster Parent Mother Child Other Participants Active Service Providers Father Other DCF Staff Attorney/GAL (Child) Parents' Attorney Percentage with documented Participation/Engagement in Treatment Planning Discussion 68.2% 66.7% 58.3% 55.2% 53.8% 41.0% 37.1% 11.1% 7.1% Percentage Attending the TPC/ACR or Family Conference (when held) 47.8% 58.3% 17.4% 41.4% 47.5% 41.0% 24.2% 8.3% 7.1%

As with prior reviews, this review process continued to look at eight categories of measurement when determining the overall appropriateness of the treatment planning process (OM3). Scores were based upon the following rank/scale.

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____________________________________

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.

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, Table 9 is the full sample (n=51), the second, Table 10 is the children in out of home placement (CIP) cases (n=36) and the third, Table 11 is the in-home family cases (n=15). 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. Progress3 II.3 Action Steps to Achieving Goals Identified II.4 Planning for Permanency Optimal "5" 38 74.5% 14 27.5% 22 43.1% 20 39.2% 11 21.5% 20 40.8% 6 11.8% 22 43.1% Very Good "4" 11 21.6% 31 60.8% 20 39.2% 26 51.0% 23 45.1% 25 51.0% 19 37.3% 20 39.2% Marginal "3" 2 3.9% 6 11.7% 9 17.7% 5 9.8% 14 27.5% 3 6.1% 23 45.1% 8 15.7% Poor "2" 0 0.0% 0 0.0% 0 0.0% 0 0.0% 3 5.9% 1 2.0% 3 5.9% 1 2.0% 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. Progress4 II.3 Action Steps to Achieving Goals Identified II.4 Planning for Permanency Optimal "5" 27 75.0% 6 16.7% 17 47.2% 14 38.9% 5 13.9% 13 37.1% 4 11.1% 14 38.9% Very Good "4" 8 22.2% 26 72.2% 13 36.1% 19 52.8% 16 44.4% 19 54.3% 15 41.7% 14 38.9% Marginal "3" 1 2.8% 4 11.1% 6 16.7% 3 8.3% 13 36.1% 2 5.7% 16 44.4% 7 19.4% Poor "2" 0 0.0% 0 0.0% 0 0.0% 0 0.0% 2 5.6% 1 2.9% 1 2.8% 1 2.8% 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%

3 4

Two cases were rated "too early to rate" and are therefore excluded from this measurement. One case rated as "too early to rate" and is 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. Progress5 II.3 Action Steps to Achieving Goals Identified II.4 Planning for Permanency Optimal "5" 11 73.3% 8 53.3% 5 33.3% 6 40.0% 6 40.6% 7 50.0% 2 13.3% 8 53.3% Very Good "4" 3 20.0% 5 33.3% 7 46.7% 7 46.4% 7 46.4% 6 42.9% 4 26.7% 6 40.0% Marginal "3" 1 6.7% 2 13.3% 3 20.0% 2 13.3% 1 6.7% 1 7.1% 7 46.7% 1 16.7% Poor "2" 0 0.0% 0 0.0% 0 0.0% 0 0.0% 1 6.7% 0 0.0% 2 13.3% 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). Improvements in the quality of sections detailing progress (II.2) and reporting the present situation and assessment of the child and/or family on the date the plan is written (I.4) are evident from the prior period.

5

One In-Home Family case was rated "too early to rate" and therefore is excluded from this measurement.

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____________________________________ In spite of the difficulties in achieving 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, rather than achieve a statewide average within the passing range, six of the eight categories this quarter 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 11: Mean Averages for Outcome Measure 3 - Treatment Planning (3rd Quarter 2006 - 4th Quarter 2007)
Mean Scores for Categories within Treatment Planning Over Time 3Q2006 4Q2006 1Q2007 2Q2007 3Q2007 4.46 4.27 4.63 4.50 4.66 Reason For Involvement 3.94 3.89 3.96 3.82 3.92 Identifying Information 4.09 4.04 4.07 3.93 4.16 Strengths, Needs, Other Issues Present Situation And Assessment 4.14 3.97 3.96 3.93 4.02 to Date of Review 3.80 3.48 3.68 3.66 3.70 Determining Goals/Objectives 4.00 3.91 3.87 3.86 3.82 Progress Action Steps for Upcoming 6 3.71 3.44 3.19 3.30 3.40 Months 4.03 4.04 4.13 4.01 4.08 Planning for Permanency 4Q2007 4.71 4.16 4.25 4.29 3.82 4.31 3.55 4.24

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____________________________________ III. 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 47.1% of the 51-case sample. There is disparity among the area offices when reviewing results for this measure. Crosstabulation 8: 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) Manchester (100.0%) Middletown (100.0%) New Britain (100.0%) Willimantic (100.0%) Greater New Haven (66.7%) Bridgeport (50.0%) Meriden (50.0%) Torrington (50.0%) Norwich (33.3%) Hartford (20.0%) Waterbury (16.7%) Danbury (0.0%) New Haven Metro (0.0%) Norwalk (0.0%) Stamford (0.0%) Total (47.1%) Overall Score for Outcome Measure 15 Needs Met 5 2 5 3 2 2 1 1 1 1 1 0 0 0 0 24 Needs Not Met 0 0 0 0 1 2 1 1 2 4 5 2 5 2 2 27 Total 5 2 5 3 3 4 2 2 3 5 6 2 5 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 within the Torrington Office which has a rate of 78.6% "needs met" for the 14 cases sampled. This is followed by Manchester at 75.8% within 33 cases reviewed, and the Middletown Office with 64.3% compliance within the 14 cases reviewed. The lowest rate of compliance is within the Meriden Office which shows compliance with needs met in 28.6% of the 14 cases reviewed to date.

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____________________________________

There are internal and external issues that contribute to children and families having their needs met or not. Cases that were deemed to not meet the child's needs were often impacted by circumstances beyond the assigned social worker's or social work supervisor's immediate control. The lack of sufficient foster homes, readily available appropriate services and actions by children, parents, providers, other state agencies, courts municipal operations and other contributors to the findings indicated above. A combination of internal case management issues, systemic issues (internal and outside the Department) and client determination are at the root of identified barriers to service provision. There is only a slight variation when looking at the case assignment type in relation to needs met. Of the 15 cases selected as in-home family cases, 7 or 46.7% achieved "needs met" status. Seventeen of the 36 cases with children in placement (47.2%) achieved "needs met" status. This quarter, Voluntary Service cases, both in-home and out of home failed to achieve "needs met" status. Crosstabulation 9: 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? Needs Met CPS In-Home Family Case (IHF) 7 50.0% CPS Child in Placement Case (CIP) Voluntary Services In-Home Family Case (VSIHF) Voluntary Services Child in Placement Case (VSCIP) Total 24 47.1% 27 52.9% 51 100.0% 17 48.5% 0 0.0% 0 0.0% 7 50.0% 18 51.4% 1 100.0% 1 100.0% 14 100.0% 35 100.0% 1 100.0% 1 100.0% Needs Not Met Total

The overall score was also looked at through the filter of the stated permanency goal. Transfer of Guardianship had the best rate of compliance with Outcome Measure 15 in that all three cases had needs met - 100.0%. Adoption was second highest in having needs met in that 62.5% of cases with a goal of adoption had "needs met" status. APPLA cases had the lowest rate of compliance with Outcome Measure 15 in that 33.3% had needs met. This was followed closely by reunification cases in which only 38.5% had their needs met. The full breakdown is shown below:

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____________________________________ Crosstabulation 10: 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
Overall Score for Outcome Measure 15 Needs Needs Not Met Total Met 5 8 13 38.5% 20.8% 9.8% 5 62.5% 20.8% 9.8% 3 100.0% 12.5% 5.9% 7 46.7% 29.2% 13.7% 4 33.3% 16.7% 7.8% 24 47.1% 61.5% 100.0% 29.6% 15.7% 3 25.5% 25.5% 8

What is the child or family's stated goal on the most recent approved treatment plan in place during the period? Reunification Count % within stated goal during the period? % within Overall Score for OM15 % of Total Count % within stated goal during the period? % within Overall Score for OM15 % of Total Count % within stated goal during the period? % within Overall Score for OM15 % of Total Count % within stated goal during the period? % within Overall Score for OM15 % of Total Count % within stated goal during the period? % within Overall Score for OM15 % of Total Count % within stated goal during the period? % within Overall Score for OM15 % of Total

Adoption

37.5% 100.0% 11.1% 5.9% 0 15.7% 15.7% 3

Transfer of Guardianship

.0% 100.0% .0% .0% 8 5.9% 5.9% 15

In-Home Goals Safety/Well Being Issues

53.3% 100.0% 29.6% 15.7% 8 29.4% 29.4% 12

APPLA

66.7% 100.0% 29.6% 15.7% 27 23.5% 23.5% 51

Total

52.9% 100.0%

100.0% 100.0% 100.0% 47.1% 52.9% 100.0%

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 a break between passing scores (5 or 4) and those not passing (3 or less) there is a marked difference in performance among the categories. Taken in isolation, the Department shows promising practices in legal action, safety of children in placement,

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____________________________________ attending to medical needs, and recruitment efforts for the prior period. The most problematic areas continue to be the provision of timely dental services, and mental health, behavioral health, and substance abuse services. Reviewers also felt that children in intact family situations continue to be in marginally risky situations in 15.8% of the cases. There were, however, no adverse or poor scores assessed related to risks/safety in either in-home or placement cases during this review. Please note that percentages are based on applicable cases within that category. Table 12: Treatment Plan Categories Achieving Passing Status for 4Q 2007
Category DCF Case Management ­ Legal Action to Achieve the Permanency Goal During the Prior Six Months (II.2) Safety ­ Children in Placement (I.2) Educational Needs (IV. 2) Securing the Permanent Placement ­ Action Plan for the Next Six Months (II.1) Safety ­ In Home (I.1) DCF Case Management ­ Recruitment for Placement Providers to achieve the Permanency Goal during the Prior Six Months (II.3) Child's Current Placement (IV.1) Medical Needs (III.1) Dental Needs (III.2) DCF Case Management ­ Contracting or Providing Services to achieve the Permanency Goal during the Prior Six Months (II.4) Mental Health, Behavioral and Substance Abuse Services (III.3) # Passing (Scores 4 or 5) 47 92.2% 35 92.1% 42 85.7% 33 84.6% 16 84.2% 36 83.7% 30 81.1% 41 80.4% 39 76.5% 35 68.6% 31 63.3% # Not Passing (Scores 3 or Less) 4 7.8% 3 7.9% 7 14.3% 6 15.4% 3 15.8% 7 16.3% 7 18.9% 10 19.6% 12 23.5% 16 31.4% 18 36.7%

Table 13 below provides the complete scoring for all cases by each category.

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____________________________________ Table 13: Measurements of Treatment Plan OM 15 ­ Percentage of Rank Scores Attained Across All Categories6
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" 3 15.8% 23 60.5% 18 46.2% 37 72.5% 27 62.8% 15 29.4% 26 51.0% 30 58.8% 14 28.6% 14 37.8% # Ranked Very Good "4" 13 68.4% 12 31.6% 15 38.5% 10 19.6% 9 20.9% 20 39.2% 15 29.4% 9 17.6% 17 34.7% 16 43.2% # Ranked Marginal "3" 3 15.8% 3 7.9% 6 15.4% 4 7.8% 7 16.3% 16 31.4% 7 13.7% 8 15.7% 16 32.7% 5 13.5% # Ranked Poor "2" 0 0 0 0 # Ranked Adverse/Absent "1" 0 0 0 0 N/A To Case

32 13 12 0

0

0

8

0

0

0

2 5.9% 3 5.9% 2 4.1% 2 5.4%

0 1 2.0% 0 0

0 0 2 14

25 51.0%

17 34.7%

5 10.2%

1 2.0%

1 2.0%

2

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.
6

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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 14: Mean Averages for Outcome Measure 15 - Needs Met (3rd Quarter 2006 - 4th Quarter 2007)
Outcome Measure Needs Met - Median Scores Over Time 3Q2006 4Q2006 1Q2007 4.00 3.75 3.78 4.43 4.15 4.39 2Q2007 4.00 4.36 3Q2007 4.20 4.57 4Q2007 4.00 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

4.29

4.45

4.67

4.67

4.74

4.65

4.42

4.42

4.20

4.43

4.56

4.47

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

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____________________________________ In 29 of the 51 cases, the reviewers found evidence of unmet needs during the six-month period. 70 discrete needs were identified across those 29 cases. Of those identified needs remaining unmet during the last treatment planning cycle, "mental health services" accounted for 28.6% of all needs. Table 15: Frequency of Unmet Service Needs
Category of Need Mental Health Services (n=20) Service Sub-Category Family or Marital Counseling Individual Counseling Other State Agency Therapeutic Child Care Anger Management Behavior Management JJ Intermediate Evaluation Psychiatric Evaluation Mentoring Parenting Classes Family Reunification Services Adoption Supports Foster Care Support Dental Screenings/Evaluation Dental or Orthodontic services Health/Medical Screening or Evaluation Medication Management Other Medical Intervention Developmental Screening/Evaluation DV Services - Perpetrator DV Services - Victim Outpatient Substance Abuse Substance Abuse Screening/Evaluation Substance Abuse Prevention Adoption Recruitment Matching (including ICO) Relative Foster Care Therapeutic Foster Care Life Skills Training Emergency Shelter (Family) Head Start Total Total 6 6 2 2 1 1 1 1 6 5 2 1 1 7 2 2 2 2 1 5 1 2 2 1 1 1 1 1 2 1 1 70

Support Services (n=15)

Dental (n=9) Medical (n=7)

Domestic Violence Treatment (n=6) Substance Abuse Treatment (n=5)

Out of Home Care (n=4)

Training (n=2) Housing (n=1) Education (n=1)

Barriers to meeting the needs were identified for the majority of cases. There is a combination of internal case management issues, systematic issues, (both internal and outside of the Department), and client determination issues raised as follows: 29

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____________________________________ Table 16: Barriers to Service during last six months
Provider Issue (staffing or unwilling to engage referred client) Service Does Not Exist in Community Financing Unavailable Deferred pending completion of another service DCF delay in referral no service identified Hours of Operation Insurance Issues Client Refused

wait listed

Language

No slots

Other

Service Category Dental Screenings/Evaluation Family or Marital Counseling Individual Counseling Mentoring DV Services - Perpetrator Parenting Classes Dental or Orthodontic services Family Reunification Services 1 3 2 1 1 1 1 2 1 0 1 1 1 1 2 1

2

1

1 2 1

1 - case mgmt

2

1

1 1

1- FP not in agreement

2 1 1 1 - removal caused missed appointment, 1-case mgmt 2 1-parent delay

Health/Medical Screening or Evaluation Life Skills Training 1 Medication Management Other Medical Intervention Other State Agency Outpatient Substance Abuse Substance Abuse Screening/Evaluation Therapeutic Child Care Adoption Recruitment Adoption Supports Anger Management Behavior Management Developmental Screening/Evaluation DV Services - Victim Emergency Shelter (Family) Foster Care Support Head Start JJ Intermediate Education Matching (including ICO) Psychiatric Evaluation Relative Foster Care Substance Abuse Prevention Therapeutic Foster Care All Unmet Needs 13 3 6 2 2 1 1 13 3 5 2 1 1 3 9 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 2 1 1

1 - related to side effects

1-process itself

7

30

Total 7 6 6 6 5 5 2 2 2 2 2 2 2 2 2 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 70

UTD

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____________________________________ In looking at the barriers identified, it is clear that DCF case management issues were identified in 21 of the cases cited (including deferred services, delayed referrals, internal process, financing), the client was the identified barrier for 15 instances identified, lack of provider resources are identifiable in 13 responses, issues related to a provider or foster parent resource were identified in 6 instances, and insurance issues were identified in 6 cases. In 9 cases the reviewer indicated unable to determine (UTD) the barrier. When looking forward using the current treatment planning document for the upcoming six-month period, 25 cases (49.0%) had evidence of a service need that was clearly identified at the ACR/TPC or within LINK documentation but that was not incorporated into the current treatment plan document. A total of 49 services were identified within the 30 cases. Table 17 below provides the list identified by the reviewers: Table 17: Services Not Incorporated into Current Approved Treatment Plan
Service Category Case Management/Support/Advocacy Dental Screenings/Evaluation Life Skills Training Substance Abuse Screening/Evaluation Educational screening or evaluation Individual Counseling Mentoring Therapeutic Foster Care Behavior Management Childcare/Daycare Day Treatment/Partial Hospitalization DCF Foster Care DV Shelter Family or Marital Counseling Family Reunification Services Health/Medical Screening or Evaluation Job Coaching/Placement Life Long Family Ties Matching (including ICO) Medication Management Other Medical Intervention Parenting Classes Preparation for Adult Living Residential Sexual Abuse Therapy - Victim Therapeutic Child Care Youth Shelter/STAR # 8 8 3 3 2 2 2 2 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 49

The failure to include these services directly on treatment plan action steps to achieve stated goals for the current cycle lends to subsequent failure to address the engagement and progress of these items on future treatment planning documents, as well as, misrepresenting the level of expectation for clients, providers and DCF during the period to follow.

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____________________________________

Appendix 1
Rank Scores for Outcome Measure 3 And Outcome Measure 15

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Page 33 of 77

__________________________________ Action Steps to Achieving Goals Identified for the Upcoming Six Month Period Optimal

What is the social worker's area office assignment? Bridgeport 1

Was the family or child's language needs accommodated? yes

Has the treatment plan been approved by the SWS? yes

Reason for DCF Involvement Optimal

Identifying Information Optimal

Strengths, Needs and Other Issues Optimal

Present Situation and Assessment to Date of Review Optimal

Determining the Goals/Objectives Optimal

Progress Optimal

Planning for Permanency Optimal

Overall Score for OM3 Appropriate Treatment Plan Appropriate Treatment Plan Not Appropriate Not Appropriate Not Appropriate Not Appropriate

2 yes 3 yes 4 yes 1 Danbury 2 yes yes Very Good Very Good Marginal Very Good Marginal yes yes Optimal Very Good Optimal Very Good Optimal Optimal Very Good Poor Optimal yes Optimal Marginal Marginal Marginal Very Good yes Optimal Very Good Marginal Marginal Marginal Very Good Very Good Marginal Marginal yes Optimal Very Good Very Good Very Good Very Good Optimal Marginal Very Good

Marginal

Optimal

Marginal

Marginal

33

Case 2:89-cv-00859-AHN
Juan F. v Rell Exit Plan Quarterly Report March 31, 2008

Document 554-2

Filed 04/02/2008

Page 34 of 77

__________________________________

What is the social worker's area office assignment? 1 Greater New Haven 2

Was the family or child's language needs accommodated? yes

Has the treatment plan been approved by the SWS? yes

Reason for DCF Involvement Very Good

Identifying Information Marginal

Strengths, Needs and Other Issues Marginal

Present Situation and Assessment to Date of Review Marginal

Determining the Goals/Objectives Marginal

Progress Very Good

Action Steps to Achieving Goals Identified for the Upcoming Six Month Period Marginal

Planning for Permanency Very Good

Overall Score for OM3 Not Appropriate Not Appropriate Appropriate Treatment Plan Not Appropriate Not Appropriate Appropriate Treatment Plan Not Appropriate Not Appropriate

yes 3 yes 1 Hartford 2 yes 3 yes 4 yes 5 yes yes

yes

Very Good

Marginal

Very Good

Very Good

Very Good

Marginal

Marginal

Optimal

yes

Optimal

Optimal

Optimal

Very Good

Very Good

Optimal

Very Good

Optimal

yes

Optimal

Very Good

Optimal

Very Good

Marginal

Very Good Very Good

Marginal

Marginal

yes

Optimal

Very Good

Very Good

Very Good

Marginal

Very Good

Marginal

yes

Optimal

Very Good

Optimal

Very Good

Very Good

Optimal Too early to note progress Marginal

Very Good

Very Good

yes

Optimal

Very Good

Marginal

Marginal

Poor

Poor

Very Good

yes

Very Good

Optimal

Marginal

Very Good

Very Good

Marginal

Optimal

34

Case 2:89-cv-00859-AHN
Juan F. v Rell Exit Plan Quarterly Report March 31, 2008

Document 554-2

Filed 04/02/2008

Page 35 of 77

__________________________________ Action Steps to Achieving Goals Identified for the Upcoming Six Month Period Optimal

What is the social worker's area office assignment? 1 Manchester 2

Was the family or child's language needs accommodated? yes

Has the treatment plan been approved by the SWS? yes

Reason for DCF Involvement Optimal

Identifying Information Very Good

Strengths, Needs and Other Issues Very Good

Present Situation and Assessment to Date of Review Very Good

Determining the Goals/Objectives Optimal

Progress Optimal

Planning for Permanency Optimal

Overall Score for OM3 Appropriate Treatment Plan Appropriate Treatment Plan Appropriate Treatment Plan Appropriate Treatment Plan Appropriate Treatment Plan Appropriate Treatment Plan Appropriate Treatment Plan

yes 3 yes 4 yes 5 yes 1 Meriden 2 yes yes

yes

Optimal

Very Good

Optimal

Optimal

Optimal

Optimal

Very Good

Very Good

yes

Optimal

Very Good

Optimal

Very Good

Very Good

Very Good Very Good Very Good Very Good

Very Good

Optimal

yes

Optimal

Very Good

Very Good

Optimal

Very Good

Very Good

Very Good

yes

Optimal

Optimal

Very Good

Very Good

Marginal

Very Good

Very Good

yes

Very Good

Optimal

Optimal

Optimal

Optimal

Very Good

Very Good

yes

Optimal

Very Good

Very Good

Very Good

Marginal

Optimal

Very Good

Very Good

35

Case 2:89-cv-00859-AHN
Juan F. v Rell Exit Plan Quarterly Report March 31, 2008

Document 554-2

Filed 04/02/2008

Page 36 of 77

__________________________________

What is the social worker's area office assignment? 1 Middletown 2

Was the family or child's language needs accommodated? yes

Has the treatment plan been approved by the SWS? yes

Reason for DCF Involvement Optimal

Identifying Information Optimal

Strengths, Needs and Other Issues Optimal

Present Situation and Assessment to Date of Review Optimal

Determining the Goals/Objectives Optimal

Progress Very Good

Action Steps to Achieving Goals Identified for the Upcoming Six Month Period Optimal

Planning for Permanency Optimal

Overall Score for OM3 Appropriate Treatment Plan Appropriate Treatment Plan Appropriate Treatment Plan Appropriate Treatment Plan Appropriate Treatment Plan Appropriate Treatment Plan Appropriate Treatment Plan

yes 1 New Britain 2 yes 3 yes 4 yes 5 yes yes

yes

Optimal

Very Good

Optimal

Optimal

Very Good

Optimal

Very Good

Very Good

yes

Optimal

Very Good

Very Good

Very Good

Very Good

Optimal

Optimal

Very Good

yes

Optimal

Optimal

Optimal

Optimal

Very Good

Optimal

Very Good

Optimal

yes

Optimal

Very Good

Very Good

Optimal

Very Good

Very Good Very Good

Very Good

Optimal

yes

Optimal

Very Good

Optimal

Optimal

Very Good

Optimal

Optimal

yes

Optimal

Optimal

Optimal

Optimal

Optimal

Optimal

Marginal

Optimal

36

Case 2:89-cv-00859-AHN
Juan F. v Rell Exit Plan Quarterly Report March 31, 2008

Document 554-2

Filed 04/02/2008

Page 37 of 77

__________________________________

What is the social worker's area office assignment? 1 New Haven Metro 2 3

Was the family or child's language needs accommodated? yes

Has the treatment plan been approved by the SWS? yes

Reason for DCF Involvement Very Good

Identifying Information Very Good

Strengths, Needs and Other Issues Optimal

Present Situation and Assessment to Date of Review Optimal

Determining the Goals/Object