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Home My WebLink AboutMINUTES - 05051998 - SD2 D . FHS*9 TO: BOARD OF SUPERVISORS •� CON T'RA } COSTA FROM: FAMILY&HUMAN SERVICES COMMITTEE COUNTY TY DATE: May 5, Ing SUBJECT: Group Home Placement Practices SPECIFIC REQUEST(S)OR RECOMMENDATION(S) & BACKGROUND ANIS JUSTIFICATION 1. ACCEPT the attached report from the Social Service Director on the independent review of the County's group home placement practices. 2. ACKNOWLEDGE that the group home practices program review, conducted by the California Department of Social Services, did not find any evidence of racial discrimination or ethnic insensitivity in the selection of group home placements. 3. ACKNOWLEDGE that the program audit conducted by the state 'did find three areas for improvement in administration of the program, all of which related to documentation of actions while the third area related to the need for supportive services to reduce out-of-home and group placements. 4. ACKNOWLEDGE that the Social Service Department concurs with the recommendations of the state audit and either has implemented or is in the process of implementing the audit recommendations. CONTINUED ON ATTACHMENT: 4 YES SX MATURE: -RECOMMENDATION OF COUNTY A#x nsTRAToR_jmcoMMENDATON OF BOARD COMMITTEE APPROVE OTHER SIQNATURE(S� Donna r Mark MSaulnler ACTION OF BOARD ON APPROVED AS RECOMMENDED X OTHER VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A UNANIMOUS(ASSENT I TRUE AND CORRECT COPY OF AN AYES: NOES: ACTION TAKEN AND EMrEREDD ABSENT: ABSTAIFI:�„�,�,_____ ON MINUTES OF THE BOARD OF SUPERVISORS ON THE DATE SHOWN. Contact.Sara Hof ftvtn,835.10"0 ''n �'00' � ATTESTED 1 �' ..G1 PHIL BAT OR,CLERK OF T OF SUPERVISORS COUNTY ADMINISTRATOR cc: S.Hoffman,CAO J.CtAen,Solei Service D.Fabella,Seri Service TY FES#9 RECOMMENDATION(S) cpnfd: 5. ACCEPT the recommendation of the Family and Human Services Committee that this referral be reported out of committee as concluded. RA&KQRQUND RL N(S1 FQR R€COMMEN'DATION(S) On April 27, 1998, the Family and Human Services Committee met with John Cullen, Social Service Director, and Danna Fabella, Assistant Social Service Director, on the results of the California Department of Social Services (CDSS) program audit of group home placement practices in the Social Service Department. The purpose of the audit was to determine if there was any racial discrimination or ethnic insensitivity in the selection of group home placements. Mr. Cullen reported that the state program audit found no evidence of racial discrimination or ethnic insensitivity in the selection of group home placements. The state identified 189 cases active in March 1997. Of those, a random sample resulted in the examination of 64 cases active during the review month. Each case was reviewed for compliance with the County's group home placement practices policy and procedures, which,'by law, must include both state and federal placement requirements.' In particular, the review focused on the assessed needs for each child, the appropriateness of the group home in meeting the child's needs and the County's compliance with its own placement practices, policies and procedures. Mr. Cullen reviewed the conclusions and recommendations of the audit. In response to a question by Supervisor Gerber, Mr. Cullens stated that most of the recommendations for action were administrative in nature. These included: • case file documentation -The County is in the process of ensuring that documentation of all placement decisions are maintained in each child's service case file rather than in the case file of the division manager or other administrative staff. • group home section process documentation -The County has begun documentation of this process in the child's case regard. This is being facilitated by the CWS/CMS system, which now allows documentation where multiple workers are involved in a single case. • group home placement of children under the age of 10- Documentation of the approval process was with the assigned division manager, not with the child's case file. This practice/policy has since been changed. The final recommendation related to support to help reduce the need for out-o€home placements. The department reported that since the March 1997 review by the state audit team, they had developed a variety of services, including the intensive intermittent intervention program, kinship centers and the shared family care program. In response to a,question by Supervisor DeSaulnier, Mr. Cullen noted that the number of children in group home placements is going down with the emphasis on relative caregiver foster care. According to Mr. Cullen, a relative placement is the preferred alternative. Both Supervisors'Gerber and DeSaulnier agreed that the Family and Human Services Committee had exhaustively examined the issue of group home placements and felt satisfied that the state audit concluded their investigation into allegations of racial discrimination and/or ethnic insensitivity. Both agreed to recommend that the Board of Supervisors accept the committee's recommendation to report this referral out of committee as concluded. 2 t SOCIAL SERVICE DEPARTMENT Contra Costa County TO Family and Human Services Committee DATE April 20, 1998 FROM John CullenJDirector jVV SUBJ GROUP-HOME PLACEMENT PRACTICES This matter last appeared before the Board of Supervisors on December 17, 1996. At that time the Department was directed to have an independent review of group-home placement practices to determine if there were any indications of racial discrimination:in the selection of group-home placements. Toward that end,in January, 1997,we requested a program audit be undertaken by the California Department of Social Services(CDSS). CDSS conducted their program review in April, 1997,and submitted their written report (attached)to our Department in February, 1998. We are very pleased to report that there were not findings to support any allegations of discrimination or ethnic insensitivity in the selection of group-home placements. ' - As can be noted in the attached report, CDSS came to four conclusions about our group- home practices and submitted recommendations for our consideration. • CONCLUSION/RECOMMENDATION#1 CDSS found that we were not in compliance with our own internal procedures. They found our group-home placement decisions to be clearly evidenced in their review but could not locate documentation to track how we made our decisions. They recommended that Contra Costa County should take appropriate action to ensure that applicable documentation and approvals are maintained in each child'sservice case in compliance with the County's group-home placement practices, policies and procedures. Further...development of a single-page form for all internal approvals could...maximize efficiency and accessibility. Response This is an excellent recommendation. While we have administrative review processes in place,we never gave direction to staff to establish where to file documentation in the case file to show mandated procedures were followed. Documents had to be located either with the Division Manager who gives approval, in the case file or with other administrative staff. In the next 90 days,we will "formalize the administrative process and issue instructions to staff to file documentation in the individual child's case record. This will be done on a single authorization form as recommended by CDSS. ......... ......... Family and Human Services Committee April 20, 1998 Page 2 • CONCLUSION/RECOMMENDATION#2 CRSS noted that our group-home placement decisions were appropriate. However, they noted no documentation in the child's record regarding the Department's efforts to determine available resources and the level of"match"of the child and the facility. The recommendation was for the County to develop a tool to capture the group-home selection process,including the exploration of available resources. ° Response Again the reviewers have an excellent recommendation. In the past when we were operating from"paper cases"with one worker in possession of that case, it was very difficult to document the contacts and activities of auxiliary staff in the"paper case." This is particularly true since the paper cases of children needing group- home placement are with workers in different geographic locations than our group- home unit. Now that we have implemented portions of CWS/CMS,it is possible to document the wolk of multiple workers by assigning them as"secondary workers," therefore allowing multiple workers to record their work electronically in a case record. Our group-home unit(Children's Residential Placement Unit [CRPU])has an assigned"Placement Specialist"who is responsible for receiving referrals of any child in need of a higher level of care,from licensed Foster Family Agency(FFA)to high-level residential treatment facility. Under the direction of the supervisor of CRPU,extensive efforts are made to"match"each referred child to the appropriate placement. Since we received the CDSS report,we have issued instructions to staff who refer a case for group-home or FFA care to assign the Placement Specialist as a secondary worker in the CWS/GMS system. Following that assignment the Placement Specialist can record all contacts with facilities and clients directly into the CWS/CMS system. Given that this is the vehicle CRSS will use to do program reviews/audits in the future,all appropriate documentation will now be easily retrievable. • CONCLUSION/RECOMMENDATION#3 CRSS noted that they had difficulty locating documentation of our procedures requiring prior approval at the Division-Manager level of any child under ten for whom group- home placement is being considered. ° Response Many years before legislation mandated tight restrictions regarding the placement of Family and Human Services Committee April 20, 1998 Page 3 young children in foster care,because of our commitment to maintaining children in family settings whenever possible,our Department put into place policies opposing congregate care of young children. Our policies require administrative approval by the Division Manager over CRPU whenever staff wish to consider placement of a child under ten in a group home or FFA. However,our internal process has never required filing the documentation in the case file. Rather,the assigned manager maintains both a log of approvals and paperwork on each child. As a result of the CDSS review,however,we are reissuing our written policy relating to young children. We plan to further expand this material to include instructions to file the required"sign off"in the child's case file. We agree with CDSS that this material should be easily accessible in the individual child's case. • CONCLUSIONIRECOM1l ENDA.TION#d CDSS noted that the County should develop services which can be provided in a family setting to reduce the need for out-of-home and group-home placements', ° R:estaonse We are pleased to report that subsequent to the CDSS review of March, 1397,we have developed a variety of services to support birth families,relative caregivers and faster parents to maintain children in family settings. Of note is the"IIIP" (Intensive,Intermittent Intervention Program)which is an interagency effort with Mental Health to have teams of professionals and paraprofessionalsavailable to respond to family crises when needed, In addition we now have Kinship Centers where relatives struggling to raise their kin receive the support both'of community resources and of other kin in similar circumstances. Further, we used our federal family-preservation funding in part to fund a Shared Family Care program which pairs families in crisis with experienced families who can mentor and teach skills in the shared family home. . SI�MMARY At our request CDSS reviewed our group-home placement practices to determine if there was evidence of discrimination, specifically regarding African-American children. We are pleased to report they found no such evidence. The issues they note in their report are administrative in nature and are easily remedied. We have no issue with their conclusions and are either following their recommendations or plan to in the near future. JC.ceb Attachment wgiphomesIhs r-disk 8 FEB 2 3 1998 STATE OF CALIFORNIA-HEALTH AND WELFARE AGENCY PETE WILSON;GOVeMr , DEPARTMENT OF SOCIAL SERVICES 744 P Street, MS 19-74, Sacramento,CA 95814 February 18, 1998 Ms. Danna Fabella, Assistant Director Contra Costa County Social Services Department 40 Douglas Drive Martinez, California 94553-4068 Dear Ms. Fabella: This letter transmits the California Department of Social Services (CDSS) "Contra Costa County Group Home Placement Report." This report was prepared in response to your request for a review of Contra Costa County Social Services Department's group home placement practices, policies, and procedures. Data contained in this report is based on actual case review findings and group home occupancy rates maintained in the CDSS group home data base. We hope that this report is responsive to your request and that it provides information and recommendations that you will find helpful in managing the placement of Contra Costa children in out-of-home care. I would also like to express my thanks to your staff for their cooperation, patience and assistance in all phases of the review and data gathering process. This task was simplified due to their timely response to our many questions and needs. Should you have any questions regarding the enclosed report, please contact me at (916) 324-9084. Sincerely, PATRIC B. ASHBY, Chief Foster Care Branch Enclosure :...... ...N<m... :..... ....ttttt Mutt CONTRA COSTA COUNTY GROUP HOME PLACEMENT 3 REPORT TABLE OF CONTENTS Page L INTRODUCTION l Review Taal l Sample Methodology 2 II. COUNTY PLACEMENT PROCESS ' 3 III. SPECIFIC FINDINGS 4 Case Disposition 4 Child-Specific Data 5 Placement Documentation b Group Home Data 7 IV. CONCLUSIONS/RECOMMENDATIONS 9 TABLES 1-6 A-B '.,...I............................................................................................................................................................................................. .. ... ..................................................................... CONTRA COSTA COUNTY GROUP HOME PLACEMENT REPORT 1. INTRODUCTION At the request of the Contra Costa County Social Services Department (Contra Costa County) the California Department of Social Services (CDSS) conducted an independent review of Contra Costa County's placement practices and policies with respect to group home placements. The review was initiated by Contra Costa County at the direction of its Board of Supervisors who have received complaints of discrimination in regards to the county's group home placement practices. Therefore the purpose of the CDSS review was to determine the county's compliance with its own placement practices, policies and procedures and identify any problems, inconsistencies or flaws within its practices or policies that would bias,,prohibit, or otherwise impact the placement of children in group homes. The scope of review was limited to State and federal Aid to Families with Dependent Children-Foster Care (AFDC-FC) cases active in March 1997. Each case was reviewed according to the county's group home placement practices, policies and procedures. Incorporated in Contra Costa County's group home placement process are the State and federal placement requirements as set forth in the United States Code, Division 42, Section 675 and the CDSS Manual of Policies and Procedures (MPP), Division 31,,Child Welfare Services Program, beginning with Section 31-000. Although Child Welfare law requires that a child be placed in the least restrictive family setting available, as requested the review focused more narrowly on the assessed needs for each child, the appropriateness of the group home in meeting the child's needs, and the county's compliance with it's own placement practices, policies, and procedures. Comments regarding these findings are addressed in Sections Ill and IV of the report. During the case file review, documents within each child's service case were reviewed and information entered on a review tool. The review tool was designed to capture child-specific data, county placement procedures and practices, and the appropriateness of the child's assessment and placement disposition. All data and information gathered from the case review process are discussed in Section Ill of this report. Review Tool The review tool was designed to gather and document multiple pieces of information including child-specific data, group home placement information, compliance with county placement procedures, the child's assessed needs, services needs, case plan, and the appropriateness of the group home placement. Child-specific data captured from the case record includes the child's age at the time of placement, gender, ethnicity, placement date, group home name, and the Rate Classification Level (RCL) for the group home program in ........................................................................................................ ................................................................... -2- which the child was placed in March 1997. However, information that would identify the case, including the child's name and/or case number, was not captured on the review tool for purposes of confidentiality and to maintain the integrity of the random sample. Additional information and data gathered for the review was provided by Contra Costa County and/or captured from CDSS group home case files maintained for group home rate setting purposes. The group home data gathered included: group home location (county in which the group home facility was located), RCL for each group home program, licensed capacity, and actual capacity data for calendar year 1995 as submitted to CDSS by the group home providers in the annual group home program rate application process for Fiscal Year (FY) 1996-97. Calendar year 1996 placement data was used for new providers in the absence of placement data for calendar year 1995. The child's behaviors/problems and assessed needs were separated into threecategoties on the review tool. These categories were based on the child's assessed need for group home placement and equate to RCL 12-14, RCL 9-11, and RCL 1-8. An indicator was designed into the review tool to determine if the child'i need for group home placement was supported by documentation maintained in the case files, and if the child was appropriately placed in a group home program consistent with the assessed needs. The review tool also identified significant documents that are filed in each foster child's case file in compliance with State and federal mandates. These documents include the initial and most recent court reports, psychological and social studies, needs assessment, case plan, report of significant changes, placement history, immunization records, and school information. An indicator provided on the review tool identified the case plan goal as either permanent placement, family reunification, or emergency placement. Other information captured on the review tool included the county generated forms for group home placements: the Children's Residential Placement Unit (CRPU) Placement Request Form (CRPU 6); the CRPU Referral Form (CRPU 6A); indication that the Interagency Placement Committee (IPC) was involved with all RCL 13-14 placements; and, the Division Manager Approval Form that is required when the monthly placement costs exceed $4,000 per month per child and/or a child under the age of 10 is placed in a group home. The remaining indicator documents that the child/group home interview was completed prior to the group home placement. Two items on the review tool were excluded during the case review process because the data was captured in another element on the review tool. Sample Methodology The CDSS Foster Care Branch worked with the CDSS Information Services Bureau (ISB) to develop sample selection criteria for appropriate case identification. These criteria limited the fields for case selection from a universe of statewide foster care cases to _3- Contra Costa County cases only. Selected criteria further reduced case selection to cases active in March 1997. The final case selection criteria limited case selection to group home placements only. A total of 189 cases were identified using this case selection criteria. To ensure that the sample of cases selected from the universe of 189 cases was based on a statistically valid, random sample, case numbers (1 through 189) were scrambled electronically by the ISB. This redistributed the cases from a sequential numbering system to a random number assignment for each case. This case selection process provided a statistically valid case sample that would support an in-depth case review process and permit available CDSS resources to achieve maximum case review. From the universe of 189 cases that were identified as group home placements in March 1997, the review team completed a review of 67 cases. Of the 67 cases reviewed, three cases were excluded (dropped) from the sample list because the children were not in group home placement in the review month. Please refer to Section III of this report for case disposition and findings. II. COUNTY PLACEMENT PROCESS Contra Costa County provided the CRSS review team with information>related to the county's group home placement practices, polices, and procedures prior to the case file reviews. The review team held an entrance interview with county staff prior to conducting the case reviews. Significant information regarding the county's placement procedures was gathered during the interview process. County staff also provided the review team with an orientation to the facilities, case location, and case files during the entrance interview process. All cases assessed as possible group home placements are referred to the CRPU located in Martinez from district offices located throughout the county. It is the CRPU Placement Specialist who is responsible for matching the child's assessed needs with a group home program/RCL that can meet the child's needs and has bed availability. Placement decisions by the Placement Specialist are made under supervisory review and with Division Manager consultation when prudent. The CRPU Placement Coordinator tracks group home resource availability. County forms used for referral to the CRPU include: the CRPU Placement Request (CRPU 6), and the CRPU Referral (CRPU 6A). The Placement Specialist must consider several factors when determining the appropriate group home program for each child. These factors include: the chiles assessed/therapeutic needs, and other factors that include, but are not limited to, ethnicity, age, and gender; reunification if feasible; other primary relationships, community of origin; the child's health -4- needs, and school requirements. However, the final decision, first and foremost, is based on whether the group home program can meet the child's therapeutic needs and availability of bed space at time of need. County group home placement procedures require that all group home placements be reviewed and approved by the CRPU supervisor. Additional county procedures require Division Manager approval for group home placement costs exceeding $4,000 per month per child and for all children placed in group homes who are under the age of 10 years. Documentation must also support IPC review for RCL 13-14 placements. Documentation in the case file should verify that the child/group home interview was completed prior to the child's placement in the home. The Placement Specialist is responsible for scheduling this interview, coordinating social worker involvement if requested, and transporting the child to and from the interview location. It is also the Placement Specialist's responsibility to send information packets to group home providers for any child who is being considered for placement in their program and notify the child's social worker when the child is placed. III. SPECIFIC FINDINGS The findings presented below are based on data gathered during the case file reviews. These findings are based on documents, records, notes, reports and forms reviewed in each child's services case files. No additional data or case information was accepted from Contra Costa County subsequent to the conclusion of the case file review. All data gathered from the case files was documented on the review tool for each case reviewed. Additional data for group home programs was extracted from the CDSS group home program files. This information was limited to actual occupancy information as reported by the group home providers for each group home program identified in the case file reviews. The actual occupancy information was reported for calendar year 1995 as submitted by group home providers in their annual rate application for FY 1996-97. For one new provider the occupancy rate was taken from the provider's initial annual rate application for FY 1997-98 and reflects actual occupancy for calendar year 1996. Information regarding group home occupancy is discussed below. Case Disposition A total of 67 cases were reviewed from the 189 Contra Costa County State and federal cases identified with group home placements. The 67 cases represents 35.5% of the 189 cases. However, it was determined that in 3 cases the children were not residing in group -5- homes in the review month, March 1997. These cases were dropped from the sample. This reduced the universe of cases from 189 to 186 with a total of 64 case reviews completed. The 64 cases represent 34.4% of the sample universe. The case findings are presented below. Child-Specific Data Age: For purposes of this report, the child's age was determined at the time of the most recent group home placement prior to the review month, March 1997. With the exception of ages 2, 3, and 5, all other age levels (1 through 18) were identified during the case review process. The child's age and the percent of placements by each age group are displayed in Table 1. The age group with the highest concentration of children in placement was ar 15 representing 23.5% (15) of the 64 cases reviewed. The second highest concentration was age 16 representing 10.9% (7) of the total cases reviewed. The third highest concentration of children included ages 8, 10, 13, and 14 with each age group representing 9'.3%fl (6) of the cases reviewed. Age 9 represented 4 placements at 6.3%, age 12 represented 3 placements at 4.7%, and the remaining ages 1, 4, 6, 7, 17, and 18 each represented 1.6% (1) of the total cases reviewed. Gender: Table 2 displays gender by number of children (frequency) with the percent of total placements. Of the 64 cases reviewed, 38 or 59.4% of the children were male. The remaining 26 cases were female representing 40.6% of the total cases. Ethnicity: Table 3 displays ethnicity by frequency with the percent of total placements. The breakdown of ethnicity was limited to 5 categories: African-American, Asian, Caucasian, Hispanic, and Other. Of the 64 cases reviewed, the representations of ethnicity were as follows: African-American 32 (50.0%); Asian 0'(0.0%); Caucasian 25 (39.10/o); Hispanic 4 (6.2%); and, Other 3 (4.7%). Rate Classification Level (RCL): The placement of children in the various levels�of group home programs reflect the highest concentration of placements in RCL 08, 10, 11, and 12. These four RCLs captured 50 (78.1%) of the total placements. The number of children placed at each RCL includes: RCL 14, 4 cases (6.2%); RCL 12, 16 cases (25.0%); RCL 11, 8 cases (12.5%); RCL 10, 17 cases (26.5%); RCL 9, 6 cases (9.4%); RCL 8, 9 cases (14.1%); RCL 6, 3 cases (4.7%); and, RCL 5, 1 case (1.6%). Table 4 displays these l findings by the number of children placed in group home programs by RCL and the percent of total placements.' Assessed Need for Group Horne Placement: The assessed need for group home placement for each child was determined based on multiple documents viewed in the case files. Of the 64 cases reviewed, all 64 children (100.0%) were placed in group homes at an appropriate ................................................................................................................ ................................................................................................. . ......... -6- RCL consistent with the various medical, psychological, behavioral, school and other reports and documents reviewed in each child's case record. The number of placements at each RCL are noted on page 5. All placements at RCL 12 or higher required documentation identifying at a minimum 3 different symptoms and/or behaviors that equate to severe or extreme problems and require a higher level of treatment services to meet the child's therapeutic needs. Case Plan Goal: The case plan goals for each of the 64 cases identified indicated that 54 (84.4%) of the children were determined to be permanent placements (PP); 7 (10.9%) family reunification (FR); and, 3 (4.7%) emergency placements (EP). This information is displayed in Table 5. It was noted that 3 of the children identified as PPs were actually placed in group homes as EPs because the child had requested replacement or the child had run away and was in an EP pending location of a group home that would accept the child. Group Home Placements/County/Ethnicity: Table 6 identifies the group homes in which the children were placed in the review month. This Table displays the number of children placed in each group home program, the percent of total placements in each group home, and the ethnicity of each child by group home. Table 6 also identifies the number of group home facilities located in Contra Costa County. A total of 33 group homes, accounting for 34 programs, were utilized for placements in the 64 cases reviewed. Of the 33 group homes, 13 were located in Contra Costa County, 10 in surrounding counties (counties that boarder Contra Costa County), 9 in other northern California counties, and I in Santa Barbara County. A total of 20 children were placed in group homes located in Contra Costa County. This represents 31.3% of the 64 cases reviewed. The group home with the highest number of placements was located in Stanislaus County. A total of 10 children were placed in this group home representing 15.6% of the total cases. The second highest number of placements (4) representing 6.2% of the total placements was applicable to each of four group homes. One group home had 3 placements representing 4.6% of the total placements. Of the remaining group homes 8 had 2 placements each (3.1%) and 19 homes had I placement each (1.6%). Placement Documentation Contra Costa County has developed an internal procedure for the placement of foster children in group homes. These placement procedures and tools are noted below with the findings for each procedure in this process. CRPU Placement Request (CRPU 6) and CRPU Referral (CRPU 6A) Forms: The CRPU 6 Form is used to initiate a group home placement and transmits pertinent information ................................. _ ....._. ......... ......... ......... ......... ......... ......... ......... ......... ......... .._...... .._. ..... . .... ........... ......... ......... _....... ......... ......... ......... ......... .......... ........ ......... . ........ ......... -7- regarding the child to the CRPU Placement Specialists. Information captured on this form is a synopsis of the child's problems and needs and the justification for group home placement. The CRPU 6A transmits materials including the CRPU Placement Request Form, court reports, placement history, school information, etc. Of the 64 cases reviewed, the CRPU 6 and CRPU 6A were on file in 25 (39.1%) of the cases. The referral forms were absent in 39 (60.9%) of the cases. Child/Provider Interview: Documentation that the interview between the child and the group homeprovider occurred prior to the child's placement in the group home was difficult to locate in the case file. Of the 64 cases reviewed, evidence that the child/group home provider interview had occurred was verified in 19 (29.7%) of the 64 eases reviewed. Interagency Placement Committee (IPC) Review: All RCL 13-14 placements must be reviewed by the IPC. This team is made up of representatives from Social Services, Mental Health, and Education. Of the 4 children placed in RCL 13-14 group home;programs, no evidence of the IPC review was located in the case files. Program Needs: Each child's program needs were identified in 61 (95.3%) of the cases reviewed. However, not all case file folders for each case reviewed were available to the review team. CRPU Supervisor Approval: CRPU supervisory approval was on file in 7 (10.9%) of the 64 cases reviewed. However, during the entrance interview information was provided that the CRPU Supervisor takes an active role with the Placement Specialists in determining the child's placement needs and the selection of the group home in which the child is placed. Placement Approval - Rate atlexceeds $4,000 per month: Of the 28 children placed in group homes at RCL 11-14 (more than $4,400 per month), the required Division Manager approval'was on file in 10 cases representing 35.7% of the 28 cases. Placement Approval - child under 10: A total of 14 children under the age of 10 were placed in group homes in March 1997. Division Manager Approval was verified in 4 (28.6%) of'(hese 14 cases. Group Hone Data: Additional group home data, submitted annually for each group home program to CDSS by group home providers, is being presented in this report to enhance the data captured from the case file reviews. Although this data has been submitted and certified as true and correct by all group home providers statewide, for purposes of this report the information presented is limited to the 33 group home providers (34 group home programs) identified in the case file .......................................................................................................................................................................................................................................................................................................................... -8- reviews and is focused on group home program occupancy rates. This annual group home data is entered in the CRSS group home rates data base. Table A displays the occupancy rates for each of the 34 group home programs in which the 64 children were placed in March 1997. Of the 34 group home programs identified, Table B displays the occupancy rates for group homes located in Contra Costa County. Group home program-specific information provided in each of the Tables (Tables A and B) includes each program's RCL, license capacity, average actual occupancy, and the occupancy rate calculated based on the data submitted by each group home provider for calendar year 1995. However, actual data for calendar year 1996 was used for one new group home provider in the absence of data for 1995. The list of occupancy rates provided in Tables A and B are generated from the data base using established computer programs designed to extract specific data elements from the foster care group home rates data base and calculate the occupancy rates based on the selected group home population. Therefore, all occupancy rates calculated, including all annual average occupancy rates, as provided in Tables A and B, are computer generated based on data submitted by the group home providers. The formula used to arrive at the occupancy rates is the average actual occupancy divided by the license capacity. This number is then multiplied by 100. The resulting number equals the occupancy rate. The occupancy rate is the percentage of beds filled during a specified time period. The formula provided above will not accurately compute the occupancy rate for some group homes. This is due to license capacity change(s) that occur during the calendar year (capacity increase and/or decrease). The computer application averages the monthly capacity for a calendar year rather than using the higher or lower licensed capacity numbers. This average provides a more accurate view of the occupancy rates for a calendar year. Table A displays the occupancy rates for each of the 34 group home programs identified in the case reviews. The annual average occupancy rate for the 34 group home programs is 92.60% calculated by excluding the 2 new provider homes with no data available. The annual average occupancy rates were also computed excluding all new providers which increases the annual average occupancy rate to 93.07%. When all new providers and providers with occupancy rates under 60.00% are removed, the annual average occupancy rate increases to 93.40%. Further breakout of the occupancy rates is provided in Table B. Table B identifies the group home programs located within the geographic boundaries of Contra Costa County. Of the 13 group home programs identified, 2 are new providers with no data available and I is a new provider with available data for 1996 only. The occupancy rate for the 13 group home programs is 82.45%. Excluding the three group home programs identified above, the -9- occupancy rate is 85.52%. The final annual average occupancy rate excludes the new providers and one provider with an occupancy rate under 60.00%. This increases the occupancy rate to 88.04%. IV. CONCLUSIONS/RECOMMENDwATIONS All information and data gathered during the entrance interview, the on-site case file reviews, and CRSS foster care group home rates data base was tabulated and analyzed. These findings were presented in Section Iil of this report and are captured and presented in Tables 1-6 and A-B. Our conclusions and recommendations based on these findings are provided below. Y Conclusion 1: Contra Costa County is not in compliance with group home placement policies and procedures established by the county. Although placement decisions were clearly evidenced in the cases reviewed, the case files did not contain appropriate documentation to verify that required approvals and actions had occurred. The county procedures for group home placement is initiated with the CRPU 6 and CRPU 6A forms which transmit the requests for group home placement to the CRPU Placement Specialist. These forms also transmit case identifying information, reason for residential placement, a brief synopsis of the child's problems, the child's family, and the child's placement needs to the Placement Specialist. The CRPU 6A transmits information pertinent to the determination of a'suitable group home that will meet the child's needs. This information includes the child's placement history, court reports, school information, immunization records, and other materials of importance to the group home selection process. These forms were retained in 39.0% of the cases reviewed. However, although other documentation in the case record contained adequate information to determine the child's treatment needs, the CRPU 6 and CRPU 6A conveyed The CRPU Supervisor Approval, required for all group home placements, was retained in 7 cases. The Division Manager's Approval for children placed in group homes who are under the age of 10 and/or whose placement costs exceed $4,000 per month were located in only 30.0% of the cases requiring this approval. Evidence that the child/provider interview occurred was located in a limited number of cases. The child/provider interview documentation was difficult to locate and required additional review time. Placements requiring IPC staffing (review) were required in only 4 cases. However, the review team was unable to locate documentation that this procedure had been completed in the 4 cases with RCL 14 placements. -10- Recommendation 1: Contra Costa County should take appropriate action to ensure that all applicable documentation and approvals are maintained in each child's service case in compliance with the county's group home placement practices, policies and procedures. Further, these documents should be filed in a manner that is consistent with and facilitates expedient access and viewing. Self monitoring by CRPU staff and periodic or random monitoring of case files by supervisory or managerial staff for compliance could reduce or eliminate this problem. Development of a single page form for all internal approvals could minimize file content and maximize efficiency and accessibility. The IPC review documentation for RCL 13-14 placements should also be easily accessible in the service case file. Acknowledgment that children requiring this level of services have received the necessary multi-agency review is currently required. Conclusion 2: The county's group home placement decisions appear appropriate based on the documentation available in each child's case file and the appropriateness of the group home programs in which the children were residing in the review month. Information maintained in each child's service case was consistent with and allowed county staff to make prudent placement decisions based on State and federal requirements. However, there was no documentation on file regarding the county's efforts to determine group home resource availability at the time of anticipated placement or immediate need. For example, name and number of group home(s) contacted, availability of beds, willingness of group home to accept the child, the need for out-of-county placement, and the group home program/child match. Recommendation 2: Contra Costa County should develop a tool that will capture the group home selection process for each child at the time of placement/replacement. This tool could be used as a check list for the child/group home match documenting the number of group home contacts required to identify a suitable group home program. This tool could also be used to support or justify existing or increased staffing patterns for the placement unit. . More importantly, the county should explore alternative placement options as noted in Recommendation 4. Conclusion 3: Although only 2 cases of the 64 cases (3.13%) reviewed were children under the age of six, placement of these children in group homes is questionable. In both cases the required 1.11.11''..'.......................................................................................................................................................................................... ..................................................................................... Division Manager approval was not located in the child's file. It was also noted that one of the infants was placed in a group home prior to his/her first birthday. Recommendation 3: All approvals for the placement of children under six should be obtained prior to the child's placement in a group home. Further, the approval document should be placed in the case file where it can be easily located. The CDSS has recognized that statewide children under six are placed in group homes without standards for their care being specifically addressed. Children under six placed in group homes frequently have a myriad of needs including emotional, social and behavioral. Separation from their families and chaotic histories lead to maladaptive neurological development, attachment disorders and other psychological and psychiatric needs. It is imperative that out-of-home placements optimize infants and toddlers capacity for repair at a time when they are undergoing the most rapid-paced period of development in the entire human growth experience. Although CDSS is currently in the process of adopting regulatory standards for group homes providing care to children under six, the county should develop services which can be provided in a family setting to meet the unique needs of children in this age group. Conclusion 4: Children are experiencing placement failure at a high frequency level resulting in multiple placements for individual children. Although the county was diligent in its efforts to find appropriate and stable placements for these children, many of them continued in the replacement cycle. In many of the cases reviewed it was noted that this cycle began with social services intervention while the child remained with the biological parent or a relative. Movement then progressed to relative placement, foster family home placement and then placement with a foster family agency and/or in group homes. In a few instances the children continued contact with a relative or foster parent after replacement. Recommendation 4: Contra Costa County should explore and develop other service alternatives, such as the wraparound process and other intensive services strategies, which reduce the need for out-of- home or group home placements. ......... ....... ......... ......... ......... ................ __ __......... ......... ......... _. .......................................................................... TABLES TABLE PLACEMENT AGE 1 GENDER 2 ETHNICITY 3 RATE CLASSIFICATION LEVEL (RCL) 4 CASE PLAN GOAL 5 GROUP HOMEXHILD-SPECIFIC DATA 6 GROUP HOME OCCUPANCY RATES Group Horne Occupancy Rates A Group Horne Occupancy Rates Contra Costa County B CONTRA COSTA COUNTY GROUP HOME PLACEMENT REPORT CHILD-SPECIFIC DATA TABLE 1 PLACEMENT AGE AGE #e OF CHILDREN %OF TOTAL PLACEMENTS 1 1 1.6 4 1 1.6 6 1 1.6 7 1 1.6 8 6 9.3 9 4 63 10 6 9.3 11 5 7.8 12 3 4!.7 13 6 9.3 14 6 9.3 15 15 23.5 16 7 10.9 17 1 1.6 18 1 1.6 64 104.0 TABLE2 GENDER GENDER #OF CHILDREN %OF TOTAL PLACEMENTS MALE 38 59.4 FEMALE 26 40.6 64 100.0 _ _ _ CONTRA COSTA COUNTY GROUP HOME PLACEMENT REPORT CHILD-SPECIFIC DATA TABLE 3 ETHNICITY Ethnicity #of Children % of Total Placements African-American 32 50.0 Asian 0 0.0 Caucasian 25 39.1 Hispanic 4 6.2 Other 3 4,7 64 100.0 TABLE 4 RATE CLASSIFICATION LEVEL RCL #OF CHILDREN % OF TOTAL PLACEMENT 5 1 1.6 6 3 4.7 8 9 14.1 9 6 9.4 10 17 26.5 11 8 12.5 12 16 25.0 14 4 6.2 64 100.0 ''I'll'',................................................................................................................................................................................................ ....................................................................... CONTRA COSTA COUNTY GROUP HOME PLACEMENT REPORT CHILD-SPECIFIC DATA TABLE CASE PLAN GOAL #OF CASES PERCENT OF TOTAL CASES Permanent Placement 54 84.4 Family Reunification 7 10.9 Emergency Placement 3 4.7 TOTAL 64 100.0 .......... ......................... .............................................................................................................. .........................................................................11.1111.111'', ........ ....................................... ........................................................................................... ........................ CONTRA COSTA COUNTY GROUP HOME PLACEMENT REPORT GROUP HOMEXHILD-SPECIFIC DATA TABLE GROUP HOMES BY#OF PLACEMENTS AND%OF PLACEMENTS ETHPICITY ff OF GROUP HOME CHILDREN %OF TOTAL AA CAUCASIAN HISPANIC ASIAN OTHER PLACED PLACEMENTS Allums House a 1 1.6 Bay Area Youth Center 2 3.1 Bay Area Youth In Action a 1 1.6 Breakthrough a 1 1.6 Chamberlain's Childrens 2 3.1 2 Children's Home of Stockton 1 1.6 1 College Haven I a 2 3.1 2 Creative Alternatives 10* 15.6 9 1 EDK House Inc. a 4 6.2 2 1 1 Families First a 1 1.6 1 Fred Finch Youth Center 1 1.6 Guadalupe-Trinity School 1 1.6 1 Just 4 People a 1 1.6 1 La Cheim-Adolescent a 1 1.6 Lincoln Child Center 4 6.2 4 Mt.St.Joseph-St. Elizabeth 2 3.1 2 Plumfield Children's Center 2 3.1 1 1 Randon H.O.P.E. 1 1.6 1 Roxanna House a 1 1.6 1 Rubicon Centers 4 6.2 3 1 Sacramento Children's Home 3 4.6 2 1 Savannah's 1 1.6 1 Seneca Residential Center 1 1.6 1 Social Options a 1 1.6 1 St.Vincent's 2 3.1 1 1 Stanford Home For Children 2 3.1 2 Sumlin House Youth Services 2 3.1 2 Tender Loving Care a 1 1.6 True To Life Counseling 1 1.6 Victor Treatment Centers 1 1.6 Walden House,Inc. 1 1.6 We Care Connection a 1 1.6 Youth Homes,Inc. a 4 6.2 4 TOTAL 64 100.0** 32 25 4 0 3 AA African/American a Contra Costa County Group Rome Facilities Total for two programs Due to rounding,total will not equal 100.0% ............. .......... .............................................................................................................................................................................. ........................................................................... CONTRA COSTA COUNTY TABLE A GROUP HOME PLACEMENT REPORT GROUP HOME OCCUPANCY RATES GROUP HOME RCL LICENSE AVG.ACTUAL % OCCUPANCY CAPACITY OCCUPANCY-L/ RATE 2/ Allums House 08 10 6.10 91.50* Bay Area Youth Center 10 36 30.50 84.72 Ba Area Youth In Action 10 06 4.92 82.00 Breakthrough 11 12 6.46 53.83* Chamberlain's Childrens Center 10 24 22.12 92.17 Children's Home of Stockton 08 52 49.48 95.15 College Haven I 11 06 5.31 88.50 Creative Alternatives-0 en Environment 08 06 5.96 99.33 Creative Alternatives/Closed Environment 10 50 46.72 93.44 EDK House Inc. 11 06 5.99 99.83 Families First-Oak Grove 14 08 5.90 72.50 Fred Finch Youth Center 12 50 41.40 82.80 Guadalupe-Trinity School 12 86 82.47 Y 95." Just 4 People 10 25 15.15 89.12* La Cheim-Adolescent 14 12 11.40 95.00 Lincoln Child Center 12 38 35.93 94.55 Mt.St.Jose-St.Elizabeth 12 26 23.93 92.04 Plumfield Children's Center 06 24 22.93 95.54 Randon H.O.P.E. 06 10 9.20 92.00 Roxanna House 08 12 9.27 9170* Rubicon Centers 10 30 28.99 96.63 Sacramento Children's Home 12 86 81.49 94.76 Savannah's 08 12 9.72 101.72* Seneca Residential Center 14 58 37.05 87.54* Social Options 05 10 5.99 59.95 St.Vincent's 12 18 12.73 79.56* Stanford Home For Children 12 50 46.73 93,46 Sumlin House Youth Services 09 12 9.23 76.92 Tender Loving Care 08 06 True To Life Counseling 12 12 11.26 93.83 Victor Treatment Centers 14 188 183.82 96.33* Walden House,Inc. 11 40 43.71 99.34 We Care Connection 08 06 Youth Homes,Inc. 09 30 27.57 91.90 Annual Average Occupancy Rate 92.60 Annual Average Occupancy Rate (Excluding New Providers) 93.07 Annual A4We QccuonSy Rate(Excluding New Providers&Less Than 60%Occu anc 93.40 IJ Avg.Actual Occupancy for Calendar Year 1995 _11 Avg.Actual Occupancy-License Capacity X 100= %Occupancy Rate(Col.5) Formula does not compute due to license capacity change/during year. Now Provider New Provider-No data available .............. .................................................. CONTRA COSTA COUNTY GROUP HOME PLACEMENT REPORT TABLE B CONTRA COSTA COUNTY GROUP HOME OCCUPANCY RATES GROUP HOME RCL LICENSE CAPACITY AVG.ACTUAL %OCCUPANCY OCCUPANCY 1/ RATE 2/ Allums House 08 10 6.10 9I.50* Ba_y Area Youth In Action 10 06 4.92 82.00 Breakthrough 11 12 6.46 53.83** College Haven I i 1 06 5.31 8$.50 EDK House Inc. 11 06 5.99 99.83 Families First-Oak Grove 14 08 5:80 72,50 Just 4 Peo le 10 25 15.15 89.12* La Cheim-Adolescent 14 12 11.40 95.00 Roxanna House 08 12 9.27 92.70* Social Options 05 10 5.99 5995 Tender Loving Care 08 06 *** *** We Care Connection 08 06 *** *** Youth Homes,Inc. 09 30 25.57 91.90 Annual Average Occupancy Rate 82.45 Annual Average Occupancy Rate (Excluding New Providers) 85.52 Annual Average Occupancy Rate(Excluding New Providers&Less Than 60%Occu anc 88.04 I/ Actual Occpancy for Calendar Year 1995 2/ Avg.Actual Occupany-by License Capacity x 100=%Occupancy Rate(Col.5) * Formula does not compute due to license capacity change/during year. ** New Provider *** New Provider-No data available I