Free Order - District Court of Connecticut - Connecticut

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Juan F. v Rell
Exit Plan Outcome Measures 2005 Annual Progress Report

Civil Action No. H-89-859 (AHN)
November 7, 2005

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 Page 3 9 12 Page 17 23 33 38 40 42 43 49 55 62 64 66 68 70 72 77 81 87 95 98 100 103

Executive Summary Key Findings Introduction Outcome Measures 1. Commencement of Investigation 2. Completion of Investigation 3. Treatment Plans 4. Search for Relatives 5. Repeat Maltreatment 6. Maltreatment of Children in Out-of-Home Care 7. Reunification 8. Adoption 9. Transfer of Guardianship 10. Sibling Placement 11. Re-Entry into DCF Custody 12. Multiple Placements 13. Foster Parent Training 14. Placement Within Licensed Capacity 15. Needs Met 16. Worker-Child Visitation (Out-of-home) 17. Worker-Child Visitation (In-home) 18. Caseload Standards 19. Residential Reduction 20. Discharge Measures 21. Discharge of Mentally Ill or Retarded Children 22. Multi-Disciplinary Examinations Appendix · Appendix 1: Exit Plan Outcome Measures Summary Report, Second Quarter 2005, April 1, 2005 ­ June 30, 2005 · Appendix 2: Crosswalk of Services to Category of Needs Identified · Appendix 3: Case Review Tools

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Executive Summary The Juan F. v. Rell Exit Plan requires the Monitor's Office to produce two annual reports (2005 and 2006) documenting the Department of Children and Families' progress in implementing the 22 Exit Plan Outcome Measures. The planning for this first report commenced in late 2004, when the Monitor's Office began to solicit questions and information from DCF Facility staff, Area Office and Central Office staff and the Plaintiffs related to a review of the quality of the work associated with the stated outcomes. Review protocols were drafted and submitted to both parties for review and comment before they were finalized in April 2005. In all, eleven reviewers took part in the record review process. The review team included five members of the Department's Quality Improvement Division, four contracted reviewers with prior DCF experience, the DCF Liaison to the Court Monitor, and our Monitoring Specialist. Of that group, four individuals conducted interviews with front line social workers. Prior to the review, the team trained on the tool via a series of interrator testing. This resulted in several minor revisions to the tool, and a clarification of several definitions and directions that improved the reliability of the tool and reliability of reviewer response. The results of this comprehensive case review process confirm the significant improvements in case practice that have been noted in prior quarterly reports. The analysis offers considerable insight into the strengths and weaknesses of the Department's overall performance in meeting the Exit Plan Outcome Measures. The concentrated, coordinated, and focused approach the Department has employed to implement fundamental and sustainable changes is evident throughout our review of all 22 Outcome Measures. Nevertheless, considerable effort will be required to address areas of the work that although improved, clearly remain a major challenge, especially within the timeframe outlined in the Exit Plan. The record review began in May 2005 and concluded in August 2005. The methodological process is detailed within the full report but in brief includes the following components: LINK Reports: Exit Outcome Measures one through 22 were evaluated per the requirements outlined in the bolded text box fields of the Revised Juan F. v. Rell Exit Plan dated July 2004. All Outcome Measures, with the exception of 3,4,7,10,11,131, 15, 20 and 21 were reviewed for compliance via the LINK automated reports2 as outlined in the Exit Plan. The Monitor has continuously verified the accuracy of the LINK reporting and with the exception of methodological differences, LINK data entry errors, and slight deviations in reporting periods; our case review

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Outcome Measure 13 is reported via scheduled submission/memorandum of OFAS/CAFAP. DCF Exit Plan Outcome Measures Summary Report, Second Quarter 2005, April 1 ­ June 30, 2005.

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findings are consistent with LINK reports.3 The quantitative performance scores provided by LINK automated reporting are supplemented with a qualitative review as required by the Exit Plan methodology. LINK Record Review: To review the quality of practice for investigation Outcome Measures 1 & 2, a LINK record review of 50 investigation cases was conducted via a sample from the universe of all reports accepted at the DCF Hotline during the period of January 1, 2005 through March 31, 2005. Outcome Measures 3 and 15 were the primary focus of this case review. Findings for these two Outcome Measures are based upon a sample drawn at a 95% statewide confidence level with a ± 4% margin of error. These two measures cannot be captured and reported on via an automated system and will always require case review. The Monitor's statistically valid statewide review of 569 cases focuses on the period of February 15, 2005 through May 15, 2005. Record reviews commenced in June 2005. The record review was LINK based and included a thorough reading of the LINK record, treatment plans and Treatment Planning Conferences/Administrative Case Review (ACR/TPC) documentation for a period of 60 days to 12 months prior to May 15, 2005. In addition to the statistically valid sampling and data analysis for Outcome Measure 3 and Outcome Measure 15, the remaining Outcome Measures were reviewed for qualitative benchmarks via a series of questions developed with input from the Department and the Plaintiffs. These data elements were collected only when applicable to a given case selected for the Outcome Measure 3 and Outcome Measure 15 case record review. While the data collected for these measures may not represent a statistically valid sample, it offers the Monitor's Office an opportunity to evaluate the quality of case practice, LINK reporting reliability, information related to continuous quality improvement efforts, and the opportunity to assess the progress for Outcome Measures where data is currently lacking. Since the Department has been unable to provide an automated report for Outcome Measures 4, 7, 10 and 11, this data, while limited by the number of cases included for each measure, can help inform the parties on the current status of the Department's progress. Outcome Measures 20 and 21 were measured on the full universe of 29 individuals over the age of 18 who were discharged from care during the period of February 15, 2005 through May 15, 2005. The universe was identified through LINK data and the adolescent units statewide. This review was undertaken as an additional task, as the Department is not able to produce automated information on these measures, and our preliminary data analysis

The primary data entry errors involve missing removal dates and legal status and discharge data inaccuracies. The Department recently completed a clean up of legal status data but errors persist. Additionally, approximately 6% of the children in placement have no removal date recorded in LINK. These errors will have varying impact on automated reporting of Outcome Measures 4, 7, 8, 9, 10, 11, 12, 20, 21, and 22.

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revealed that the sample selected did not include any children discharged from care. Interviews: To supplement the LINK record review, a random sub-sample of 100 Ongoing Service Social Workers were contacted and asked to participate in an interview. This component was included so that reviewers could gather Ongoing Service Social Worker insight that may not be available through a LINK record review process. In all, 96 of the 100 Ongoing Service Social Workers contacted for interview chose to participate in the process. As with the interview component in the 569 ongoing service cases, there was also an interview component related to investigative practices. Twenty-five Investigation Social Workers were randomly selected from the investigation sample (n=50) to participate in an interview. All 25 Investigation Service Social Workers participated in the process. Interviews were held in June, July and early August 2005. Social Workers were contacted after the reviewer had completed the record review to set up an appointment for interview. The data from this process is reported in aggregate form and will not identify any individual worker. A team of four reviewers conducted the interviews. Each of the four interviewers was assigned specific cases to review and interview so that they had read the LINK documentation, and could conduct the interviews with basic knowledge of the case specifics. The interviews were held at a location and time most convenient to the worker. Exit Plan Second Quarter Results: Compliance was measured upon the Department's verified LINK reports on the full universe of affected populations where that data was available (Outcome Measures 1, 2, 5, 6, 8, 9, 12, 14, 16, 17, 18, 19, and 22). The remaining scores were based upon the Court Monitor's case review findings (Outcome Measures 3, 4, 7, 10, 11, 15, 20, and 21). Refer to Table 2 for the sample size information. Table 1 reflects the Department's submitted data report for the second quarter 2005. Table 2 reflects the Court Monitor's case review findings, and Table 3 represents the scores as determined by the methodology outlined in the Exit Plan document. Those Outcome Measures with a "" to the right of the score indicate the verified achievement of the measure for the timeframe indicated by the automated LINK report or the Court Monitor's case review.

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The Department submitted the following progress report for performance during the quarter ending June 30, 2005. Percentages are reflective of the Department's performance on the given measure based upon the LINK universe of cases.4 An "X" indicates that the Department did not report on the measure via automated reports. Table 1: Department of Children & Families Second Quarter Progress Report 2005 of the Exit Plan Outcome Measures
Department of Children & Families Requirement 2Q 2005 Report >=90% >=85% >=90% >+85% <=7% <=2% >=60% >=32% >=70% >=95% <=7% >=85% 100% >=96% >=80% >=85% 100% >=85% 100% <=11% >=85% 100% >=85% 95.1% 92.3% X X 8.5% 0.7% X 25.2% 72.8% X X 95.7% 100.0% 95.9% X M: 86.7% Q: X 78.0% 100.0% 12.6% X X 55.4%

Outcome Measure 1: Commencement of Investigation 2: Completion of the Investigation 3: Treatment Plans 4: Search for Relatives 5: Repeat Maltreatment of In-Home Children 6: Maltreatment of Children in Out-of-Home Care 7: Reunification 8: Adoption 9: Transfer of Guardianship 10: Sibling Placement 11: Re-Entry into DCF Custody 12: Multiple Placements 13: Foster Parent Training 14: Placement Within Licensed Capacity 15: Children's Needs Met 16: Worker-Child Visitation (Out-of-Home) 17: Worker-Child Visitation (In-Home) 18: Caseload Standards 19: Reduction in the Number of Children Placed in Residential Care 20: Discharge Measures 21: Discharge of Mentally Ill or Retarded Children 22: Multi-disciplinary Exams (MDE)

LINK reporting results are impacted by data entry errors in legal status and the failure to enter correct removal and discharge dates.

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The Court Monitor's review included data collection for all 22 Outcome Measures as reported below. As there are no automated LINK reports on Outcome Measures 3, 4, 7, 10, 11, 15, 20, and 21, compliance for these outcomes were measured via the Court Monitor's Case Review findings. While the numbers reported in our case review findings provide insight into Departmental practice, I caution that some findings are based on small samples. Please refer to the table below. Table 2: Juan F. Court Monitor's 2005 Exit Plan Case Review Findings
Measure 1: Commencement of Investigation 2: Completion of the Investigation 3: Treatment Plans 4: Search for Relatives 5: Repeat Maltreatment of In-Home Children 6: Maltreatment of Children in Out-of-Home Care 7: Reunification 8: Adoption 9: Transfer of Guardianship 10: Sibling Placement 11: Re-Entry into DCF Custody 12: Multiple Placements 13: Foster Parent Training 14: Placement Within Licensed Capacity 15: Children's Needs Met 16: Worker-Child Visitation (Out-of-Home) 17: Worker-Child Visitation (In-Home) 18: Caseload Standards 19: Reduction in the Number of Children Placed in Residential Care 20: Discharge Measures 21: Discharge of Mentally Ill or Retarded Children 22: Multi-disciplinary Exams (MDE) Requirement >=90% >=85% >=90% >+85% <=7% <=2% >=60% >=32% >=70% >=95% <=7% >=85% 100% >=96% >=80% >=85% 100% >=85% 100% <=11% >=85% 100% >=85% Sample Size 50 50 569 27 211 313 9 8 7 61 19 332 195 255 569 319 267 569 286 295 296 84 Findings 96.0% 94.0% 6.9% 88.3% 6.6% 0% 66.7% 50.0% 42.9% 65.6% 15.8% 96.0% 100.0% 87.8% 55.8% M: 89.5% Q: 99.1% 73.2% 100.0% 11.9% 61.5% 50.0% 57.7%

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The sample of 29 individuals for OM20 and OM21 represent the full universe for the period. The sample of 29 individuals for OM20 and OM21 represent the full universe for the period.

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Table 3 below represents the verified scores for the period. Those with a "" to the right of the score have achieved compliance with that measure as outlined within this report. Table 3: Court Monitor's Findings related to compliance with Exit Plan Outcome Measures for the period ending June 30, 2005
Outcome Measure 1: Commencement of Investigation (LINK) 2: Completion of the Investigation (LINK) 3: Treatment Plans (n=569) 4: Search for Relatives (n=27) 5: Repeat Maltreatment of In-Home Children (LINK) 6: Maltreatment of Children in Out-of-Home Care (LINK) 7: Reunification (n=9) 8: Adoption (LINK) 9: Transfer of Guardianship (LINK) 10: Sibling Placement (LINK) 11: Re-Entry into DCF Custody 12: Multiple Placements (LINK) 13: Foster Parent Training (DCF/CAFAP REPORT) 14: Placement Within Licensed Capacity (LINK) 15: Children's Needs Met (n=569) 16: Worker-Child Visitation (Out-of-Home) (M: LINK) (Q: n=319) 17: Worker-Child Visitation (In-Home) (LINK) 18: Caseload Standards (LINK) 19: Reduction in the Number of Children Placed in Residential Care (LINK) 20: Discharge Measures (N=29) 21: Discharge of Mentally Ill or Retarded Children (N=29) 22: Multi-disciplinary Exams (MDE) (LINK) Requirement >=90% >=85% >=90% >+85% <=7% <=2% >=60% >=32% >=70% >=95% <=7% >=85% 100% >=96% >=80% >=85% 100% >=85% 100% <=11% >=85% 100% >=85% Score Achieved 95.1% 92.3% 6.9% 88.3% 8.5% 0.7% 66.7% 25.2%7 72.8%8 65.6% 15.8% 95.7% 100.0% 95.9% 55.8% M: 86.7% Q: 99.1% 78.0% 100.0% 12.6% 61.5% 50.0% 55.4%

The Department's quarterly report indicated that 25.2% met the adoption measure. However, this report excluded 10 children with no removal date from their analysis. Given the missing data, the performance is adjusted to 23.4% (33 of 141 children adopted during the quarter). 8 The Department reports that 72.8% of all transfer of guardianships during the quarter were completed within 24 months. However, a review of the LINK data indicates that an additional 31 children with no removal date had a transfer of guardianship during this period. These individuals were excluded from the LINK quarterly reports submitted. Given this missing data, the performance is adjusted to 50% (63 of 126 children with transfer of guardianship during the quarter). The Monitor cannot confirm compliance with this measure.

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Key Findings The Monitor, upon review of all available information obtained and utilizing the prescribed methodology, finds the following: · The Department is in compliance with the following outcome measures: Commencement of Investigation (Outcome Measure 1) Completion of Investigation (Outcome Measure 2) Search for Relatives (Outcome Measure 4) Maltreatment of Children in Out-of-Home Care (Outcome Measure 6) Reunification (Outcome Measure 7) Multiple Placements (Outcome Measure 12) Foster Parent Training (Outcome Measure 13) Placement Within Licensed Capacity (Outcome Measure 14) Worker-Child Visitation (Out-of-Home)9 (Outcome Measure 16) Caseload Standards (Outcome Measure 18) · The results of the comprehensive case review confirm and verify the overall accuracy of the automated LINK reports. Differences between the case review and the automated data can be traced to differences in the methodology, LINK data entry errors, and slight differences in the reporting periods. The primary LINK data entry errors involve missing removal dates, legal status inaccuracies, and discharge data mistakes. The Department is aware of these issues and has begun the necessary steps to resolve them. · The analysis of investigation data reveals some improvement in a number of quality indicators including the percentage of victims and perpetrators interviewed, contact with prior social workers in cases with a prior DCF history, completion of initial risk assessments and documentation of investigation activities. The Department has sustained the goal for both investigation measures for three consecutive quarters. · Only 6.9% of the treatment plans reviewed included the minimal requirements outlined by the Exit Plan. Reviewers' indicated that despite the low level of overall compliance, the quality and completeness of treatment plans had improved since the last comprehensive review of treatment plans two years ago. In previous reviews there were often no treatment plans less than seven months old, and those that were less than seven months old were many times of such poor quality that they did not reflect the circumstances in the case. Clear articulation of the action steps and goals is the weakest component of the treatment plans reviewed. · 5% of the cases reviewed did not have a current treatment plan. · Case participants in-person attendance or teleconferencing at the Administrative Case Reviews/Treatment Planning Conferences remains low: 43.1% of the mothers, 21% of the fathers, 14.9% of children aged 12 or older, 35.1% of the current caretakers, 15.2% of the active service provider agencies and 5.1% of the identified attorneys participated in the 504 Administrative Case Reviews (ACR) or Treatment Planning Conferences (TPC) documented in the sample cases. · Relative searches for children entering placement January 1, 2005 or later, were conducted in 88.3% of the 27 cases in our sample.

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The monthly requirement was achieved.

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·

· ·

·

·

· ·

·

The Department has sustained achievement of the goal for maltreatment of children in out-of-home care for six consecutive quarters. None of the 313 children in the sample who were in placement during the period of February 15, 2005 through May 15, 2005 had a substantiated report of abuse or neglect by a substitute caretaker. 91% of the cases with a goal of reunification had identified concurrent plans, and 74% of the cases with concurrent plans had documentation that both plans were actively being pursued. The Department has improved the practice of finalizing adoptions within 24 months. Additionally, the case review data and Monitor's review of the Department's quarterly data indicate that the Department continues to pursue adoption for those children with adoption as their goal, regardless of whether they will meet the measure. At the time of the initial placement, sibling groups were placed together in 65.6% of the sample cases. The review data indicated that 23.8% of those not initially placed together later had been reunited, 42.9% of those not placed together had subsequently documented therapeutic reasons for being separated, and 33.3% still remained separated on May 15, 2005. In addition, 72.7% of the sibling cases that required visitation plans had them documented and 67.3% had documentation that sibling visitation was consistently occurring. The review of quarterly data confirms that as required, the Department has offered the required foster parent training (Outcome Measure 13) to the pool of DCF foster parents statewide. However, the case review data indicates that foster parent provider records do not reflect completion of required training. Despite the requirement for nine hours per year of post licensing training, 76.9% of the foster parents in our sample had no documented training last year. The review found that 58.1% of the homes in our sample that were re-licensed during the period of February 15, 2005 through May 15, 2005 did not have documentation of the required post-licensing training. The Department has reported achievement of the goal for multiple placements for five consecutive quarters. Despite the support of the Governor and Legislature in providing additional resources to the Department, the case review data indicates that children and families had all of their service needs met in slightly more than half of the cases reviewed. This finding is overstated since the reviewers found a significant number of cases where a clearly identifiable need was documented in the case record but not incorporated into the treatment plan. In addition, 5% of the cases did not have a current treatment plan to review and 9.8% of cases had Administrative Case Review/Treatment Planning Conference documentation of a service need that was not documented in the treatment plan. The current inadequacy of treatment plans seriously undermines determining whether children and families needs are met. The Department has made dramatic improvements in visitation with children and families. The review found that 99.1% of the children in out-of-home care had been seen quarterly. 89.5% of the out-of-home cases had been seen monthly. 73.2% of the in-home cases had been successfully visited twice a month. 10

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· ·

·

· ·

A sufficient amount of Social Workers and Social Work Supervisors are essential to make the improvements necessary to meet the outcome measures. The Department has maintained caseload standards for five quarters. The Department has made a significant reduction in children placed in residential care. The Monitor's case review data indicated that 11.9% of children are in residential care. On August 14, 2005, there were 722 children in residential placement. This is an 18.8% reduction from the April 11, 2004 total of 889 children in residential care. In addition, consistent oversight of out-of-state placements has allowed the Department to considerably reduce its' number of out-of-state placements. The Monitor found that 10 of the 29 youth discharged from care in the time period of February 15, 2005 through May 15, 2005 required adult services. Of those 10, only two youth's records had documentation that adult services were in place at the point of discharge. Five of the ten youth in the discharge universe had written discharge plans submitted to either Department of Mental Health and Addiction Services (DMHAS) or Department of Mental Retardation (DMR). 57.7% of the children entering care for the first time received a Multi-Disciplinary Exam (MDE) within 30 days of placement. This outcome measure is central to the assessment of children's needs and implementation of appropriate services. Nine additional MDE sites were opened recently in an effort to improve performance on this measure.

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Introduction The Juan F. v. Rell Exit Plan requires the Monitor's Office to produce two annual reports (2005 and 2006) documenting the Department of Children and Families' progress in implementing the 22 Exit Plan Outcome Measures. The planning for this first report commenced in late 2004, when the Monitor's Office began to solicit questions and information from DCF Facility staff, Area Office and Central Office staff and the Plaintiffs related to a review of the quality of the work associated with the stated outcomes. Review protocols were drafted and submitted to both parties for review and comment before they were finalized in April 2005. In all, eleven reviewers took part in the record review process. The review team included five members of the Department's Quality Improvement Division, four contracted reviewers with prior DCF experience, the DCF Liaison to the Court Monitor, and our Monitoring Specialist. Of that group, four individuals conducted interviews with front line social workers. Prior to the review, the team trained on the tool via a series of interrator testing. This resulted in several minor revisions to the tool, and a clarification of several definitions and directions that improved the reliability of the tool and reliability of reviewer response. The results of this comprehensive case review process confirm the significant improvements in case practice that have been noted in prior quarterly reports. The analysis offers considerable insight into the strengths and weaknesses of the Department's overall performance in meeting the Exit Plan Outcome Measures. The concentrated, coordinated, and focused approach the Department has employed to implement fundamental and sustainable changes is evident throughout our review of all 22 Outcome Measures. Nevertheless, considerable effort will be required to address areas of the work that although improved, clearly remain a major challenge, especially within the timeframe outlined in the Exit Plan. The record review began in May 2005 and concluded in August 2005. The methodological process is detailed within the full report but in brief includes the following components: LINK Reports: Exit Outcome Measures one through 22 were evaluated per the requirements outlined in the bolded text box fields of the Revised Juan F. v. Rell Exit Plan dated July 2004. All Outcome Measures, with the exception of 3,4,7,10,11,1310, 15, 20 and 21 were reviewed for compliance via the LINK automated reports11 as outlined in the Exit Plan. The Monitor has continuously verified the accuracy of the LINK reporting and with the exception of methodological differences, LINK data entry errors and slight differences in the reporting periods; the case

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Outcome Measure 13 is reported via scheduled submission/memorandum of OFAS/CAFAP. DCF Exit Plan Outcome Measures Summary Report, Second Quarter 2005, April 1 ­ June 30, 2005.

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review findings are consistent with LINK reports.12 The quantitative performance scores provided by LINK automated reporting are supplemented with a qualitative review as required by the Exit Plan methodology. LINK Record Review: To review the quality of practice for investigation Outcome Measures 1 & 2, a LINK record review of 50 investigation cases was conducted via a sample from the universe of all reports accepted at the DCF Hotline during the period of January 1, 2005 through March 31, 2005. Outcome Measures 3 and 15 were the primary focus of this case review. Findings for these two Outcome Measures are at a 95% statewide confidence level of +/- 4%. These two measures cannot be captured and reported on via an automated system and will always require case review. The Monitor's statistically valid statewide review of 569 cases focuses on the period of February 15, 2005 through May 15, 2005. Record reviews commenced in June 2005. The record review was LINK based and included a thorough reading of the LINK record, treatment plans and Treatment Planning Conferences/Administrative Case Review (ACR/TPC) documentation for a period of 60 days to 12 months prior to May 15, 2005. In addition to the statistically valid sampling and data analysis for Outcome Measure 3 and Outcome Measure 15, the remaining Outcome Measures were reviewed for qualitative benchmarks via a series of questions developed with input from the Department and the Plaintiffs. These data elements were collected only when applicable to a given case selected for the Outcome Measure 3 and Outcome Measure 15 case record review. While the data collected for these measures may not represent a statistically valid sample, it offers the Monitor's Office an opportunity to evaluate the quality of case practice, LINK reporting reliability, information related to continuous quality improvement efforts, and the opportunity to assess the progress for Outcome Measures where data is currently lacking. Since the Department has been unable to provide an automated report for Outcome Measures 4, 7, 10, and 11, this data, while limited by the number of cases included for each measure, can help inform the parties on the current status of the Department's progress. Outcome Measures 20 and 21 were measured on the full universe of 29 individuals over the age of 18 that were discharged from care during the period of February 15, 2005 to May 15, 2005. The universe was identified through LINK data and the adolescent units statewide. This review was undertaken as an additional task, as the Department is not able to produce automated information on these measures, and our preliminary data analysis revealed that the sample selected did not include any children discharged from care.
The primary data entry errors involve missing removal dates and legal status and discharge data inaccuracies. The Department recently completed a clean up of legal status data but errors persist. Additionally, approximately 6% of the children in placement have no removal date recorded in LINK. These errors will have varying impact on automated reporting of Outcome Measures 4, 7, 8, 9, 10, 11, 12, 20, 21, and 22.
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Table 4: In-home universe of cases open in ongoing services at any point during February 15, 2005 through May 15, 2005
Area Office Bridgeport Danbury Greater New Haven Hartford Manchester Meriden Middletown New Britain New Haven Norwalk Norwich Stamford Torrington Waterbury Willimantic Statewide Universe 424 156 393 448 416 206 226 482 616 120 432 186 122 261 343 4831 % of Caseload 8.8% 3.2% 8.1% 9.3% 8.6% 4.3% 4.7% 10.0% 12.7% 2.5% 8.9% 3.9% 2.5% 5.4% 7.1% 100.0% Sample Set 22 8 20 24 22 11 12 25 32 6 23 10 6 14 18 253

Table 5: Universe of open ongoing service cases with an identified child in placement February 15 through May 15, 2005
Universe Bridgeport Danbury Greater New Haven Hartford Manchester Meriden Middletown New Britain New Haven Norwalk Norwich Stamford Torrington Waterbury Willimantic Statewide 514 145 379 872 627 242 162 643 643 94 555 69 157 575 379 6056 % of Caseload 8.5% 2.4% 6.3% 14.4% 10.4% 4.0% 2.7% 10.6% 10.6% 1.6% 9.2% 1.1% 2.6% 9.5% 6.3% 100.0% Sample Set 27 8 20 45 33 13 8 33 33 5 29 4 8 30 20 316

An oversample of 10% was selected in the event that a case did not meet the criteria set for review and required replacement. Although requested, the Department's universe did not exclude cases open a minimum of 60 days during the period. As a result, multiple exclusions were required as a treatment plan was not required during the period and the case could not be subject to measurement for Outcome Measures 3 or 15. 14

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Investigation Cases Sampling Process: The Monitor's Office requested a data file including "all reports accepted at the DCF Hotline during the period of January 1, 2005 through March 31, 2005." The investigation universe provided included a total of 6,940 reports accepted at the Hotline during the first quarter of the 2005 calendar year. The Monitor's Office, determined that a sample of 50 cases would provide an adequate snapshot of the quality of the Department's practice. To determine the distribution of the cases, the universe was broken down by area office assignment, and the resulting percentage was used to calculate each region's portion of the 50 case sample. Additionally, 25 of the fifty cases were randomly selected for social worker interview to obtain information related to case practice that we would not be able to glean from the LINK case record. Table 6 below provides the details related to the distribution of the universe (N=6,940) and sample set (n=50). A 10% oversample was selected in the event that substitutions were required. Table 6: Universe of all accepted reports at Hotline and resulting sample allocation for case review
Area Office Bridgeport Office Danbury Office Gen'l Administration Greater New Haven Hartford Office Hotline Manchester Office Meriden Office Middletown Office New Britain Office New Haven Metro Norwalk Office Norwich Office Stamford Office Torrington Office Waterbury Office Willimantic Office Grand Total Total investigations 649 254 6 592 690 141 630 287 280 660 520 182 573 193 247 622 414 6,940 Percentage 9.35% 3.66% 0.09% 8.53% 9.94% 2.03% 9.08% 4.14% 4.03% 9.51% 7.49% 2.62% 8.26% 2.78% 3.56% 8.96% 5.97% 100% Sample 5 2 0 4 5 1 5 2 2 5 4 1 4 1 2 4 3 50 Subsample 2 1 0 2 3 0 2 1 1 3 2 1 2 1 1 2 1 25

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Discharge Measures Universe ­ Outcomes 20 and 21: When it became apparent from early data analysis that data would not be included on the population of children discharged from care (Outcome Measures 20 and 21) the Monitor's Office determined a separate review would be required. Therefore, on July 18, 2005 our office requested the following data file from the Department's Information Systems Unit: ... the universe of all children discharged at age 18 or older during the period of February 15, 2005 through May 15, 2005. Per the Exit Measure parameters, exclusions from this universe would be any child that is committed delinquent or children exiting voluntary services placements. The data file was then shared with the adolescent units statewide to verify the accuracy, as there is ongoing concern with the reliability of data files based on legal status and placement end dates. The resulting corrected file included a universe of 29 children. The full universe was studied using the questions developed for the larger tool for Outcome Measures 20 and 21. Interviews: To supplement the LINK record review, a random sub-sample of 100 Ongoing Service Social Workers were contacted and asked to participate in an interview. This component was included so that reviewers could gather Ongoing Service Social Worker insight that may not be available through a LINK record review process. Ninety-six of the 100 Ongoing Service Social Workers contacted for interview chose to participate in the process. As with the interview component in the 569 ongoing service cases, there was also an interview component related to investigative practices. A subset of 25 Investigation Social Workers was randomly selected from the investigation sample (n=50) to participate in an interview. All 25 Investigation Social Workers participated in the process. Interviews were held in June, July and early August 2005. Social Workers were contacted after the reviewer had completed the record review to set up an appointment for interview. The data from this process is reported only in aggregate form so as not to identify any individual worker. A team of four reviewers conducted the interviews. Each of the four interviewers was assigned specific cases to review and interview so that they had read the LINK documentation, and could conduct the interviews with basic knowledge of the case specifics. The interviews were held at a location and time most convenient to the worker.

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Outcome Measure 1: Commencement of Investigation Court Monitor's Case Review Findings: 96.0% (Sample Size: 50) DCF LINK Report for the period of April ­ June 2005: 95.1% The Juan F. Exit Plan requires that at least 90% of all reports13 must be commenced on the same calendar day, within 24 hours, or 72 hours depending on the response time designation. The Department's automated reports for the last three quarters indicate that the investigations requirement for the response time has been consistently exceeded. In fact, the Department's LINK reporting for the second quarter 2005 indicates that 95.1% of all investigations met this measure. In all 96.0% of the sample set (n=50) met or exceeded the response time set at Hotline, or modified response time if changed by area office management. The details of the case review are provided below to provide information related to both the numeric requirements and quality of case practice as it relates to the sample data. Sample Demographics (n=50): As detailed in the Methodology section, our review included fifty reports accepted at Hotline during the first quarter 2005. All fifty cases were reviewed during the period of May 14, 2005 through May 19, 2005. Reports selected included calls that were received at the Hotline from January 3, 2005 through March 30, 2005. The calls were most frequently received between 2:00 p.m. ­ 3:00 p.m. (7 calls). Forty-one of the reports (82.7%) were involving a report of abuse or neglect by the biological parent(s), adoptive parent(s) or legal guardian(s). Three reports (6.0%) involved foster family providers, two (4.0%) were school settings and four (8.0%) were "other" (Domestic Violence Shelter, Group Home, Hospital, non-custodial parent). Of the 50 cases opened for investigation, the LINK person maintenance record indicated that of the named case participants, 36 spoke English as their primary language, six were primarily Spanish speaking, two spoke primarily Portuguese, two French, one Chinese, and one was identified as Bilingual (English/Spanish). In two cases there was no documentation in the person maintenance record related to language. The Hotline documentation indicated a total of 66 allegations within the 50 case sample. Physical neglect was alleged most frequently. It was alleged in 29 of the 50 cases (58.0%). The table below provides the total number of allegations documented and the percentage of the sample that included each specific allegation.

13

Except Probate and Voluntary cases.

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Table 7: Allegations as identified by Hotline
Allegations Physical Neglect Physical Abuse Emotional Neglect Emotional Abuse Medical Neglect Sexual Abuse Education Neglect Moral Neglect Total Allegations Number 29 16 14 3 2 2 0 0 66 % of Cases 58% 32.0% 28.0% 6.0% 4.0% 4% 0% 0% ------

In one case, the report was accepted at Hotline and then determined not to be appropriate for investigation. The family's case was open in Ongoing Services with a child out of control and neglect petitions recently filed. At the time of acceptance of the report at Hotline, 11 of the 50 cases (22.0%) were already open in Ongoing Services, of which five cases had a substantiation within the 12 months prior to the referral included in our sample. Three cases (6.0%) were open in investigations at the point of acceptance of the report included in our sample. Eighteen (36.0%) were newly opened, with no prior CPS history. The remaining 18 reports (36.0%) included alleged perpetrators with a DCF history, but with no open case at the point of acceptance at the Hotline. Alleged Perpetrators: There were 63 identified alleged perpetrators in the reports transmitted from Hotline. Alleged perpetrators were more frequently female, as there were 36 female and 27 male perpetrators included in the sample. There were 13 cases in which two perpetrators were identified. Thirty-seven cases identified one perpetrator. Perpetrators ranged from age 16 to age 53 with an average age of 33.5. Race of perpetrators was predominately white, with 39 alleged perpetrators identified as white (61.9%), and nine identified as African American/Black (14.3%). One perpetrator was identified as unknown, 14 were identified as UTD (22.2%) as there was no race information located in the LINK record. 16 alleged perpetrators were identified as Hispanics, 43 Non-Hispanics and four unknown. Identified Victims: A total of 107 victims were identified in the protocol documentation14. The population was almost equally split, with 53 males and 54 females identified. Ages ranged from newborn to 17, with the most frequently reported age being one (10 children) and the average (mean) age being 7.5 years old.
14

Our tool allowed for up to five identified victims per case. In a few instances, the number exceeded the maximum allowed. Therefore the number of identified victims may be slightly underreported.

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Table 8: Age of identified victims within the 50 reports of abuse/neglect accepted at Hotline during the first quarter 2005
Age (years) 0-2 3-5 6-8 9-11 12-14 15-17 Number of Children 22 17 24 14 16 14

Each case designates a reference child at the point of acceptance. This is generally the youngest child, but may be otherwise if the abuse is not directed at the youngest household member. In the 50 cases reviewed, the relationship between that referenced child and the alleged perpetrator(s) of the abuse or neglect was most frequently a parent/child relationship. Table 9: Relationship between identified victims to the 63 identified perpetrator(s)
Alleged perpetrator's relationship to victim Custodial Parent Caretaker Step Parent School Personnel Other Relatives Guardian Group Home Staff Paramour Number of children having this relationship 44 8 4 2 2 1 1 1

Outcome Measure One Issues: Supervisory conferences at the point of Social Worker assignment were documented in 41 investigations (82.0%) of the sample. The response time designated by Hotline was most frequently 72 hours (52.0%), followed by 24 hours (38.0%) and finally, same day response (10.0%). Modification of the response time was documented in seven cases (14.0%). The required response time was met in 96.0% of the sample. Eight of the 50 cases had one or more additional reports accepted during the quarter. Three were accepted within seven days of the first report. One was appropriately merged with the prior accepted report. The interviews with the 25 Investigation Social Workers provided some insight into the challenges faced by Investigation Units in attempting to meet the requirement of Outcome Measure 1. At the beginning of our interview, the reviewers asked the 19

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Investigation Social Worker "Do you feel the Hotline's system for establishing the response time is valid?" · 64.0% indicated that they did indeed feel the response time designation15 was valid. · 36.0% indicated that they did not feel it was valid, as there seemed to be some issues with reliability/consistency in the process for assigning response designation among Hotline workers. Using a Likert Scale16 the interview asked the investigators "How would you rate the general quality of information that was received upon transfer of the referral to investigation services, and then "Specific to the identified case, how would you rate the quality of information provided". The investigators overwhelmingly indicated the quality to be good or higher for both questions (92.0%), but the ranking scores for the general question were consistently lower than the ranking assigned to the specific case responses. In the general question, three cases ranked as superior and one case ranked as outstanding, while in the specific case ranking question ten workers indicated superior quality and five outstanding. See the crosstabulation below for details. Table 10: Crosstabulation: Specific to this case, how would you rate the quality of information provided to you from Hotline with in general, how do you rate the quality of information that you receive from the Hotline
Count Specific to this case, how would you rate the quality of information provided to you from Hotline Poor Good Superior Outstanding Total 0 1 1 0 2 2 7 7 3 19 0 0 2 1 3 0 0 0 1 1 2 8 10 5 25

In general, how do you rate the quality of information that you receive from the Hotline Total

Poor Good Superior Outstanding

The interviewer went on to ask, "Is there any information that is consistently lacking in the reports that you receive, or are there quality issues in the work produced at Hotline that negatively impacts your ability to perform your job?" Of the 25 investigators, 21 or 84.0% indicated that there are some issues related to the quality of information they receive. When asked to identify or elaborate on those areas, the following list of issues was collected (please note that this was an open ended question with no restriction on the number of issues to be identified).

15 16

The Department has policy that establishes a protocol for assigning response time. Tools provided in appendix for reference.

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Table 11: Issues identified by the Investigation Social Worker related to the Hotline
Issue Identified # of times identified % of cases in which this issue was identified 44.0% 44.0% 16.0%

Incorrect or missing address information Inaccurate or missing Case Participant information LINK searches improperly conducted resulting in poor historical perspective, duplication of participants in the system, and data merges later in the process Hotline Worker misrepresents/incorrectly captures reporters comments No issues identified Language/Ethnicity information is not provided Allegations are not clear Basic questions are not asked of the reporter Safety issues are not documented Spelling and grammar are so poor that the report is hard to understand Hotline response after hours/weekends is not adequately documented and leads to gaps in information or duplication of efforts

11 11 4

4 4 2 1 1 1 1 1

16.0% 16.0% 8.0% 4.0% 4.0% 4.0% 4.0% 4.0%

Some investigators did indicate that they could not be certain if the inaccuracies were the result of the work at Hotline or the reporter's accuracy. When asked how frequently the investigator met the required response time17 for their assigned cases, 14 (56.0%) indicated that they met the designated response time 100% of the time, while the remaining 11 workers indicated that they met the response time between 75.0%-99.9% of the time. Our interview captured information relative to the barriers/obstacles that Investigation Social Workers faced in meeting the designated response time. Investigation Social Workers could identify up to three barriers. In 14 of the cases (56.0%) the worker indicated the reason for failing to meet the designated response time was the result of demands of other cases. Table 12 provides the full list of barriers/obstacles identified by the Investigation Social Worker.

17

Response time is met upon the SW attempt to make physical contact with the parent or person responsible for the child's care, and or the child(ren). DCF Policy 34-4.

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Table 12: Barriers to meeting response time as identified by Investigation Social Work interview
Barrier/Obstacle Other case emergencies/caseload demands Incorrect address or case participant information Delays in assignment (Hotline or SWS) Inability to interview/family not home Coordination with Police or DPH required Car availability No barriers to meeting response time Court Worker illness # of Times Identified 14 8 7 6 5 4 2 2 1 % of workers citing this issue 56.0% 32.0% 28.0% 24.0% 20.0% 16.0% 8.0% 8.0% 4.0%

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Outcome Measure 2: Completion of the Investigation Court Monitor's Case Review Findings: 94.0% (Sample Size: 50) DCF LINK Report for the period of April ­ June 2005: 92.3% The Juan F. Exit Plan requires that at least 85% of all reports shall have their investigation completed within 45 calendar days of acceptance by Hotline. The Department's automated reports for the last three quarters indicate that the requirement for response time has been consistently exceeded. In fact, the Department's LINK reporting for the second quarter 2005 indicates that 92.3% of all investigations met this measure. In all, 94.0% of the 50 cases selected for review were completed with the 45-day requirement. The range of days to completed investigation was four days to 55 days. In all, 47 of the 50 reports were completed within 45 days. See Table 13 below for more details: Table 13: Length of investigation (acceptance at Hotline to Social Work Supervisor approval)
Days 1-5 6-10 11-15 16-20 21-25 26-30 31-35 36-40 41-45 46-50 51+ Number of Cases 1 2 4 2 5 4 12 8 9 1 2

For each interview with the Investigation Social Worker, the interviewer captured the barriers to closing a case within the 45-day Consent Decree mandate. Table 14 below provides the list in order of the frequency of response by the Investigation Social Worker. Please note that the workers were not limited to one response.

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Table 14: Barriers to achieving Outcome Measure 2
Barriers Caseload/other case emergencies Resistant client Families schedules (work/school) ABH evaluations delays Court LINK issues Wait Lists Supervision Placement Police collaboration Cannot locate family Forensic evaluations Transfer conference Cars Illness Percentage of Investigation Social Workers Identifying Barrier 64.0% 36.0% 28.0% 24.0% 24.0% 16.0% 16.0% 16.0% 12.0% 12.0% 8.0% 8.0% 4.0% 4.0% 4.0%

The documentation within LINK indicates that the Investigation Social Worker contacted the Ongoing Service Social Worker in all cases in which an open ongoing services case was under investigation. In 18 cases (36.0%) this was the first involvement with DCF. Findings indicate that 32 of the cases involved allegations on families with a known CPS history (64.0%). Of these 32 cases with a history of DCF involvement, 87.5% of the investigations had documentation of a record review prior to disposition. In the 14 cases in which the history included DCF involvement in the 12-month period preceding the report selected for our sample only eight cases (57.1%) had documented contact with the prior DCF worker. Five of the alleged perpetrators had a substantiated report in the 12-months preceding the report included in this review. In 48 cases the primary caretakers were interviewed prior to establishing the disposition of the report (96.0%). Of the 48 documented interviews with primary caretakers, 93.6% were interviewed in their primary language. Secondary caretakers were interviewed in 89.7% of the cases in which such an individual was identified. The 63 alleged perpetrators identified within our 50 case sample were interviewed prior to the disposition of the case in 88.9% of the sample. Documentation indicates that three of the 56 interviews held were not conducted in the primary language of the alleged perpetrator. All identified victims were seen face-to-face at least once during the course of the investigation in 90.6% of the sample cases. However, only 88.0% of the cases had documentation of the required interview with the identified victim. While there is no requirement in current DCF policy regarding a required number of visits during an investigation of a report of abuse or neglect, this was an area of case 24

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practice for which data was collected during our review. When asked during the interview process, "How often do you visit a home during an investigation?" All 25 workers indicated that they visit two to four times during an investigation. When looking at the actual visits on the identified cases, only 64.0% of the workers recorded a minimum of two visits. 28.0% had one recorded visit and 8.0% had no visits to the home. Ten workers (40.0%) interviewed felt that there was often a shift in purpose during later visits, when the focus became more concentrated on assessment of service needs rather than the informational gathering process that is the focus during the initial visit. Table 15 below provides the frequency of contact with the 107 identified child victims within the case sample. Table 15: Frequency of visitation during investigation
Frequency of face to face contacts 0 1 2 3 4 Total Number of children having the indicated frequency of visits 10 52 38 5 2 107

Documentation also indicates an additional 22 adults and 30 other (non-victim) children living in the homes in which the alleged abuse/neglect took place were interviewed by the assigned Investigation Social Worker. Reviewers searched for documentation of interview or assessment of the case participants identified within each case. In 34 cases (68.0%), all identified participants were interviewed and/or visually assessed. Fifteen cases (30.0%) had some record of interviews, but did not document all needed interviews, and one case did not include any interviews. While Outcome Measure One measures the commencement of the investigation, our tool also captured the time frame from acceptance of the case at Hotline to the time the identified reference child victim was seen/interviewed. The data indicates that:
· · · ·

The range of time documented from assignment to successful contact was "same day" to 32 days from assignment (0...32). Three cases did not have successful contact documented. The most frequently documented time frame to contact (mode) is same day of assignment (11 cases). The average length of time to successful contact (excluding the three cases with no contact) is 4.64 days.

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Removals: Eleven children (10.3%) that were participants in six investigations were removed from their home at some point during the investigations within this sample. Six children were removed at the onset, four at the first face-to-face meeting with the investigator, and one at some point later in the investigation. Three of the children remained in placement with commitment pending at the time of review. Of the 11 children with placement activity, only one had more than one placement during the placement episode. In one case, the child was able to remain in the home as the perpetrator was asked to leave. The documentation in the investigation protocols indicates that the investigators documented a search for relative placement resource in three of the six cases with removals. Two sibling groups were impacted by placement. One group was maintained together in placement, the other group was separated. In reply to questions regarding interaction with FASU during the placement process, 72.0% of Investigation Social Workers report that they work closely or very closely with their Foster and Adoptive Service Unit during the matching process. Services During Investigations: In 24 cases, the Investigation Social Worker offered the family/child a service referral to help address conditions in the home and avoid placement. In 19 of the 24 cases with a referral (79.2%), the documentation indicates that family engaged in at least one of the referred services. The needs identified by the documentation in these 50 cases was collected, as was the number of cases in which the needs identified had corresponding referrals made. Data indicates that 76.5% of the needs identified during investigation result in a referral to service. The protocol used did not provide additional data regarding whether the referral may not have been made, as services were sought by the family or through a provider active with the family. This may be an issue to be considered in future reviews. In the interview with the 25 Investigation Social Workers, we asked, "With whom did you share your assessment of needs?" Only 52.0% of the Investigation Social Workers indicated that a family member was provided with the information.

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Table 16: Needs identified during investigation
Services Substance abuse treatment Mental health ­ child Mental health ­ adult Domestic Violence Foster care placement Parent education Family support center Financial Assistance/Concrete Needs Shelter/Housing Early childhood (Birth to 3) FAST (Foster & Adoptive Support Team) Parent aide Extended day treatment EMPS Other needs Total # of cases in which need was identified 14 11 9 5 4 4 3 3 2 2 1 1 1 1 7 68 # of cases in which referral was made 11 8 6 4 4 3 2 3 1 1 1 1 1 1 5 52 Percentage of Referrals to Need 78.6% 72.7% 66.7% 80.0% 100.0% 75.0% 66.7% 100.0% 50.0% 50.0% 100.0% 100.0% 100.0% 100.0% 71.4% 76.5%

Our interview also included a general question: "In general, what service(s) do you most often identify for families during an investigation?" The following table identifies the Investigation Social Workers response: Table 17: Investigation Social Workers most frequently identified needs during investigation process
Need Substance Abuse Treatment Individual Counseling Parent Aide Domestic Violence Parent Education ABH/Substance Abuse Evaluation Intensive Family Preservation Anger Management Financial Assistance/Concrete Needs Mentor Placement Family Counseling Couples Therapy Respite, Systems of Care, Adolescent Shelters, Birth to 3, CJR, Hartford Street Youth Project, Behavior Therapy, Info Line, Group Counseling, Juvenile Court, Transportation, EMPS, Housing (each reported once) # of times need was cited 15 14 13 10 9 7 6 3 3 2 2 2 2 1 % of workers identifying 60.0% 56.0% 52.0% 40.0% 36.0% 28.0% 24.0% 12.0% 12.0% 8.0% 8.0% 8.0% 8.0% 4.0%

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Investigators identified substance abuse treatment as a need in 60.0% of the interviews. This is followed by individual counseling (56.0%), parent aide service (52.0%) and domestic violence service (40.0%). When asked if "the area office had sufficient services to meet identified needs?" 80.0% of the investigators replied "no". Ninety-two percent of investigators interviewed indicated that the Area Resource Group could be helpful during the investigation process. However, utilization rates (as identified by the investigators) differed dramatically. One investigator indicated use in only 5.0% of his cases while another investigator indicated 100% utilization. The average (mean) utilization rate is calculated at 43.0%. Table 18: What percentage of time do you use the Area Resource Group on investigations either in accompanying you on a home visit or in consultation?
ISW Utilization of ARG 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 40.0% 50.0% 60.0% 65.0% 70.0% 75.0% 100.0% Frequency 1 2 1 1 2 4 2 3 4 2 1 1 1 Percent 4.0% 8.0% 4.0% 4.0% 8.0% 16.0% 8.0% 12.0% 16.0% 8.0% 4.0% 4.0% 4.0% Cumulative Percent 4.0% 12.0% 16.0% 20.0% 28.0% 44.0% 52.0% 64.0% 80.0% 88.0% 92.0% 96.0% 100.0%

Our tool asked the reviewers, "Were there service needs clearly warranted by the facts of the investigation, but for which there was no documented offer to provide service?" In 15 cases (30.0%) the reviewer answered "yes". All 15 of these cases had investigations completed within the 45-day mandate. The services they noted as not being addressed included: · Mental Health/Counseling: 5 · Domestic Violence Services: 3 · Substance Abuse Evaluation/Treatment: 3 · Intensive Family Preservation: 2 · Parent Education: 2 · Anger Management: 1 · Family Coach (recommended by child's therapist during investigation): 1 · Court Intervention to change visitation: 1 · Sexual Abuse Treatment - victim: 1 · Teen support group: 1 · Birth to three: 1 28

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· · · · ·

Board of Health: 1 Parent Aide: 1 DCF Case Management: 1 Daycare: 1 Educational Assessment/Program: 1

Table 19: Crosstabulation: What percentage of the time do you seek out and provide services to reduce immediate safety risks or prevent removal of children from families during investigation? * How often do you identify service needs for families investigated?
Count How often do you identify service needs for families investigated? Sometimes Usually Almost Always Always (25% - 49%) (50%-74%) (75%-99%) (100%) 0 0 3 0 1 0 0 1 1 0 2 0 0 2 4 0 0 0 1 0 0 1 2 1 1 2 2 1 3 5 14 3

Total 3 2 3 6 1 4 6 25

What percentage of the time do you seek out and provide services to reduce immediate safety risks or prevent removal of children from families during investigation? Total

0-15 16-30 31-45 46-60 61-75 76-90 91+

One hundred percent of transferred cases had an initial assessment completed prior to transfer. In the seven cases that were opened in Ongoing Services, three cases included documentation of an invitation to the Investigation Social Worker to participate in the treatment planning conference. The Investigation Social Worker participated in only one case. Disposition: Of the 50 reports, 13 resulted in substantiation (24.0%). The allegations included in those substantiated reports included: · 3 counts of emotional neglect · 1 count of physical abuse · 9 counts of physical neglect · 1 count of moral neglect · 1 regulatory violation Documentation: The review found that 98.0% of the 50 case sample cases contained documentation that addressed the specific allegations outlined in the Hotline report. The review looked at several requirements of the investigation documentation to determine the level of compliance with practice standards. The review found that: · 98.0% of all cases had completed the risk assessment · 96.0% of all cases had a documented criminal check · 80.0% of all cases had documentation of the domestic violence screen · 76.0% of all cases had documentation of the substance abuse screen 29

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·

·

·

75.6% of the cases requiring educational contacts documented the collateral contact. o 38.5% of the school age children identified in the report subsequently had the educational icon created in LINK 72.0% of the sample cases had the required medical collateral contact documented prior to disposition. o 42.0% of the sample cases had the medical icon created in LINK for all children identified as victim within the report. 48.0% of the alleged perpetrators were contacted with information related to the disposition of the case.

Interviewees cited several explanations or barriers to documentation of the medical collateral contact requirement. The top four reasons cited by the Investigation Social Workers are: 1) large clinics have poor response time; 2) medical provider response is received after we close the case; 3) parents refuse to sign a release of information; and, 4) contact with medical providers is not initiated if case is open in ongoing services. During our 25 interviews, the Investigation Social Workers were asked their opinion on the effectiveness/usefulness of the tools available to them in conducting investigations. See Tables 20 and 21 below for their response. Table 20: Investigation Social Workers' ratings of investigation screening tools (n=25)
Screening Tool Substance Abuse Screen Domestic Violence Screen Risk Assessment Poor 9 10 11 Fair 5 4 4 Good 11 11 10

Table 21: Investigation Social Workers' opinion of current DCF protocol
Comment Redundant Good/thorough/useful Okay/fair Inconsistency in use among units is troublesome Don't use format/not user friendly LINK issues/doesn't retain all info entered Outdated Needs to link to other key documents Number 10 8 4 2 1 1 1 1 Percentage 40.0% 32.0% 16.0% 8.0% 4.0% 4.0% 4.0% 4.0%

In 11 cases (22.0%), reviewers identified a level of abuse/neglect allegation, which would have required contact/collaboration with law enforcement or the Assistant Attorney General. In eight of the cases, this documentation was found (72.7%). In three cases, the reviewer indicated there was no such documentation.

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In 45 of the 50 reports (90.0%), the reporter was identified. In 33 of those 45 cases (73.3%) there was documented contact between the Investigation Social Worker and the reporter. During interviews, 44% of the Investigation Social Workers indicated that they never or almost never (0%-24%) make joint visits to the home at the time of or following the transfer to Ongoing Services. We also collected data on the gap in visitation between Investigations Social Workers and the assigned Ongoing Services Social Worker. Two of the cases transferred (33.3%) had the visit within seven days of the last Investigation Social Worker visit. There was a range of 20 days that elapsed between contacts for the cases reviewed (days: 1,6,9,16,18,21). Supervision: The review captured several data elements