I. ADMINISTRATION AND SERVICE DELIVERY - OVERVIEW Administering Agency for IV-B, CAPTA and Chafee Missouri Department of Social Services Children's Division P O Box 88 615 Howerton Court Jefferson City, MO 65103-0088 Organized with the Department of Social Services (DSS), the Missouri's Children's Division (CD) is responsible for the Title IV-B Subpart I (Child Welfare Services), IV-B Subpart II (Promoting Safe and Stable Families), Title IV-E (Foster Care and Adoption Assistance), Child Abuse Prevention and Treatment Act (CAPTA), Chafee Foster Care Independence Program (CFCIP), and Chafee Education and Training Vouchers (ETV). Program Improvement Plan In January 2005, the division's finalized version of the Program Improvement Plan (PIP) was approved by the Administration for Children and Families. This two year term plan was developed in response to the federal Child and Family Services Review (CFSR) conducted December 2003. The PIP provides a framework for achieving systemic improvement in practice and ultimately improved outcomes for Missouri’s children and families. CD Mission and Principles The mission of the CD has been affirmed as follows: To partner with families, communities, and government to protect children from abuse and neglect and to assure safety, permanency and well being for Missouri’s children. The guiding principles for the CD are: Partnership: Families, communities and government share the responsibility to create safe, nurturing environments for families to raise their children. Only through working together can better outcomes be achieved. Practice: The family is the basic building block of society and is irreplaceable. Building on their strengths, families are empowered to identify and access services that support, preserve and strengthen their functioning. Prevention: Families are supported through proactive, intentional activities that promote positive child development and prevent abuse and neglect. 3 Protection: Children have a right to be safe and live free from abuse and neglect. Permanency: Children are entitled to enduring, nurturing relationships that provide a sense of family, stability and belonging. Professionalism: Staff are valued, respected and supported throughout their career and in turn provide excellent service that values, respects and supports families. Organizational Structure The CD organizational structure is designed to focus on responsiveness, support and enhancing practice. We believe the CD has good policy and extremely dedicated employees. Our people are our strength. CD seeks to honor and respect our people by strengthening the supervisory support available, increase the number of frontline workers, increase our ability to respond, improve our communication flow and strengthen our quality improvement and assurance activities. The design focuses on creating strong personnel, communication, strategic planning, practice improvement, training, field support and quality assurance. Additionally, the structure places increased emphasis on building partnerships with communities to prevent child abuse and neglect. The structure seeks to blur the lines between central office and field personnel in order to maximize our resources for supporting frontline activities. Central office staff and field staff are working more closely together through the Quality Assurance (QA) Unit and Practice Enhancement Teams (PET) to provide assistance and support to circuits. The QA Unit and the PET are available to support field staff as they conduct their daily activities and develop and implement plans to strengthen practice and improve outcomes. The Division Director has statutory responsibility for supervising the overall administration of child welfare services in the state, while much of the day-to- day operation and coordination is delegated to other executive staff within the division. The Human Resource and Constituent Services Section is led by a Designated Principal Assistant (DPA). The DPA has oversight for Human Resources, communications, constituent services, and legislative affairs. Proactive communication both internally and externally is the focus of the Human Resources and Constituent Services Section. The DPA position also offers additional support to the Director in issues requiring overall leadership and management across the division. The Planning and Performance Section is led by a Deputy Director. A strong emphasis is given to strategic planning and the use of data to manage 4 performance improvement. The federal Child and Family Services Review Program Improvement Plan, and Accreditation planning are coordinated through strategic planning function. Additional functions included in this section are Policy and Contract Development, Information System Development (including SACWIS), Performance-Based Contract oversight, Quality Assurance, Interdepartmental Initiatives, Residential and Child Placing Agency Licensing, and Interstate Compact on the Placement of Children. The Practice Development and Support Section is led by a Deputy Director. This section houses the functions of Program and Policy implementation, practice and program, Quality Improvement, Professional Development and Training, the Child Abuse and Neglect Hotline, and Background Screening. Technical Assistance, including Practice Enhancement Teams, is coordinated out of the Quality Improvement Unit. The Early Childhood & Prevention Services Section, led by a Deputy Director, has four critical functions: • Administration of the federal Child Care and Development Fund (CCDF) which encompasses enhancement activities. The purpose of the program is to assist families with the cost of child care services while they pursue activities that promote self-sufficiency and family stability. • Administration of the Early Childhood Development Education and Care Fund (ECDECF) which is dedicated funding from the riverboat casino entrance fees. The ECDECF funds four early childhood programs targeting children from birth to age three. • Oversight of prevention initiatives to reduce the risk of child abuse and neglect through early intervention and other activities. • Administration of the Child Care Provider Relations Unit (CCPRU). This unit is a team of dedicated staff that provides intensive customer service and technical assistance to childcare providers requesting to participate in childcare subsidy reimbursements. The Management Services Section, led by a Deputy Director, is a shared function with the Family Support Division (FSD). Management Services provides support for budget related functions, purchasing, contracting, payment processing, and facilities management. Five Regional Directors serve on the executive team and report to the Division Director. The Northern, Southern, Jackson County, St. Louis County and St. Louis City Regional Directors with assistance from the field support managers oversee and administer CD activities in their various geographic locations. 5 II. Service Description for Child Welfare Services • Report on the specific accomplishments and progress achieved in the past fiscal year toward meeting each goal and objective including improved outcomes for children and families and a more comprehensive, coordinated, effective child and family services continuum. A. Child Abuse and Neglect Prevention, Intervention, and Treatment Services Child Abuse and Neglect Hotline Missouri statute specifically charges the CD with the responsibility of operating a single, statewide toll-free telephone number at all times for receiving reports of child abuse and neglect (CA/N). Since August 15, 1975, the CA/N Hotline has been accepting calls 24 hours a day, 7 days a week. During Fiscal Year (FY) 2005, the Hotline received over 107,000 calls. It is staffed by employees who interview reporters, classify and prioritize calls to assure child safety, and then refer these concerns of abuse and neglect to the field office where the child is located. Of the over 107,000 calls received, 53 percent were classified as child abuse/neglect reports; 31 percent were classified as non CA/N referrals. Another 16 percent did not meet criteria for the above and were “documented”. Many of these did not have the necessary information to be classified as a CA/N report and non-CA/N referral. They are documented, and in the event more information is received later, they can then be considered for reclassification. The interpretation of Missouri’s child abuse and neglect statutes can be complicated, thus Structured Decision Making (SDM) tools and philosophy have been implemented as recent improvements to the Child Abuse/Neglect Hotline Unit (CANHU) system and protocol. In 2004 the SDM and Call Management Protocols were incorporated into the CA/N Hotline Process and workers were trained. As required by the program improvement implementation, field staff was instructed to review 10 percent of CA/N cases using the SDM review tool. Review results were evaluated and imminent needs for training were identified and provided. During June 2005 these Hotline protocols were automated and a supervisory tool was developed to assess quality. Child Abuse/Neglect Reports As established by Missouri law, many professionals who work with children and families are identified as mandated reporters of child abuse and neglect. Mandated reporters accounted for 50 percent of CA/N 6 reports in Calendar Year (CY) 2005. All other reporters are considered permissive reporters. Permissive reporters may report when they have reasonable cause to suspect that a child has been or may be subjected to abuse or neglect or when they observe a child being subjected to conditions or circumstances which would reasonably result in abuse or neglect. Permissive reporters accounted for 35.9 percent. These figures for permissive reporters do not include anonymous reporter figures. There were 54,108 CA/N reports made involving 80,577 children. Victims were found to have been neglected in 47.8 percent. Physical abuse was determined in 25.3 percent. Sexual maltreatment was determined in 24.1 percent. In CY 2005, 60.4 percent of children in substantiated CA/N reports were abused and or neglected by one or both (biological/adoptive) parents. Other relatives, such as stepparent, grandparent, or sibling, were responsible in 12.7 percent of these cases. In 5.3 percent of these cases the perpetrators were of an unknown relationship to the child. As part of the PIP, in an effort to address Safety Outcome S1: Timeliness of initialing investigations of reports of child maltreatments, CD clarified policy regarding timeliness of initiating reports. Policy clarified the definition of “initiating” reports and who can be considered as part of a multi-disciplinary team. In addition, data system entry guidelines were either developed or clarified. Improved timeliness of initial contact was monitored locally and improvement plans developed as needed. The agreed upon goal of 80.4 percent was met during the third quarter PIP (August-October 2005). The national standard for CA/N recidivism is 6.1 percent or less. Missouri’s performance at the time of the CSFR was 8.3 percent. Based on the federal formula for goal setting, the agreed upon goal to achieve is 7.4 percent. The CD has developed several strategies to ensure consistent and accurate completion of the SDM Safety and Risk Assessment. The current performance for this measure after five PIP quarters is 4.8 percent. The National Standard for incidences of CA/N in foster care is .57 percent or less. The CD passed this data measure during the CFSR and has continuously maintained the goal of reduced incidence of CA/N in foster care. Average performance of this measure during FY 2005 was .39 percent. The following strategies were developed to address such occurrences: • Implemented a process and strengthened policies to address safety at and throughout placement. 7 • Strengthened policy and practice relating to chronic neglect and accumulation of harm. • PET teams assist circuits in developing local improvement strategies. • Conduct a pilot in a selected circuit to address chronic neglect and accumulation of harm. • Developed performance based contracts for foster parents. CA/N Investigations/Family Assessments The underlying principle of Missouri's Child Protective Services (CPS) is that children and their families coming to the attention of the CD have different intervention needs and require flexible responses from CD and the community in order to protect children and meet the needs of their family. The primary goals of the CPS system are to: (1) ensure the protection of children from abuse or neglect; and, (2) provide this protection to the child and family in the most efficient manner possible by collaborating with and better utilizing state, community and family resources. Senate Bill 961 established the expansion of the flexible child protective services response. This approach was designed to focus the investigation efforts of CD and law enforcement on cases that would be a violation of law. An Investigation is a classification of response by the CD to a report of abuse or neglect, based upon structured decision making protocols, and based upon the reported risk and injury to the child, where the acts of the alleged perpetrator, if confirmed, are criminal violations and/or where the action/inaction of the alleged perpetrator may not be criminal, but which if continued, would lead to the removal of the child or the alleged perpetrator from the home. Investigations are completed jointly with all co-investigators to gather/obtain relevant data and evidence. In 2005, 10.7 percent of CA/N reports were substantiated and 25.5 percent were unsubstantiated. Preventive services were indicated in 4.5 percent of the unsubstantiated findings. A Family Assessment is a classification of response to a child abuse or neglect report for allegations of mild, moderate, or first-time non-criminal allegations of abuse or neglect. These will include reports where a law enforcement co-investigation does not appear necessary to ensure the safety of the child. The Family Assessment process will address the reported concern alleged in the hotline report and take into account the family’s situation as a whole. During this process the worker will engage and empower the family to the fullest extent possible, provided the child’s safety is not jeopardized. The worker will consult their supervisor to assure their action plan protects the family’s right to self- determination as much as possible. 8 Families who are investigated and those who receive a Family Assessment are entitled to prompt and effective delivery of services in order to address their individual child/family needs. In 2005, 57.5 percent of the CA/N reports were screened as Family Assessments. The above CA/N report or Family Assessment definitions are not applicable on some cases, including Unable to Locate; Inappropriate Report; Located out of State; and Home Schooling. These miscellaneous determination approximately 6.3 percents of the CA/N reports. The CFSR found the agency had not consistently assessed the needs of and made provision for services for children and their families. One problem included incomplete assessments. Several strategies were developed to improve performance, in reaching the target goal of 90.3 percent, for providing services to families to protect children in the home and prevent removal: • Improve family assessment and case plan tools to better link service provision to the needs of the family identified in the initial and ongoing assessments; include a mechanism for family self-assessment and identified areas specifically related to child safety and risk concerns. • Strengthen worker/supervisor skills in engaging families in the assessment, case planning and case plan review process to increase parent, caregiver (alternative care provider) and child involvement in case assessment, plan development and reassessment. • Improve supervisory capacity to monitor enhanced practice relating to case planning. • Establish procedures to access various service funding streams. • Develop state comprehensive children’s mental health plan to increase level of cooperation between court, mental health, child welfare and families. Structured Decision Making The purpose of Structured Decision Making (SDM) is to assist staff in assessing risk, target services to children and families who are the greatest risk of maltreatment, and to improve outcomes for children and families such as reducing subsequent harm. Using prompts from SDM tools, workers are able to make more consistent and reliable decisions in regard to services aimed at alleviating the abuse and neglect situations in families that are at a “high” risk of causing future harm to their children. Early identification of risk factors allows workers to develop strategies that aim at the prevention of future occurrences of child maltreatment within the family. 9 SDM tools feature questions that also help the worker identify critical decisions about the family, and provide a consistent set of factors for each decision point in the process. Each factor is defined so that there is less chance for varied interpretations. The end result is a process that provides consistent decision making using the state child abuse and neglect statutes and nationally accepted practice standards that assure the most accurate and appropriate response the families in need. Preventive Services/Non-CA/N Referrals While 53 percent of the child abuse/neglect reports received met statutory requirements for child abuse and neglect, approximately 31 percent of the calls did not meet the criteria and were accepted as non- CA/N referrals including: Mandated Reporter Referrals, Non-Caretaker Referrals, Newborn Crisis Assessment Referrals, Preventive Services Referrals and Non-Child Abuse and Neglect (CA/N) Fatalities. Approximately 24 percent of these referrals were forwarded for Preventive Services. With limited resources at its disposal, the CD is making every effort to focus attention and resources on its core functions. Investigations and assessments for child abuse and neglect are the division’s top priority and field staff must be available to work with families in which child abuse and neglect is occurring. The division is in the process of revising policy relating to non-CA/N referrals. The policy revision under planning is a concerted effort to better address the core functions and statutory mandates of the division with its existing available resources. These calls would no longer be dispatched to the local offices for follow-up. Rather, the call would be screened at the hotline to determine if it meets the criteria for a CA/N report, and if not, the caller will be redirected to more appropriate local resources which may better address the caller’s concerns. A proposed plan for information dissemination on practice changes has been shared with CD’s Regional Directors and members of the Children’s Justice Task Force. This policy revision is intended to be in effect by November 2006. The non-caretaker referrals will not be included in this practice change at this time, due to further discussions needed with CD Administration, the Office of State Court Administrators and the Missouri Juvenile Justice Association. Newborn Crisis Assessment and Services Pursuant to Chapter 191 RSMo, the Division must respond to calls to the child abuse/neglect hotline in which a home assessment is requested by a physician or other medical personnel when they have serious reservations about releasing an infant from the hospital who may be sent 10 home to a potentially dangerous situation. There may also be other non- drug related situations in which a physician/health care provider is concerned about releasing a newborn infant from the hospital. Non-drug involved referrals will be accepted until the child is one year of age. During March 2006, staff was introduced to the Newborn Crisis Assessment Tool (NCAT) and instructions. The NCAT was derived from a tool first developed in Jackson County and later revised in the greater St. Louis area to assess mothers and families in which a child has been born drug exposed. After the family has been contacted and assessed, CD staff makes a referral to the local DHSS/Special Health Care Needs (SHCN) Regional Office for service coordination. In situations in which there are documented concerns that the child is “at risk of abuse/neglect”, CD is mandated to provide services. Services will be offered to the family when the above SHCN referral criteria are present and a physician has referred the case for services (191.739, RSMo). There were 2,341 Newborn Crisis Assessments during FY 05, an increase from 2,033 in FY 04 and 1,799 from FY 03. This increase is attributed to the number of infants born drug exposed. Out of Home Investigations The Out of Home Investigations (OHI) Unit functions to investigate referrals alleging child abuse and neglect in child caring facilities. These facilities include licensed foster homes, licensed and license exempt and accredited residential treatment centers, licensed and license exempt day care providers and public and private schools. While the OHI Unit has no direct regulatory responsibility or administrative authority over any of the entities it investigates, it does share investigative information with those responsible for regulating the particular child caring facility being investigated. Below are examples of when this might occur: • During an investigation of a licensed residential treatment center, information is shared with the state Residential Program Unit that licenses and regulates residential treatment centers. • During an investigation in a school, information is shared with the superintendent of schools and the school board. • During an investigation of a licensed day care facility, information is shared with the Bureau of Health Care that licenses and regulates daycare facilities. • During a foster home investigation, information is shared with other CD staff that license and regulate licensed foster homes. 11 State Technical Assistance Team The State Technical Assistance Team (STAT) was established to assist in child abuse/neglect, child sexual abuse, child exploitation and pornography, child fatality, and other child-related investigations at the request of the department, law enforcement, or other child protection agencies. STAT is responsible for managing the Missouri's Child Fatality Review Program (CFRP), to include training and support for the 115 county-based, multidisciplinary CFRP panels, as well as collecting data to identify trends, patterns and spikes to facilitate the development of prevention strategies. STAT is not based in the CD, but rather is supervised by the Deputy Director of the DSS. It is available 24-hours a day to respond to requests for assistance. STAT’s investigative responsibilities are considerably different than those of the CD. STAT investigates about 200 cases annually. Of those, almost 75 percent are sexual abuse or exploitation related. Because of the tremendous growth of consumer availability to inexpensive, high-tech electronic imaging equipment, there has been a significant growth in the number of “cross over” cases (sexual abuse cases that also involve cameras, computers and other digital media). These complex cases require an ever-increasing amount of time and resources. This multidisciplinary approach has proven to be a key link in the investigation and evaluation of child fatalities, which ultimately leads to meaningful prevention strategies. Background Screening and Investigation Unit The Background Screening and Investigation Unit (BSIU) conduct checks through the Child Abuse and Neglect (CA/N) systems in the CD. These checks are on current or prospective employees/volunteers who have responsibility for child care/supervision. The purpose of the unit is to provide information to a prospective employee so that the employer/volunteer agency can assess if the person is appropriate to be caring for children. BSIU staff is also responsible for processing applicant cards and communicating the responses from the Missouri State Highway Patrol and the FBI back to the appropriate offices. During 2005, BSIU processed 139,744 screenings. After the CFSR, policy was enhanced on background screening for foster/kinship and court ordered providers and incorporated into on- going training for staff and foster parents. 12