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MINUTES - 05132008 - C.77 (2)
FHS #95 Contra TO: BOARD OF SUPERVISORS ` Costa FROM: Family and Human Services Committee ,Iv`kor DATE: May 6, 2008 °'S'A court County SUBJECT: Children & Family Services System Improvement Plan Annual Update SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECOMMENDATION: ACCEPT the attached report from the Director of the Employment and Human Services Department regarding an annual update of the Child Welfare Self Assessment and System Improvement Plan, as recommended by the Family and Human Services Department. BACKGROUND/REASON(S) FOR RECOMMENDATION(S): On April 28, 2008 the Family and Human Services Committee received a report from the Employment and Human Services Department regarding annual update on the Departments efforts on Child Welfare Redesign and implementing the System Improvement Plan required by the State's Child Welfare Performance Outcomes and Accountability Act, including the lessons learned during the first year of the System Improvement Plan, performance update, what is working and why, and the challenges and barriers to improvement. CONTINUED ON ATTACHMENT:-YES SIGN (URE: d�2� RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION'13F BOARD COMMITTEE APPROVE OTHER SIGNATURE(S): Susan A.Bonilla,Chair Mary N.Piepho,Member ACTION OF BOARD ON_ � ,��4 3 171-7 S! x APPROVE AS RECOMMENDED - O�T n VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE UNANIMOUS (ABSENT�I% G ) AND CORRECT COPY OF AN ACTION TAKEN AND ENTERED ON THE MINUTES OF THE BOARD AYES: NOES: OF SUPERVISORS ON THE DATE SHOWN. ABSENT: ABSTAIN: ATTESTED ' N CU CLERK OF THE BOARD OF SUPER ORS AND COUNTY ADMINISTRATOR Contact Person: Dorothy Sansoe 5-1009 CC: CAO Valerie Earley,EHSD BY' DEPUTY v*� r Intentionally Blank EMPLOYMENT AND HUMAN SERVICES CONTRA COSTA COUNTY TO: Family and Human Services DATE: April 28, 2008 Committee Members Cc: John Cullen FROM: Joe Valentine, Director, Employment &Human Services Department Valerie Earley, Director of Children &Family Services Bureau SUBJECT: Children &Family Services System Improvement Plan Annual Update March 2008 Recommendation Accept this report from the Employment and Human Services Department; and Continue to support the Children and Family Services Bureau efforts on Child Welfare Redesign and implementing the System Improvement Plan required by the State's Child Welfare Performance Outcomes and Accountability Act. Introduction and Overview Contra Costa selected 8 outcomes, 1 new federal measure, and 2 systemic areas for the March 2007 Systems Improvement Plan. Under these areas there are 65 activities. Outcome and Systemic Factor areas were selected for this SIP last March for a variety of reasons. Progress in activities and performance measurement in various outcomes have also been influenced and impacted based on internal changes and external circumstances. • Two of the SIP outcomes (Referrals by Time to Investigation and Timely Social Workers Visits with Child) were selected to continue a focus on monitoring compliance. Compliance with timely social worker visits has, in fact, declined for this reporting period. The administrative team believes this is, in part, related to changes in philosophy about exceptions to visits. Recommendations from the supervisor led workgroup on Contacts, Waivers, and Exceptions are recommending policy changes to further limit the use of exceptions for stable placements that allowed visits to occur only every 3 or 6 months instead of monthly. The impact of the shift in policy will benefits children and families but the short term impact is a decline in performance as adjustments are made to these changes. • Some of the SIP activities represent expansion of activities that were piloted in a specific region of the county and have proved to successfully impact performance and/or enhance service. For example, geographically assigned Emergency Response Investigators (under Safety Outcome i 2B, Referrals by Time to Investigation) have been implemented across the county. The California Permanency for Youth strategy (under the new Federal Measure, Permanency Composite 3, A2) that searches for permanent connections for youth while in Foster Care and continuing past emancipation originally piloted in West County is being implemented countywide. • Other activities called for research of Best Practice or Evidence Based Practice before a direction was set and implementation could be planned. For example the Siblings Placed Together Workgroup (under Well Being, Outcome 4A, Siblings Placed Together) was given the assignment to develop a protocol for siblings placed together. Research in how this is managed in other counties and states has influenced the recommendations from this workgroup. • Outcome IC, Rate of Child Abuse and Neglect in Foster Care, was added to improve performance in this area but also in response to a child's death in a Foster Home. Though the county was meeting regulations and policy requirements in this area, activities were added to go beyond regulations to add preventive activities to address the safety of children in the county's care. Activities such as Dual Licensure to cross check for complaints against the home in both licensed Foster Care and licensed Day Care, Foster Parent Mentoring Programs to connect an experienced Foster Parent to a newly licensed Foster Parent, and changing/monitoring health care for children in Foster Care by establishing a clinic and pharmacy to meet the needs of children and increase the communication between Health Services and Children' Services were added as SIP activities. o Establishment of a weekly Foster Care Clinic staffed by a County pediatrician o Standardized processes for identification of those children entering the foster care system who require prompt medical attention o Public Health Nurses who work with Children & Family Services staff can now schedule appointments directly into the foster care clinic o System in place to ensure that each child leaving the foster care clinic has an identified primary care provider o Department of Pediatrics is in the process of finalizing a teaching document that will outline best practice considerations for providers seeing a foster child in a medical setting o Arranging cross training opportunities for Children & Family Services and Health Services staff o Continue to explore ways to integrate existing data to enable identification of foster children in existing HSD clinic and hospital systems. • Under the Systemic Factor Disproportionality, performance reflects a decline in returning African American children home. Contra Costa had made great progress in reducing Disproportionality in this area previously. The performance decline may be attributed, in part, to staff's reaction to high media attention on the death of one young African American child thus creating a more cautious environment in making decisions to return children home. ii One of the most effective changes with the work being done for this year's SIP was a broader inclusion of supervisors and staff in the coordinating, planning, and implementing of various strategies and activities. Under the direction of a new Child Welfare Director, supervisors asked for stronger voice in the vision and direction for Children's Services. In response to that, committees were established or restructured for more communication around SIP activities and general direction and planning for Children's Services. In addition, CWS Supervisors were given the opportunity to directly participate in policy making by chairing workgroups. The creativity, innovation, and progress of the county and the success of this direction is apparent by a review of this document. Contra Costa has made progress in addressing the strategies and activities over the past year, the first year in a 3 year SIP: • Work has been completed on 18 of the activities. "Completed" indicates planning for the activity and full implementation has been accomplished. In most instances, the activity itself continues with the expectation that it has become integrated into standard practice. • All but 4 of the activities have had some work done. • In many of the activities, planning is well under way and committees are now working with policy staff and Staff Development trainers to write policy and plan training for implementation. In many of the outcomes and strategic areas, improved performance reflects the efforts and progress. In other outcome areas, practice changes can be measured, but impact on outcomes performance may not be reflected in the short term. As stated above, in some areas, improvements in practice may generate a short term decline in outcome performance but the longer term effect will be improved service to families and children. These Systems Improvement strategies, in conjunction with the 2 federal grants (Systems of Care, Partnering for Permanency and Comprehensive Assessment for Positive Family Outcomes), and various other initiatives and strategies, reflect Contra Costa's continued vision and goal for best practices to serve families and children. Use of Data In 1997, the statewide Child Welfare System/Case Management System (CWS/CMS) was implemented in Contra Costa. This gave a much broader scope of data recorded about children and families and services provided by the agency. With the award of a federal Systems of Care grant in 2003, the county was able to hire a Children's Services Research and Evaluation Manager. The culture shift since that time has progressed from the perception that Data is "scary" and shifts social workers' attention to numbers instead of families, to Data "is our friend" and can point CFS in the right directions to improve outcomes for children and families. Data does not in itself answer questions but allows the organization to drill down, ask tactical questions to study hypotheses and measure whether strategies work or not, and therefore allow the manipulation of strategies when necessary. Data driven decision making has impacted the county's Self Assessment, supported the planning for the Systems Improvement Plan, and supported the various workgroups and managers in assessing "best practice" and "evidence based" efforts as the county moves forward to implement SIP activities. iii Changes from Original Plan Over the past year, no significant changes have been made to planned SIP activities. However, the baseline performance data as well as improvement goal has been updated on several, but not all, of the SII' items. This was necessitated by the fact that the state and federal outcome measures have changed since our most recent SIP was submitted to the State in early 2007. The new outcomes and improvement goals are listed for each SIP item affected. If there is a national standard/goal associated with a given outcome, it is also reported. In addition, timelines for activities, Start and Finish dates, have been modified as required based on current progress and/or coordination of implementation of activities. Project Leadership Roles Each Outcomes under Safety, Permanence and Well Being was given an Outcome Manager to oversee the outcome as a whole. Either a Manager (referred to as the functional Project Manager) or a Lead Supervisor were assigned to each of the activities in the SIP. The Lead Supervisors works on a defined project and reports to the Outcome Manager. The essential part of this "matrix" style of management is that many people share the responsibility for planning, implementation and monitoring of a practice change and subsequent outcome improvement. Roles and responsibilities of the Outcome Manager The Outcome Manager is responsible for collecting the information from each of the Project Managers and lead supervisors regarding their specific outcome and tracks the progress on each of the projects. The Outcome Manager presents summary reports to committees on all projects in the Outcome area. This summary information is submitted annually for inclusion in the annual report to CDSS. The outcome manager also supports the lead supervisors in chairing and managing areas assigned to them as well as advocating for resources needed (such as staff, trainers, policy analysts to write policy) and helps the supervisor frame their presentations to request input or support. Roles and responsibilities of Project Manager The Project Manager is responsible for the project assigned to them and for keeping the Outcome Manager up to date on the project. It is the Project Manager's responsibility to ensure the project is planned and implemented. Roles and responsibilities of the Lead Supervisor The Lead Supervisor prepares a project plan (template provided) and communicates with the Outcome Manager regarding their specific project. The Lead Supervisor presents "concise" updates of their project and their committees work at Children's Leadership Team (CLT) every two months, paying special attention to providing only updates and requesting help with challenges to planning or implementation. Communication and Organizational Structure To support effective communication and cross co-ordination of activities in the bureau as well as provide an inclusive planning process for supervisors and staff, the following committees have been created or restructured for reporting, monitoring, and tracking progress and/or approving direction and policy. iv Program Committee Program Committee membership consists of a broad representation of CWS staff and programs as well as Program Analysts and Staff Development trainers. The role of Program Committee is to establish projects, work issues, and recommend changes to the Administrative Team. The committee also serves as a forum for reviewing some of the strategies and activities in the SIP prior to finalization and implementation. Children's Leadership Team (LILT) To implement projects at the practice level it was determined that increased involvement and accountability was needed at the Supervisor and Staff level. Their expertise in how to translate new initiatives and/or projects into everyday practice is essential for successful operations. The team that is most able to implement practice changes, including the voice of managers, supervisors, and analysts, and therefore lead the Bureau is the Children's Leadership Team. CLT is led by the Director and meets 2 hours once each month. Project Management Team The Project Management team provides ongoing monitoring and coordination of projects and activities, hears bi-monthly updates from managers in each outcome areas, addresses resource needs for project development. The team consists of the Director, Managers, Parent Partners, and the Research and Evaluation Manager. Work has included determining the definition of a project, categorizing what are projects, monitoring projects through operationalization, and assigning responsibility for projects. Lead Supervisors and staff participating on workgroups report to this team on an ad hoc basis. The PMT is under the direction of the Director and chaired by a consultant and meets once per month for 3.5 hours. Children's Services Administrative Team (CSAT) The Administrative Team, the Director and Managers including the Research and Evaluation Manager, looks at every day administration and policy, provides oversight on policy, and resolves and responds to high level policy questions from the committees. This committee is under the leadership and direction of the Director, meets weekly and rotates between each District Office to have a"presence"in each district. Performance Update Summary For the 11 SIP items we are currently focusing upon, we have shown improvement (from baseline) in 7, no change in 2, and some decrement in performance in 2 areas. Of the 5 areas that have national standards/goals, we are meeting or exceeding the standard in 2 of the 5 (40%). The specific outcome areas are listed in the table below. Outcome Improvement from Meeting Natl Std? Baseline? Recurrence of Maltreatment No change Yes Rate of Child Abuse/Neglect in Foster Care No change No Referrals by Time to Investigation Improved N/A v Timely Social Worker Visits Worsened N/A Length of Time to Reunification Improved No Multiple Foster Care Placements Improved Yes Siblings Placed Together Worsened N/A High School Degree or GED Improved N/A Exit to Permanency(24 Months in Care) Improved No Disproportionality of Removals Improved N/A Foster Home Recruitment/Retention Improved N/A Lessons Learned During First Year of This SIP—What's Working Supervisors as "Team Leaders The SIP activity workgroups chaired by Supervisors have presented a fresh innovative approach in many of the SIP activities. Bringing a perspective more closely aligned with front line staff who provide direct service delivery, policy recommendations from these workgroups take into account best practice for children and families as well as a knowledge of the impact on the Social Workers. An added benefit of this is the opportunity for supervisors to serve in a leadership capacity in project planning and management; this allows for mentoring by managers to support supervisors in preparing for secession to Manager positions. Staff Involvement in Change Strategies The inclusion of supervisors and staff in discussions about vision, direction, and strategy direction has created a stronger team for the bureau. Policy changes consider their input and the advance communication allows discussions regarding implementation challenges before rather than after policy is scheduled for implementation. SIP has Defined Goals and Direction The Project Management efforts around the SIP activities and the coordination of these activities with strategies outside the SIP (such as changes being planned to meet federal grant initiatives) has led to a more thoughtful approach to scheduling ... It has also helped define the bureau's direction and vision. Connection to Data Use of data in not only evaluating outcomes but also in determining/confirming best practices has supported the committee's recommendation. In addition, with supervisor lead workgroups, vi the Research and Evaluation Manager has been able to be responsive to Workgroups Leads and Workgroups further solidifying the connection of practice and performance to outcomes. Committee Structure and Reporting and Tracking Protocols The standing Oversight committee (County Leadership Team and Project Management Team) have helped Activity Team Leads in their progress toward practice and implementation recommendations because there is a standing forum to share ideas and request needed resources such as other staff's participation, etc. This has also presented a forum to get feedback from the management team and the broader teams represented on the CLT and PMT during the process rather than at the end of the process only to find out the initial premise wasn't accepted. In addition, since all programs and functional areas are represented on workgroups and in the committees, there are opportunities for cross training of staff in other areas, such as ILSP or Homefinding, to learn their focus, program goal, and challenges. Outcome Managers for SIP Activities Since each outcome has a Division Manager assigned as an Outcome Manager that provides direction to activities in their area, some of the supervisors are cross reporting to managers other than their own. This cross-pollination of reporting has broadened the experience of managers and supervisors. Knowledge Management The inclusion of supervisors and staff in planning and implementing SIP activities shifts the management approach from top down to inclusive structure. Tracking Matrix A year ago, when assignments were being made for each of the Activities, it was clear that tracking progress was going to be cumbersome because of the high number of activities. It was at that time that Managers were assigned to each of the Outcome areas. To further facilitate the generation of this annual reporting document, a standard matrix format was created for each of the outcome managers to use for summarizing activities bi-monthly for committee reporting and annually for state reporting. The creation of this report was based on the compilation of the matrices from each Outcome Manager. Ch alienges/Barriers Budget Constraints With the impending fiscal outlook, it is anticipated that there will be delays in implemention of some of the strategies as the emphasis shifts to management of fiscal restraints. For example, there is a demonstrated need for additional support in the area of Research and Evaluation and Staff Development. There may be delays in being able to fill such vacancies. vii Broader Outreach.to Line Staff The current approach has been very successful including Supervisors in planning. However, more work needs to be done in outreaching to workers for participation on various committees. Culture Shifts Directions being set at Workgroup levels that include Supervisors and some workers may reach direct line staff level and meet with resistance. Planning needs to continue to understand the complexity of changes in the line workers view and still seek buy-in and motivate staff at line staff level. Reaching Consensus Since policy making workgroups now include staff at more levels and from various regions, reaching consensus for doable, best practice approaches is more of a struggle. Juggling"Cine to Include Project Planning With the inclusion of Supervisors now chairing workgroups, there is a greater awareness of the impact of juggling the necessary and job enriching Project Management efforts with the tasks already required of Managers and Supervisors. viii C) � O N O U C2 ° U cl O .0 N O F N O F3 r. 03 cd D 3 O Ln CZ. p V) O N aj w V) ,� Q. O 3 cd �) C1. O 03 U +. 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' ƒ � � t 2 « 0 0 q t2 / ƒ ) to { 2 . � ± � & • \ § � / � \ •E \ \ S ts / k v � � � ■ § 2 § SD.. o 7 # E 2 � « ¢ i o a n o £ e u '@ c # n k Q z / \ CHILD WELFARE SELF ASSESSMENT & SYSTEM IMPROVEMENT PLAN ANNUAL UPDATE Joe Valentine, EHSD Director Valerie Earley, CFS Bureau Director April 28, 2098 CONTRA COSTA COUNTY Continues as . . . • One of eleven funded pilot counties in California to lead child welfare redesign efforts • One of 7 national sites to receive Child Welfare System of Care grant • A leader in Annie E. Casey Family to Family strategy And Newly awarded as one of nine national sites to receive a child welfare "Comprehensive Family Assessment Grant" 1 Target of Federal and State Outcomes -*.-Is To Improve: ■ Child Safety • Child Wellbeing • Child Permanency Summary Of Outcomes Outcome Improvement from Meeting Natl Baseline? Std? Recurrence of Maltreatment No change Yes Rate of Child Abuse/Neglect in No change No Foster Care _ Referrals by Time to Investigation Improved N/A Timely Social Worker Visits Worsened N/A Length of Time to Reunification Improved No Multiple Foster Care Placements Improved Yes Siblings Placed Together Worsened N/A High School Degree or GED Improved N/A Exit to Permanency(24 Months in Improved No Care) _ Disproportionality of Removals Improved N/A Foster Home Recruitment/Retention Improved N/A 4 2 Performance Outcomes 2007- 2010 Safety Outcomes Maintain timely response compliance on 10- day referrals at 90% or above. Maintain social worker visits compliance at 90% or above. Decrease child abuse/ neglect in foster care by 50% to .25% Continue to decrease the re-occurrence of maltreatment of children investigated by Children and Family Services. Percent of Children with No Recurrence of Maltreatment (Fed) (National Std = 94.6 - red line) 100.0 -- 98.0 96.0 c State 94.0 1 -♦-CCC Q 92.0 j- 90.0 '6 � � too 6o 6 O o 0 0 O o 0 0 O o O o O1'4 N O O O N O N O N O O Z H a. z U z x J z a UW Qw dQ � � ULL C) U) � � QOfn Percent of children with substantiated allegation in first 6 months,and another substantiated allegation in next 6 months 6 ^t What We're Doing To Address Issues Reduce Recurrence of Maltreatment Improvement Goal Decrease recurrence of maltreatment by an additional 25% to less than 6% for the base period Oct 1, 2007 through Sept 30, 2008. Revised Improvement Goal Increase the percentage of no recurrence of maltreatment to 95% or greater. This is above the national standard/goal for this outcome. Performance Update For the period July 2006 —June 2007, the percentage of no recurrence of maltreatment within 6 months of a previous substantiated allegation is 94.6%. This is equal to the national standard/goal. Reduce Recurrence of Maltreatment Strategy By ensuring maximum use of available resources, staff will have better information for decision making, families will' have access to more supportive services and incidences of recurrence of maltreatment will decrease. •A staff run workgroup recommended a change in policy to increase the use of Voluntary Family Maintenance Services. •Coordinated with Health Services and CAPC to develop a training plan for medical and dental providers regarding recognizing and reporting abuse and neglect. -Developed an updated mandated reporter trairing curriculum and provide training for the Mandated Reporter Speakers Bureau. -Trained approximately 85 medical providers have been They include new public health nursing staff, general nursing staff and doctors at the local hospitals. -Developed protocol for follow up of Differential Response Services 4 Percent Of Children With No Maltreatment While in Foster Care (National Std = 99.68% - red line) 99.8 ------ —--- �, 99.712 -- -- - c 99.6 -+-State 99.5 - - — --- — -�CCC tv 99.4 99.3 00 00 00 0o rL0 c c 00 00 0 0 0 0 0 0 0 J Z d Z U � 0� J Z H d Upu - Q VOA Meet previous National Standard(.57%or less)are not however meeting the newest National Standard for this measure(99.67%not being abused). Worse than Stale average 9 Reduce Rate of Child Abuse and/or Neglect in Foster Care Improvement Goal Decrease child abuse and/or neglect in foster care by 50% to 0.25% or less for the period Oct 1, 2008 through Sept 30, 2009. Revised Improvement Goal Increase the percentage of children in care who are not maltreated to 99.68% or greater—thus meeting or exceeding the new national standard/goal. Performance Update For the period July 2006—June 2007, the percentage of children in care who were not maltreated was 99.60%. This is essentially equivalent to the baseline period and is slightly below the national standard/goal of 99.68%. 10 Reduce Rate of Child Abuse and/or Neglect in Foster Care strategy Develop a comprehensive response system will ensure children in out of home care are safe from abuse and neglect while providing supportive, preventive and ameliorative services for substitute care providers. _ Revised the Out of Home Policy to establish a centralized • Revised our Licensing home study, application and case tracking protocol all require cross reporting to Community Care Licensing to determine if home is a dual licensed fosterlchild care home. -Establishment of a weekly Foster Care Clinic staffed by a County pediatrician •Continue to explore ways to integrate existing data to enable identification of foster children in existing HSD clinic and hospital systems Reduce Rate of Child Abuse and/or Neglect in Foster Care -Standardized processes for identification of those children entering the foster care system who require prompt medical attention -Public Health Nurses who work with Children & Family Services staff can now schedule appointments directly into the foster care clinic -System in place to ensure that each child leaving the foster care clinic has an identified primary care provider -Department of Pediatrics is in the process of finalizing a teaching document that will outline best practice considerations for providers seeing a foster child in a medical setting -Arranging cross training opportunities for Children & Family Services and Health Services staff i 6 Well Being Outcomes Increase the number of youth graduating from High School or completing GED Increase the percentage of siblings placed together with all or some of their siblings. Percent of Children with Some or All of their Siblings 80.0 --- --- - - — - 70.0 -- - - 60.0 - 50.0 ------ ----- 40.0 -s State 30.0 ----- --- ---------—---— -CCC a 20.0 10.0 0.0 p0 O� pO 01 O� 01 'Z1 01 14 7 Increase Siblings Placed Together Improvement Goal Increase siblings placed together with some or all of their siblings to 65% by Jul 1 , 2009 Performance Update For July 2007, the most recent data available, 58.4 /0 of those with siblings were placed with some or all of their siblings. Increase Siblings Placed Together FS,tra tegy Continue to improve sibling placement policies and practices and increase the number of licensed foster homes. _ •'Developed a plan to clean up data to ensure all families are identified properly. •1=ncouraged use of Receiving Centers for 23 hour stays to give more tirne to locate a home rather than separating siblings. •Sibling status and visitation is addressed at all case review meetings. 16 Youth Receiving High School Degree or GED 112 - - -- 110 108 106 -- ..--- - --- ; 104 -- -- 102 -- 100 98 -- 96 94 - --- 92 OCT2004-SEP2005 OCT2005-SEP2006 17 Permanency Outcomes Increase the number of children with no more than two placements. Increase children who reunify within 12 months to 48%. r Increase permanency for children/youth who are in foster for 24 months to 15%. 9 Percentage of Youth With 2 or Fewer Placements (National Std = 86% - red line) 92 ------ -- --- 90 88 ---- ------- .3 86 - State 82 CCC d80 ------— - a78 ---- ------- ---- — - —-- -- --- 76 o 6 o � r 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 CD 0 0 0 N N N N CN CL ZU Y- x -iz Cq a w w Q w � � 0U) Qo a¢ � � � 000 19 Strategic Outcome Reduce the rate of first time removals for African American youth by 15%. Increase the number of available foster homes for youth which will allow them to be placed within their own community. 10 Incidence Rate of Removals of African American Children 8 Days or More 11.4 —--- -- -- 11.2 CD 11 10.8 m 10.6 0E 10.4 Z 10.2 — — —-- 10 9.8 2006 2007 Year 2' Me 0 ns?;4 1