Free Notice (Other) - District Court of Connecticut - Connecticut

Case 2:89-cv-00859-AHN

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Juan F. v Rell Exit Plan
Civil Action No. H-89-859 (AHN)
Exit Plan Outcome Measures Summary Report First Quarter 2007 January 1, 2007-March 31, 2007

May 2007

Submitted by: Exit Planning Division 505 Hudson Street, 10th Floor Hartford, CT 06106 Tel: (860) 550-6300

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Exit Plan Outcome Measures Summary Report First Quarter 2007

Cover Letter...........................................................................................3 Commissioner Mattiello's Highlights for First Quarter 2007 Exit Plan Report..... .......4 Outcome Measure Overview Chart...............................................................10

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May 15, 2007 Dear Mr. Mancuso, It is with great pride in the work of Department staff that we submit to you our First Quarter 2007 Exit Report. This report shows steady and solid performance in which the Department once again has met 16 out of 20 measures reported during the period. For two other measures, repeat maltreatment and re-entry into care, staff came within one-half of one percent or less of meeting goal. Our staff's continued focus on helping children achieve timely permanency is demonstrated in all three permanency outcomes (reunification, adoption, and transfer of guardianship) meeting goal and exceeding last quarter's percentages. In two of the measures, staff achieved their highest performance to date. We also see improvements from the Fourth Quarter 2006 report in the areas of repeat maltreatment and re-entry into care. Automated reports (accessible to all staff) have become a daily management tool for many, a way to encourage self-monitoring and a way to identify trends. This has brought a greater focus and a much more sophisticated look at outcomes. With this in mind, the Department continues to work on enhancing reports, developing new reports and utilizing other data systems to help inform discussions and decisions. Overtime, we have also enhanced our communications venue. With the department's monthly newsletter Essential Connections (currently in its second year) we effectively share a variety of information across all our offices and facilities. It has allowed us to highlight best practices, resources, research, programs, special initiatives/divisions, agency progress on outcomes and sharing art/poetry/letters from our current and former foster youth. This has proven to be a successful tool for reinforcing good practice and highlighting our strengths. As we continue to work on improving our system and its impact on children and families, particularly in the areas of treatment planning and needs met, we must acknowledge the tremendous efforts being put forth by our staff. More and more children are living with relatives and discharging to permanent homes. Due to the consistent low caseloads, our staff is able to spend more time visiting and working with families and children. With our new Structured Decision Making tools, we are confident that our assessments and interventions will continue to improve. Our focus now includes developing a much more sophisticated process for assessing our own work and for steadily improving the ways we partner with Connecticut families. We are committed to ensuring that all the Connecticut families we interact with receive the best possible services so that together we can continue to improve the lives of children. Respectfully,

Brian Mattiello Acting Commissioner

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First Quarter 2007 Exit Plan Report Commissioner Highlights The First Quarter 2007 Exit Plan report demonstrates not only the Department's ability to achieve challenging outcomes but also to maintain a high level of performance. We are committed to ensure that safety, permanency and well-being are at the forefront of our work with families and children and of our values as an organization. Department staff are focused on continuing to build a stronger and more supportive and inclusive system. At the onset of the Exit Plan in the First Quarter of 2004, the Department met the goal for only two outcomes: maltreatment in care and relative search (which was a small case review). Many of the other outcomes, such as adoption, sibling placement, in-home visitation, caseload standards, and Multi-Disciplinary Exams, were well below goal. Three years later, we have achieved and exceeded the goals for sixteen of these measures for at least two or more quarters. For two other measures, repeat maltreatment and re-entry into care, staff came within one-half of one percent or less of meeting goal. Fourteen measures have met goal for three or more consecutive quarters. Three additional outcomes (repeat maltreatment, re-entry into care, and appropriate discharge of children with mental health and mental retardation treatment needs) have met goal once or more during the last year. Important milestones also were reached during the First Quarter. Staff reached their highest performance for the timeliness of reunification and transfer of guardianship. Monthly out of home visitation also achieved the highest percentage since the onset of the Exit Plan. Consistent attention in these important areas impacting children and families has resulted in impressive improvements over time. ACCOMPLISHMENTS This quarterly report shows we met the following 16 outcomes: · · · · · · Commencement of Investigations: The goal of 90 percent was exceeded for the tenth quarter in a row with a current achievement of 96.5 percent. Completion of Investigations: Workers completed investigations in a timely manner in 93 percent of cases, also exceeding the goal of 85 percent for the tenth consecutive quarter. Search for Relatives: For the sixth consecutive quarter time, staff achieved the 85 percent goal for relative searches and met this requirement for 92.2 percent of children. Maltreatment of Children in Out-of-Home Care: The Department sustained achievement of the goal of 2 percent or less for the thirteenth consecutive quarter with an actual measure of 0.2 percent, the best performance under the Exit Plan. Timely Reunification: For the seventh consecutive quarter, this measure exceeded the 60 percent goal with a mark of 70.5 percent. Timely Adoption: For the third of the last five quarters, staff exceeded the 32 percent goal for finalizing adoptions within two years of a child's entering care by meeting the goal in 34.5 percent of adoptions in the quarter.

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· · · · ·

· · · ·

·

Timely Transfer of Guardianship: For the third consecutive quarter, staff exceeded the 70 percent goal for achieving a transfer within two years of a child's removal with a performance of 78 percent, the highest under the Exit Plan. Multiple Placements: For the twelfth consecutive quarter, the Department exceeded the 85 percent goal with a rate of 96.3 percent. Foster Parent Training: For the twelfth consecutive quarter, the Department met the 100 percent goal. Placement within Licensed Capacity: For the third consecutive quarter, staff met the 96 percent goal with an actual rate of 96.8 percent. Worker-To-Child Visitation In Out Of Home Cases: Staff reached their highest level of performance ever and exceeded the 85 percent goal for visitation of children in out-ofhome cases for the sixth consecutive quarter by hitting the mark in 95.1 percent of applicable cases. Worker to Child Visitation in In-Home Cases: For the sixth consecutive quarter, workers met required visitation frequency in 89 percent of cases, thereby exceeding the 85 percent standard. Caseload Standards: For the eleventh quarter, no Department social worker carried more cases than the Exit Plan standard. Reduction in Residential Care: For the fourth consecutive quarter, staff met the requirement that no more than 10.9 percent of children in DCF care are in a residential placement. Discharge Measures: For the seventh consecutive quarter and the seventh time overall under the Exit Plan, staff met the 85 percent goal for ensuring children discharged at age 18 from state care had attained either educational and/or employment goals by achieving an appropriate discharge in 98 percent of applicable cases. Multi-disciplinary Exams: For the fifth consecutive quarter, staff met the 85 percent goal by ensuring that 91.1 percent of children entering care received a timely multidisciplinary exam.

The agency's commitment to providing supportive services and increasing teamwork within and outside of the agency has improved the quality of our work. The Managed Service System (MSS), therapeutic group homes, and the Administrative Services Organization (ASO) are all advancing the ways in which we meet the behavioral health and placement needs of our youth. In addition, our internal Administrative Case Review process, which evaluates numerous key areas of treatment planning, now is assessing the appropriateness of placements. This was implemented May 1, 2007. Timely permanency is an area where much improvement has been made. However, we remain diligent and committed in pursuing permanency for all children. Our quarterly report shows that we are achieving the measure for each of the timely permanency goals. However, we recognize that permanency is equally important for children who have been in care beyond these timeframes and whose permanency would not "count" toward achieving the goal. For example, in the last year (2Q 2006-1Q 2007), a total of 2,379 children achieved permanency either through reunification (1275), adoption (481) transfer of guardianship (462) or exited to live with a

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relative (161). Several procedures are in place to help us stay focused on this outcome for all children. First, the Multi-Disciplinary Assessment for Permanency (MAP) brings together our legal staff, permanency staff and assigned social worker to review the permanency goal and timelines. As a results, recommendations are made early in the case. Second, management data reports are used by staff to closely examine various permanency outcomes (i.e. permanency 24 months entry cohort, reunification/adoption/transfer of guardianship exit cohorts, and permanency exception reports). Steps are then taken to address any identified areas of concern. Third, case reviews are regularly conducted to evaluate appropriateness of goals and progress toward achieving permanency. As permanency continues to be a challenge, we are more confident that we can identify the barriers accurately and develop ways to address them. All of these tools in support of determined efforts by our staff make manifest our value to ensure that children achieve permanency. A number of other outcomes also contribute to the goal of permanency. Multi-disciplinary exams (MDE) establish a baseline for health, dental, mental health and developmental issues for the children who enter foster care. In the First Quarter 2004 report, 19% of the children received an MDE within 30 days of entering care. A closer look at the barriers identified a need for more MDE clinics, and, with the support of the Governor and the Legislature, the additional clinics were up and running within a year. In addition, the MDE was revised to cover a more comprehensive look into a child's wellbeing. Today, 91.1% of the children have received an MDE within the timeframes. The Area Office Resource Group (ARG) nurses often inform staff about diagnoses and treatments, review medicine changes, and offer follow-up recommendations. The combination of these supports and tools, ensure that children's needs are addressed appropriately and that their well-being is a top priority.

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CHALLENGES Over the last three years, the Department and its staff have made exciting progress. Many of our children and families have benefited from theses efforts and services. Yet, we there remain areas of great challenge that must be met to provide the best possible services for the children and families of Connecticut. Building collaborative teams (with parents, youth, providers, and kin), increasing the options for interventions/services, increasing the options for placement, and addressing needs are crucial to success. In addition, the Department must continue to improve how it secures appropriate and stable placements ­ in the community when possible and only as long as required -- for those children whose treatment needs preclude family living. The Department understands that resources are crucial, but so are the tools used by the Department to assess and plan for families and children. Development of valid assessment tools is not an easy task and requires thoughtful planning and monitoring. Assessments are at the core of identifying and understanding underlying issues contributing to abuse and neglect. They are valuable for establishing a collaborative relationship with families ­ one that can lead to solid treatment plans to address these core issues. This, in turn, affects change within a family that can be sustained and help the family deal with crisis in healthier ways. Following is an update on a number of initiatives that will improve assessments, treatment plans, and case decisions: · Structured Decision Making (SDM): SDM is an evidence-based approach to delivering child welfare services proven to be both valid and reliable. SDM tools focus on three major areas: safety, risk and strengths and needs/reunification. This vitally important and major initiative required comprehensive training of all staff levels (management, supervisory, frontline, administrative support). As of this report, over 2,000 staff have been trained. All areas offices have implemented SDM. Hotline has had its first case record review and follow-up that resulted in identifying some areas needing further clarification. Staff viewed this as a very positive and helpful process to enhance the use of the tools. Global Appraisal Of Individual Needs (GAIN): GAIN is an evidence-based tool that was primarily designed for assessing treatment needs related to substance abuse. There are multiple versions that are essentially subsets of the full GAIN and are valid and reliable instruments. In cooperation with the UCONN Health Center, a nationally certified GAIN trainer continues to train our investigation staff to employ the GAIN Short Scale as a part of our investigation protocol in all cases. Two offices, Bridgeport and New Britain, have been trained and are using the GAIN assessments. All other offices have begun training, and Intensive Family Preservation (IFP) providers have completed their training.

·

Initiatives that will improve how we deliver services include the following: · Differential Response System (DRS): DRS utilizes a non-blaming, strength-based, assessment approach to engage families in identifying needs for the majority of accepted

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reports to the Hotline. There is no associated substantiation or placement of any adult on the Central Registry. The traditional forensic-based approach of a CPS investigation will be utilized only for those cases indicating serious injury or risk of immediate harm to a child. Currently, several community partners are involved with DCF in planning this effort. They include: the Commission on Children, Bridgeport Hospital, Kids Link (local child advocacy agency), TVCCA, Children's Trust fund, the Office of the Child Advocate, DSS, and FAVOR. This approach is expected to be taken statewide in State Fiscal Year 2009, and the interim period is being dedicated to planning, policy and implementation readiness. · Intensive Safety Planning (ISP): ISP is designed to provide intensive, concrete, homebased services with select families immediately upon removal of a child through a court order. The focus is on mitigating the safety factors that led to the removal in order to consider prompt reunification before the 20 day Order of Temporary Custody hearing. Two evidence-based practices will be utilized as part of the ISP intervention, including the Structured Decision Making (SDM) Safety Assessment Tool (completed by DCF staff during the initial investigation and before the decision to remove is made as well as before reunifying the child). In addition, the Global Appraisal of Individual Need (GAIN)-Quick tool will be administered to the primary caretaker during the ISP intervention in order to identify the constellation or behavioral health, medical or other treatment issues. Twelve service providers have been identified through competitive procurement and approved by the Commissioners Office. Two contracts have been fully executed, and three contractors are delivering ISP services.

Initiatives that will improve specific services offered to children and families include the following: · Building Stronger Families: An evidence-based, integrated, in-home model for helping families with parents who need substance abuse treatment and children over the age of seven who have suffered maltreatment and have mental health treatment needs. The Annie Casey Foundation supports this approach, which currently is being piloted in New Britain and is a modification of the MST model. Services are being expanded to New Haven, with training there currently underway and expected to be completed in February 2007. Services in New Haven are expected to begin in March. Intensive Home Based Services aka "Family-Based Recovery" Treatment (for substance abusing parent): Similar to Building Stronger Families except the children are under age two, Family Based Recovery Treatment targets substance abuse of parents and maltreatment issues. This in-home substance abuse treatment program focuses on parenting skills and repairing parent/child attachment issues. Services began in New Haven in January 2007 and other three additional regions are preparing to begin services in March. The last of the five regions to gain a provider was awarded a contract and will start services in April 2007. Each of the five programs will serve 12 families at a time. Project SAFE Outreach And Engagement: Now in Hartford and New Haven, this program will become a component of ISP (see above) when ISP becomes operational.

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·

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Case managers work in the home to address substance abuse. High participation is anticipated in contrast to traditional Project SAFE outcomes. · Supportive Housing for Families: The Supportive Housing for Recovering Families Program (SHRF) offers family support services and safe housing to families involved with DCF. The program serves families statewide through a network of contractors managed by The Connection, Inc. Case management services are funded through DCF. Housing is funded through a combination of DCF funds, DSS Rental Assistance Program (RAP) certificates, and federal Section 8 Housing Vouchers. The program was recently expanded (July 06) to serve an additional 100 families increasing the total program capacity to 465 families. Short-Term Assessment Resource (STAR) Centers: STAR Centers are now replacing the outdated shelter system across Connecticut. Instead of reliance on traditional shelters, which have struggled to meet the changing needs of children, "STAR" Centers around the state will offer treatment and support planning for a more effective course of care. The new system will have capacity to serve 84 children through 12 program sites across the state. Eight of those sites have been secured and the remaining four are in process.

·

Foster care resources have continued to be a great challenge for the Department. The month of May is Foster Care Month and numerous recruitment efforts are underway across the state. A substantial and targeted radio recruitment campaign is underway to help recruit foster and adoptive families as well as mentors for children in need. Research conducted by the University of Connecticut is helping the Department to target key groups more likely to consider becoming a resource for children. Additional targeted recruitment efforts include advertising on a prominent Internet search engine, resulting in many additional visitors to the DCF recruitment WebPages. Throughout the state, a number of Friendly's Restaurants are sponsoring "Family Nights" as a way to celebrate the commitment of foster parents. Continued and ongoing efforts are being directed into this area, and a recently proposed, phased foster care plan addresses a number of issues including ensuring that quality standards for foster care are consistent across the state as well as improving the retention, support and recruitment of foster parents, relative caregivers, and "like family" caregivers. Efforts to improve recruitment are already underway and include the use of "resident experts," who include children, existing foster parents and birth parents. These "experts" help recruit and support foster parents at open houses, PRIDE trainings, support groups, and in obtaining free media coverage about the need for and value of foster parenting. These efforts will continue to expand over the next 12 months.

CONCLUSION The significant improvements and sustained progress over the last three years of the Exit Plan, demonstrates that staff are focused on achieving results and advancing positive outcomes for children and families. However, we continue to recognize and identify the great challenges that remain. Indeed, for the Department to reach its fullest potential, we must constantly be willing and able to identify the evolving and multi-dimensional issues that come from partnering with children, families and communities to promote child safety, permanence, and well-being.

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Thorough and comprehensive individualized assessments, effective planning, and successful interventions always will strain our capacity to achieve quality work if we insist ­ as we must ­ on a child-centered, family-focused practice.

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1Q January 1 ­ March 31, 2007 Exit Plan Report

Outcome Measure Overview
Measure Measure Baseline 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

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

>=90% >=85% >=90% >=85% <=7% <=2% >=60% >=32% >=70% >=95% <=7% >=85% 100%

X 73.7% X 58% 9.3% 1.2% 57.8% 12.5% 60.5% 57% 6.9% X X

X 64.2% X 93% 9.4% 0.5% X 10.7% 62.8% 65% X X X

X 68.8% X 82% 8.9% 0.8% X 11.1% 52.4% 53% X 95.8% 100%

X 83.5% 10% 44.6% 9.4% 0.9% X 29.6% 64.6% X X 95.2% 100%

91.2% 91.7% 17% 49.2% 8.9% 0.6% X 16.7% 63.3% X X 95.5% 100%

92.5% 92.3% X 65.1% 8.2% 0.8% X 33% 64.0% X X 96.2% 100%

95.1% 92.3% X 89.6% 8.5% 0.7% X 25.2% 72.8% X X 95.7% 100%

96.2% 93.1% X 89.9% 9.1% 0.8% 64.2% 34.4% 64.3% 96% 7.2% 95.8% 100%

96.1% 94.2% X 93.9% 7.3% 0.6% 61% 30.7% 72.4% 94% 7.6% 96% 100%

96.2% 94.2% X 93.1% 6.3% 0.4% 66.4% 40.8% 60.7% 75% 6.7% 96.2% 100%

96.4% 93.1% X 91.4% 7.0% 0.7% 64.4% 36.9% 63.1% 77% 7.5% 96.6% 100%

98.7% 94.2% 54% 92.2% 7.9% 0.7% 62.5% 27% 70.2% 83% 4.3% 96.8% 100%

95.5% 93.7%

96.5% 93.0% X

8/15/07* 11/15/07* 7.9% 0.2% 61.3% 33.6% 76.4% 85.5% 8.2% 95% 100% 7.4% .2% 70.5% 34.5% 78% 84.9% 7.5% 96.3% 100%

>=96%

94.9%

88.3%

92.0%

93.0%

95.7%

97%

95.9%

94.8%

96.2%

95.2%

94.5%

96.7%

96.4%

96.8%

>=80%

X

53% 72% 87% 39% 73.1% 13.9% 74% 43% 19.0%

57% 86% 98% 40% 100% 14.3% 52% 64% 24.5%

53% 73% 93% 46% 100% 14.7% 93% 56% 48.9%

56% 81% 91% 33% 100% 13.9% 83% 60% 44.7%

X 77.9% 93.3% X 100% 13.7% X X 55.4%

X 86.7% 95.7% 81.9% 100% 12.6% X X 52.1%

X 83.3% 92.8% 78.3% 99.8% 11.8% 96% 78% 54.6%

X 85.6% 91.9% 85.6% 100% 11.6% 92% 70% 72.1%

X 86.8% 93.1% 86.2% 100% 11.3% 85% 95% 91.1%

X 86.5% 90.9% 87.6% 100% 10.8% 91% 97% 89.9%

62% 92.5% 91.5% 85.7% 100% 10.9% 100% 100% 86% 94.7% 99.0% 89.2% 100% 11% 100% 97% 94.2%

X 95.1% 89% 100% 10.9% 98% 90% 91.1%

>=85% Monthly 100% Quarterly >=85% 100% <=11% >=85% 100% >=85% X 69.2% 13.5% 61% X 5.6%

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Results based on Case Reviews
OM 1, 2, 4, 5, 7, 8, 9, 10*, 11, 16, 17 & 22 4 6, 12, 14, 18 & 19 3+, 13*, 15+, 20** & 21** Comments ROM Reports * ROM report with supplemental case review, conducted by Results Management, to evaluate and confirm clinical reasons for separating sibling groups.

ROM report posted for 1Q 2007 reflecting status of children entering care for the 3Q 2006 period. This is consistent with the Exit Plan measure definition. Refer to 3Q 2006 column. LINK Reports

Case Reviews +Court Monitor and DCF collaborative in depth case review *Administrative Report from CAFAP **Case Review conducted by DCF Continuous Quality Improvement Division

Treatment Plans**
** Conducted by the Court Monitor's Office and DCF. 2006 1Q N/A 2Q N/A 3Q 54% (refer to Court Monitor's Report for results of their case review) 4Q 2007 1Q

2006 In addition, two (2) additional areas were evaluated: Treatment plan must be written and treatment conference conducted in the family's primary language and treatment plans developed in conjunction with parents/child/service providers (for example, treatment plan modifications as a result of input from the ACR). 1Q N/A 2Q N/A 3Q 100% (refer to Court Monitor's Report for results of their case review) 4Q 2007 1Q

Caseload Standards +
2006 1Q As of May 15, 2006 the Department met the 100% compliance mark. The sixty (60) cases over 100% caseload utilization meet the exception criteria (cases over 100% and not over for 30 days or more). 2Q As of August 15, 2006 the Department met the 100% compliance mark. The thirty (30) cases over 100% caseload utilization meet the exception criteria (cases over 100% and not over for 30 days or more). 3Q As of September 30, 2006 the Department met the 100% compliance mark. The forty (40) cases over 100% caseload utilization meet the exception criteria (cases over 100% and not over for 30 days or more). 4Q As of December 31, 2006 the Department met the 100% compliance mark. The fifty-three (53) cases over 100% caseload utilization meet the exception criteria (cases over 100% and not over for 30 days or more). 2007 1Q As of May 15, 2007 the Department met the 100% compliance mark. The sixty (60) cases over 100% caseload utilization meet the exception criteria (cases over 100% and not over for 30 days or more).

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