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

Case 2:89-cv-00859-AHN
Juan F. v Rell Exit Plan Quarterly Report June 20, 2007 _____________________________

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Juan F. v. Rell Exit Plan Quarterly Report January 1, 2007 ­ March 31, 2007 Civil Action No. H-89-859 (AHN) June 20, 2007

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

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Table of Contents Juan F. v Rell Exit Plan Quarterly Report January 1, 2007 ­ March 31, 2007

Page Highlights January 1, 2007 through March 31, 2007 Exit Plan Outcome Measure Overview Chart Monitor's Office Case Review for Outcome Measure 3 and Outcome Measure 15 ­ First Quarter 2007 Juan F. Action Plan Appendix 1 ­ The Department's Exit Plan Outcome Measures Summary Report First Quarter Report January 1, 2007 ­ March 31, 2007 Appendix 2 ­ Rank Scores for Outcome Measure 3 and Outcome Measure 15 ­ First Quarter 2007 2

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Juan F. v Rell Exit Plan Quarterly Report January 1, 2007 ­ March 31, 2007 Highlights 1. The Monitor's quarterly review of the Department's efforts toward meeting the Exit Plan measures during the period of January 1, 2007 through March 31, 2007 indicates that the Department achieved 16 of the 22 measures. The Department met all three permanency goals Reunification (Outcome Measure 7), Adoption (Outcome Measure 8), Transfer of Guardianship (Outcome Measure 9) for the second consecutive quarter. The performance levels of the Department in meeting the Transfer of Guardianship and Reunification Outcome Measures are the highest achieved percentages thus far. 2. The revised methodology to measure Treatment Planning (Outcome Measure 3) and Needs Met (Outcome Measure 15) was once again utilized for a full sample of 75 cases during the first quarter of 2007. The first quarter January 1, 2007 through March 31, 2007 case review data indicates that the Department achieved 41.3% appropriate Treatment Plans (Outcome Measure 3) and 45.3% on Children's Needs Met (Outcome Measure 15). The Department's performance regarding Treatment Planning is relatively unchanged from the previous quarter (41.1%), and Needs Met declined from 52.1%. Treatment Plans Despite a number of interventions and directives aimed at improving the treatment planning process, many treatment plans reviewed this quarter were not collaboratively developed and failed to incorporate the input of family or providers. The majority of treatment plans reviewed continue to be less a vibrant and individualized action plan than a pro forma document. Action steps remain unfocused, incomplete or missing entirely for many active participants in the cases reviewed (57.3% of the plans did not achieve acceptable scores in this category). Identification of goals and objections are likewise problematic with 42.7% of the plans failing to meet expected performance. Inclusion of thoughtful and comprehensive assessments and meaningful progress statements are lacking for many of the cases reviewed (26.7% and 34.7% not achieving acceptable scores respectively). Reviewers note that despite issues being actively raised, discussed and decided at the Treatment Planning/Administrative Case Review Conference/Family Conference (TPC/ACR/FC), treatment plans often times do not incorporate the decisions reached at the meeting. This lack of follow through renders the input of participants as meaningless and reinforces a culture where treatment plans do not recognize the input provided by families, family members, providers and other significant participants.

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Children's Needs Met The data and analysis reveal that children and families face many obstacles to getting their identified needs met. Most frequently noted: children remain in restrictive levels of care well beyond the time clinically appropriate, are often wait-listed for community services, have specific mental health or educational needs that are not addressed in a timely manner or with specialized treatment of choice, and do not have their well-child medical or dental needs met per EPSDT standards. In addition, the review indicates that a significant portion of the children in the sample have not had their permanency needs addressed through progressive case work and decisions. Records reflect lack of timely recruitment, unfocused and unclear steps toward permanency goals, lack of Life Book work, lack of effort toward concurrent goals and delayed decisions regarding maintaining placements that while stable, are not permanent. Many of the records reviewed provide very little detail or insight into the progress attained through use of DCF referred services that are provided. Progress reports or meaningful updates from providers through collateral contacts are minimally documented or absent all together. Only 56.2% of cases documented engagement of active service providers in treatment planning efforts. Only 25.2% of providers actually attended the TPC/ACR/FC to provide first hand feedback. 3. The Monitor's quarterly review of the Department for the period of January 1, 2007 through March 31, 2007 indicates that the Department has achieved compliance with a total of 16 measures. · Commencement of Investigations (96.5%) · Completion of Investigations (93.0%) · Search for Relatives (92.2%) · Maltreatment of Children in Out-of-Home Care (0.2%) · Reunification (70.5%) · Adoption (34.5%) · Transfer of Guardianship (78%) · Multiple Placements (96.3%) · Foster Parent Training (100.0%) · Placement within License Capacity (96.8%) · Worker to Child Visitation in Out-of-Home Cases (95.1%) · Worker to Child Visitation in In-Home Cases (89.0%) · Caseload Standards (100.0%) · Reduction in Residential Care (10.9%) · Discharge Measures (98.0%) · Multi-disciplinary Exams (91.1%)

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4. The Department has maintained compliance for at least two (2) consecutive quarters1 with 15 of the Outcome Measures shown above (number of consecutive quarters indicated below): · Commencement of Investigations (tenth consecutive quarter) · Completion of Investigations (tenth consecutive quarter) · Search for Relatives (sixth consecutive quarter) · Maltreatment of Children in Out-of-Home Care (thirteenth consecutive quarter) · Reunification (seventh consecutive quarter) · Transfer of Guardianship (third consecutive quarter) · Multiple Placements (twelfth consecutive quarter) · Foster Parent Training (twelfth consecutive quarter) · Placement within Licensed Capacity (third consecutive quarter) · Worker to Child Visitation in Out-of-Home Care (sixth consecutive quarter) · Worker to Child Visitation in In-Home Care (sixth consecutive quarter) · Caseloads Standards (twelfth consecutive quarter) · Residential Reduction (fourth consecutive quarter) · Discharge Measures (seventh consecutive quarter) · Multi-Disciplinary Exams (fifth consecutive quarter) 5. The Monitor's quarterly review of the Department for the period of January 1, 2007 through March 31, 2007 indicates that the Department did not achieve compliance with six (6) of the measures: · Treatment Plans (41.3%) · Repeat Maltreatment (7.4%) · Sibling Placement (84.9%) · Re-Entry (7.5%) · Children's Needs Met (45.3 %) · Discharge to DMHAS (90.0%) 6. The Monitor's Office is conducting a Targeted Comprehensive Case Review of the Exit Plan Outcome Measures. This effort encompasses a review of multiple samples totaling approximately 2,000 cases. The review is being directed by the Court Monitor's Office and follows the methodology employed for all Court Monitor reviews which integrates Quality Improvement staff from the Department with staff contracted by the Court Monitor to conduct the work. The full report on this quantitative/qualitative review is expected to be completed in July 2007.

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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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7. As outlined in the last quarterly report, the Juan F. Action Plan focuses on heightened attention to permanency, placement and treatment issues including 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. The plan details action steps, strategies and implementation time frames. The Monitor has developed a set of monitoring strategies to review the Juan F. Action Plan. These strategies include regular meetings with Department staff, the Plaintiffs, provider groups and other stakeholders that will focus on the critical steps outlined in the Juan F. Action Plan; selected site visits each quarter; targeted reviews of critical elements of the Juan F. Action Plan; ongoing analysis of key data reports, and attendance at a variety of meetings related to the specific initiatives and ongoing activities outlined in the Juan F. Action Plan. Updates of specific action steps included in the Juan F. Action Plan follow in this report on page 6. The Department's full, unedited, but verified report to the Court Monitor is incorporated at the end of this Monitor's Report to the Court (See Appendix 2). Updates on a number of key initiatives including Structured Decision Making (SDM); Global Appraisal of Individual Needs (GAINS); Differential Response System (DRS); Intensive Safety Planning (ISP); Building Stronger Families; Family-Based Recovery; Project SAFE Outreach and Engagement; Supportive Housing and the Short-Term Assessment Resource (STAR) Centers are provided within this document.

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

X

X

X

X

91.2% 92.5% 95.1% 96.2% 96.1% 96.2% 96.4% 98.7% 95.5% 96.5%

73.7% 64.2% 68.8% 83.5% 91.7% 92.3% 92.3% 93.1% 94.2% 94.2% 93.1% 94.2% 93.7% 93.0% X 58% 9.3% 1.2% 57.8% X 93% X 10% 17% X X X X X X 54.3% 41.1% 41.3%

82% 44.6% 49.2% 65.1% 89.6% 89.9% 93.9% 93.1% 91.4% 92.2% 8/15/07* 11/15/07* 7.9% 0.2% 7.4% .2%

9.4% 8.9% 9.4% 8.9% 8.2% 8.5% 9.1% 7.3% 6.3% 7.0% 7.9% 0.5% 0.8% 0.9% 0.6% 0.8% 0.7% 0.8% 0.6% 0.4% 0.7% 0.7% X X X X X X

64.2% 61% 66.4% 64.4% 62.5% 61.3% 70.5%

12.5% 10.7% 11.1% 29.6% 16.7% 33% 25.2% 34.4% 30.7% 40.8% 36.9% 27% 33.6% 34.5% 60.5% 62.8% 52.4% 64.6% 63.3% 64.0% 72.8% 64.3% 72.4% 60.7% 63.1% 70.2% 76.4% 57% 6.9% X X 65% X X X 53% X X X X X X X X X 96% 94% 75% 77% 78%

83% 85.5% 84.9% 8.2% 7.5% 96.3% 100%

7.2% 7.6% 6.7% 7.5% 4.3%

95.8% 95.2% 95.5% 96.2% 95.7% 95.8% 96% 96.2% 96.6% 96.8% 95% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

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

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%

X

53%

57% 86% 98% 40%

53% 73% 93% 46%

56%

X

X

X

X

X

X

62.9% 52.1% 45.3%

>=85% Monthly 72% 100% Quarterly 87% >=85% X 39%

81% 77.9% 86.7% 83.3% 85.6% 86.8% 86.5% 92.5% 94.7% 95.1% 91% 93.3% 95.7% 92.8% 91.9% 93.1% 90.9% 91.5% 99.0% 33% X 81.9% 78.3% 85.6% 86.2% 87.6% 85.7% 89.2% 89%

100% <=11% >=85%

69.2% 73.1% 100% 100% 100% 100% 100% 99.8% 100% 100% 100% 100% 100% 13.5% 13.9% 14.3% 14.7% 13.9% 13.7% 12.6% 11.8% 11.6% 11.3% 10.8% 10.9% 11% 61% 74% 52% 93% 83% X X 96% 92% 85% 91% 100% 100%

100% 10.9% 98%

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

X

43%

64%

56%

60%

X

X

78%

70%

95%

97% 100%

97%

90%

5.6%

19.0% 24.5% 48.9% 44.7% 55.4% 52.1% 54.6% 72.1% 91.1% 89.9% 86% 94.2% 91.1%

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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 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 Treatment Planning (Outcome Measure 3) and Needs Met (Outcome Measure 15). The implementation of this review began with a pilot sample of 35 cases during the third quarter 2006, 73 cases during the fourth quarter, 2006 and most recently, 75 cases during the first quarter 2007, which is the sample upon which the following data is reported. The 75 case sample was stratified based upon the distribution of area office caseload on December 1, 2006. The sample incorporates both in-home and out-of-home cases based on the overall statewide percentage reflected at the point that the universe was drawn for sampling. Table 1: First Quarter Sample Required Based on December 1, 2006 Caseload Universe
Area Office Bridgeport Danbury Greater New Haven Hartford Manchester Meriden Middletown New Britain New Haven Metro Norwalk Norwich Stamford Torrington Waterbury Willimantic Statewide Caseload 1,070 305 938 1,811 1,214 590 400 1,497 1,493 256 1,137 293 430 1,311 866 13,611 % of State 7.9% 2.2% 6.9% 13.3% 8.9% 4.3% 2.9% 11.0% 11.0% 1.9% 8.4% 2.2% 3.2% 9.6% 6.4% 100.0% Sample Required 6 3 5 9 6 3 3 8 8 2 6 2 3 7 4 75 OOH Cases 5 2 4 7 4 2 2 5 6 1 4 1 2 5 3 53 IH Cases 1 1 1 2 2 1 1 3 2 1 2 1 1 2 1 22

The methodology continues to pair the Department's staff with Monitor's Review staff. Reviewers were assigned to different teams and office locations. This methodology will continue through the end of the second quarter 2007, when staffing changes at DCF will reduce the number of reviewers available, and will require reviews to be done most frequently by one assigned reviewer.

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Each case was subjected to the following methodology (A case review typically requires seven to 12 hours to complete). 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 is conducted fourteen to twenty days following the date identified within the TPC/ACR/FC schedule from which the sample was drawn. Each reviewer completes an individual assessment of the treatment plan and needs met outcome measures and fills out the scoring forms for each. 4. A final meeting with the assigned teammate is held to jointly arrive at the final scores for each section and overall scoring for OM3 and 15. Individual scoring and joint scoring forms are then submitted to the Monitor. (This step may change as determined appropriate by the DCF Court Monitor after evaluation of the process, feedback from review staff and fiscal/staffing considerations.) 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 agreement cannot be reached, the team requests that the supervisor become a third voice on those areas of concern. They present their opinions and findings and the supervisor determines the appropriate score to reflect the level of performance for the specific item(s) and assists them in the overall determination of compliance for OM3 and OM15. If the team indicates that there are areas that do not attain the "very good" or "optimal" level, yet the consensus is the overall score should be "an appropriate treatment plan" or "needs met" the team outlines their reasoning for such a determination and it is reviewed by the Court Monitor for approval of an override exception. These cases are available to the Technical Advisory Committee (TAC) for review. During the fourth quarter, there were 5 cases submitted for override consideration. Of the 5 cases, two resulted in the approval of an override to allow passing score. Two cases were reviewed by the Monitor and after consultation with reviewers changes were made to the scoring so that the override was no longer required. In one case the request for override was denied.

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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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Sample Demographics As indicated earlier, the sample consisted of seventy-five cases distributed among the fifteen area offices. Sample cases are identified by Assignment Type. At the point of review, the data indicates that the majority of cases (90.7%) open for protective service reasons. A full description of the sample is provided below: Table 2: Case Assignment Types with the Sample Set (n=75)
Assignment CPS In-Home Family CPS Child in Placement Voluntary Services In-Home Family Voluntary Services Child in Placement Total Frequency 21 47 3 4 75 Percent 28.0% 62.7% 4.0% 5.3% 100.0%

Of the 52 children in placement at any point during the quarter, ten children (19.2%) had some involvement with the juvenile justice system during the quarter. In looking at this population of ten children in relation to the overall scoring for OM3 and OM15, the rates of children with an appropriate treatment plan is 20% (two of the 10) and children with needs met is 30% (three of the ten). This is a lower percentage in comparison to those children in placement with no juvenile justice involvement: which have an appropriate treatment plan in 40.5% of the cases reviewed (17 of 42) and with 47.6% having needs met (20 of 22). In establishing the reason for the most recent case open date identified, reviewers ascertain all substantiations or voluntary service needs identified at the point of the most recent case opening. This is a multiple response question which allows the reviewers to select more than one response. In total, 144 reasons were identified for the case sample. The data indicates that physical neglect is the most frequent reason for a case opening in treatment, as 58.7% of the cases cited this as one of the factors for the case opening. This is followed by Parental Substance Abuse/Mental Health which is present in 32.0% of the cases reviewed, and Child's TPR, which is identified in 21.3% of the cases reviewed.

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Table 3: Reasons for DCF involvement at the point of most recent case open/reopen date
Reason(s) Cited Physical Neglect Substance Abuse/Mental Health (Parent) Child's TPR Domestic Violence Voluntary Services Request Emotional Neglect Medical Neglect Physical Abuse Abandonment FWSN Educational Neglect Emotional Abuse/Maltreatment Sexual Abuse Total Number 44 24 16 15 10 8 7 6 6 4 2 2 0 144 Percent of Instances Identified (n=) 30.6% 16.7% 11.1% 10.4% 6.9% 5.6% 4.9% 4.2% 4.2% 2.8% 1.4% 1.4% 0.0% 100.2%3 Percent of Sample Cases with Identified Reason (n=75) 58.7% 32.0% 21.3% 20.0% 13.3% 10.7% 9.3% 8.0% 8.0% 5.3% 2.7% 2.7% 0.0% N/A

When asked to isolate the primary reason for case opening among those identified for each case; physical neglect is most frequently identified and represents 33.3% of the sample set. Table 4: What is the primary reason cited for case opening/reopening?
Primary Reason Physical Neglect Child's TPR Substance Abuse/Mental Health (Parental) Voluntary Services Domestic Violence Medical Neglect Abandonment FWSN Physical Abuse Educational Neglect Emotional Abuse Emotional Neglect Sexual Abuse/Exploitation Total Frequency 25 15 10 8 4 4 3 2 2 1 1 0 0 75 Percent 33.3% 20.0% 13.3% 10.7% 5.3% 5.3% 4.0% 2.7% 2.7% 1.3% 1.3% 0.0% 0.0% 99.9%4

Approved permanency/case goals are identified for 73 of the 75 cases reviewed. Of the 20 situations in which "Reunification" is the permanency goal, there is a required
3 4

Due to rounding. Due to rounding.

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concurrent plan documented in 19 cases. Of the three cases with the goal of "APPLA: Other", two identified the goal of "Independent Living", and one listed "Specialized Care to Transition to DMHAS/DMR". Table 5: 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 Reunification Adoption APPLA: Permanent Non-Relative Foster Care APPLA: Other Transfer of Guardianship Goal is not an approved treatment planning goal UTD - plan incomplete, unapproved/missing for this period Long Term Foster Care with a licensed relative Total Frequency 22 20 16 10 3 2 1 1 0 75 Percent 29.3% 26.7% 21.3% 13.3% 4.0% 2.7% 1.3% 1.3% 0.0% 99.9%5

Children in placement had various lengths of stay at the point of our review. Episodes start dates range from April 1995 to January 2007. The distribution of length of stays is provided below for those children still in placement at the point of review. Table 6: How many consecutive months has the child been in out of home placement at the date of review?
1-6 Months 7-12 Months 13-18 Months 19-24 Months Greater than 24 Months Total CIP at Point of Review Frequency 4 13 10 4 21 52 Percent 7.7% 25.0% 19.2% 7.7% 40.4% 100.0% Cumulative Percent 7.7% 32.7% 51.9% 59.6% 100.0%

The population of children in care greater than 24 months is down slightly in comparison to the 4th quarter sample (n=51) which had 23 children, or 45.1% in care greater than 24 months. Further data provides an indication of whether TPR has been filed in relation to the case permanency goal and ASFA requirement. In 17 of the 22 cases in which TPR was filed, TPR had been granted prior to our review. There are three children exceeding the ASFA 15 of the last 22 month time-frame for which neither TPR has been filed nor a Compelling Reason has been identified in the appropriate manner. Compelling Reasons were documented in nine situations, but in two of these TPR has also been filed.

5

Due to rounding

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Crosstabulation 1: 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?
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 Filed N/A ­ In Home Family Case (CPS or Voluntary) Total yes no N/A ­ Compelling Reason in LINK 4 3 2 0 9 N/A - child's goal and length of time in care don't require TPR 1 16 0 1 18 N/A - In-Home Case (CPS or Voluntary Services) 0 1 0 22 23 Total

1 2 19 0 22

3 0 0 0 3

9 22 21 23 75

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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 first quarter 2007 case review data indicates that the Department attained the level of "Appropriate Treatment Plan" in 31of the 75-case sample or 41.3%. This is relatively unchanged from the fourth quarter 2006 result of 41.1%. Despite a number of interventions and directives aimed at improving the treatment planning process many treatment plans reviewed this quarter were not collaboratively developed and failed to incorporate the input of family or providers. With a few exceptions the treatment plans continue to be less a vibrant and individualized action plan than a pro forma document. Action steps remain unfocused, incomplete or missing entirely for many active participants in the cases reviewed (57.3% of the plans did not achieve acceptable scores in this category). Identification of goals and objections are likewise problematic with 42.7% of the plans failing to meet expected performance. Inclusion of thoughtful and comprehensive assessments and meaningful progress statements are lacking in a large number of cases reviewed (26.7% and 34.7% failing respectively). Reviewers note that despite issues being raised, discussed and decided at the ACR/TPC/FC, treatment plans oftentimes did not incorporate the decisions reached at the meeting. This renders the input of participants as meaningless and reinforces that treatment plans do not recognize the input provided by families, family members, providers and other significant participants. No case fails solely as a result of the language or approval requirement. However, of the plans not passing due to less than "very good" scores, two plans also do not have social work supervisory approval. In one case, we are unable to determine if the family's language needs were met. This case was one of the two plans without supervisory approval. Crosstabulation Table 2: What is the type of case assignment noted in LINK? * Overall Score for OM3
Overall Score for OM3 What is the type of case assignment noted in LINK? CPS In-Home Family Case (IHF) CPS Child in Placement Case (CIP) 1 Voluntary Services In-Home Family Case (VSIHF) 2 Voluntary Services Child in Placement Case (VSCIP) Total 31 44 75 2 4 2 3 Appropriate Treatment Plan 12 16 Not an Appropriate Treatment Plan 9 31 Total

21 47

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As shown in the crosstabulation table above, the overall score designation differs between the in-home and out of home cases in this quarter's sample. In 13 of 24 in-home family treatment plans (both CPS and Voluntary Services) reviewed the treatment plan passes the overall measure with a designation of appropriate treatment plan (54.2%). Comparatively, only 18 of 51 CIP treatment plans reviewed (both CPS and Voluntary Services) achieve the "appropriate treatment plan status" (35.3%). For a more in-depth review by individual categories of OM3 by case type, please see Tables 8 through 10 on page 15. The reviewers collected data regarding 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. Each case had a unique pool of active participants for the Department 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 these 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 for each participant type across all the cases reviewed. Table 7: Participation and Attendance Rates for Active Case Participants within the Sample Set
Identified Case Participant Percentage with documented Participation/Engagement in Treatment Planning Discussion 74.1% 79.6% 31.4% 91.7% 52.6% 24.5% 24.3% 46.2% 68.6% Percentage Attending the TPC/ACR or Family Conference 25.9% 59.2% 23.4% 69.4% 25.2% 1.9% 5.4% 21.6% 45.5%

Child Mother Father Foster Parent Active Service Providers Attorney/GAL (Child) Parents' Attorney Other DCF Staff Other Participants

It is clear from the attendance and engagement rates indicated above that the Department, while demonstrating some improvement, still requires considerable effort to appropriately engage key participants. The attendance by key case participants at the TPR/ACR or Family Conference remains problematic and is indicative of the continued need to embrace and encourage families to be full participants in decision making. Reviewers note a failure to invite adolescents and fathers to the TPC/ACR/FC, and an overall lack of engagement with both children's and parents' attorneys. Similarly, it is noted that ARG or other DCF staff active within the case are also not participating in the treatment planning process as much as would be expected. The engagement process cannot end with solicitation of opinions or attendance at the requisite meetings. Treatment plans must value and accurately reflect each parties' input, finalized treatment plans must incorporate all decisions arrived at during the collaborative treatment planning process.

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As with the previous quarters, this review process looked at eight categories of measurement when determining overall appropriateness of the treatment planning (OM3). Scores were based upon the following rank/scale. Optimal Score ­ 5 The reviewer finds evidence of all essential treatment planning efforts for both the standard of compliance and all relevant consideration items (documented on the treatment plan itself). Very Good Score ­ 4 The reviewer finds evidence that essential elements for the standard of compliance are substantially present in the final treatment plan and may be further clarified or expanded on the DCF 553 (where latitude is allowed as specified below) given the review of relevant consideration items. Marginal Score ­ 3 There is an attempt to include the essential elements for compliance but the review finds that substantial elements for compliance as detailed by the Department's protocol are not present. Some relevant considerations have not been incorporated into the process. Poor Score ­ 2 The reviewer finds a failure to incorporate the most essential elements for the standard of compliance detailed in the Department's protocol. The process does not take into account the relevant considerations deemed essential, and the resulting document is in conflict with record review findings and observations during attendance at the ACR. Absent/Adverse Score ­ 1 The reviewer finds no attempt to incorporate the standard for compliance or relevant considerations identified by the Department's protocol. As a result there is no treatment plan less than 7 months old at the point of review or the process has been so poorly performed that it has had an adverse affect on case planning efforts. "Reason for Involvement" and "Present Situation to Date" were most frequently ranked with an Optimal Score. Deficits were most frequently noted in two of the eight categories: "Determination of Goals/Objectives" and "Action Steps to Achieve Goals". The following table provides the scoring for each category for the sample set and the corresponding percentage of cases within the sample that achieved that ranking. The set of three tables on page 15 provide at a glance, the scores for each of the eight categories of measurement within Outcome Measure 3. The first is the full sample, the second consists of children in out of home placement cases (CIP) and the third table is comprised of the in-home family cases. For a complete listing of rank scores for Outcome Measure 3 by case, see Appendix 2.

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Table 8: 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. Progress II.3 Action Steps to Achieving Goals Identified II.4 Planning for Permanency Optimal "5" 47 (62.7%) 10 (13.3%) 25 (33.3%) 23 (30.7%) 18 (24.0%) 24 (32.0%) 2 (2.7%) 28 (37.3%) Very Good "4" 28 (37.3%) 52 (69.3%) 32 (42.7%) 32 (42.7%) 25 (33.3%) 25 (33.3%) 30 (40.0%) 33 (44.0%) Marginal "3" -13 (17.3%) 17 (22.7%) 16 (21.3%) 24 (32.0%) 20 (26.7%) 28 (37.3%) 11 (14.7%) Poor "2" ---2 (2.7%) 6 (8.0%) 4 (5.3%) 10 (13.3%) 2 (2.7%) Adverse/Absent "1" --1 (1.3%) 2 (2.7%) 2 (2.7%) 2 (2.7%) 5 (6.7%) 1 (1.3%)

Table 9: 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" 10 (41.7%) 6 (25.0%) 10 (41.7%) 10 (41.7%) 7 (29.2%) 11 (45.8%) 1 (4.2%) 14 (58.3%) Very Good "4" 14 (58.3%) 15 (62.5%) 9 (37.5%) 7 (29.2%) 10 (41.7%) 7 (29.2%) 12 (50.0%) 9 (37.5%) Marginal "3" -3 (12.5%) 4 (16.7%) 6 (25.0%) 6 (25.0%) 4 (16.7%) 7 (29.2%) -Poor "2" -----1 (4.2%) 2 (8.3%) -Adverse/Absent "1" --1 (4.2%) 1 (4.2%) 1 (4.2%) 1 (4.2%) 2 (8.2% 1 (4.2%)

Table 10: 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. Progress II.3 Action Steps to Achieving Goals Identified II.4 Planning for Permanency Optimal "5" 33 (64.7%) 4 (7.8%) 15 (29.4%) 13 (25.5%) 11 (21.6%) 13 (25.5%) 1 (2.0%) 14 (27.5%) Very Good "4" 18 (35.3%) 37 (72.5%) 23 (45.1%) 25 (49.0%) 15 (29.4%) 18 (35.3%) 18 (35.3%) 24 (47.1%) Marginal "3" -10 (19.6%) 13 (25.5%) 10 (19.6%) 18 (35.3%) 16 (31.4%) 21 (41.2%) 11 (21.6%) Poor "2" ---2 (3.9%) 6 (11.8%) 3 (5.9%) 8 (15.7%) 2 (3.9%) Adverse/Absent "1" ---1 (2.0%) 1 (2.0%) 1 (2.0%) 3 (5.9%) --

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It is clear from the tables provided regarding these eight categories of measurement that the Department continues to struggle with identifying the action steps for the case participants in relation to those goals (II.3). The highest percentage of "Marginal", "Poor" or "Adverse" scores were identified for Section II.3 (Action Steps to Achieving Goals Identified) with 57.3% of the cases not achieving a passing grade. This is a decline in performance during the 4th quarter, which had 50.7% of the plans not achieving a passing score. It appears that there is still some confusion on the part of the social worker and social work supervisors regarding the distinction between goals, and the development of action steps to achieve those goals. As noted in prior reviews, the Department often fails to incorporate its own responsibilities and action steps for the case for the next six months, minimizes parent or provider responsibility, or does not provide clear measurement, time-frames, or identify responsible participants. The next area most frequently noted as problematic during the period of January through March 2007 was the Determination of the Goals and Objectives Section (II.1). While showing some improvement over the 4th quarter results, in which 50.7% of plans failed to accurately identify goals and objectives, this category failed to achieve a passing score in 42.7% of the treatment plans sampled. Table 11: Percentage of Plans Achieving Passing Level Scores for Individual Sections 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 and Objectives II.2 Progress II.3 Action Steps to Achieving the Goals Identified for Upcoming Six Month Period II.4 Planning for Permanency Overall Score # Passing (Scores 4 or 5) 100% 82.6% 76.0% 73.3% 57.3% 65.3% 42.7% 81.3% 41.3% # Not Passing (Scores 3 or Less) -17.4% 24.0% 26.7% 42.7% 34.7% 57.3% 42.7% 58.7%

The sample data indicates that 81.3% of the plans did identify an appropriate treatment plan permanency goal for the child or family (slightly decreased from 82.2% last quarter). Small gains are noted in other categories as well; most notably the Department is becoming more adept at including appropriate identifying information for active case participants (82.6%).

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IV. Monitor's Findings Regarding Outcome Measure 15 ­ Needs Met Outcome Measure 15 requires that, "at least 80% of all families and children shall have all their medical, dental, mental health and other service needs met as set forth in the "DCF Court Monitor's 2006 Protocol for Outcome Measures 3 and 15 dated June 29, 2006, and the accompanying `Directional Guide for OM3 and OM15 Reviews dated June 29, 2006." The case review data indicates that the Department attained the designation of "Needs Met" in 45.3 % of the 75-case sample. This is a decline from the fourth quarter 2006 results of 52.1%. The data and analysis reveal that children and families face many obstacles to getting their identified needs met. Most frequently noted: children remain in restrictive levels of care well beyond the time clinically appropriate, are often wait-listed for community services, have specific mental health or educational needs that are not addressed in a timely manner or with specialized treatment of choice, and do not have their well-child medical or dental needs met per EPSDT standards. In addition, the review indicates that a significant portion of the children in the sample have not had their permanency needs addressed through progressive case work and decisions. Records reflect lack of timely recruitment, unfocused and unclear steps toward permanency goals, lack of Life Book work, lack of effort toward concurrent goals and delayed decisions regarding maintaining placements that while stable, are not permanent. Many of the records reviewed provide very little detail or insight into the progress attained through use of DCF referred services that are provided. Progress reports or meaningful updates from providers through collateral contacts are minimally documented or absent all together. Only 56.2% of cases documented engagement of active service providers in treatment planning efforts. Only 25.2% of providers actually attended the TPC/ACR/FC to provide first hand feedback. There is a slight variation when looking at the case assignment type in relation to needs met. Of the 24 cases selected as in-home family cases, twelve or 50.0% achieved "needs met" status. Comparatively, twenty-two of the 51 cases with children in placement (both CPS and Voluntary) achieved "needs met" status (43.1%). There is a decline in scores for both case type categories from the prior quarter.

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Crosstabulation 3:

What is the type of case assignment noted in LINK? * Overall Score for Outcome Measure 15
Overall Score for Outcome Measure 15 Needs Met 11 21 1 1 34 Needs Not Met 10 26 2 3 41 Total 21 47 3 4 75

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

The overall score for Outcome Measure 5 is also viewed through the filter of the stated permanency goal as shown below: Crosstabulation 4: 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? Reunification Adoption Transfer of Guardianship Long Term Foster Care with a licensed relative APPLA: Permanent Non-Relative Foster Care APPLA: Other In-Home Goals - Safety/Well Being Issues UTD - plan incomplete, unapproved/missing for this period Stated Goal is not an approved DCF goal Total Needs Met 11 10 1 0 1 0 11 0 0 34 Needs Not Met 9 6 1 0 9 3 11 1 1 41 Total 20 16 2 0 10 3 22 1 1 75

As clearly seen in Crosstabulation 4 above, those children identified with "APPLA: Permanent Non-Relative Foster Care" or "APPLA": Other "are achieving Needs Met" status with much less frequency than those children with other identified permanency goals. Of those with Reunification as the stated goal, 55% had needs met. Of those with Adoption as the goal, 62.5% achieved the measure with "needs met". Transfer of Guardianship cases had needs met in 50.0% of the cases. All three "APPLA: Other" cases failed to achieve "needs met" status. Of those cases with "APPLA: Permanent Non-Relative Foster Care", 10.0% achieved the measure.

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The Department has recently implemented changes in practice related to the use of the APPLA goals which may have a substantial impact upon its performance related to OM 15. There is now a permanency review process that must be utilized prior to approving a child's permanency goal as APPLA. Outcome Measure 15 looks at twelve categories of measurement to determine the level with which the Department is able to meet the needs of children and families. When looking at passing scores (5 or 4) and those not passing (3 or less) there is a marked difference in performance among the categories. DCF scores highest in providing Prompt Legal Action (II.2) which passes in 93.3% of the cases reviewed, and Safety of Children in Placement (I.2) which passes in 81.5% of applicable cases. Of note, the data also shows an increase in the passing rate of the Current Placement Section (IV.4), which showed 80.8% of the cases passing. There is a shift from prior reviews which had the Department showing the most difficulty in meeting the dental needs of children. However, while the overall percentage has improved when needs are not met in this category (III.2), it is more likely that the score assigned by the reviewer was in the poor or adverse range. Reviewers indicate that a majority of the concerns are related to excessive gaps in well care visits or no documentation regarding dental care. In this quarter, the category with the lowest percentage of passing scores is Section III.3: "Well-Being ­ Mental Health, Behavioral and Substance Abuse Services." This quarter a passing score is achieved for Section III.3 in only 60.6% of the cases reviewed. This is followed closely by deficits noted in Section I.1: "Safety ­ In-Home", which has a passing rate of 60.9%.

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Table 12: Identification of Outcome Measure 15 categories and resulting percentage achieving/not achieving "passing" scores of 4 or 5
Category DCF Case Management ­ Legal Action to Achieve the Permanency Goal During the Prior Six Months (II.2) Safety ­ Children in Placement (I.2) Child's Current Placement (IV.1) Medical Needs (III.1) Securing the Permanent Placement ­ Action Plan for the Next Six Months (II.1) DCF Case Management ­ Recruitment for Placement Providers to achieve the Permanency Goal during the Prior Six Months (II.3) Dental Needs (III.2) Educational Needs (IV. 2) DCF Case Management ­ Contracting or Providing Services to achieve the Permanency Goal during the Prior Six Months (II.4) Safety ­ In Home (I.1) Mental Health, Behavioral and Substance Abuse Services (III.3) # Passing (Scores 4 or 5) 93.3% 81.5% 80.8% 80.0% 79.6% 76.7% # Not Passing (Scores 3 or Less) 6.7% 18.5% 19.2% 20.0% 20.4% 23.3%

70.7% 69.8% 61.6%

29.3% 30.2% 38.4%

60.9% 60.6%

39.1% 39.4%

All categories are in Table 13 below with the frequency and percentage of applicable cases achieving each rank score below.

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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 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 (26.1%) 30 (55.6%) 22 (40.7%) 57 (76.0%) 31 (51.7%)

8 (34.8%) 14 (25.9%) 21 (38.9%) 13 (17.3%) 15 (20.0%)

7 (30.4%) 8 (14.8%) 9 (16.7%) 4 (5.3%) 9 (15.0%)

2 (8.7%) 1 (1.9%) 2 (3.7%) 0 (0%) 5 (8.3%)

0 (0%) 1 (1.9%) 0 (0%) 1 (1.3%) 0 (0%)

52 21 21 0 15

23 (31.5%)

22 (30.1%)

18 (24.7%)

10 (13.7%)

0 (0%)

2

43 (57.3%) 38 (50.7%) 20 (28.2%) 29 (55.8%) 26 (41.3%)

17 (22.7%) 15 (20.0%) 23 (32.4%) 13 (25.0%) 18 (28.6%)

10 (13.3%) 7 (9.3%) 19 (26.8%) 4 (7.7%) 15 (23.8%)

3 (4.0%) 4 (5.3%) 8 (11.3%) 5 (9.6%) 4 (6.3%)

2 (2.7%) 11 (14.7%) 1 (1.4%) 1 (1.9%) 0 (0%)

0 0 4 23 12

For a complete listing of rank scores for Outcome Measure 15 by case, see Appendix 2.

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 24 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.

6

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In addition to looking at the twelve categories of Outcome Measure 15, the review collected data on situations in which a case had a need identified at the prior ACR, in the prior treatment plan or within the six-month period of LINK record reviewed. Data was collected on those needs that remained unresolved at the point of the most recent treatment planning efforts. In 29 of the 75 cases (38.7%), the reviewers found all needs from the six-month period of review met at the point of scoring post ACR. The remaining 46 cases identified at least one unmet need carried over from the prior treatment planning period with a total of 97 unmet needs. Table 14: Unmet Service Needs Identified within the Sample Set Cases
Category of Need No Unmet Needs Child Care (1.0%) Dental (7.2%) Domestic Violence (5.2%) Education (3.1%) Housing (2.1%) Medical (5.2%) Mental Health (28.9%) Unmet Needs from Prior Treatment Planning Period No Unmet Needs from prior treatment planning period after school program dental screenings and evaluation dental or orthodontic services domestic violence services - perpetrator domestic violence services program - victim educational screening or evaluation occupational therapy housing assistance (Section 8) health/medical screening or evaluation other medical interventions individual counseling family or marital counseling other state agency program (DMR, DMHAS, MSS) therapeutic child care behavior management group counseling mental health - care coordination mental health screening or evaluation other: wraparound services to allow for discharge problem sexual behavior therapy psychological or psychosocial evaluation residential facility care therapeutic foster care group home adoption recruitment matching/placement/processing (includes ICO) Frequency 29 1 5 2 3 2 2 1 2 4 1 11 6 2 2 1 1 1 1 1 1 1 6 3 2 1 1 Percent of All Unmet Needs N/A 1.0% 5.2% 2.1% 3.1% 2.1% 2.1% 1.0% 2.1% 4.1% 1.0% 11.3% 6.2% 2.1% 2.1% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 6.2% 3.1% 2.1% 1.0% 1.0%

Out of Home Care (13.4%)

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Category of Need (cont'd) Substance Abuse (10.3%)

Unmet Needs from Prior Treatment Planning Period drug/alcohol testing outpatient substance abuse treatment substance abuse screening/evaluation inpatient substance abuse treatment relapse prevention program family reunification in-home parent education and support family stabilization positive youth development program mentoring respite services maintaining family ties supervised visitation life skills training DCF case management/support/advocacy DCF worker/child visitation DCF/provider contact Total Unmet Needs

Frequency 4 2 2 1 1 2 2 1 1 5 2 1 1 1 5 1 1 97

Percent of All Responses 4.1% 2.1% 2.1% 1.0% 1.0% 2.1% 2.1% 1.0% 1.0% 5.2% 2.1% 1.0% 1.0% 1.0% 5.2% 1.0% 1.0% 100.0%

In-Home Supports (6.2%)

Out of Home Support (9.3%)

Training (1.0%) DCF (7.2%)

"Delay in referral by DCF Worker" was the most frequently identified barrier noted, with 20.6% of unmet needs resulting from this issue. "Client refusal" was cited 19.6% of the time. However, reviewers report there is little documentation of Social Worker's efforts to utilize the ARG, community providers, or family members to engage parents. "Unable to determine" was selected by the reviewers in 14.4% of the situations and results from the process which does not incorporate interview to clarify lack in documentation. The "Other" category comprises19.6% of the needs unmet. The variant issues are detailed in table 16.

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Table 15: Barriers for Identified Unmet Service Needs during Prior Six Months
Barriers Delay in referral by worker Client refused service Other UTD from treatment plan or narrative Placed on waiting list Referred service is unwilling to engage client Service deferred pending completion of another Transportation unavailable Service not available in primary language service not available for age group No slots available Insurance issues Hours of operation (alternate hrs needed) No service identified to meet this need Approval process Total Barriers Identified for Unmet Needs Frequency
20 19 16 14 8 3 3 2 2 2 2 2 2 1 1 97

Percent of Barriers Identified
20.6% 19.6% 16.5% 14.4% 8.2% 3.1% 3.1% 2.1% 2.1% 2.1% 2.1% 2.1% 2.1% 1.0% 1.0% 100.1%7

"Other Barriers" cited in the chart above are identified as: Table 16: "Other" Barriers Identified during Review Process
No TX plan/action developed around need Child left state Daycare Discharge planning needed DCF undecided regarding appropriate service Foster family not willing to adopt Miscommunication with the provider No appropriate facility to meet need Referral delay due to change in CPT Reluctance by Connecting Families to facilitate siblings visits Required specialist dental work SW it would be upsetting to sibs Income Total Frequency 4 1 1 1 1 1 1 1 1 1 1 1 1 16

7

Due to rounding.

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In addition, when looking specifically at the most recent treatment planning document, 43 cases (57.3%) had a service need that was clearly identified at the TPC/ACR/FC or within LINK documentation that was not incorporated into the most recent treatment plan document. This included a total of 101 service needs. The most frequently noted need is dental service. Table 17: Needs Identified but not incorporated into the Treatment Plan Reviewed for 1Q 2007
Frequency Dental screenings and evaluation Mentoring Case management/support/advocacy Health/medical screening or evaluation Therapeutic child care Educational screening or evaluation Other medical interventions Worker/provider contact Family or marital counseling In-home treatment (MDFT, MST or FFT) Worker/child visitation Family reunification Foster care support Individual counseling In-home parent education and support Life skills training Maintaining family ties Medication management Adoption supports Care coordination Childcare/daycare Housing assistance (Section 8) Individualized programs per IEP Evaluation Mental health screening or evaluation ARG consultation Outpatient substance abuse treatment Psychological or psychosocial evaluation Residential facility Sexual abuse therapy (victim) Substance abuse screening/evaluation Worker/parent visitation Total 16 9 8 7 7 6 6 6 3 3 3 2 2 2 2 2 2 2 1 1 1 1 1 1 1 1 1 1 1 1 1 101 % of all Needs Not Incorporated 15.8% 8.9% 7.9% 6.9% 6.9% 5.9% 5.9% 5.9% 3.0% 3.0% 3.0% 2.0% 2.0% 2.0% 2.0% 2.0% 2.0% 2.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 1.0% 100.0%

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The data was reviewed in light of how time in care may impact the frequency with which the Department is able to meet children's needs. Crosstabulation 5 below provides data that requires further study, as it suggests that the Department decreases in OM15 performance when children are in placement for extended periods of time. For children in placement with less than 24 months in care, the Department achieved "Needs Met" status 54.8% of the time. When looking at those children in care greater than 24 months, the rate of cases with "Needs Met" status drops to 28.6%. Crosstabulation 5: How many consecutive months has this child been in out of home placement as of the date of this review or date of case closure during the period? * Overall Score for Outcome Measure 15
Overall Score for Outcome Measure 15 Needs Met How many consecutive months has this child been in out of home placement as of the date of this review or date of case closure during the period? 1-6 months 7-12 months 13-18 months 19-24 months Greater than 24 months N/A - no child in placement (in-home case) Total 2 9 5 1 6 11 34 Needs Not Met 2 4 5 3 15 12 41 Total 4 13 10 4 21 23 75

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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 the 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 have been drafted by the Court Monitor and are in the process of final review by both parties. Many of the monitoring strategies have been initiated during the previous quarter. The monitoring strategies include regular meetings with the Department staff, the Plaintiffs, provider groups, and other stakeholders to focus on the impact of action steps outline in the Juan F. Action Plan; selected site visits 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 will be undertaken 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 are intended to inform the parties and promote practice improvement. The Monitor will continue to work closely with both parties to ensure that the reviews are targeted, integrated and results orientated. Populations for planned targeted reviews may include: · Children age 12 and under in congregate care settings · Children receiving STAR/Shelter services · Children receiving Therapeutic Group Home services · Children with Another Planned Permanency Goal (APPLA) · Children receiving Multi-Disciplinary Assessment of Permanency (MAP) and children requiring Permanency Planning Team services · Children receiving Intensive Safety Planning Services (ISP) · Placement stability of children within Private Foster Care service settings · Child Adolescent Needs and Strengths (CANS) and Global Appraisal Individual Needs (GAINS) assessed children · Children served by Individualized Community-based services First Quarter 2007 Updates: · The data file for disruptions in placement during FY 06 was delivered to the Connecticut Behavioral Health Partnership (CTBHP) in April 2007. The CTBHP is conducting a study to determine the correlates between disruption of first or second foster homes and behavioral health utilization indications. The findings were originally intended for August 2007 but are now expected in October 2007 due to Department delays in providing additional data.

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There has been inconsistent progress across the area offices in implementation the action steps of the Local Area Development Plans (LADP). A summary of each area office goals and progress was presented at a Commissioner's Meeting attended by the Monitor's Office in February 2007. Planning groups are being reconvened at this time to review the progress and begin preparation for next year's LADP submission. The Monitor will review the next iteration of LAPD's and will track the progress of implementation and the integration of the LAPD's with ongoing service needs assessment and activities. Training on the use of Child and Adolescent Needs and Strengths (CANS) inventory has been completed and area office staff are now utilizing this inventory with requests for therapeutic placement settings to Value Options. While the use of CANS represents a great opportunity to improve assessment and integration of information within each case, variability in the quality of the CANS has been noted. These quality issues lead to redundant and or additional efforts by Value Options. Often area office staff must reconcile conflicting or missing information, and this leads to delays in consideration of a specific child for treatment/placement. This is an area identified for targeted review by the Monitor's Office. Efforts have been undertaken to address children in a delayed status for placement services. A specific plan for addressing overstays in Emergency Departments (ED) was implemented during the past two months. Elements of the plan include on-site assistance to Emergency Departments from Value Options, Emergency Mobile Psychiatric Services (EMPS), and DCF staff; development of an inpatient resource directory (i.e. available beds), an MOU between ED's and EMPS, ongoing analysis of recent ED admissions, implementation of a Child And Adolescent Rapid Emergency Stabilization Service (CARES) proposal, a flex capacity plan that includes priority access and targeting of EMPS services and inhome service models (IICAPS); and a review of discharge activities related to children residing at Riverview Hospital. These elements have resulted in more timely and effective transitions for many children out of the Emergency Departments but other children with complex behavior conditions continue to be "stuck" due to the inability to identify inpatient services willing or able to accept these children. The May point-in-time data from the Behavioral Health Partnership indicates that 117 children are on delayed status. Beginning on page 26, the section entitled "Analysis of Delay in 24-hour care under the Community Behavioral Health Partnership" provides additional data regarding the population of children in delayed status. Clinical reviews of children ten and under in inpatient treatment settings were conducted by CTBHP staff. The findings and data were used to promote area office focus on discharge planning for this population. Value Options staff are tracking and following up on this data.

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Case 2:89-cv-00859-AHN
Juan F. v Rell Exit Plan Quarterly Report June 20, 2007 ______________________________

Document 536

Filed 06/22/2007

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Bi-weekly clinical rounds are held to assist in managing the treatment/placement needs of children as related to available residential and group home slots. The Monitor attends these meetings. The Department continues to struggle with identifying appropriate treatment/placement options in a timely manner. Due to the loss or reduction of beds resulting from Licensing or Program Review concerns, the Department is again resorting to utilization of out-of-state providers to ensure treatment needs are provided for. This has the potential to undo three years of progress that resulted in a reduction of over 200 children placed out-ofstate. Currently, in-state providers are unable and/or unwilling to provide service for children with complex psychiatric needs (including fire setting, problem, sexual behavior, and aggressive and assaultive behavior) and significant cognitive impairment. Recent data from the CTBHP indicated that 276 children were awaiting placement and service in residential treatment centers and group homes. There were potential matches for 131 of these children although only 22 had been accepted at the point of the report. These totals represent those children for whom a request for service via a submission of CANS has been received. Recent reviews by the Monitor's Office has revealed additional children where CANS submissions have not been timely, resulting in children further delayed in receiving services to meet identified needs. Children for whom CANS have not been developed or submitted are waiting for foster care services (public and private), inpatient service