Free Order - District Court of Connecticut - Connecticut

Case 2:89-cv-00859-AHN

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Monitor's Office Juan F. v Rell Exit Plan Quarterly Report June to September 2004 December 16, 2004

Respectfully submitted: 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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Report on DCF's Progress Toward Achieving Juan F. Exit Plan Outcome Measures June - September 2004 Page 2 of 37 ______________________________________________

Table of Contents Monitor's Office 3rd Quarter Exit Plan Report Summary Page 3 10

Executive Summary Table 1: Exit Outcomes Overview Commissioner Dunbar's Statement on the Exit Plan Outcome Measures 2004 Third Quarter Report Exit Plan - Status of Work

12 16

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Executive Summary The Department of Children & Families (DCF) continued to make consistent forward progress toward exit from the Juan F. Consent Decree during the quarter ending in September 2004. DCF has complied with five (5) outcomes during this quarter. On four (4) of the 22 outcome measures, DCF has maintained compliance for two (2) consecutive quarters. Some of these outcome measures are based only on a review of a small snapshot of cases that cannot be generalized to the full population; however, they indicate solid progress since the reviewed cases were randomly selected and the sample size ranged from 50 to 75 cases. The most important measures in this group are caseload standards, and repeat maltreatment of children in out-of-home care, both of which DCF has maintained for two (2) consecutive quarters, and which is based on 100% of all open DCF cases since it is derived from LINK, the Department's information system: Outcome Measure (Standard)
Repeat maltreatment of children in out-of-home care (<=2%) Foster & adoptive parent offered training (100%) 1 Caseload standards met (100%) Discharge measures achieved (>=85%) Multiple placements (>=85%)

Second Quarter Score 0.8% 100% 100% 52% 95.8%

Third Quarter Score 0.8% 100% 100% 93.0% 95.2%

DCF has made progress toward achieving five (5) additional outcome measures. The most notable of these are the dramatic improvements on completing investigations in a timely fashion; the number of adoptions completed within 24 months of the child's most recent entry into DCF custody; the completion of transfers of guardianships within 24 months of the child's most recent entry into DCF custody; and, the number of multidisciplinary examinations completed on time: Outcome Measure (Standard)
Completion of the investigation (>=85%) Adoption completed (>=32%) Transfer of guardianship (>=70%) Placement of children within licensed capacity (>=96%) Multi-disciplinary examinations on time (>=85%)

Second Quarter Score 68.8% 11.1% 52.4% 92% 24.5%

Third Quarter Score 83.5% 29.6% 64.6% 93% 48.9%

1

Based on report from the Connecticut Association of Foster and Adoptive Parents (CAFAP).

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Report on DCF's Progress Toward Achieving Juan F. Exit Plan Outcome Measures June - September 2004 Page 4 of 37 ______________________________________________

Accurate and comprehensive reporting on nine (9) outcome measures is dependent on LINK additions or modifications before reliable reports are possible. All the LINK improvements are scheduled to be complete by mid-2005. Those outcome measures are: Commencement of the investigation; Search for relatives; Reunification within 12 months; Siblings placed together; Re-entry into DCF custody; Discharge measure on children that exit from DCF services; Appropriate measures taken prior to discharge of mentally ill or retarded children from DCF custody; Worker-child visitation for children placed in out-of-home care; and, Worker-child visitation for in-home cases. The Monitor's Office and DCF will jointly conduct a larger case review in mid 2005 for those measures on which LINK is not able to report. The larger case review will also provide an opportunity to collect qualitative information related to all of the outcome measures. Some of the currently reported measures are based on small random snapshots. Whether or not children's needs are met is based on a review of only 69 cases, for example. On the two (2) following outcome measures, only the case review process will be the source: Whether treatment planning processes are comprehensive and completed on time; and, Whether all identified needs of children are met. When DCF certifies to the Monitor's Office that it has achieved compliance on all outcome measures for two (2) consecutive quarters, the Monitor's Office will select a 96% statewide statistically valid sample to inform the Court as to whether the Defendants have, in fact, achieved and maintained compliance with all 22-outcome measures. DCF has regressed slightly on four (4) of the outcome measures: Outcome Measure (Standard)
Repeat maltreatment of children (<=7%) Children's needs met (>=80%) Reduction in the number of children placed in residential care as a percentage of the total number of children in DCF out of home care (>=11%)2 Appropriate discharge of mentally ill or retarded children (100%)
2

Second Quarter Score 8.8% 57.0% 14.3%

Third Quarter Score 9.4% 53.0% 14.7%

64.0%

56.0%

The number of children placed out-of-state has decreased by 46 since January 1, 2004. The number of children in DCF custody has also declined from 6805 as of May 31, 2004 to 6463 as of November 30, 2004.

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Report on DCF's Progress Toward Achieving Juan F. Exit Plan Outcome Measures June - September 2004 Page 5 of 37 ______________________________________________

Overall, the results demonstrate consistent forward progress. Time will be required to complete the process that has begun so well. The dramatic increase in the number of adoptions completed within 24 months of the child's most recent entry into DCF custody is based on a total of 209 adoptions completed during the quarter. However, this degree of progress in one quarter (29.6%) is surprising. The backlog of adoptions has been processed out of the central office, and both the probate courts and the Superior Court for Juvenile Matters have taken actions to expedite adoptions. Because the expectations of most were that more time would be required to reach and sustain this measure, DCF is commended for its progress on finalizing so many adoptions within 24 months during this quarter. A few more quarters of observation are needed to determine if this adoption progress represents the upward trend this quarter's data suggests. The source of this data is LINK, and therefore, includes all children adopted during the quarter. The progress in completing multi-disciplinary examinations (MDEs) is noted. This improvement appears to be the result of an increased documentation rather than an actual increase in the number of MDEs. The DCF has made plans to increase the number of sites conducting MDEs and the number of hours such examinations can be performed. This is crucial for progress on the timely and comprehensive completion of the treatment planning process. Attendance at treatment planning conferences, administrative case reviews, and case record documentation all demonstrate that this early planning process requires major attention from the DCF leadership team, which has recently initiated a new family conferencing model in an attempt to improve performance. Without adequate assessment of the needs of children and families at the outset, valid treatment planning and sufficient service planning and delivery is impossible. More funds will be required in the short-term as the Department completes its LINK information system and DCF transitions from a system heavily reliant on long-term institutional care to a community-based, family-centered system actually based on the individual needs of children and families. At the present time, DCF applies an undifferentiated treatment and service model for a dramatically differentiated group of families and children. Individualized, tailored services for each child and family are necessary. In the long run, the funding required should lessen. The Department's budget projections for current services and its budget options must be approved if the outcome measures of the Exit Plan are to be achieved. The Department requires more funding to transition from an institutional system to a community-based, family-centered system.

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Report on DCF's Progress Toward Achieving Juan F. Exit Plan Outcome Measures June - September 2004 Page 6 of 37 ______________________________________________

Governor M. Jodi Rell has demonstrated her commitment to achieve the outcome measures and thus end the jurisdiction and management of the Federal Court by personally breaking through bureaucratic obstacles when that is consistent with her other responsibilities. For example, when new staff was hired, but no cars were purchased for them to do their work, Governor Rell cut through the red tape and 100 cars were delivered by October 31, 2004 as she promised. One of the members of the Transition Task Force that is managing DCF, Secretary of OPM, Marc Ryan, is leaving Connecticut State Government. The expertise and commitment he has brought to the management process will be sorely missed. It is in part a tribute to him that a solid management team is developing at DCF central and area offices. The consistent leadership of the Transition Task Force and the Commissioner and her deputies, assisted by the services of Ray Mancuso, Deputy Monitor, must be maintained. In the next quarters, the Department must dramatically: Improve its treatment planning processes and the coordination among the private providers that serve Connecticut's most vulnerable families and children; Improve its coordination and delivery of services among State Agencies to provide the most efficient delivery of services; Improve the management and coordination of expensive residential services by bringing Connecticut's children home and by developing a continuum of services, of which residential care is a crucial part; Improve its ability and comfort with using existing funding more flexibly and efficiently; Improve its recruitment, training and retention of foster and adoptive parents; Improve adoption opportunities by removing disincentives to adoption by providing the same services and payments for foster children and adoptive children; Overhaul shelter facilities and programs so they become part of the treatment continuum rather than a mere place for children to live while waiting for critically needed services to become available There is no doubt that continued consistent and persistent attention must be paid to each of the outcome measures to achieve exit from the Juan F. Consent Decree. Nothing stated here is meant to diminish the strong start the Department and the Transition Task Force has begun. Rather, it recognizes the amount of work that remains to be done.

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Report on DCF's Progress Toward Achieving Juan F. Exit Plan Outcome Measures June - September 2004 Page 7 of 37 ______________________________________________

In addition to the focus on individual outcome measures, a far-reaching series of major changes and reforms are necessary. Several of those have begun during this quarter. In April 2004, the Department convened a group of providers, advocates and DCF staff for the purpose of presenting information about the specific service needs of the children served by the Department and to request creative proposals to meet those needs. The proposals were intended to help the Department achieve multiple exit outcome measures including meeting the needs of children and the reduction of the overuse of residential care. The Department has notified five (5) providers that they will enter into negotiations with each of them to create community-based group homes for youth currently in residential care facilities with a strong emphasis on the those children placed out of Connecticut. These five (5) group homes will begin serving 25 youth in 2005. The Department is also planning six (6) additional group homes to serve 30 additional youth beginning in 2006. The early completion of MDEs (multi-disciplinary examinations) is essential for a successful treatment planning process. DCF has prepared a Request for Proposal for release in December 2004. The RFP is intended to expand the MDE provider system to all area offices. Start-up for the expanded services is targeted for April 2005. Connecticut is also in the process of deciding the most appropriate place in State Government for the provision of services to developmentally disabled children and voluntary service cases involving no child abuse and/or neglect. DCF is currently meeting the needs of these children, but the combined expertise of other agencies could meet their needs more effectively. As part of its continuing effort to achieve greater efficiency and effectiveness, the Transition Task Force approved the reorganization and division of the New Haven Area Office in September 2004. A New Haven Area Office and the Valley/Shore Area Office with satellite operations will be established early in 2005. Too many of Connecticut's children are placed out-of-state in residential facilities and they are visited too seldom. DCF has established five (5) Social Worker positions to meet the visitation requirements for children placed out of Connecticut. These workers will be expected to visit these children twice a month and to assist in the process of bring them home to appropriate Connecticut services3. At this stage in the exit process, the treatment planning process is the area in the most dire necessity for sustained, solid improvement and consistency across DCF area offices and significantly impacts outcome measures. The difficulty of revamping the treatment planning process cannot be over-stated. It is a huge task that will require a major change throughout DCF. The treatment planning process consists of more than 20 separate
The number of children placed out-of-state has decreased by 46 since January 1, 2004. The number of children in DCF custody has also declined from 6805 as of May 31, 2004 to 6463 as of November 30, 2004.
3

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elements that must be completed to meet the outcome measure. Approximately 10% of the small sample reviewed achieved this standard. The Monitor's staff has noted that far too many DCF Social Workers and Supervisors seem to consider the treatment planning process and resulting plan to be of little value, rather than the primary document detailing the purposes and goals for DCF's involvement with the child and/or family. Attendance of attorneys, parents, children and other significant parties in the administrative case review is poor, and, it is not even clear they are consistently invited to participate in many of the treatment planning conferences/administrative case reviews. A major change in both the process, and the attitude toward it, is essential. The Department needs to improve by: Encouraging participation of families and providers via timely invitation and use of available technology, Clearly identifying service needs, Working to families' strengths, Clearly identifying responsible parties and timelines for completing tasks, and clarifying how progress will be measured, Making timely changes to the draft plans and finalizing the process via SWS approval so that all participants have an official document of reference for case direction in the six months following the treatment planning process or administrative case review. The Department has initiated a managed service system to improve the provision of appropriate levels of care in a timely manner and to reduce the number of children and families waiting for appropriate services. DCF will convene providers weekly to coordinate services in private facilities, safe homes, and residential facilities based on the needs of each individual child and family. This collaboration should also reduce the uneven use of programs throughout the system. Programs that cannot currently provide the services needed by the children in DCF custody will have to modify their programs to meet the existing needs. Additional enhanced care coordinators will be hired to complete comprehensive assessment, treatment and service plans and to assist the DCF Area Offices and providers to identify and develop appropriate services and supports to successfully transition and/or maintain children in their communities. This system will also help improve the treatment planning process. DCF's shelter system is in dire need of an overhaul. These programs were not developed or funded to meet the growing mental health needs of the populations they are now expected to serve. Lengthy stays waiting for the availability of more appropriate placements and services are commonplace. What follows is the report submitted to the Monitor's Office by DCF. It is unedited, except in cosmetic ways. Table 1 of that report summarizes the Department's degree of progress toward achieving each measure. The table also indicates which outcome measures are based on 100% of all cases through LINK or based on a review of a small number of cases.

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Report on DCF's Progress Toward Achieving Juan F. Exit Plan Outcome Measures June - September 2004 Page 9 of 37 ______________________________________________

The Department's working document, Exit Plan - Status of Work is also attached. This document is just one of the ongoing mechanisms that the Department is employing to facilitate both improvements to their operations and to assure success with the exit plan. There are a wide array of similar activities that promote agency readiness, such as the development of a communications plan targeting both internal and external audiences, the development of specific Area Office plans, and the embedding of exit plan activities in management review and Quality Improvement Plans for each Area Office. The progress made by DCF during the first three (3) quarters is impressive.

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Report on DCF's Progress Toward Achieving Juan F. Exit Plan Outcome Measures June - September 2004 Page 10 of 37 ______________________________________________

Table 1: Exit Outcomes Overview Third Quarter Report (July 1- September 31, 2004)
Measure Measure Target Dates Baseline Jan-Mar 04 Apr-Jun 04 Jul-Sep 04

1: Commencement of Investigation 2: Completion of the 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

>=90% >=85% >=90% 85% <=7% <=2% >=60% >=32% >=70% >=95% <=7% >=85% 100% >=96% >=80% >=85%

9/1/04 1/1/05 7/1/05 12/1/04 7/1/05 5/1/06 5/1/06 5/1/06 5/1/06 5/1/06 5/1/06 1/1/04 12/1/04 1/1/05 5/1/06

X 73.7% X 58% 9.2% 1.2%

X 64.2%
Qualitative**

2/15/05 * 68.8%
Qualitative **

2/15/05* 83.5%
10%

93% 9.4% 0.5%

2/15/05* 8.8% 0.8 2/15/05* 11.1% 52.4% 2/15/05 * 2/15/05* 95.8% 100% 92.0% 57% 86% monthly 98% quarterly 40% 100% 14.3% 52% 64% 24.5%

5/15/05* 9.4% 0.8% 5/15/05* 29.6% 64.6% 5/15/05* 5/15/05* 95.2% 100% 93.0% 53.0% (69 cases) 73% monthly 93% quarterly 46% 100% 14.7% 93% 56% 48.9%

57.8% 11/15/04* 12.5% 10.7% 60.5% 62.8% 57% 65% 6.9% 11/15/04* X X X X 94.9% X 88.3% 53% 72% monthly 87% quarterly 39% 298+ 13.9% 74% 43% 19.0%

16: Worker-Child Visitation (Outof-Home) 17: Worker-Child Visitation (InHome) 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)

4/1/05 100% >=85% 100% <=11% >=85% 100% >=85% 10/1/05 7/30/04 5/1/06 12/1/05 1/1/05 5/1/06

X

X 348+ 13.5% 61% X 5.6%

Results based on Case Reviews Note: Case reviews are conducted from a small case sample and provides a "snapshot" of current practice.

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Exit Outcomes Overview

Third Quarter Report (June 1- August 31, 2004)
NOTE: Case reviews will continue to be conducted for two quarters following the LINK build (this will allow for a two quarter testing period). A LINK report will be conducted for the third quarter following the LINK Build. * OM1 ­ LINK reports available for the 4Q 2004 (2/15/05) reports. OM 4 ­ Case Review for 1Q due 11/15/04, 2Q due 2/15/05, 3Q due 5/15/05. First LINK report 4Q due 8/15/05 OM7, 11 ­ OM10 ­ December LINK enhancement and case review reports submitted for 2/15/05, 5/15/05, and 8/15/05. First LINK report for 11/15/05. ** Treatment Plans were evaluated based on four (4) major categories (including 15 elements a-o): 1Q Background Information (53%), Assessment Information (52%), Treatment Services (47%), and Progress Toward Case Goals (18%). (Approved and Not Approved treatment plans) 2Q Background Information (60%), Assessment Information (37%), Treatment Services (43%), and Progress Toward Case Goals (32%). (Approved and Not Approved treatment plans) 3Q Background Information (66%), Assessment Information (52%), Treatment Services (55%), and Progress Toward Case Goals (35%). (Approved treatment plans only ­ 86) In addition, two (2) additional areas were evaluated: Treatment plan must be written and treatment conference conducted in the family's primary language and treatment plans developed in conjunction with parents/child/service providers (for example, treatment plan modifications as a result of input from the ACR) 1Q Treatment Plan Written in the family's primary language n/a and Treatment Plan Conference conducted in the family's primary language (95%) 2Q Treatment Plan Written in the family's primary language (91%) and Treatment Plan Conference conducted in the family's primary language (98%) 3Q Treatment Plan Written in the family's primary language (89%) and Treatment Plan Conference conducted in the family's primary language (97%) ***OM 3 and 15 (X) ­ no LINK report expected. Case Review Only. + 1Q Data results for baseline and 1Q only reflect cases over 100% not those that meet exception criteria. 2Q As of August 1, 2004 the Department has achieved caseload standards ­ 100% (in accordance with the exception criteria). On August 1, 2004 fifteen (15) cases, over 100% caseload utilization, met the exception criteria (cases over 100% and not over for 30 days or more). 3Q As of November 15, 2004 the Department remains at the 100% compliance mark. The sixteen (16) cases over 100% caseload utilization meet the exception criteria (cases over 100% and not over for 30 days or more).

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Commissioner Dunbar's Statement on the Exit Plan Outcome Measures 2004 Third Quarter Report The Department has continued to move forward in its commitment to meeting the 22 measures outlined in the Exit Plan that benefit Connecticut's children and families. All levels of the Department continue to use the Exit Outcome Measures and the Positive Outcomes for Children (POC) Plan as the guiding platform by which our social work practice and service provision are created, delivered and enhanced. The Exit Outcomes are now integrated into the Performance Appraisal System (PARS) of Area Directors and each Area Office has developed a Quality Improvement Plan highlighting their individual efforts to achieve our Exit Plan Outcome Measures. Additionally, the POC leadership team has completed a comprehensive Status of Work Matrix that continuously documents all activities and resource needs associated with the plan. This work has given rise to the recent designation of a communication plan project lead to implement a variety of strategies to efficiently communicate the POC activities and provide information to the general public and staff. Also, as an overarching undertaking, each Area Office has established a Quality Assurance/Improvement infrastructure which consists of Quality Improvement managers, Quality Improvement teams (various area office staff), teams from the Quality Improvement Division (central office), and the Positive Outcomes for Children Leadership team. The teams develop quality assurance processes and support plans that the particular office's Quality Improvement Plan and directly correlates with Exit Plan data results. Finally, with respect to cultural competency, the Division of Multicultural Affair's recently implemented several contracted translation/interpreter services covering 150 languages and the hearing impaired, which can be utilized 24 hrs a day/7 days a week. This brings the Department closer to achieving success across the outcome measures in a culturally competent manner. DCF staff are aware of this service and there is a listing of services and a "how-to-use guide" available via the DCF intranet. This service also provides translation of documents, including reports (as requested by parents). With this backdrop, the Third Quarter Report results further demonstrate our staff's efforts and accomplishments in moving the Department closer to achieving the Exit Plan Outcome Measures. Below are several highlights that depict the progress and results emanating from our work. Completion of investigations has increased substantially from the baseline measure. Adoptions had a significant increase from the Second Quarter Report. Achievement of the outcome goal for Discharge Measures improved substantially. Steady progress continued for Placement within Licensed Capacity and achievement of this measure is very close.

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Outcomes for Multiple Placements, Foster Parent Training, and Caseload Standards met the goal for two consecutive quarters. More specifically, the Department has experienced steady progress towards achieving Exit Outcome #2: Completion of Investigations, with a 19.3 % increase from the First Quarter (64.2%) to the Third Quarter report (83.5%). The most recent data reports for the month of October show that 12 of the 13 area offices achieved the measure with all 12 achieving compliance at above 90%. In another area, one of the most significant improvements occurred with Exit Outcome #8: Adoption. This measure increased by 18.5% from the Second Quarter (11.1%) to the Third Quarter (29.6%). Although this shows great progress, we are cautious in examining this "jump" and are analyzing the data elements to further support efforts made in this area. The Department had expected progress but believed the progress would be at a slower but steady pace. Currently, we are analyzing the data to identify commonalities and differences among the population meeting the adoption goal and those not meeting the goal. Our greatest improvement was in Exit Outcome #20: Discharge Measures showing a significant increase of 41% from the Second Quarter (52%) to Third Quarter (93%) report. During a quality review of the data, it was discovered that an entire subpopulation was excluded from the first and second quarter reports. All adolescents already enrolled in a university or college had not been originally captured in this measure. With this inclusion, the data results accurately represented the agency's performance. For Exit Outcome #14: Placement within License Capacity, this report indicates that the Department is at 93% with the outcome goal of 96%. This measure has demonstrated a steady increase, and the Department expects this to continue with the development of new relative search efforts through the use of Family Conferencing and Locate Plus. These efforts will efficiently aid in our ability to locate parents and relatives for assessment as possible placement resources for children. Sustaining exit outcome goals once achieved is a no less serious task. We have established a quality assurance process to monitor performance and involve Central Office staff working with Area Office staff to identify areas of strength and to ensure that new activities do not inadvertently impact exit outcome measures, particularly among those at which we have been successful. This vigilance will continue to be at the center of our work. For example, in the area of multiple placements, an outcome measure we have had success with, we continue to expand our efforts at specialized recruitment to create more opportunity to better match foster placements and better accommodate the changes in the population of children now entering care. In the area of Exit Outcome #3: Treatment Plans, we have developed and begun implementation of the Family Conferencing Model, which focuses on several exit outcomes and best practices that will enhance our ability to engage, empower, and

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partner with families and therefore improve the practice of treatment planning. This model is in process in two area offices (Manchester and Norwich) with two additional offices (Meriden and Middletown) beginning with their model design period. Introductory meetings also have been held in the Bridgeport and Stamford/Norwalk office. Several elements to support this important training process are also underway, including enhancements and/or revisions of all automated documents related to treatment planning. And, various individual Area Offices have begun to monitor, analyze and provide training in treatment plan development. For example, the Hartford Area Office Quality Improvement Team has completed a 75 case review and is compiling their findings to best identify areas that are deficient and coordinate training/support. With respect to Exit Outcome #22: Multidisciplinary Exams (MDE), the Department is making considerable progress, moving from 24.5% to 48.9% from the Second Quarter to the Third Quarter. There are three major efforts underway to achieve this measure. First, the Department improved its internal referral system and emphasized the importance of these referrals, a task that is largely responsible for the increase in this quarterly report. Second, we have worked with existing MDE providers to assure their capacity and performance. Third, this month the Department will issue an RFP to increase the number of MDE providers by early spring, thereby providing statewide capacity of this service and putting the Department in a good position to achieve this measure. Overall, the Third Quarter Report demonstrates transition from idea development to action, and from action to achievement. Still the Department continues to actively focus efforts on achieving the most challenging measures. For example, to assist in the development of expanded placement resources to adequately address Exit Outcome # 10: Sibling Placement, the Department has invested in the use of Locate Plus, a search engine generally used by law enforcement to locate fathers, mothers, and relatives. Siblings are more likely to be placed together and have increased placement stability if placed with relatives. System training has been provided to staff on how to conduct diligent search efforts and when to use Locate Plus. Also, the documentation of sibling placement will be made much easier with the December LINK enhancement. This new screen will enable staff to document the occurrence of sibling placements and more efficiently report on any clinical reasons for not placing siblings together. It also allows for documentation of siblings who are reunified at a later time. Through qualitative case reviews, the Department continues to examine progress in Exit Outcome # 17: Worker-Child visitation (in-home). The measure calls for staff to visit the home monthly and see each "active case participant". In a situation where there are a number of family household members this can be quite challenging. It is often that some children will not be present during a visit. Older children may be involved in after school activities, attending therapy sessions, or visiting with friends. Less involved adults who are also household members may be not be regularly present. In other words, despite the

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social worker's regular weekly visitation not all "active case participants" will be seen weekly. The Department is taking a closer look at the frequency of visits and who is seen during these visits to better determine our actual performance on this measure and what other steps we can take to improve our performance. Also, in the area of residential reduction, the Third Quarter report indicates the percentage has remained largely unchanged. Yet, overtime a closer look of all children in care reveals a different story. Because the measure is written as a percentage, as the number of children in care substantially decreased, but at a slower rate for those in residential care versus other settings, the real reduction in the number of those in residential care is not reflected in the percentage calculation. This affirms the need to look at the measure in a careful way. Concerns of this nature were sounded early on by the Department and we have taken the time to establish both an actual number in residential placement overtime and a percentage of all those in out-of-home placement. Below is a chart, which affords a deeper look at the agency's performance and its current emphasis on community-based options. Month May 31, 2004 August 31, 2004 November 30, 2004 Number of children in Placement 6,805 6,567 6,463 Number of children in residential care 1,194 1,153 1,130

Finally, it is worth noting the challenges related to the discharge of children with mental health or mental retardation. Improvements are needed to assure the timely documentation and early identification of youth in need of this type of transition planning. The Area Offices recently have been provided with a list of all youth from age 16 who are recognized as either mentally ill or mentally retarded. Each case is being reviewed carefully and discharge plans are being developed. Staff has been provided with all criteria for access to services at the Department of Mental Health and Addiction Services (DMHAS) and Department of Mental Retardation (DMR) to facilitate these referrals and work continues with both sister agencies to improve our program and fiscal protocols around transitions. We expect to see a steady improvement towards this in the upcoming months. In closing, the Department has experienced tremendous change and growth, and is poised for much of the same as we press forward with our work. We recognize and value the accomplishments to date and draw inspiration from the momentum that has been created. But we also are grounded in the reality of the complexity and difficulty associated with achieving the measures, particularly when understood not as simple math equations, but as a fundamental and sustainable shift, in the way we serve kids and families in Connecticut.

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Outcome Measure/ Definition

Outcome Performance Goal or Standard

Current Performance % & Trends

Method of Measurement and Qualifiers

Key Action Steps

Next Steps Resource / Management Issues Scheduled for December LINK build. Final stages of review. Slated for issuance by end of December.

1. Commencement of 90% of all reports Investigation: to assure that must be commenced assessments of safety can same calendar day, 24 quickly be determined and hours or 72 hours increases collaborative depending on referral interviewing and intervention. code.

X

LINK reports begin: A.) Develop LINK capacity to document and measure 5/15/05 (1Q 2005) LINK commencement time and modifications to commencement time. build scheduled for Provide corresponding LINK training to staff. December includes the B.) Revision of policy #34-3-3 "Conducting the Investigation"development of a Response Modification To direct that the Social Work Supervisor can approve modification of commencement times. Previously, Program Window. The Department will produce Supervisor approval was required and was inefficient. a test report 2/15/05 to C.) Area Offices use LINK data reports to assess staffing levels review initial in investigations and take any supervisory or practice commencement link improvement steps necessary to ensure performance goals. build from 8/29/04. D.) Central Office will work with any Area Office not meeting Currently, using the goal as reported. LINK report Investigations - Open Investigation to provide E.) Area Office Quality Improvement Plans to reflect areas for estimate response time improvement and progress, and under PARS review meet and averages. sustain outcome measure goal.

On-going On-going

On-going Practice implemented in the area offices, reviewed by CO staff to ensure compliance To be effective Mid-January

85% of all reports A.) Implement a quality review process in each Area Office that Baseline - 73.7% LINK reports began: 2. Completion of shall have their serves as a tickler system at 28, 35, and 40 days and calls for any 1st Quarter - 64.2% 5/15/04 (1Q 2004) and Investigation: to assure that investigations corrective action plans. 2nd Quarter - 68.8% will continue for the case assessment and completed within 45 disposition is handled in a 3rd Quarter - remainder of the exit plan calendar days of timeframes. timely manner. 83.5% acceptance. B.) Develop a quality review process for the Special Investigations Unit through Hotline. C.) Area Office Quality Improvement Plans to reflect areas for improvement and progress and under PARS review meet and sustain outcome measure goal. D.) Central Office will work with any Area Office not meeting goal as reported.

On-going On-going

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E.) Develop standards for the release of information that will assist with the sharing of information between DCF and community providers and/or other state agencies. F.) The department has proposed legislation requesting a change in the statutory requirement of completing investigations within 30 days. This request extends the statutory requirement to 45 days so that it comports with the Exit Plan. 3. Treatment Plans: to Within 60 days of Baseline - X provide a family-centered case opening in 1st Quarter: foundation from which all treatment, or 60 days Background (53%), case service planning will from date of Assessment (52%), occur-timeframes, roles and placement- whichever Treatment (47%), responsibilities-and a means comes sooner. Progress (18%). for assessing service Random reviews 2nd Quarter: outcomes and needs met. done by DCF and Background (60%), Court Monitor. Assessment (37%), Treatment (43%), Progress (32%). 3rd Quarter: Background (65%), Assessment (53%), Treatment (56%), Progress (13%). Qualitative case reviews will be used to measure A.) Modify current LINK treatment plan to reflect Family this outcome for all Centered Practice, make it available through E-help to provide staff with guidelines, enhanced tools for case documentation, and Quarter reports. Treatment Plans were provide training on the utilization of translation services and evaluated based on four improve the LINK screens for treatment plans to make them (4) major categories more efficient and user-friendly. (including elements a-o). No LINK reports currently available, B.) Train and implement in all area offices on the agency's new however 3Q findings will Family Conferencing Model, develop & implement a method to be submitted by 11/15/04 evaluate its success and/or areas needing improvement through feedback from families, staff, management and providers.

On-going Legislation is pending with OPM/Governor's Office.

Consider securing $30,000 to develop the modifications. Training schedule has been developed covering all Area Offices by MidJune.

C.) Develop an electronic "case face sheet" for quick access to Deliverable priority information in a more readable and user-friendly format expected by end of for all parties involved in a case. December.

D.) Develop a comprehensive assessment process and a uniform set of assessment tools in order to enhance the role of the social work supervisor to improve the effectiveness of identifying underlying issues with the family and in making case decisions. Ultimately, all documentation and data collected by the Department from a family-centered approach will be prioritized, Need to raise with deficit areas will be identified, redundancy eliminated, and Karl to test consistent language and definitions will be used. viability of option

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E.) Develop and implement a step-by-step process assessment guide for all staff regarding their responsibilities towards family Need to raise with centered practice and how they can enhance the overall Karl to test assessment process. viability of option F.) Development of an enhanced assessment model and timely service delivery to reflect a collaborative approach with external providers. The Managed Service System develops a process for review and coordination of discharge plans for all children in residential care and to identify all community resources in support of children to remain in their communities. G.) Advance major training endeavors including family conferencing, treatment planning and concurrent planning. H.) Central office will work with any Area Office not meeting goal as reported. I.) Area offices have developed an Area Resource Group to assist in the development of a treatment plan for complex cases requiring significant supports (i.e. Parents with Cognitive Limitations, Medically Complex cases, etc.). 4. Search for Relatives: to DCF shall conduct increase the availability of searches for relatives, Baseline: 58% supports for children extended or informal 1st Quarter: 93% consistent with the goal of networks, friends, LINK report begins: A.) Implement the Placement Resource Search window in one 2/15/05 (covering the central place in LINK for accurate and easily accessible reporting period of: 2Q documentation of placement resource search efforts. 2004). LINK build

Will hold assessment meeting on MSS in late January Tied to budget option On-going Develop plan to better communicate an ARG role. August 29th Link Build--area office staff trained--ongoing

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keeping them within their community and in maintaining lifelong family ties.

family, former foster parents or other significant persons known to the child. Must be documented in LINK.

completed 8/29/04. Qualitative case review will be conducted for 1Q, 2Q and 3Q 2004. The 2Q and 3Q will be a test period both Qualitative and LINK reports will be reviewed. This measures requires relative search through the 1st six months following removal from home. Thus, a 6 mos lag must be allowed in order to B.) Use family conferencing model to assist in the identification capture the data of appropriate relative resources early on in the life of the case. accurately.

Tied to family conferencing training-conducted in Norwich and Manchester, scheduled for Middletown and Meriden, design meetings underway with Bridgeport, Stamford/Norwalk. All offices to be trained by Summer 05

C.) Revise Search - Requests for Identifying Information policy (41-40-8) and Affidavit Regarding Diligent Search for Parent's Underway--to be Identity and Location policy (46-3-18) to be more reflective of completed by our current practice. March 1, 2005. D.) Provide training and guidelines to social work staff regarding all possible "search" options (i.e. tools, websites, etc.) and implement the use of Locate Plus software when normal Complete--Review search efforts fail. in March 2005. Reviews set for E.) Started Casey Family Programs Supporting Kinship Care March and Collaborative in the Bridgeport area office (12-month project). October F.) Central Office will work with any Area Office not meeting On-going goal as reported. G.) Area Office Quality Improvement Plans to reflect areas for improvement and progress, and under PARS review meet and sustain outcome measure goal.

On-going

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5. Repeat Maltreatment: to reduce incidents of maltreatment and the number of children in out of home care and maintain and provide services to children in order for them to remain with their families and in their communities.

No more than 7% of Contract for children who are Chapin Hall under victims of negotiation; LINK reports began: Baseline: 9.3% substantiated information has 5/15/04 (1Q 2004) and maltreatment during a 1st Quarter - 9.4% been supplied for will continue for the 6-month period shall 2nd Quarter - 8.9% A.) Develop various data analysis tools such as ROM, Chapin early designs of remainder of the exit plan be the substantiated 3rd Quarter - 9.4% Hall, Pew Partnership and Survival Analysis to support evidence- ROM and Chapin timeframes. victims of additional based practice and strengthen the method in which social work Hall. Testing and maltreatment during a supervisors and program supervisors direct and assess case roll-out periods are subsequent 6-month decision making and need for services. underway. period. Plan is in draft form and all focus groups have been conducted. Meeting to be scheduled with B.) Increase the consistency of handling and identifying repeat Karl by mid maltreatment via training and supervision. Correspondingly December to review and revise policy to reflect practice. discuss next steps. C.) Evaluate validity of current risk assessment tool, conduct literature review, examine models/tools from research in other states to develop a safety protocol and risk assessment tool to identify underlying issues of maltreatment and appropriate interventions. Research effort should also include the development of a structured decision making supervision model. D.) Central Office will work with any Area Office not meeting goal as reported. E.) Critical Response Reviews/Special Case Reviews--Study committee established to look at patterns of incidents, agency process and procedures, and if any training/practice improvement steps are necessary. Complete draft write-up on research and setup meeting with Karl, Joyce, Heidi, Ray and Kim by years end. On-going; Provide Service Plan

15-Jan

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F.) An RFP was distributed and applications received for Parent/Child Centers which will provide screening and assessments, targeted hands-on parenting education and family support services to parents, caregivers, family members, and Contracts are children up to 8 years of age who are referred by the department. expected 1/1/05 G.) Kidcare rollout to broaden the range of services and supports designed to help children with behavioral challenges. Meet their needs in their home, school and community environment. Contract for Chapin Hall under No more than 2% of 6. Maltreatment in care negotiation; children in out of Baseline: 1.2% LINK reports began: Out-of-home: to assure information has home care shall be 1st Quarter - 0.5% 5/15/04 (1Q 2004) and children's safety while in outbeen supplied for the victims of 2nd Quarter - 0.8% will continue for the of-home care, improve early designs of substantiated 3rd Quarter - remainder of the exit plan placement stability, and ROM and Chapin maltreatment by timeframes. 0.8% reduce additional trauma. A.) Develop various data analysis tools, to be used by SWS and Hall. Testing and substitute caretaker. PS, such as: ROM, Chapin Hall, Pew Partnership and Survival roll-out periods are Analysis, to better identify trends and enhance services. underway. Buck working on activity; to be B.) Centralize foster care abuse/neglect investigations in order to complete by midbring greater uniformity and accountability. January Buck to arrange meeting with C.) Develop and implement a corrective action plan protocol for Doreen to all regulatory violations and all out-of-home substantiations. implement any Incorporate any corrective action plans into Foster Family policy/protocol Support Plan. revisions. Timeline for D.) Move special investigations management from Hotline to a completion by direct report under Bureau Chief for Child Welfare. mid-January

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E.) Enhance the Special Investigation Unit's process of investigating facility reports, both public and private, as well as assuring LINK documentation of abuse/neglect reports against DCF employees. F.) Central Office will work with any Area Office not meeting goal as reported. 7. Reunification: to reduce 60% of children who the length of time children are are reunified with parents/guardians in care, minimize trauma shall be reunified from separation, allow opportunities for children to within 12 months of their most recent maintain connectedness to family and community, help removal from home. parents safeguard their homes, and recognize the importance of expediting permanency planning. Baseline: 57.8% 1st Quarter - X 2nd Quarter - X 3rd Quarter - X LINK reports begin: A.) Area Office Quality Improvement Plans to reflect areas for 11/15/04 (for 1Q 2004). improvement and progress, and under PARS review meet and There is a 6-month lag sustain outcome measure goal. beyond the end of the reporting period to determine the children discharged during the period. B.) Implement Multidisciplinary Assessment for Permanency (MAP) for each area office. Legal consult completed for all children in out of home care at 6 months (prior to the ACR). This brings together legal, medical, behavioral health, and cps staff to identify outstanding issues that need to be addressed before filing the permanency plan. C.) Expansion of Supportive Housing Contract ­ Connection Inc. by $2.1 million; increase capacity to serve 345 families in Hartford, Bridgeport, Danbury and Torrington areas. Establish priority access for family preservation/reunification referrals.

Timeline for completion by mid-January On-going; Provide Service Plan

On-going Evaluate tool to determine its effectiveness. Modify tool assessment as necessary. Conduct random sample to assess compliance to ensure console is being completed.

Develop tool to assess effectiveness of program. Conduct random sample. Followup with Area Office D.) Implementation of formalized supervisory conference- SWS Management to discuss viability of current permanency goal for all children in teams. Review OOH care at 3 months. Process. E.) Develop ROM reports to strengthen the tracking of Federal ASFA timelines (reunification within 12 months of most recent placement) and the identification of family/child characteristics Finalize data. or gaps in services that become barriers to the successful Implementation achievement of this outcome measure. and Rollout.

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F.) Develop new Intensive Reunification Services through RFP to offer an array of services to families along a continuum that promotes reunification/permanency for children using federal funds. Release by Dec. 15 Complete and release RFP. Select a Provider. Explore funding sources beyond G.) Expand intensive in-home services such as IICAPS and federal money to MST for those children with behavioral health issues in order to support the avoid re-entry into care through budget options. program. H.) Concurrent Planning Training will be offered to staff (targeting social workers with OOH cases) that focuses on enhancing skills. Curriculum through the NRC has been identified. Identify potential modifications to the program as well as time frames for the training. Budget option submitted under Workforce Development. I.) Ensure Flex Funds policy and guidelines support reunification efforts and post-reunification needs by meeting emergency needs that if not addressed result in crisis and often re-entry into care. J.) Central Office will work with any Area Office not meeting goal as reported. K.) Locate Plus to help locate non-custodial parents in order to improve opportunity for reunification. L.) Redesign Project Safe to improve outcomes of this jointly managed program - DCF/DMHAS, provides access to substance abuse services for adults in families in our CPS system. M.) An RFP was distributed and applications received for Parent/ Child Centers which will provide screening and assessments, targeted hands-on parenting education and family support services to parents, caregivers, family members, and Contracts are children up to 8 years of age who are referred by the department. expected 1/1/05

Finalizing curriculum and will circulate next week Need to establish periodic reviews based on full report On-going Complete

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N.) Kidcare rollout to broaden the range of services and supports designed to help children with behavioral challenges. Meet their needs in their home, school and community environment. Evaluate took to determine its effectiveness. Modify tool assessment as necessary. Conduct random sample to assess compliance to ensure console is being completed. Completed

8. Adoption: promotes and emphasizes permanency for children in out-of-home care, decreases trauma, and focuses DCF and courts in an effort to make adoptions more timely and successful.

32% of the children who are adopted shall Baseline: 12.5% LINK reports began: have their adoptions 1st Quarter - 10.7% 5/15/04 (1Q 2004) and finalized within 24 2nd Quarter - 11.1% will continue for the A.) Implement Multidisciplinary Assessment for Permanency months of most 3rd Quarter - remainder of the exit plan (MAP) for each area office. Legal consult completed for all recent removal from timeframes. 29.6% children in out of home care at 6 months (prior to the ACR). home. This brings together legal, medical, behavioral health, and cps staff to identify outstanding issues that need to be addressed before filing the permanency plan. B) Memo distributed by BCW and continued reinforcement by permanency managers clarifying the "perceived wait period" for adoption finalization (staff was reporting that they had to "wait" 12 months after placement to finalize adoption--effort is aimed at clearing up confusion with the law).

12/10 follow-up C.) Collaboration with Probate Court staff to streamline adoption meeting packets submitted for finalization. Probate Court is circulating for review and comment and will be reporting back to DCF. Policy effective D.) Decentralize the processing of finalizing adoptions. Each area office will be responsible for this function. Subsidy requests October 1--will be evaluating for Feb. will continue to be processed through OFAS. Training and 1 implementation completed. E.) Submitted legislative proposals/budget options to create greater incentives for adoption ­ including support to adoptive parents. Pending OPM and Governor's approval

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F.) Concurrent Planning Training will be offered to permanency/treatment staff. Department is currently developing the curriculum and a workplan will be developed with the NRC. A budget option also seeks to support this effort for the next two fiscal years. G.) Allocation of $500,000 (budget option) for specific recruitment activities: Expand the support and development of recruitment initiatives to meet the special cultural and ethnic needs of our children that will provide stable and long-lasting permanency using in-house, private contract and faith-based networks. H.) Data reports (i.e. Link Reports, ROM tool and Chapin Hall) to track individual/unit performance, identify trends and target supervisory discussions for children in Out-of-Home care. I.) Resource Family Development to promote long-lasting support resources for children in out of home care. This program promises early identification of permanent resources and helps to reduce placement instability. Foster parents commit to serve as mentors and provide ongoing support and connection to birth families while providing permanent care to children. Initial pilots to be established in at least 2 area offices.

Receive feedback from distributed curriculum. Collaboration with NRC to develop curriculum. Schedule and deliver training to staff Contracts need to be finalized and recruitment activities to begin. Ongoing collaboration with providers. Additional LINK reports and contracts need to be finalized. Identify 2 pilot sites, modify training curriculum. Collaborate with safe home and implement.

J.) Revise Permanency Planning Team policy (48-14-6 through Draft to Permanency 48-14-6.5) to standardize the approval process for selecting Planners by Jan 1. appropriate families for available children and ensuring successful and timely identification of adoptive parents. K.) Kidcare rollout to broaden the range of services and supports designed to help children with behavioral challenges. Meet their needs in their home, school and community environment.

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L.) Collaborative with Casey Family Services to increase adoption-competent mental health practitioners in the community to increase support for adoptive families. Engaged with two state universities to develop certification programs. M.) Review foster and adoption training curriculum and area office outreach and engagement activities for prospective families. 9. Transfer of Guardianship: 70% of all children Baseline: 60.5% LINK reports began: A.) Area Office Quality Improvement Plans to reflect areas for promotes and emphasizes whose custody is 1st Quarter - 62.8% 5/15/04 (1Q 2004) and improvement and progress. permanency for children in legally transferred, 2nd Quarter - 52.4% will continue for the out-of-home care, decreases shall have the 3rd Quarter - 64.6% remainder of the exit plan B.) Implement a Licensing Review Team for consideration of waivers for relative caregivers who have been denied licensure trauma, and allows children guardianship timeframes. due to substantiated CPS history and/or criminal history. to maintain connection with transferred within 24 family. months of the child's most recent removal C.) Revised subsidized guardianship policy (41-50-1 through from home. 41-50-14) to reflect current practice and ASFA timeframes.

on-going Process to be finalized and implemented. Policies have been distributed and Area Offices to be trained.

D.) Revise Permanency Planning Team policy (48-14-6 through Finalize policy, 48-14-6.5) to reflect the approval process for subsidized distribute and train guardianships. staff. Guidelines to be developed and E.) Develop policy and guidelines for use of Flex Funds to distribute to staff. support transfer of guardianship so that children remain with Monitor and track their families and within their communities. usage. Training to be F.) Train and reinforce the practice of concurrent planning to delivered to staff once curriculum assure a timely permanency plan should reunification not be possible. has been finalized. G.) Propose legislation to shorten the timeframe for relative foster care eligibility into the subsidized guardianship program to Need to be approved. a minimum of 6 months (from 12 months) in placement. H.) Central Office will work with any Area Office not meeting On-going goal as reported.

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I.) Kidcare rollout to broaden the range of services and supports designed to help children with behavioral challenges. Meet their needs in their home, school and community environment. Tied in part to budget option. Expansion of Queen Esther model to 4 other sites state-wide. January 1, 2005 will be the Kick off. RFPs for recruitment and training of 3 identified populations, sibling groups, medically complex and teens to be implemented in February 2005.

LINK report begins: 5/15/05 (1Q 2005). LINK build scheduled for 95% of siblings December 2004. A.) Expand the support and development of recruitment entering out of home 10. Sibling Placement: Qualitative reviews will initiatives to meet the special cultural and ethnic needs of our maintains life's longest placement shall be Baseline: 57% be held for 1Q, 2Q, 3Q sibling groups that will provide permanency using in-house, lasting relationship, increases placed together unless 1st Quarter: 65% and 4Q 2004. Both private contract and faith-based networks. Enhance contract there are documented family connections, and qualitative and LINK support for specialized foster care recruitment. decreases trauma. reasons for separate reports will be held and placements. reviewed for 1Q and 2Q B.) LINK build to assure accurate and consistent documentation 2005 for testing of sibling placement. Staff training to reinforce the definition purposes. and intent of outcome #10, what is used to define "sibling", and what is an acceptable therapeutic reason to not place siblings together (LINK build training for December). C.) Utilization of Flex Funds policy and guidelines support sibling placement efforts by meeting emergency needs.

December 19th online will be available.

On-going On going - Review D.) Locate Plus to help locate non-custodial parents and relatives set for March and October. in order to improve opportunity for resources. E.) Central Office will work with any Area Office not meeting On-going goal as reported.

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