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 July 1, 2007 ­ September 30, 2007 Civil Action No. H-89-859 (AHN) December 19, 2007

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 December 19, 2007 _________________________________

Table of Contents Juan F. v Rell Exit Plan Quarterly Report July 1, 2007 ­ September 30, 2007 Page Highlights July 1, 2007 through September 30, 2007 Exit Plan Outcome Measure Overview Chart Outcome Measure 3 & 15 Report (Third Quarter) Appendix 1 ­ Rank Scores for Outcome Measure 3 and Outcome Measure 15 ­Third Quarter 2007 Juan F. Action Plan Appendix 2 ­ The Department's Exit Plan Outcome Measures Summary Report Third Quarter Report July 1, 2007 ­ September 30, 2007 3 6

7 25

28 52

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Juan F. v Rell Exit Plan Quarterly Report December 19, 2007 _________________________________

Juan F. v Rell Exit Plan Quarterly Report July 1, 2007 ­ September 30, 2007 Highlights 1. The Monitor's quarterly review of the Department's efforts in meeting the Exit Plan Outcome Measures during the period of July 1, 2007 through September 30, 2007 indicates that the Department achieved 17 of the 22 measures. 2. For the fourth consecutive quarter, the Department achieved all three permanency measures, Reunification (Outcome Measure 7), Adoption (Outcome Measure 8), and Transfer of Guardianship (Outcome Measure 9). 3. Based on the Monitor's review of a 50 case sample (see Monitor's Office Case Review for Outcome Measure 3 and Outcome Measure 15, pages# 7 to # 27), the Department of Children and Families attained the level of "Appropriate Treatment Plan" in 15 of the 50-case sample or 30.0% and attained the designation of "Needs Met" in 32 of the 50 case sample or 64.0%. While some improvement was noted, many treatment plans lacked sufficient action steps, short-term goals and explanations of progress in meeting the steps and goals articulated in the previous treatment plan. Provider input was again minimal or absent in a number of the cases reviewed. System gridlock continues to exist and discharge delays, waiting lists for community services, and the lack of sufficient foster and adoptive homes are identified in many of the cases sampled within the various reviews conducted during the recent months. A number of initiatives were undertaken during the quarter to facilitate improvement with these measures. In addition to specific trainings, utilization of practice guides and case review activities by the Area Office Managers, there were multiple training events for the Administrative Case Review staff in collaboration with the Court Monitor's Office. In addition, in an effort to give real-time information, interim feedback by the Court Monitor's Office was provided to the Area Offices as individual case reviews were completed, rather than after the completion of the quarterly sample. Some offices utilized the feedback to revise treatment plans and/or improve service provision to correct deficiencies. Revised plans were forwarded to all parties involved with the family or child by these offices. The quarterly report section, Juan F. Action Plan, includes additional information related to meeting the service and permanency needs of children and families.

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Juan F. v Rell Exit Plan Quarterly Report December 19, 2007 _________________________________

4. The Department exceeded the Repeat Maltreatment standard (Outcome Measure 5) for the second consecutive quarter with a rate of 6.1%. 5. There are a large number of adolescents (approximately 1300) who have the nonpreferred permanency goal of Another Planned Permanent Living Arrangement (APPLA). Many of these children have extended stays in out of home placement and have not had their permanency needs adequately attended to by DCF and the providers serving them. While some of these children are in stable placements and may have stated their desire for no further adoption recruitment, our ongoing reviews find that in addition to placement and permanency needs, other needs remain unmet at a higher rate than other children in care. These include: appropriate mental health treatment, education services, medical/dental treatment and transitional services. 6. The Court Monitor's Office has completed the data collection on a review of children in temporary placements who are in overstay status (STAR/Shelter programs and SAFE Homes). The data is currently being entered and analyzed. The Court Monitor will produce a report of the findings later this month. 7. The Monitor's quarterly review of the Department for the period of July 1, 2007 through September 30, 2007 indicates the Department has achieved compliance with the following 17 Outcome Measures: · Commencement of Investigations (97.0%) · Completion of Investigations (94.2%) · Search for Relatives (91.8%) · Repeat Maltreatment (6.1%) · Maltreatment of Children in Out-of-Home Care (0.3%) · Reunification (65.5%) · Adoption (36.2%) · Transfer of Guardianship (76.8%) · Multiple Placements (94.4%) · Foster Parent Training (100.0%) · Placement within Licensed Capacity (96.9%) · Worker-Child Visitation Out-of-Home Cases (94.8% Monthly/ 98.7% Quarterly) · Worker-Child Visitation In-Home Cases (89.4%) · Caseload Standards (100.0%) · Residential Reduction (10.8%) · Discharge Measures (95%) · Multi-disciplinary Exams (95.2%)

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Juan F. v Rell Exit Plan Quarterly Report December 19, 2007 _________________________________

8. The Department has maintained compliance for at least two (2) consecutive quarters1 with 17 of the Outcome Measures. (Measures are shown with designation of the number of consecutive quarters for which the measure was achieved): · Commencement of Investigations (twelfth consecutive quarter) · Completion of Investigations (twelfth consecutive quarter) · Search for Relatives (eighth consecutive quarter) · Repeat Maltreatment (second consecutive quarter) · Maltreatment of Children in Out-of-Home Care (fifteenth consecutive quarter) · Reunification (ninth consecutive quarter) · Adoption (fourth consecutive quarter) · Transfer of Guardianship (fifth consecutive quarter) · Multiple Placements (fourteenth consecutive quarter) · Foster Parent Training (fourteenth consecutive quarter) · Placement within Licensed Capacity (fifth consecutive quarter) · Visitation Out-of-Home (eighth consecutive quarter) · Visitation In-Home (eighth consecutive quarter) · Caseload Standards (thirteenth consecutive quarter) · Residential Reduction (ninth consecutive quarter) · Discharge Measures (ninth consecutive quarter) · Multi-disciplinary Exams (seventh consecutive quarter) 9. The Monitor's quarterly review of the Department for the period of July 1, 2007 through September 30, 2007 indicates that the Department did not achieve compliance with five (5) measures: · Treatment Plans (30.0%) · Sibling Placements (83.39%) · Re-Entry (9.0%) · Children's Needs Met (64.0%) · 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 December 19, 2007 _________________________________ 3Q July 1- September 30, 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

1: Investigation Commencement 2: Investigation Completion

>=90%

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%

>=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% X X X X 10% 93% 17% X X X X X X 54% 41.1% 41.3% 30.3 X

3: Treatment Plans** >=90% 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 >=85% <=7% <=2% >=60%

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

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%

>=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% >=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% >=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%

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

>=96% 88.3% 92%

93% 95.7% 97% 95.9% 94.8% 96.2% 95.2% 94.5% 96.7% 96.4% 96.8% 97.1% 96.9%

>=80% >=85% 100% >=85%

53% 72% 87% 39%

57% 86% 98% 40%

53% 73% 93% 46%

56%

X

X

X

X

X

X

62% 52.1% 45.3% 51.3%

X

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

100% 73.1% 100% 100% 100% 100% 100% 99.8% 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% >=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%

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%

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Juan F. v Rell Exit Plan Quarterly Report December 19, 2007 _________________________________

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 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 Third Quarter 2007, the Monitor's Office reviewed a total of 50 cases. This quarter's 50-case sample was stratified based upon the distribution of area office caseload on June 1, 2007. 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 June 1, 2007 Caseload Universe
Area Office Bridgeport Danbury Greater New Haven Hartford Manchester Meriden Middletown New Britain New Haven Metro Norwalk Norwich Stamford Torrington Waterbury Willimantic Grand Total Total Caseload 1,198 346 929 1,857 1,302 593 415 1,493 1,493 248 1,123 276 457 1,302 847 13,879 % of State Caseload 8.6% 2.5% 6.7% 13.4% 9.4% 4.3% 3.0% 10.8% 10.8% 1.8% 8.1% 2.0% 3.3% 9.4% 6.1% 100.0% % of In-Home Cases in AO 36.0% 14.0% 24.0% 20.0% 27.0% 31.0% 25.0% 35.0% 32.0% 35.0% 32.0% 39.0% 13.0% 22.0% 28.0% In-Home Sample 1 1 1 1 1 1 1 2 2 1 1 1 1 1 1 17 OOH Sample 3 1 2 4 4 1 1 3 3 1 3 1 1 3 2 33 Total Sample 4 2 3 5 5 2 2 5 5 2 4 2 2 4 3 50

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

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Juan F. v Rell Exit Plan Quarterly Report December 19, 2007 _________________________________

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 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 (TAC) for review. During the fourth quarter, there were 8 such cases submitted for consideration/assistance of supervisory oversight. Two cases were requests for override on Outcome Measure 3 and six cases were requests for override on Outcome Measure 15. All requests were valid and resulted in the approval of an override to allow a passing score. These cases can be identified in the appendix document scoring tables later in this document. Sample Demographics The sample consisted of 50 cases distributed among the fifteen area offices. The work of 50 Social Workers and 44 Social Work Supervisors' work was incorporated into the record review. At the point of review, the data indicates that the majority of cases (66.0%) are children in care for child protective service reasons. A full description of the sample by case type is provided below along with indication of the children in placement during the quarter having some involvement with the Juvenile Justice System during the quarter.
2

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 December 19, 2007 _________________________________

Crosstabulation 1: What is the type of case assignment noted in LINK? * Does child in placement have involvement with the juvenile justice system?
Does child in placement have involvement with the juvenile justice system? What is the type of case assignment noted in LINK? CPS In-Home Family Case (IHF)3 In-Home CPS or Voluntary Service Case 1 26 1 0 28 15 0 1 1 17

Yes 0 5 0 0 5

No

Total 16 31 2 1 50

CPS Child in Placement Case (CIP) Voluntary Services Child in Placement Case (VSCIP) Voluntary Services In-Home Family Case Total

As shown above, of the 33 children with out of home placements during the quarter, five or 15.2% also had documented involvement with the juvenile justice system during the period. In establishing the reason for the most recent case open date identified, reviewers were asked to identify all substantiations 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, 113 reasons were identified. The data indicates that physical neglect remains the most frequent reason for a case opening in treatment, as 72.0% of the cases cited this as one of the factors for the case opening. This was again followed by Parental Substance Abuse/ Mental Health which was present in 52.0% of the cases reviewed, and Emotional Neglect cited in 26.0% of the cases sampled. Additionally, our tool was edited to include three new questions, first related to the child's condition, asking, "Did the child have behavioral, medical, substance abuse or delinquent behaviors in conjunction with CPS concerns in the home?" Thirty-six percent of the cases designated this as a "yes" response. Second, "Is there a history of prior investigations?" which indicated 56% of the sample had at least one prior investigation on record. And, lastly, "does the parent have a history including prior TPR'd children?" which reported a 10% population having had one or more children for which the parents rights were terminated prior to the recent case open date.

3

Includes one child who had placement episode during the quarter but was reunified at point of review.

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Juan F. v Rell Exit Plan Quarterly Report December 19, 2007 _________________________________

Table 2: Causes for DCF involvement on Date of Most recent Case Opening
What was the cause for DCF's involvement on this date? Physical Neglect Substance Abuse/Mental Health (Parent) Emotional Neglect Domestic Violence Physical Abuse Voluntary Services Request (child) FWSN Referral Abandonment Child's TPR Case prompted new opening Emotional Abuse/Maltreatment Sexual Abuse Educational Neglect Medical Neglect Total Number Alleged/Identified 36 26 13 8 8 6 4 3 3 2 2 1 1 113 Number Substantiated 34 10 7 4 4 3 1 0 1 1 65

When asked to isolate the primary reason for case opening among those identified for each case; physical neglect was identified for 46.0% of the sample set. Table 3: What is the primary reason cited for case opening/reopening?
Reason Physical Neglect Substance Abuse Voluntary Service Request Child's TPR Domestic Violence Physical Abuse Abandonment Educational Neglect Emotional Abuse/Maltreatment Emotional Neglect Medical Neglect Sexual Abuse Total Frequency 23 7 6 4 2 2 1 1 1 1 1 1 76 Percent 46.0% 14.0% 12.0% 8.0% 4.0% 4.0% 2.0% 2.0% 2.0% 2.0% 2.0% 2.0% 100.0%

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Juan F. v Rell Exit Plan Quarterly Report December 19, 2007 _________________________________

DCF approved permanency/case goals were identified for 47 of the 50 cases reviewed (94.0%). DCF policy requires concurrent planning when reunification or APPLA are the designated. Of the 10 situations in which "Reunification" was the permanency goal, there was a required concurrent plan documented in 9 cases (90.0%). Of the five cases with the goal of APPLA, only one case (20%) identified a concurrent goal. Two of these instances were deemed "very good" due to the facts presented at the ACR and through the record review. The teenager in each case indicated that they did not wish to pursue adoption or transfer of guardianship, and family relationships remained a focus maintained through visitation and therapy services. The remaining cases did not document such clear rationale for the APPLA and were scored marginally and poor as a result of the failure to identify a concurrent plan to the APPLA goal. Table 4: What is the child or family's stated permanency 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 APPLA: Permanent Non-Relative Foster Care UTD - plan incomplete - unapproved or missing Goal indicated is not an approved DCF goal Long Term Foster Care with a licensed relative Total Frequency 17 14 10 3 2 2 1 1 50 Percent 34.0% 28.0% 20.0% 6.0% 4.0% 4.0% 2.0% 2.0% 100.0%

Children in placement had various lengths of stay at the point of our review. This ranged from less than one month, to greater than 24 months. Below 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 three cases in which the child's length of stay and permanency goal required the filing of TPR, it had not been done nor was an exception noted in LINK.

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Juan F. v Rell Exit Plan Quarterly Report December 19, 2007 _________________________________

Crosstabulation 2: Has child's length of stay exceeded the 15 of the last 22-month 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 N/A - TPR has already been filed or granted Yes No Has TPR been Filed? N/A N/A - Child's Exception goal and length Noted in of time do not LINK require TPR 3 0 1 7 0 0 4 7 Total

2 1 7 10

3 6 0 9

8 15 7 30

At the point of review, the children in placement were predominantly in foster care settings. Twenty-one children were in DCF licensed foster homes, of which there were 12 relative homes and one special study home. Three children were living in private provider foster homes in Connecticut. One child was in a group home, and one child was in a Safe Home. Three children were in in-state residential settings and two were in out of state residential settings. One child was on a trial home visit with their biological parent/guardian. One child was in detention. Five of the children in placement were identified as awaiting placement on the ASO list. Of that number, one was indicated as being in delayed status. 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 third quarter case review data indicates that the Department of Children and Families attained the level of "Appropriate Treatment Plan" in 15 of the 50-case sample or 30.0%. All of the cases sampled (100%) had a plan less than 7 months old at the point of review. Two of the plans not passing (4.0%) did not have social work supervisory approval. Both of these plans had one or more sections with less than a "very good" rating and would have been deemed inappropriate regardless of approval status. In respect to accommodating primary language of clients, 98.0% of the cases had documentation that families' language needs were met (One case was unable to be determined as to compliance with meeting language needs due to inability to confirm that biological father was directly approached to determine need for translation. Narratives indicate ongoing language barrier but remainder of family speaks predominately English). Of the 33 cases with children in placement, eight, or 27.3% achieved an overall determination of "appropriate treatment plan". In-Home cases achieved this designation

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Juan F. v Rell Exit Plan Quarterly Report December 19, 2007 _________________________________

35.3% of the time. The following crosstabulation provides further breakdown to distinguish between voluntary and child protective services cases as well. Crosstabulation 3: What is the type of case assignment noted in LINK? * Overall Score for OM3
Type of Case Assignment CPS In-Home Family Voluntary Services In-Home Family CPS Child in Placement Voluntary Services Child in Placement Total Appropriate Treatment Plan # % 5 31.3% 1 100.0% 8 25.8% 1 50.0% 15 30.0% Overall Score for OM3 Not an Appropriate Treatment Plan # % 11 68.8% 0 0% 23 74.2% 1 50.0% 35 70.0% Total # 16 1 31 2 50 % 100.0% 100.0% 100.0% 100.0% 100.0%

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. Table 5: Participation and Attendance Rates for Active Case Participants within the Sample Set
Identified Case Participant Other Participants Foster Parent Mother Active Service Providers Child Other DCF Staff Father Parents' Attorney Attorney/GAL (Child) Percentage with documented Participation/Engagement in Treatment Planning Discussion 80.9% 79.2% 67.4% 54.4% 54.2% 46.2% 29.3% 16.1% 14.3% Percentage Attending the TPC/ACR or Family Conference (when held) 83.3% 62.5% 56.4% 35.5% 36.4% 44.0% 28.6% 10.7% 12.1%

Attendance rates still appear to be problematic for most case participants. Reviewers most noted a failure to invite adolescents and fathers, and the overall lack of engagement with both children's and parents' attorneys. However, it is evidenced by the data that there is an increase in the rate of inclusion of other supports or kin when identified by the family. 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.

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Juan F. v Rell Exit Plan Quarterly Report December 19, 2007 _________________________________

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. 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=50), the second is the children in out of home placement (CIP) cases (n=33) 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. "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".

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Juan F. v Rell Exit Plan Quarterly Report December 18, 2007 _________________________________ Table 6: 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. Progress4 II.3 Action Steps to Achieving Goals Identified II.4 Planning for Permanency Optimal "5" 36 8 17 17 12 11 4 20 Very Good "4" 11 32 24 19 15 22 15 20 Marginal "3" 3 9 9 12 19 12 28 5 Poor "2" 0 0 0 2 4 4 3 4 Adverse/Absent "1" 0 1 0 0 0 0 0 1

Table 7: 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" 21 3 9 12 7 8 3 9 Very Good "4" 9 22 15 12 10 14 8 14 Marginal "3" 3 8 9 7 12 8 20 5 Poor "2" 0 0 0 2 4 3 2 4 Adverse/Absent "1" 0 0 0 0 0 0 0 1

Table 8: 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
4 5

Optimal "5" 15 5 8 5 5 3 1 11

Very Good "4" 2 10 9 7 5 8 7 6

Marginal "3" 0 1 0 5 7 4 8 0

Poor "2" 0 0 0 0 0 1 1 0

Adverse/Absent "1" 0 1 0 0 0 0 0 0

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

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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), and in 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). While acknowledging the disappointing overall results of cases meeting the Outcome Measure 3 standard, the Department has made strides in some areas which can be recognized when examining the averages over time. The requirement for Outcome Measure 3 is for 90% of the sample cases to have an overall passing score rather than achieve a statewide average for individual subcategories that are within the passing range. This quarter, four of the seven 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.
Chart 1: Mean Averages for Outcome Measure 3 - Treatment Planning (3rd Quarter 2006 3rd Quarter 2007)
Quarterly Mean Scores for Treatment Planning Categories 3Q2006 to 3Q2007

5.00 4.75 4.50 4.25 4.00 3.75

Rank Scores

3.50 3.25 3.00 2.75 2.50 2.25 2.00 1.75 1.50 1.25 1.00
In fo rm at io n M on th s pc om in g 6 Pl an ni n U ev ie w m en t fo rP er m an en cy g th er Is su es ec tiv es Pr og re ss
2Q2007

In vo lve

of R

St re ng th s, N ee d

As se ss m en tt o

ea so n

Id en tif

D et er m in in g

G oa ls /O bj

Fo r

yin g

s, O

D

at e

R

Pr es en tS it u at io

n

3Q2006

4Q2006

1Q2007

Ac tio n
3Q2007

An d

St ep s

fo r

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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." Review Findings and Trends The case review data indicates that the Department of Children and Families attained the designation of "Needs Met" in 64.0% of the 50-case sample. There is only a slight variation when looking at the case assignment type in relation to needs met. Of the 16 cases selected as CPS in-home family cases, 9 or 56.3% achieved "needs met" status. Twenty of the 31 CPS cases with children in placement (64.5%) achieved "needs met" status, and all of the three Voluntary Service cases, both in-home and out of home achieved "needs met" status. Crosstabulation 4: Overall Score for Outcome Measure 15 * What is the type of case assignment noted in LINK?
Assignment Type CPS In-Home Family CPS Child in Placement Voluntary Services In-Home Family Voluntary Services Child in Placement Total Count % within Assignment Type % within Overall Score Count % within Assignment Type % within Overall Score Count % within Assignment Type % within Overall Score Count % within Assignment Type % within Overall Score Count % within Assignment Type % within Overall Score Overall Score for Outcome Measure 15 9 7 16 56.3% 43.8% 100.0% 28.1% 38.9% 32.0% 20 11 31 32.3% 36.7% 100.0% 60.6% 64.7% 62.0% 1 0 1 100.0% 0.0% 100.0% 3.0% 0.0% 2.0% 2 0 2 100.0% 0.0% 100.0% 6.1% 0.0% 4.0% 32 18 50 64.0% 36.0% 100.0% 100.0% 100.0% 100.0%

The overall score was also looked at through the filter of the stated permanency goal. The full breakdown is shown below:

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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 Outcome Measure 15
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? Count Reunification % within goal % within Overall Score Adoption Count % within goal % within Overall Score Long Term Foster Care with a licensed relative Count % within goal % within Overall Score APPLA: Permanent Non-Relative Foster Care6 Count % within goal % within Overall Score APPLA Count % within goal % within Overall Score In-Home Goals - Safety/Well Being Issues Count % within goal % within Overall Score Goal indicated is not an approved DCF goal Count % within goal % within Overall Score UTD Count % within goal % within Overall Score Total Count % within goal % within Overall Score Needs Met 7 70.0% 21.2% 13 92.9% 39.4% 0 0.0% 0.0% 1 50.0% 3.0% 1 33.3% 3.0% 10 58.8% 31.3% 0 .0% .0% 0 .0% .0% 33 66.0% 100.0% Needs Not Met 3 30.0% 17.6% 1 7.1% 5.9% 1 100.0% 5.9% 1 50.0% 5.9% 2 66.7% 11.8% 7 41.2% 38.9% 1 100.0% 5.9% 2 100.0% 11.8% 17 34.0% 100.0% Total 10 100.0% 20.0% 14 100.0% 28.0% 1 100.0% 2.0% 2 100.0% 4.0% 3 100.0% 6.0% 17 100.0% 34.0% 1 100.0% 2.0% 2 100.0% 4.0% 50 100.0% 100.0%

This APPLA goal is not longer an acceptable designation, but given the crossover of area office training and our review process for this quarter, we are not identifying them as "unapproved goals" at this juncture.

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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, attending to medical needs, and recruitment efforts for the prior period. Most problematic continue to be 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 situations of questionable risk in 26.9% of the cases. The majority of these cases were borderline/marginal in nature. In only one case did the review score the in-home situation "poor". There were no adverse scores noted related to safety. Table 9: Treatment Plan Categories Achieving Passing Status for 3Q 2007
Category DCF Case Management ­ Legal Action to Achieve the Permanency Goal During the Prior Six Months (II.2) Medical Needs (III.1) DCF Case Management ­ Recruitment for Placement Providers to achieve the Permanency Goal during the Prior Six Months (II.3) Dental Needs (III.2) DCF Case Management ­ Contracting or Providing Services to achieve the Permanency Goal during the Prior Six Months (II.4) Safety ­ Children in Placement (I.2) Mental Health, Behavioral and Substance Abuse Services (III.3) Securing the Permanent Placement ­ Action Plan for the Next Six Months (II.1) Educational Needs (IV. 2) Child's Current Placement (IV.1) Safety ­ In Home (I.1) # Passing (Scores 4 or 5) 48 96.0% 42 84.0% 38 97.4% 38 76.0% 38 76.0% 35 94.6% 33 73.3% 32 88.9% 30 81.1% 29 82.9% 18 90.0% # Not Passing (Scores 3 or Less) 2 4.0% 8 16.0% 1 2.6% 12 24.0% 12 24.0% 2 5.4% 12 26.7% 4 11.1% 7 18.9% 6 17.1% 2 10.0%

Table 10 below provides the complete scoring for all cases by each category.

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Table 10: Measurements of Treatment Plan OM 15 ­ Percentage of Rank Scores Attained Across All Categories7
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 during the Prior Six Months II.4. DCF Case Management ­ Contracting or Providing Services to achieve the Permanency Goal during the 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" # Ranked Very Good "4" # Ranked Marginal "3" # Ranked Poor "2" # Ranked Adverse/Absent "1" N/A To Case

6 23 24 39 23

12 12 8 9 15

2 2 3 2 1

0 0 1 0 0

0 0 0 0 0

30 37 14 0 11

19

19

11

1

0

0

27 25 15 19 20

15 13 18 10 10

7 7 10 6 6

0 3 2 0 1

1 2 0 0 0

0 0 5 15 13

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. At the point of sampling, the total number identified for the in-home sample was 23 cases. However, a number of cases had both in-home and out of home status at some point during the six month period of review.
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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. Chart 2: Mean Averages for Outcome Measure 15 - Needs Met (3rd Quarter 2006 - 3rd Quarter 2007)

Outcome Measure 15: "Needs Met" Mean Scores Over Time
5.00 4.50 4.00

Rank Scores

3.50 3.00 2.50 2.00 1.50 1.00 Safety: In-Home Safety: CIP Permanency: Permanency: Permanency: Permanency: Securing the DCF Case Mgmt DCF Case Mgmt DCF Case Mgmt Permanent - Legal Action - Recruitment - Contracting or Placement to Achieve for Placement Providing Action Plan for Permanency in Providers to Services to the Next Six Prior Six Achieve Achieve Months Months Permanency in Permanency Prior Six during Prior Six Months 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

3Q2006

4Q2006

1Q2007

2Q2007

3Q2007

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In addition to looking at the twelve categories of Outcome Measure 15, the review also collected data on situations in which a case had a need identified at the prior ACR, treatment plan or within the period's LINK record. Data was collected on those that remained unresolved at the point of the most recent treatment planning efforts. In 32 of the 50 cases, the reviewers found unmet needs. 67 discrete needs were identified. Of those identified needs remaining unmet during the last treatment planning cycle, "mental health services" was the most frequently cited, within 46% of the sample and comprising 71.9% of the subset of cases with unmet needs. Others included: Table 11: Frequency of Unmet Service Needs
Identified Category of Service Need Type Mental Health Services Dental Substance Abuse Treatment Medical Out of Home Care Domestic Violence Treatment Housing Out of Home Support Services Education Training In-Home Support Services DCF Case Management Frequency 23 9 6 6 5 5 4 3 2 2 1 1 67 % of times identified in Cases with Unmet Needs (n=32) 71.9% 28.1% 18.8% 18.8% 15.6% 15.6% 12.5% 9.4% 6.2% 6.3% 3.1% 3.1%

Barriers were identified for the unmet needs cited above. Most frequently the barrier was identified as client refusal (as identified by the Social Worker), followed by delay in referral. There was a large portion with reviewers identifying delays but selecting UTD as a response. Reviewers have been advised to address clarifying questions to the SWS or SW in future reviews to obtain more clarity in these situations.

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Table 12: What was the primary barrier that prevented families or children from having their medical, dental, mental health or other service need met?
Barrier Client Refused Service UTD from treatment plan or narrative Other8 Delay in Referral by Worker Wait List Mother whereabouts unknown No Slots Available Insurance Gender Specific Services Not Available - Male Service Not Available for Age Group No service Identified Provider Delay due to Staffing Referred service is unwilling to engage client Service deferred pending completion of another Frequency 17 14 8 11 4 3 2 2 1 1 1 1 1 1 67 % of all Barriers Identified 25.4% 20.9% 11.9% 16.4% 6.0% 4.5% 3.0% 3.0% 1.5% 1.5% 1.5% 1.5% 1.5% 1.5%

When looking specifically at the current treatment planning document for the upcoming six month period, 30 cases (60.0%) had evidence of a service need that was clearly identified at the ACR/TPC or within LINK documentation but not incorporated into the current treatment plan document. A total of 61 services were identified within the 30 cases. Table 13 provides the list identified by the reviewers: Table 13: Service Needs Not Incorporated into the Current Treatment Plan
Identified Category of Service Need Type Out of Home Support Services Mental Health services Dental Medical In-home Support Services DCF Education Substance Abuse Treatment Training Domestic Violence Treatment Childcare Employment Housing Frequency 5 9 7 6 5 10 3 4 3 6 1 1 1 61 % within Cases with Missing Service Needs (n=30) 16.7% 30.0% 23.3% 20.0% 16.7% 33.3% 10.0% 13.3% 10.0% 20.0% 3.3% 3.3% 3.3%

Included: Court delayed receipt of evaluation materials - delaying additional evaluation; Parents moved to Utah; Prioritization of multiple services for complex needs delayed dental; SW left agency - two months passed until new SW re-referred (2 services); Mother became whereabouts unknown during period; No TFC homes are available.

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The failure to include these services directly on treatment plan action steps to achieve stated goals for the current cycle leads to subsequent failure to address the engagement and progress of these items. In addition it misrepresents the expectation levels for clients, providers and DCF during the period to follow.

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

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Left blank for insertion of OM 3 Appendix

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Left Blank for Insertion of OM15 Appendix

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Juan F. Action Plan In March 2007, the parties agreed to an action plan for addressing key components of case practice related to meeting children's needs. The Juan F. Action Plan focuses on a number of key action steps to address permanency, placement and treatment issues that impact children served by the Department. These issues include children in SAFE Homes and other emergency or temporary placements for more than 60 days; children in congregate care (especially children age 12 and under); and the permanency service needs of children in care, particularly those in care for 15 months or longer. A set of monitoring strategies for the Juan F. Action Plan were finalized by the Court Monitor. The monitoring strategies include regular meetings with the Department staff, the Plaintiffs, provider groups, and other stakeholders to focus on the impact of the action steps outlined in the Juan F. Action Plan; selected on-site visits with a variety of providers each quarter; targeted reviews of critical elements of the Juan F. Action Plan; ongoing analysis of submitted data reports; and attendance at a variety of meetings related to the specific initiatives and ongoing activities outlined in the Juan F. Action Plan. Targeted reviews are underway that build upon the current methodology for Needs Met (Outcome Measure 15) and incorporate additional qualitative review elements including interviews with children and families, assigned DCF staff, service providers, and significant collaterals within cases reviewed. These reviews will inform the parties and promote practice improvement. These reviews were developed and piloted beginning in September 2007. The Court Monitor continues to work closely with both parties to ensure that the reviews are targeted, integrated and results orientated. A review of children in temporary placements, STAR/Shelter programs and SAFE Home programs is being conducted by the Court Monitor. Data is currently being entered into the database and analysis will commence shortly. A report detailing the results and findings will be disseminated in the next month.

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Juan F. Action Plan Summary Third Quarter Updates: The Connecticut Behavioral Health Partnership (CTBHP) in collaboration with the Department of Children and Families has conducted and released a study of children placed in foster care, analyzing the relationship between the use of behavioral health services and disruption from a first or second foster home placement. The following is a summary of key findings: · Across all comparisons, disruption rates for youth placed in relative care or special study care were significantly lower than for youth placed in traditional foster care. · Most disruptions occur within the first 7 days of removal from the home. · Between 25% and 47% of youth placed in foster care experienced a care disruption between their first placement and May 1, 2007. The rate of disruption was dependent on the definition of disruption being used. For youth in relative care/special study, the rate of disruption was from 9% to 12%, depending on the definition of disruption. · Older youth (age 10 to 18) were more likely to experience a disruption than children ages birth to 10. Gender did not appear to be related to disruption rates. Certain ethnicity issues did appear to be related to disruption; Hispanic youth entering foster care and African American youth entering relative care/special study were more likely to experience disruption than respective comparison groups despite the definition of disruption being used. · When disruptions were categorized into negative and positive types, foster care youth who had been authorized for behavioral health services during the six (6) months before foster care placement were significantly more likely to disrupt (52.4%) than those without service authorizations (35.8%). There was no association, however, when other definitions of disruption were considered. · Among foster care youth and those in relative care/special study, those who had been authorized during the six (6) months after placement were significantly more likely to disrupt than those without services authorizations. · The original anecdotal question of whether children in foster care accessing the Emergency Department (ED) were an indicator for subsequent disruption from that placement could not be examined. There was inadequate sample size to test this hypothesis; there was null data for 99.5% of the 722 children in foster care and 100% null data for the 280 children in Relative/Special Study Care. Recommendations from Value Options are being developed for submission to DCF that will focus on development of appropriate clinical interventions targeted at reducing disruption in foster care placement. · On September 26, 2007, the targeted intervention utilized the previous spring was reinstated in response to a significant number of children being served by the Connecticut Children's Medical Center (CCMC) Emergency Department. In addition, a six-bed Child and Adolescent Rapid Emergency Stabilization Service (CARES) unit opened at the Institute of Living (IOL) on October 15, 2007. The crisis assessment and brief (3 day) stabilization unit is designed to provide an opportunity for children to transfer from the ED for assessment services and relieve overcrowding at the ED.

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Value Options and DCF staff are reviewing and considering changes to the roles of the System Managers. Consideration is being given to focus the System Managers role by identifying one or two major areas of work or projects that are Area Office specific that will facilitate achievement of broader goals. The areas of focus may include; developing or improving community collaborative, assisting with foster care recruitment activities, communication of provider specific information along with case review and discussion of provider performances. The efforts of System Managers have been most useful in Area Offices where integration of behavioral health expertise is embraced and utilized in a collaborative manner. The finalization of Local Area Development Plans (LADP) has been held up pending decisions on the restructuring of System Management component. These plans are intended to identify goals and action steps to support local and system development and service expansion. The primary areas of focus/goals are access to care and quality of care. A change to the referral process for the Behavioral Health Partnership is in progress. A new flow chart that details the revised process will be released shortly. The change will include further definition of the clinical information that must be provided in conjunction with Child and Adolescent Needs Strength Inventory (CANS). A two day CANS "Train the Trainer" event was held on October 15th-16th that was presented by Dr. John Lyons, the developer of CANS. This event provided a forum for staff to utilize a refresher course in the use of CANS and present questions regarding the instrument as well as system issues. New procedures to incorporate the staff assigned to each residential faculty are being developed for release later this month. The recently hired licensed clinical staff will be included in the process of reviewing referrals and matching children with treatment programs (residential and group home). These Residential Team members will serve as Program leads and will have facility, routine, and special assignments. Concurrent reviews will begin that are conducted by VO staff with in-state facilities which will provide additional clinical oversight then is currently occurring. Gridlock remains throughout the treatment and service array. Discharge delays at emergency departments, group homes, residential treatment centers, SAFE Homes and 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, DD/MR children and assaulted 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 is increasing. During the past quarter a series of meetings were held with each of the Area Directors and their Behavioral Health Program Directors (BHPD), Karl Kemper; Chief of Staff, Dr. Karen Anderson; Health Management Administrator, and Lori Szczgiel; CEO, Connecticut Behavioral Health Partnership (CTBHP). These meetings

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focused on ways to better manage existing resources including efficient utilization of residential treatment services. The Department is developing specific action plans to address the residential care population. These action steps will attempt to ensure a more focused treatment intervention, assure that treatment provided meets the presenting needs of the child, and that children do not remain in residential care once their treatment needs are met through effective discharge planning. Access to all levels of care must be prompt. · Wait-lists for in-home services and outpatient services continue to exist on a regular basis. The implementation of the recent legislation regarding Families with Services Needs (FWSN) is exacerbating the existing problem of timely provision of services due to the increasing number of children that the Department must serve via these referrals. Clinical rounds continue to be held bi-weekly over at the CTBHP Service Center. In addition to the Residential Care Team, staff members from all 4 DCF facilities and key program staff attend in order to review the waiting list for care against the immediate vacancy list. Providers have been in attendance to observe the process. A new "dashboard" report that is designed to track the number of referrals against a variety of variables including age, sex, area office, presenting problem has been completed and was distributed to BHPDs in September and again in October. While data is accurate for in-state Residential Treatment Centers, out of state residential treatment remains a problem as Value Options is experiencing difficulty outreaching to all of the 66 licensed facilities that are used (many of whom serve 3 or fewer children). Value Options intends to have all children entered into the system within the next 2 months. The point-in-time data submitted by the Department indicates some progress regarding children in overstay status in SAFE Homes. The number of children in SAFE Homes greater than 60 days was 100 in August 2007 and 81 as of November 2007. Meanwhile, the same data report indicates that 50 children were in placement longer than 60 days in a STAR/Shelter programs as of November 2007; an increase over the 39 reported in August 2007. These point-in-time views are one view of this issue. In an effort to better understand the needs, treatment and outcomes for these children, a targeted review is in process by the Court Monitor's Office and results will be disseminated shortly. Eleven STAR homes are open and ten are currently at full capacity. Three remaining programs have been procured and are slated to open in January or February of 2008.The last two shelter model facilities will remain open to maintain capacity through a transition period scheduled to be completed by June 2008. A series of meetings between DCF staff and SAFE Home providers has continued throughout the past quarter. Considerable progress has been made on a revised scope of service and outcome reporting. Appropriate enhancement of this service model to address documented clinical and staffing needs is contingent on additional funding or reallocation of current funding. As of the date of this report 48 therapeutic group homes are open with another 6 homes anticipated to be opened by June 2008 (total of approximately 260 beds for the 54 homes). Recently, 4 sessions of training were offered on October 18th and 19th 2007 to therapeutic 31

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group home staff that provided training regarding trauma informed care. This included information about understanding the impact of trauma and seclusion as well as restraint prevention tools. The training was attended by the Court Monitor who observed that the training curriculum was well received by the staff in attendance. The efforts to meet the needs of the children in this level of care is difficult due to an ongoing dilemma and challenge regarding the appropriate use of de-escalation tools, utilization of hospital, inpatient or community resources and requesting assistance from local police via 911 calls. · The following are 9 identified populations of children outlined in the Juan F. Action Plan for regular updates on progress in meeting the children's permanency needs. 1. Child pre-TPR + in care > 3 months with no permanency goal (N=67) as of November 2006. Goal = 0 by 3/1/07. As of November 2007 there are 12 children. 2. Child pre-TPR + goal of adoption + in care > 12 months + no compelling reason for not filing TPR (N=70) as of November 2006. Goal = 0 by 4/1/07. As of November 2007 there are 177 children. 3. Child post-TPR + goal of adoption + in-care > 12 months + no resource barrier identified (N=90) as of November 2006. As of November 2007 there are 201 children. 4. Child post-TPR + goal of adoption + in care > 12 months + same barrier to adoption in place > 90 days (N=169) as of November 2006. As of November 2007 there are 191 children. 5. Child post-TPR + goal other than adoption (N=357) as of November 2006. As of November 2007 there are 304 children. 6. Child pre-TPR + no TPR filed + in care < 6 months + goal of adoption. (N=18) as of November 2006. As of November 2007 there are 15 children. 7. Child pre-TPR + goal of reunification + in care > 12 months (N=550) as of November 2006. As of November 2007 there are 572 children in this population. 8. Child pre-TPR + goal other than adoption or reunification + in care > 12 months-- transfer of guardianship cases (N=133) as of November 2006. As of November 2007 there are 177 children in this population. 9. Child pre-TPR + goal other than adoption or reunification + in care > 12 months other than transfer of guardianship cases (N=939) as of November 2006. As of November 2007 there are 997 children in this population (144 are placed with a relative in a long term foster home arrangement).

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DCF has continued to exercise a focused review of children ages 12 and under who are being considered for congregate care placement. The number of children ages 12 and under in congregate care was 290 as of November 2007. This is a decrease from the 312 reported in August 2007 and 53 less than the 343 reported in November 2006. A review of the outcomes for diverted children would inform the effect and impact of these efforts to reduce reliance on congregate care. Another Planned Permanent Living Arrangement (APPLA) is not a preferred permanency goal and far too many children currently have this permanency goal. The Department has been far more vigorous in the consideration of selecting APPLA as a goal, but approximately 1300 children currently have APPLA as their permanency goal (pre-TPR and post-TPR). Ongoing reviews regarding children's needs being met continue to indicate that those with APPLA goals are more often not having their needs met. Ongoing efforts to review and inform case management decisions for these cases by Central Office, Area Office and Administrative Case Review staff continues. As a result of an RFP, three new providers of supportive housing (SWET) were selected. Programs in Bridgeport and Norwich have opened and are admitting youth. The New Haven provider was unable to secure a selected site and a new RFP was issued. The newly selected provider is attempting to secure a site. The total additional capacity for all three sites is 27 apartments. The eleven 1.0 level group homes were converted to the PASS model which includes greater emphasis on education and vocational skill development. Teachers are included for each site to provide tutoring and advocacy. During the past quarter, each of the Emergency Mobile Psychiatric Services (EMPS) completed separating out the cost centers associated with EMPS and Care Coordination. This information was required to define the parameters of the proposed redesign of this service. Development of RFPs is proceeding with the target of initializing procurement in the spring of 2008.

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Juan F. v Rell Exit Plan Quarterly Report December 18, 2007 _________________________________

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The Division of Foster Care monthly report for October 2007 indicates that there are 1218 licensed foster homes (DCF regular) with 2487 beds available. This is a net loss of 5 homes and 47 beds from the totals reported in July 2007. Additional foster care and adoptive resources are an essential component to address the well documented needs and gridlock conditions that exist in the child welfare system. Sustainable improvements to placement and treatment needs of children will require the increased availability of foster and adoptive home