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1 IIINTRODUCTIIION As of June 30, 2004, 10,738 children were in Maryland’s out- of- home placement system, 490 fewer than we reported last year, a 4.4% decrease. SSStttaaatttuuusss ooofff ttthhheee CChhhiiilllddd Weeelllfffaaarrreee SSSyyysssttteeem iiinnn 222000000444 ♦ The federal Child and Family Services Review ( CFSR) – an audit that encompasses best practices and in- depth assessment of outcomes for children – was conducted through field activities of a federal- State team in the fall of 2003. The federal government issued its report on June 8, 2004. In FY 2004, the Department of Human Resources ( DHR) and the Social Services Administration ( SSA) asked key stakeholders to collaborate on creating a Program Improvement Plan ( PIP), which will be submitted to the federal government as the primary response to the results of the CFSR. As the development of the PIP proceeded, SSA became more and more guarded. The PIP was submitted to the federal government on September 9, 2004, but at this writing, citizens have not seen the final version. ♦ The State continues to project an overall structural budget deficit, although the size of the deficit seems to be getting smaller. Child welfare services to families and children have been reduced, but total DHR child welfare spending rose to $ 444 million ( 3.2%) in 2004 because more was spent on high- cost forms of care for about 3,000 children. ♦ The State continued to struggle with a child welfare workforce that is very substantially below the strength needed to protect children, implement permanency plans, and promote the well- being of children for whom the State is responsible. The General Assembly required that DHR fill a number of vacant positions or undergo financial sanctions. ♦ The Child Welfare Accountability Task Force established by the Department of Budget and Management issued its mandated report to the General Assembly. ♦ Fewer children are entering care, and a smaller proportion of those are associated with parental substance abuse; length of stay seems to be moderating. GOALS OF CRBC’S 2004 ANNUAL REPORT FOR OUT- OF- HOME PLACEMENT ♦ To review strengths and development needs of the out- of- home placement system and provide recommendations to promote achieving CRBC’s priority goals. ( See pages 2- 4.) ♦ To provide a profile of Maryland’s children in out- of- home placement during FY 2003. Data are obtained from CRBC’s database and from DHR’s Foster and Adoptive Child Tracking System ( FACTS). ( See pages 5- 11.) ♦ To analyze the results of the federal Child and Family Services Review. ( See pages 12- 13.) ♦ To analyze the Report of the Child Welfare Accountability Task Force. ( See page 14- 17.) ♦ To report on the results of case reviews conducted by local boards during fiscal year 2004. ( See pages 18- 21.) 2 PRIIIORIIITY IIISSUES AND RECOMMENDATIIIONS CRBC’S ADVOCACY PRIORITIES FOR FISCAL YEAR 2005 The Children’s Legislative Action Committee ( CLAC) is comprised of CRBC volunteers who advocate for statewide improvement in child welfare policies and legislation. Analysis of data and members’ case review experience are tools CLAC uses to in developing priorities on which to focus its annual advocacy activities. The three priority areas for 2005 are: ♦ Improve Accountability for Child Welfare Services As a result of advocacy by CRBC and the Coalition to Protect Maryland’s Children, and with the leadership of Delegate Samuel I. Rosenberg, the General Assembly requested that the Department of Budget and Management ( DBM) create a Child Welfare Accountability Task Force to study DHR’s child welfare accountability system and charged the Task Force with developing recommendations in five specific areas: 1. A method to determine reported and unreported child abuse and neglect; 2. Performance measures and qualitative assessment tools for individual cases; 3. Best practices for delivering child welfare services; 4. Measures of child and family outcomes, and; 5. An analysis of how the State might maximize federal revenues. The Task Force completed its report in early December 2004, and made 16 recommendations. ( In- depth discussion can be found on pages 14- 17.) Recommendation: ♦ The State should implement the recommendations of the Task Force. In doing so, the State should assure the continuation of an independent case review component in the accountability system. ( See discussion on page 17.) ♦ Continue to implement the Child Welfare Workforce Initiative of 1998 ( HB 1133) During the 2004 session of the General Assembly, DHR reported that it had 1,814 caseworkers and supervisors actively deployed in late 2003 and needed 204 more to meet standards adopted by the Legislature. In acting on the FY 2005 budget, the General Assembly has required that 1,891 positions be filled or that DHR forfeit up to $ 3.5 million in State general funds. As of the first deadline ( October 1, 2004), DHR reported that it intends to meet the goal, but needed 138 more staff, citing recruitment difficulties and a late start in gearing up to increase hiring. DHR has agreed to provide clear figures to all interested persons regarding how many child welfare staff are deployed and how many are needed to meet the caseloads standards established by the Child Welfare League of America. DHR has accepted CRBC’s recommendation that caseload standards will incorporate cases of children in after care, which previously had been omitted from the caseload in calculating how many positions are needed. We are also pleased to report that the counties with the most serious workforce shortages ( on a percentage basis) did get substantial relief since we issued our 2003 report, which highlighted that issue. After the enactment of the Child Welfare Workforce Initiative of 1998, DHR developed a methodology for determining how many caseworkers and supervisors would need to be hired to meet standards established by the Child Welfare League of America. For each of the following service categories, the staff requirement is calculated by dividing the caseload by the caseload ratio standard established by the League: 1 ( See Exhibit I) In addition, it is assumed that one supervisor is needed for every five caseworkers. 1 For example, in 2001, there were 876 family preservation cases and the CWLA ratio is 1: 6. Therefore, 146 caseworkers were needed. 3 Exhibit I Caseload Ratios by Type of Service – DHR Formula Type of Service CWLA Ratio Standard Intensive Family Preservation 1: 6 Child Protective Services Investigations 1: 12 Child Protective Services Continuing 1: 17 Child Protective Services Screening Special DHR formula Foster/ Kinship Care 1: 15 Adoption ( Child’s Case) 1: 16 Adoption ( Prospective Adoptive Family) 1: 30 Services to Families with Children 1: 15 Then, the total number of staff to be added is determined by subtracting the number of incumbents from the total need. For some of the calculations, counties with excess staff were held harmless. Foster parent support services are excluded from the formula. This practice carries negative consequences for the children and for the State. Maryland lost about 1,200 foster homes ( more than 25%) between October 2000 and April 2004. If foster parents lack support, it may be more likely that a difficult child will have to be re- placed. The State is experiencing a costly shift of children into more restrictive and more expensive forms of care. ( For more on the increasing cost of care, see http:// www. dhr. state. md. us/ crbc/ annual/ 2003ohp. html, pages 14- 16 of our 2003 Annual Report.) Increasing foster parent support could be a viable strategy for reducing costs and for placing children in the most family- like settings. The formulas for family preservation, continuing child protective services, and continuing services to families with children cases do not accurately indicate the true need for those service categories because the dramatic decline in staffing levels that occurred between October 2001 and July 2004 has artificially reduced the number of cases. As local departments experienced an increasing number of vacancies, caseworkers are shifted to child protective services investigations and foster care. The other categories are left without staff and fewer such cases are opened. Since the formula that calculates the need for caseworkers is totally dependent on the number of active cases, the hiring slowdown became a self- fulfilling prophecy that now falsely signals a need for fewer workers. During this period, the number of child protection investigations fell by about 4%, but family preservation fell by 33%, services to families with children by 41%, and continuing child protection by 14%. If these categories had stayed level, the formulas would show a need for 99 additional caseworkers and 20 additional supervisors. In addition, several hundred positions occupied by non- professional support staff – clerks, secretaries, transportation aides, casework aides – have been lost since October 2001. The current approach of tying caseload allocations to the number of active cases ( to the exclusion of all other factors) gives local departments an incentive to pad the caseload. This becomes a problem in times when the budget is in surplus. Measures of a jurisdiction’s need for child welfare services could be included in the formula. For example, Oregon incorporates into their allocation formula factors such as the frequency and relative severity of abuse/ neglect allegations phoned into the various counties and their respective return home rates. ( See http:// www. cwp. pdx. edu/ html/ pgAllocation. shtml.) Finally, CRBC recognizes that a substantial upgrade in staff training is also needed to fully respond to the Workforce Initiative, performance issues raised by the CFSR, and the recommendations of the Child Welfare Accountability Task Force. 4 R Re eec cco oommmme eennndddaaatttiiiooonnnsss::: ♦ ♦ TTThhheee SSStttaaattteee BBuuudddgggeeettt ssshhhooouuulllddd iiinnncccllluuudddeee aaa nnnuuumbbbeeerrr ooofff cccaaassseeewooorrrkkkeeerrrsss aaannnddd sssuuupppeeerrrvvviiisssooorrrsss ttthhhaaattt wiiillllll eeennnsssuuurrreee meeeeeetttiiinnnggg ttthhheee cccaaassseeellloooaaaddd ssstttaaannndddaaarrrdddsss eeessstttaaabbbllliiissshhheeeddd bbbyyy ttthhheee CCChhhiiilllddd Weeelllfffaaarrreee LLLeeeaaaggguuueee ooofff AAAmeeerrriiicccaaa... 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IIInnn ttthhheee lllooonnnggg ttteeerrrm,,, DDDHHRRR ssshhhooouuulllddd eeessstttaaabbbllliiissshhh aaa ccchhhiiilllddd weeelllfffaaarrreee tttrrraaaiiinnniiinnnggg aaacccaaadddeeemyyy aaasss rrreeecccooommeeennndddeeeddd bbbyyy ttthhheee CCChhhiiilllddd Weeelllfffaaarrreee AAAccccccooouuunnntttaaabbbiiillliiitttyyy TTTaaassskkk FFFooorrrccceee ((( ssseeeeee bbbeeelllooow)))... ♦ Report, Investigate, and Prosecute Child Abuse and Neglect, Assist Families and Protect Victims. 1) Results of case reviews by Maryland’s local child protection panels indicate a need to improve thoroughness of investigations and risk and safety assessments. Both the panels and federal auditors found that too few families get appropriate services following a finding of maltreatment. National data shows that Maryland provides services to only 15% of victims, the nation’s lowest rate. The State is missing opportunities to identify families and children sooner and to intervene more effectively and more cost- effectively. In addition, all children in State custody through a local department of social services or the Department of Juvenile Services should be protected from abuse and neglect. Additional information is available in our 2003 Child Protection Report at http:// www. dhr. state. md. us/ crbc/ pdf/ child03. pdf. RReeecccooommeeennndddaaatttiiiooonnnsss::: ♦ DHR, in collaboration with key partners in the health, education, law enforcement, and legal communities, should define new standards for: 1) what constitutes a thorough investigation of maltreatment allegations; 2) protection of children who are found to be abused and neglected; and 3) protection of children in State custody. ♦ In order to protect vulnerable children and build families’ capacity to meet their children’s needs, DHR – in partnership with the Department of Budget and Management and the Governor’s Office for Children, Youth, and Families – must find a way to increase family support and family preservation services. 5 MMAARRYYLLAANNDD’’’ S OUT--- OF--- HOME PLACEMENT POPULATIIION EEENTTTRRIIIEEESSS IIINTTTO OUTTT--- OFFF--- HOMEEE PPPLLLACCEEEMEEENTTT FFFORR FFFY 222000000333 AND FFFY 222000000444 CRBC defines an entry into out- of- home placement as the beginning of any episode including when the child remained in care for one day. 2 Exhibits II and III show the changes and trends of the out- of- home placement entries. The overall number of entries was up 1%. Exhibit II shows that the number of children with special needs seems to have risen significantly. This could be related to the implementation of new policies, including relaxed terms for voluntary placement, regarding children who enter care because of their own needs for treatment for mental health or developmental delay rather than because of maltreatment. ( See, however, Exhibit III, below, for contradictory evidence.) Exhibit II Characteristics of Children Entering Placement, FY 2003 and 20043 Characteristics 2003 2004 Relative Rate of Change # of entries 3838 3876 + 1% % Male 49% 50% + 2% % Female 51% 50% - 2% % African- American 64% 64% 0% % White 29% 28% - 3% % Hispanic 2% 2% 0% % under 5 years of age ( at placement) 38% 38% 0% % between 5- 11 years of age 30% 29% - 3% % between 12- 18 years of age 32% 33% + 3% % of children in sibling group 43% 41% - 4% % with parental substance abuse as case factor 54% 51% 4 - 6% Children with special needs5 47% 50% + 6% % addiction/ dependency 13% 12% - 8% % emotional problems 19% 24% + 26% % mental retardation 2% 3% + 50% % developmental disabilities 3% 4% + 33% % learning disabilities 2% 3% + 50% % medically fragile 13% 11% - 15% 2 SSA does not include one- day episodes or disrupted aftercare in its count of entries. This will result CRBC having a higher number of entries and re- entries than SSA. Our definition is based on the child’s view of disruptions in living situation. 3 In this and similar Exhibits, categories may not add to 100% due to rounding error, and percentage increases are approximations. 4 For children entering in FY04 under the age of five, parental substance abuse factors apply to 64% of cases that factors; for children under two – substance abuse factors are 71% of cases with factors. 5 The �� Children with special needs” category is the percentage of children entering placement who had a documented special need, considered only those where the special needs data was completed. 6 Exhibit III Primary Reasons Children Entered Care during FY 03 & FY 04 5856 1717 8 9 7 6 5 5 0 1 5 6 10 20 30 40 50 60 Percentage N A AB PI CN Other Blank FY03 FY04 Abbreviations N – neglect A – abuse, including physical & sexual abuse AB – abandonment PI – parental illness CN – child’s special needs, including behavior problems Other – includes death or Incar- Creation of parent or caregiver Source: CRBC/ CIS Statewide, neglect is overwhelmingly the primary reason children enter out- of- home placement. No increase is discernible in the proportion of entries due to “ child’s special needs.” It is possible that an increase in children entering due to mental health or developmental problems is masked here because of confusion over how to register the primary reason for that type of situation. DHR should report on how many children entered under the reforms. LLLeeennngggttthhh Offf SSStttaaayyy iiinnn Ouuuttt--- ooofff--- Hooomeee PPPlllaaaccceeemeeennnttt fffooorrr FFFY 000333 aaannnddd FFFY 000444 CRBC uses three methods to evaluate length of stay in out- of- home placement. Actual Average Length of Stay ( AALS) - Measures how long children who left placement during a specified period had been in out- of- home placement. This method does not consider children who are currently in care and may have been in care for a long period. It can provide an overly optimistic perspective if a large percentage of children exiting in a given year have had short- term stays in out- of- home placement. The actual average length of stay for both FY 03 and FY 04 was 29 months. Projected Average Length of Stay ( PALS) - Equals the average daily population during the reporting period divided by the number of exits during the reporting period. PALS is the only measurement that accounts for the experience all children who were in out- of- home placement for the reporting period and is less affected by children who remain in out- of- home placement for 6 months or less ( generally 1/ 3 of the population will have short stays). In FY 03 PALS was 34 months and it dropped to 32 months for FY 04. The narrowing of the gap between AALS and PALS indicates that the system is not experiencing major changes in case flow dynamics as it was throughout the 1990s. In a totally stable system, AALS and PALS would be the same. ( See pages 10- 11 for further discussion of this issue.) Cohort Analysis – A group of children who entered care during an interval are followed to see what percentage leave by specified intervals. The length of time that a child has spent in care has an impact on the child’s prospects for permanent placement. Exhibit IV shows that a child’s chances of leaving out- of- home placement drastically decline after the first year in care. Exhibit IV measures exit and not necessarily permanent placement. It shows that for children who entered placement in 2003 a higher percentage left placement ( by the specified time intervals) than those who entered in 1999 but not as high a percentage as for the 2001 cohort. ( 2003 data are used because 2004 data are too preliminary to show trends as of this writing.) This result suggests that length of stay will be leveling off rather than continuing to decline. 7 Exhibit IV Percentage of Children Remaining in OOHP After Specified Intervals6 0% 20% 40% 60% 80% 100% fy99 fy01 fy03 fy99 100% 56% 40% 29% fy01 100% 51% 34% 23% fy03 100% 53% 38% 27% Initial Placement Placement beyond 1 year Placement beyond 2 years Placement beyond 3 years EEEXXXIIITTT FFFRROM OUUTTT--- OFFF--- HHOMEEE PPPLLLAACCCEEEMEEENNTTT During FY 04, 4138 children exited placement; 4185 exited during FY 03. Analysis of exit reasons relies on case closing data, which are slightly different from exit data. Exit occurs when a child returns home while case closing may not occur until a period of aftercare is completed. Source: CRBC/ CIS For several years, there has been a declining proportion of case closings for the desirable reasons of returned home, relative placement, and adoption. The percentage of children leaving care by reason of independence/ age had been rising. FY 04 reverses that trend – it dropped from 14% to 13%. Since reports of adoption lag for months, it is likely that the proportion shown as adoption will rise when more complete data are available. Case Closing reason “ 99” is listed on FACTS as “ Other.” Since, the interpretation of that code is ambiguous, it is good to see that figure dropping. Overall then, there is a modest trend towards better 6Data for children entering in FY 2003 for “ Placement beyond 2 years” are projected from incomplete results; for “ beyond 3 years” are estimated from prior years’ experience. Exhibit V Case Closing Reasons for Children Leaving Out- of- Home Care 38 15 18 14 5 11 38 16 18 13 6 9 20 40 60 80 RH RP A I Other Blank/ 99 percentage 2003 2004 Figure 1 Abbreviations RH – returned home RP – relative placement with le custody to the relative A – adoption I – independence/ age Other – unrelated guardian, ca transfer, not appropriate f care, runaway, child died court- ordered return hom against DSS advice 99 – Other 8 length- of- stay, and permanency- planning outcomes, but the extent of the problem is enormous. Further discussion of the length- of- stay issue can be found below. Adoption Process Maryland is not meeting the federal standard of completing a high proportion of adoptions within two years. More importantly, children are losing their opportunities to have permanent homes. CRBC believes that the causes of this unfortunate phenomenon include 1) general problems with permanency planning that are discussed in the section on the Child and Family services Review; 2) rising caseloads; and 3) specific reductions in programs and contracts that are intended to recruit, screen, train, and approve adoptive families. Exhibit VI Average Number of Months to Complete Adoption Process for FY 04 Exits7 Process Baltimore City Baltimore County Montgomery County Prince George’s County Other Counties 2003 2004 2003 2004 2003 2004 Establish plan of adoption 39 36 20 23 14 18 File TPR8 6 5 5 3 5 5 Obtain TPR 16 14 15 11 11 14 Final Adoption 64 66 47 43 38 39 Source: CRBC Data on children who exited out- of- home placement through adoption show the larger the jurisdiction the longer the process to final adoption. Note that in 2004, times to file and obtain TPR dropped in Baltimore City and the larger counties. Time to establish the plan fell in Baltimore City and generally rose in the counties. Still, Baltimore City took three years to establish a plan of adoption, much longer than other jurisdictions. Delays in the adoption process lead to serious consequences. Only about 40% of the children who have a permanency plan of adoption ever get adopted. Once the plan has been adoption, return home or relative placement is extremely unlikely; therefore, adoption delays often mean children grow up in care. The number of adoptions dropped in 2003. It appears to have risen modestly in 2004 to 746, but not enough to reach the 2002 level, when 935 adoptions occurred ( more than 21% of the cases closed). SSA’s goal for finalizing adoptions in FY 2004 was 950. RReee--- EEEnnntttrrriiieeesss IIInnntttooo Ouuuttt--- Offf--- Hooomeee PPPlllaaaccceeemeeennnttt Exhibit VII Percent of Children who Re- enter Out- of- Home Placement Within One Year of Leaving 9.5 10 10.5 11 11.5 12 FY00 FY01 FY02 FY03 FY04 Rate 7 The entries in months first three rows ( establish plan, file TPR, obtain TPR) apply only to the indicated step. The bottom row ( final adoption) is cumulative from entry to adoption. ( This is not the sum of the previous steps for a variety of technical reasons.) 8This data field includes only children within the CRBC review population. 9 Slightly more than a quarter ( 26%) of children entering placement had prior episodes of out- of-home care. CRBC tracks the percentage of children who re- enter placement within one year of leaving placement in order to give a perspective on the appropriateness of permanent placements and the effectiveness of after- care services. Exhibit VII shows a fluctuating rate of re- entry with the latest results showing a substantially lower re- entry rate. A rise in the re- entry rate is often associated with an increase in the percentage of children with shorter lengths of stay; however, the most recent results break this pattern. ( See Exhibit III.) Considering the critical nature of re- entry in children’s lives, we recommend that DHR investigate the factors that cause this fluctuation. In all the years we have been tracking indicators such as these, however, there has not been exhaustive investigation of causes and effects. This highlights the need to implement Task Force Recommendation 5, which proposes a partnership with a research institution that would generate and analyze statistics. ( See page 14.) Maaarrryyylllaaannnddd’’’ sss TTToootttaaalll Ouuuttt--- ooofff--- Hooomeee PPPlllaaaccceeemeeennnttt PPPooopppuuulllaaatttiiiooonnn Exhibit VIII Profile of Maryland’s Out- of- Home Population for Fiscal Years 2003 & 2004 Characteristics 2003 2004 Rel. Rate of Change # of children 11228 10738 - 4% % Male 52% 52% 0% % Female 48% 48% 0% % African- American 76% 76% 0% % White 21% 20% - 5% % Hispanic 1% 1% 0% % under 5 years of age ( at placement) 38% 37% - 3% % between 5- 11 years of age 39% 39% 0% % between 12- 18 years of age 23% 24% 4% % under 5 years of age ( end of FY) 18% 18% 0% % between 5- 11 years of age 29% 27% - 7% % between 12- 18 years of age 41% 42% 2% % over 18 years of age 12% 12% 0% % of children in sibling group 65% 66% + 2% % with par. substance abuse as case factor 65% 63% 3% Children with special needs % addiction/ dependency 8% 8% 0% % emotional problems 25% 27% 8% % mental retardation 4% 5% 25% % developmental disabilities 4% 4% 0% % learning disabilities 4% 4% 0% % medically fragile 9% 9% 0% Percentages may not add to 100 due to rounding error or incomplete information. Data on all children in out- of- home placement on the last day of the fiscal year ( June 30th) for 2003 and 2004 are shown in Exhibit VIII. It suggests: • The overall trend towards a smaller population since 1997 continues. • There is modest movement towards a population of teenagers. 10 • The trend toward a higher percentage with special needs, which showed up in Exhibit? regarding children entering care also appears here. CCCASSSEEE FFFLLLOW BBBY JJJURRRIIISSSDIIICCCTTTIIION Exhibit IX CASE FLOW STATISTICS FOR JULY 1, 2003 – JUNE 30, 2004 Jurisdiction # of Cases in Care on July 1, 2003 # of Cases Entered Placement During FY 04 # of Cases Left Placement During FY 04 # of Cases in Care on June 30, 2004 Projected Average Length of Stay ( months) Actual Average Length of Stay ( months) Allegany 97 68 66 99 18 17 Anne Arundel 227 122 97 252 30 23 Baltimore County 642 424 393 673 20 20 Calvert 51 34 22 63 31 22 Caroline 30 18 17 31 22 17 Carroll 57 21 29 49 22 19 Cecil 65 42 41 66 19 19 Charles 122 27 22 127 68 30 Dorchester 32 14 19 27 19 22 Frederick 238 133 151 220 18 17 Garrett 50 23 30 43 19 22 Harford 229 123 139 213 19 22 Howard 111 55 49 117 28 23 Kent 15 6 6 15 30 24 Montgomery 510 244 251 503 24 28 Prince George’s 757 201 290 668 29 33 Queen Anne’s 17 11 9 19 24 19 St. Mary’s 81 26 30 77 32 26 Somerset 47 36 21 62 31 29 Talbot 37 16 19 34 22 27 Washington 218 166 134 250 21 17 Wicomico 143 72 75 140 23 22 Worcester 47 27 27 47 21 19 Baltimore City 7,173 1,971 2,201 6,943 38 34 Statewide 10,996 3,880 4,138 10,738 32 29 This year, the projected average length of stay ( PALS) and the actual average length of stay ( AALS) are only three months apart. When we started displaying data in this format in our 1999 report, the figures were 13 months apart ( PALS equaled 37 months, AALS equaled 24 months). At that time, we wrote that if the system remained relatively stable, PALS and AALS would converge. This is now happening. Compared to 1999, for instance, a larger proportion of children who are leaving the system have been in care a relatively long time, which has driven 11 up the AALS figure. Since relatively few children left the system during 1999, PALS was high, and many of those children are now old enough to age out of the system in 2004. Jurisdictions differ vastly in regards to entries, exits, lengths of stay, and total population. Smaller jurisdictions often show a greater volatility in AALS and the PALS than the four largest jurisdictions ( Baltimore City, Baltimore County, Prince George’s County, and Montgomery County). Smaller jurisdictions are more affected than larger jurisdictions by factors such as a few children or a large sibling group that have very short or very long lengths of stay. Charles County, which had a severe shortage of staff during the fiscal year, had very few exits, and, thus, a long stay is projected. Frederick and Wicomico, which faced a similar challenge, however, show shorter- than- average lengths of stay. While PALS has fallen steadily over the past several years, we are, nonetheless, very concerned that children remain in care too long – 32 months for 2004, and for many years hovering around 36 months. This is entirely too long a portion of a child’s life to be uncertain about family ties and to be the subject of a bureaucratic system that can be a source of shame, even while it protects. The burden of long stays falls disproportionately on the 23% of children who enter placement and stay longer than three years ( see Exhibit IV). We estimate the average length of stay for these children at approximately a decade. We believe that implementing the recommendations offered in this report could significantly reduce the average length of stay. 12 ANALYSIIIS OF THE CHIIILD AND FAMIIILY SERVIIICES REVIIIEW SSuuummaaarrryyy ooofff FFFiiinnndddiiinnngggsss The Child and Family Services Review process is the federal government’s first- ever attempt to assess the quality of child welfare services. ( See http:// www. acf. hhs. gov/ programs/ cb/ cwrp/ for access to reports.) Maryland was the 47th State to go through the process. The federal government has developed 14 factors to consider in evaluating each State’s effectiveness: Type of Measure Domain Factor Outcome Safety 1. Children are protected from abuse and neglect Outcome Safety 2. Children safely maintained in their own homes Outcome Permanency 3. Children have permanency and stability of living arrangements Outcome Permanency 4. Children experience continuity of family relationships Outcome Well- Being 5. Families have enhanced capacity to care for children Outcome Well- Being 6. Children receive services to meet educational needs Outcome Well- Being 7. Children receive services to meet health needs Systemic Factor 8. Statewide Information System Systemic Factor 9. Training Systemic Factor 10. Service Array Systemic Factor 11. Agency Responsiveness to the Community Systemic Factor 12. Foster/ Adoptive Parent Licensing, Recruitment, Retention Systemic Factor 13. Agency Responsiveness to the Community Systemic Factor 14. Foster/ Adoptive Parent Licensing, Recruitment, Retention There is an elaborate methodology of assembling statistics, case data, and opinions to perform this complex assessment. Information is gathered at the State level and in three selected jurisdictions ( which must include the jurisdiction with the highest number of child welfare cases). The full audit process consists of the following steps: • State self- assessment – The State submits a set of standard statistics on the outcomes and is asked to describe its effectiveness on the systemic factors. • In- depth case reviews – A team of federal and state reviewers audits 50 cases on a total of 23 items for 7 outcomes related to permanency, safety, and well- being. The audit includes interviews with parents, children, foster parents, caseworkers, and other participants. Federal team leaders perform quality control. • Stakeholder interviews – The State- level team interviews State- level officials such as DHR executives and managers, members of the Foster Care Court Improvement Committee, members of the CRBC State Board, care providers, and many others. Also, at each of the three local sites, teams interview key stakeholders. • Determination of substantial conformity – After the State- federal team gathers all the information and rates cases, a determination is made for each of the 7 system components and each of the 7 outcomes based on statewide statistics, information in the self-assessment, case reviews, and stakeholder interviews. ( See http:// www. acf. hhs. gov/ programs/ cb/ cwrp/.) Maryland’s 100- page self- assessment was filed in September 2003. The outgoing Glendening Administration had hired a contractor to prepare it, and the new administration did not have time to review it thoroughly. The State Board found it to be of little use. It suppressed both strengths and weaknesses, and relied too much on long descriptions of policy and procedure. Although there was a limited process for stakeholder input, the assessment did not represent a broad-based consensus about the effectiveness of the child welfare system. 13 The federal review team arrived in November 2003 to conduct the case reviews and stakeholder interviews. CRBC and many other stakeholders were fully involved, and there was a consensus in the child welfare community that the audit process was rigorous, thorough, and fair. For the major outcomes, a State must score 90% to be rated in substantial conformity ( SC); otherwise the rating is, area needing improvement ( ANI). Out of 14 elements – 7 outcomes and 7 systemic factors – Maryland received SC on 3 and ANI on 11. The Program Improvement Plan must address the 11 ANI areas. Maryland’s results are unsatisfactory. The federal government sets very high standards. No state was rated SC on more than two outcome areas. Maryland was among 24 states that had zero SC ratings in the outcome area and among 13 states that had 3 or fewer SC ratings among the systemic factors. Only six other states and Puerto Rico had as few as 3 SC ratings overall. The worst outcome area for Maryland was, “ children have permanency and stability of living arrangements.” The score was 26.7%, compared to the standard of 90%. ( For a more detailed picture, consult Appendix I, in which CRBC staff summarizes the findings and indicates areas that were particularly strong or in need of improvement.) The federal evaluators found that: ♦ The permanency goal was continuously in the child’s best interests during the audit period in only 34% of cases. ♦ Court practice – especially, ordering futile plan of reunification - was identified as a key barrier. The score for implementing reunification plans was 38%. ♦ The waiver of reunification is underutilized – thus reinforcing a key CRBC finding. ♦ Plans of long- term foster care are used excessively, even for young children. This is an area where CRBC may need to be more vigilant. ♦ Parents are not receiving adequate reunification services. ♦ Effort toward adoption is insufficient, including delays in termination of parental rights; failure to use mediation, a known best practice; and inconsistent use of dual licensure. 9 The score for implementing adoption was 42%. PPPeeerrrfffooorrrmaaannnccceee IIImppprrrooovvveeemeeennnttt PPlllaaannn Maryland now must improve its performance or eventually face up to $ 1.5 million per year in federal penalties. In September, Maryland completed the first step in this process, which is to file a Program Improvement Plan, addressing the 11 areas that are ANI. Earlier, Social Services Administration officials had stated that the PIP would be a vehicle for far- reaching system reform. During the process, however, it became evident that the purpose was redefined as compliance with federal standards and that the PIP would promise minimal improvement. Although many stakeholders participated in developing suggestions for the PIP at the outset, there were firm limits on participation. To cite a key example, stakeholders were not included in the process of setting numerical goals for improvement. Maryland’s PIP will have to include a target for making progress toward the federal standard of 90% on each outcome element. In the area of permanence, the current score of 26.7% requires several quantum leaps in performance. Stakeholders were not involved in a discussion of whether that target should be 80% or 40%. The final product was completed in secrecy, and the draft that was submitted to the federal government has not been released as of this writing in December 2004. Secretary McCabe has begun a process of creating a more ambitious reform agenda entitled “ Putting Children First.” We expect that stakeholders will play an active role in that effort and that DHR will clarify the relationships between that reform effort, the PIP, the required federal Child and Family Services Plan, and the SSA strategic plan. 9 Dual licensure allows foster parents to adopt without a further home study. Although this has been announced practice in Maryland for nearly a decade, implementation has been disappointing. 14 REPORT OF CHIIILD WELFARE ACCOUNTABIIILIIITY TASK FORCE RRREEECCCOMMEEENNDDDAAATTTIIIONNNSSS OFFF TTTHHEEE TTTAAASSSKKK FFFORRRCCCEEE Below is a list of the recommendations of the Task Force, taken verbatim from the Executive Summary of the Task Force’s report. 10 1. The Governor and General Assembly must make a long- term commitment to enhance and stable funding and support for abused and neglected children in order to create a culture of excellence in Maryland’s child welfare system. This cannot be accomplished without a commitment to those communities within our state that contribute the highest number of children to out- of- home care. 2. The Governor and the General Assembly must make a long- term and stable commitment to achieving Child Welfare League of America ( CWLA) caseload standards in order to assure that families get help and children are adequately protected. 3. The Department of Human Resources ( DHR) should convene a widely representative group of stakeholders to develop a new vision and a set of principles for the child welfare system by which workers, supervisors and administrators will operate, and upon which the system will be judged. 4. DHR should re- examine and clarify key central office roles and the relationship of the central office to the county offices. Issues such as contracting for services and the allocation of staff must be addressed. 5. DHR should implement the outcome measurement system outlined in Appendix B that expands on the federal outcome measures, and is used to measure performance at the State and local levels. A university- based data repository should be established for research purposes to which all state agencies substantively involved with children who have experienced maltreatment would contribute appropriate data. 6. The Governor and General Assembly must commit stable funding to implement a fully functional statewide child welfare information system ( CHESSIE) as quickly as possible. 7. DHR should develop a quality assurance system that includes an assessment of performance at the State level, and self- assessment at local levels. 8. The Governor and the General Assembly should ensure sufficient funding for the development of child welfare best practices in order to provide cutting edge services to children and families, and to more cost effectively use limited resources. 9. DHR, in collaboration with Maryland institutions of higher learning, should enhance training and develop a comprehensive Child Welfare Training Academy for child welfare workers, supervisors, managers, foster parents, and providers in order to ensure that staff and managers are equipped to provide the highest quality services to children and families. This new Training academy should build on the existing training programs in Maryland. 10. DHR and the Department of Budget and Management ( DBM) should revise the accounting structure and workload measures used by the Social Services Administration and the local 10 The full report can be found online at http:// progressivemaryland. org/ files/ public/ documents/ archive/ 2004/ TaskForceReport2004[ 2]. 12.1. pdf 15 offices to allow a clear and comprehensible understanding of how funds are spent and to permit more flexibility in spending to meet families’ needs while reducing reliance on high-cost placements. 11. DHR and the Citizens’ Review Board for Children should implement the Quality Service Review Protocols as a means of measuring the quality of case level activities. 12. DHR should adapt California’s county self- assessment process as a means of monitoring the quality of services provided at the local level. 13. An independent researcher should replicate the National Incidence Study every six years to understand the actual incidence of child maltreatment in the State, and its relationship to reports of child maltreatment and investigations of child maltreatment and program performance. 14. DHR should aggressively pursue national accreditation for each local office and the State Agency. The State should negotiate the cost of accreditation for the remaining jurisdictions with the Council on Accreditation to make the process more affordable. 15. Maryland should contract for a review of federal funding maximization issues specific to Title IV- E, and the Department of Budget and Management ( DBM) should assure that any new revenues obtained are kept within the appropriate agency to improve services to children and families. 16. Interagency coordination should be improved in order to improve outcomes for Maryland’s most vulnerable children and families. The Governor’s Office of Children, Youth and Families ( GOCYF), DHR, the Social Services Administration ( SSA), the Department of Juvenile Services ( DJS), the Department of Health and Mental Hygiene ( DHMH) the Courts, and the Maryland State Department of Education ( MSSDE) should clarify their respective roles with regard to the implementation of the recommendations contained in this report. The Task Force evolved from a CRBC recommendation that was highlighted in our out- of- home placement Annual Report for FY 2002 ( http:// www. dhr. state. md. us/ crbc/ pdf/ annrpt02. pdf, pages 4 and 20). With action by the Coalition to Protect Maryland’s Children, Delegate Samuel I. Rosenberg, the General Assembly, and, finally, the Task Force itself, the subject matter was greatly expanded compared to our original recommendation. Kathleen Feely, a nationally recognized child welfare consultant with the Annie E. Casey Foundation, chaired the Task Force. In addition, the Foundation provided significant staff and funding support and brought in experts from across the nation. Much credit also goes to the Department of Budget and Management as well as to DHR for supporting a diverse membership and investing considerable time, effort, and expertise in the process. We endorse all the recommendations, many of which we have been advancing ourselves for years. The first two recommendations regarding enhanced and stable funding, the third regarding a vision for fundamental reform, and the eighth on implementing best practices dovetail with our 2003 report, which focused on the fact that spending on high- cost placements is displacing spending on child and family services. This trend bodes ill for children and for taxpayers. Exhibit X shows how the trend continued in FY 2004. This spending pattern portends a forbidding prospect of rising costs and worse results for children and families. The direct service categories ( first three lines) declined by $ 7.5 million, while the costs of out- of- home payments rose $ 18.1 million. We are jeopardizing the State’s ability to investigate abuse and 16 neglect thoroughly, help families care for their children so that removal can be avoided, and place children in foster homes. Placing children in the most family- like setting is a fundamental, time- tested principle of child protection. ( The decline in foster family placements is also mentioned on page 3 in the discussion of workforce issues.) Maryland has declining resources to recruit, screen, and train foster families; provide foster families with casework help; or assist foster families pay for day care or respite care. Consequently, local departments of social services may be forced to place children in homes that are not well suited to their needs, thus increasing the chances of a placement disruption. Every placement disruption risks the emotional health of the child and subjects the taxpayers to liability for escalating cost. Treatment foster care and groups homes cost between $ 36,000 and $ 90,000 per child per year. Exhibit X Cost Components of Child Welfare Services ( dollar amounts in millions) Type of Cost FY 2003 Amount FY 2003 Percent FY 2004 Amount FY 2004 Percent Percent Change Prevention & support services $ 118.7 27.5% $ 114.2 25.7% - 3.8% Out- of- home services $ 52.2 12.1% $ 49.6 11.2% - 5.0% Adoption services $ 6.8 1.6% $ 6.4 1.4% - 5.9% Out- of- home payments Foster Family Care, including Treatment FC11 Group Home & Residential Treatment Other12 $ 200.4 $ 73.0 $ 125.7 $ 1.7 46.5% 16.9% 29.2% 0.4% $ 218.5 $ 80.3 $ 138.2 $ 0.0 49.1% 18.1% 31.1% 0.0% + 9.05% + 10.0% + 9.9% - 100.0% Adoption subsidy payments $ 41.0 9.5% $ 48.6 10.9% + 8.5% Administration/ management $ 11.9 2.8% $ 7.3 1.6% - 38.7% 13 Total $ 431.0 100.0% $ 444.6 100.0% + 3.2% Source: Social Services Administration, DHR Budget Management Division Recommendation 10 addresses the spending trends directly and calls for increased flexibility in budgeting. Currently, 60% of the entire budget is tied up in the payments accounts. Funds for services can be spent on payments but the reverse is not permitted. Spending flexibility is an integral part of the quality assurance recommendations, which are discussed below. Recommendation 9 embodies a major amplification of ideas we advanced in advocating for the Child Welfare Workforce Initiative of 1998. That legislation required training for caseworkers prior to their being assigned a caseload14 and annual in- service training. A training academy would be 75% federally funded. It would greatly enhance pre- service training so that new recruits have a firm base in policy and practice techniques and would allow management to tailor in- service training to information that comes from the local assessment process ( see recommendation 12, discussed below). Recommendations 5, 11, 12, and 13 are of particular interest to CRBC as they carry forward the agenda we developed when we brought the idea for accountability reform to Del. Rosenberg. The Task Force has adapted a set of accountability measures from a system in use in California. These parts of the Task Force’s agenda would be relatively low in cost. 11 Note that the number of children in regular family foster homes ( which cost an average of about $ 600 per month) is declining and the payment rate has not risen in a decade. Therefore the increase in this cost is due to treatment foster care. 12 This line accounts for a certain share of spending for managed care project that ended in 2003. 13 The huge drop in this line is caused by the end of the managed care project ($ 1.3 million) and a decline in workers’ compensation expenditures. SSA carries the workers comp costs for the local departments. 14 This is a concept that has been all but abandoned; the current “ pre- training” occurs sometime in the first few months of employment. 17 Recommendation 5, regarding outcomes measures, establishes the foundation for the others. It builds on the federal outcome categories ( seven outcome areas split into the three domains, safety, permanency, and well- being – see page 14), but recognizes that the federal statistical indicators are not rich enough to reflect the complexity of the child welfare system. The Task Force recognized that any single statistical indicator can be manipulated to suggest good performance without real substance. A suite of indicators gives a fuller and more accurate picture. Therefore, the Task Force recommended that a series of additional indicators be developed ( some immediately, and some when CHESSIE is implemented). Among the indicators is one that would implement a sampling procedure to determine whether children are still living in their permanent placement a year after the local department has closed their case. A second critical component of a new accountability system is embodied in Recommendation 11, which calls for in- depth case reviews, known as Quality Service Reviews ( QSR). These case reviews would track whether best practices were followed and would be closely tied to the outcomes established under Recommendation 5. In order to maintain the necessary objectivity in the case review process, the Task Force called for DHR and CRBC to implement the QSRs in partnership. Objectivity and independence from political or bureaucratic influence are critical parts of CRBC’s mission, and the Task Force recognized that these qualities are necessary to make an accountability system effective. The level of detail required under QSR protocols that have been implemented in other states exceed the requirements of CRBC’s current protocols; however, there are similarities with both the out- of- home placement reviews and the child protection reviews. The current quality assurance function within the Social Services Administration focuses primarily on casework procedures and case record documentation. Recommendations 7 and 12 would create a revamped quality assurance operation at the State level and a linked system of self- assessments at the county level. The self- assessments would be based on the outcomes ( Recommendation 5) and the QSR system ( Recommendations 11). In addition, the process incorporates many levels of client and stakeholder feedback. CRBC members would sit on the committee that performs the local assessment. Each jurisdiction would then create a program improvement plan to show how it would maintain good performance and improve weak performance. It will be critical that local agencies have the flexibility called for in Recommendation 10 in order to implement improvement plans. The Social Services Administration would establish standards for completing the local assessments and have authority to accept or reject assessments submitted. It would also perform a State- level self-assessment that incorporates the 24 local assessments and evaluates how well State- only functions such as resource allocation and policy- making are performed. The Citizens’ Review Board for Children has been advocating for needed improvements for many years, including many of those cited in the CFSR and by the Task Force. Recommendations 7, 11 and 12 create an important opportunity for us to forge a more productive working relationship with DHR and the local departments so that our own system improvement recommendations are more likely to be implemented. We are encouraged by Secretary McCabe’s invitation to meet with him regarding his vision for reform and to create a new partnership that is badly needed. We are willing to be flexible in adapting our program to meet the goals of the Task Force. In Recommendation 13, the Task Force calls for a scientific method of estimating the incidence of abuse and neglect in Maryland, using a model established by the federal government. Current estimates are based solely on the results of investigations performed by local departments. This process is inherently flawed because abuse and neglect reports are made only in a fraction of the actual cases. Having a scientific estimate of incidence would enable DHR to track over time whether it is effective in combating the scourge of child maltreatment. 18 THE CIIITIIIZENS’’’ REVIIIEW PROCESS ADMIIINIIISSSTTTRRRATTTIIIVEEE RREEEVIIIEEEWSSS Title IVB of the Social Security Act, section 422( b) ( 10)( ii), requires that children in out- of- home placement have an administrative review every six months. This may be achieved through a court review, a citizen review, or a panel review ( conducted by LDSS). Failure to document the review may result in a state receiving a financial penalty. As of June 30, 2004, timely administrative reviews were documented in CRBC’s computer for 81.9% of children in care compared to 80.3% for June 30, 2003. Although some children’s files lacked proper documentation, the federal reviewers found that Maryland was in compliance with requirements for periodic case review. CRBC’s review process was praised. CCCiiitttiiizzzeeennn RRReeevvviiieeew PPPrrroooccceeessssss ♦ Child welfare agencies must provide information to the boards, including the case plan and lists of interested persons who may be invited to a case review. ♦ Interested Persons including child's caseworker, parents, relatives, and foster families are invited to the review. They provide vital information and opinions regarding the child's current and proposed living arrangement. Educational and health providers, and the child if over age ten may be invited to the initial review and subsequent reviews when the case plan changes. Siblings are reviewed together to ensure continuity and coordination of services since there may be multiple caseworkers and services providers. ♦ After the discussion, the Board makes findings and recommendations related to the child's permanency plan, current living situation, and safety. ♦ The Board sends a summary of the findings and the recommendations to invited interested persons, the local department, and the juvenile court. Local departments are required to respond in writing to the recommendations and findings from the reviews. The juvenile court is required to consider the boards’ recommendations when conducting permanency planning review hearings. SSSeeelllfff--- EEExxxaaamiiinnnaaatttiiiooonnn One of the boards conducted multiple reviews of a family in which infants were murdered. ( The parents, one of whom was a runaway from foster care, are now charged with those murders.) The State Board convened a Special Committee with State and local board members and staff, which found both strengths and weaknesses in the local board’s findings. Certain systemic changes are being made in internal procedures so that boards can be better informed about policies and procedures and can more effectively pursue individual child advocacy following a case review. The State Board is working towards integrating several of these modifications with its joint work with DHR to implement the recommendations of the Child Welfare Accountability Task Force. In addition, the Special Committee observed that the case illustrated the need for multi- disciplinary consultation and casework continuity. The case involved a family with many siblings in care who were served by at least seven different DSS caseworkers over a period of 45 months. SSSuuummaaarrryyy ooofff FFFiiinnndddiiinnngggsss aaannnddd RRReeecccooommeeennndddaaatttiiiooonnnsss maaadddeee ddduuurrriiinnnggg ttthhheee CCiiitttiiizzzeeennn RReeevvviiieeew PPPrrroooccceeessssss The following findings represent the 6,094 citizen reviews that were conducted during FY 2004 ( a 13.8% decrease over FY 03) and not the status of all children in Maryland’s out- of- home system. In rare instances, a child may have a citizen review more than once in a year. 19 Exhibit XI Findings and Recommendations made during the Citizen Review Process Votes Taken during the Citizen Review Process FY 04 Results Waiver of reunification services is the denial of time- limited services to parents or guardians to assist in returning the children home. 15 The boards must decide if they agree with LDSS’ decision to pursue or not to pursue a waiver of reunification services against the mother, father, or both. Generally this finding is made at the first review. Federal reviewers cited Maryland for failing to use this legal tool to expedite permanent placement. Boards found 74 instances in which the waiver was not used and the Boards believed it should have been applied. Termination of parental rights results from court action terminating parents’ legal rights and responsibilities and awarding guardianship to LDSS or a child placement agency. Seventy- seven percent ( 77%) or 4,711 reviews reviewed qualified for consideration of TPR. In 45% of these instances, federal requirements for mandatory consideration of TPR were applicable. If the federal requirements are applicable, the boards may nevertheless find that there is a compelling reason not to pursue TPR such as the child is with relatives who do not want to adopt, parents are making progress, or the child is a teenager and does not want to be adopted. Boards made these recommendations: Don’t file for TPR 76% File TPR petition 15% Grant filed petition 9% Deny petition 0.1% A permanency plan specifies when and with whom the child shall live and the proposed legal relationship between the child and the caregiver( s). Two votes are taken regarding the permanency plan: • The concurrence rate is the percentage of times the reviewers agree with the permanency plan. • A vote for adequate progress indicates that the responsible agencies16 acted in a reasonable and timely fashion to promote permanent placement. See Exhibit XVI The Boards must consider the safety of the child while living in the out- of- home placement. This includes whether all applicable safety assessments and child protection protocols have been used, such as whether DSS has completed an inventory of people living in the home. The Boards must also consider whether there are indicators of risk that may include, but are not limited to, parental visits that may subject the child to risk, domestic violence, and/ or a household member with a history of violence, child abuse, or child neglect. They found risk indicators in 4% of the overall reviews. One or more safety protocols were not used in approximately 3% of the reviews. Of these, the Boards found indicators of risk in 65% of the cases. The board also makes a finding about placement as to whether the current living arrangement and any planned changes of placement short of permanent placement are appropriate for the child. Boards found inapprop-riate placements in 1% of reviews. 15 For the waiver of reunification services and termination of parental rights, votes may not be taken if 1) the child was 18 years of age or over, 2) the parents were dead, or 3) the parental rights had already been terminated. 16 Responsible agency includes LDSS, courts, private child placement agency, medical and educational systems. 20 Exhibit XII Summary of Permanency Plans by Concurrence Rates and Adequacy of Progress For Fiscal Years 2003 and 2004 July 1, 2002 – June 30, 2003 July 1, 2003 – June 30, 2004 # of Plans & % of Total Concurrence Rate Progress Adequate # of Plans & % of Total Concurrence Rate Progress PERMANENCY Adequate PLAN # % # % Return Home 2024 29% 82% 90% 1952 33% 82% 89% Relative Placement 1108 16% 90% 92% 1117 19% 90% 90% Adoption 1712 25% 99% 86% 1187 20% 98% 83% Independent Living 868 13% 99% 97% 680 12% 99% 95% Long- term Foster Care 1059 15% 96% 96% 823 14% 97% 94% Permanent Foster Care 165 2% 96% 96% 101 2% 98% 99% Guardianship 1 0% 100% 0% 3 0% 100% 100% Source: CRBC’s Information System. Compared to 2003, the boards found progress towards permanent placement to be inadequate more frequently for nearly every type of permanency plan. Return home had the lowest concurrence rate and the second lowest percentage of reviews in which progress was found adequate. Board members cited high caseloads as a major barrier to progress. Lack of housing was a barrier to reunification in over 50 instances. Lack of group or residential treatment placement facilities was a frequent barrier in the counties, especially the smaller ones, and was cited over 120 times. Exhibit XIII shows how many reviews were conducted in each jurisdiction, how many problems the boards found for each required type of finding, how many cases had at least one problem, and how the local departments responded to the recommendation reports. Overall, problems requiring corrective action were found in 1,676 of 6,094 reviews conducted, a rate of 28%, with a range from 7% to 42%. Regulations require local departments to respond in writing to reach report, indicating whether they accept the board’s recommendation. The statewide response rate of 56% is misleading because Baltimore City ( 37%) dramatically drags down the rate. ( Baltimore City is beginning to show rapid improvement in meeting this requirement as of this writing.) The counties responded at a rate of 73%. The local departments agreed with the boards’ recommendations 6.6 times as frequently as they disagreed. 21 Exhibit XIII Corrective Action Case Review Recommendations and Disposition by County Jurisdiction Waiver of Reunific’n TPR Permanency Goal Permanency Progress Safety Protocols Risk Indicated Placement Plan Corr Action Reviews Total Reviews DSS Return Rate DSS Agree/ Disagree Ratio Allegany 1 8 5 13 0 3 1 22 89 100% 6.3 : 1 Anne Arundel 5 21 31 7 13 18 2 57 164 96% 2.7 : 1 Baltimore 9 50 33 9 0 8 2 91 456 80% 5.5 : 1 Baltimore City 49 524 345 374 160 154 45 1,050 2,909 37% 8.1 : 1 Calvert 0 2 2 6 0 4 0 13 51 69% 8 : 1 Caroline 0 0 0 3 0 0 0 3 24 0% N/ A Carroll 0 8 4 14 1 4 2 25 60 100% 4 : 1 Cecil 0 7 2 4 0 4 0 14 59 93% 2.3 : 1 Charles 0 6 5 28 0 8 2 39 141 67% 26 : 0 Dorchester 0 1 0 0 0 2 0 3 41 100% 3 : 0 Frederick 0 19 36 19 0 10 1 49 175 93% 5 : 1 Garrett 3 2 4 13 0 6 1 17 46 100% 14 : 0 Harford 2 17 14 12 3 7 0 37 193 97% 3 : 1 Howard 0 5 6 8 1 4 0 20 86 100% 20 : 0 Kent 0 3 2 0 1 1 0 6 22 100% 4 : 0 Montgomery 2 11 32 14 8 9 3 67 418 94% 6 : 1 Pr. George’s 0 10 15 29 0 2 0 49 537 94% 20 : 1 Queen Anne’s 0 0 0 2 0 0 1 2 11 100% 2 : 0 Saint Mary’s 0 5 3 10 0 9 0 25 74 84% 1.1 : 1 Somerset 0 5 1 14 0 6 1 22 70 73% 16 : 0 Talbot 1 1 1 3 0 0 0 3 28 67% 2 : 0 Washington 1 12 7 12 0 7 1 31 227 84% 7.7 : 1 Wicomico 1 6 3 12 0 5 0 22 145 91% 20 : 0 Worcester 0 4 1 2 0 2 0 9 68 56% 5 : 0 State 74 727 552 608 160 273 62 1,676 6,094 56% 6.6 : 1 The most frequent areas problems identified were failure to file for termination of parental rights ( TPR) in a timely fashion, inadequate progress toward permanent placement, and an inappropriate permanency goal. Note that these problems may be caused by various agencies. The court establishes the permanency plan, although the local department may share responsibility if the plan is not appropriate. In 2004, 40% of the findings of inadequate progress were identified as being the responsibility of an agency other than the local department. The results of citizen reviews are quite consistent with the patterns highlighted by the Child and Family Services Review. Permanency issues regarding reunification, termination of parental rights, and adoption deserve a high priority. CRBC and the local departments are developing improved channels of communication to correct problems identified during case reviews. Baltimore City DSS administration has been responsive and is improving its relationship with its local review boards. The CFSR and the Task Force report offer Secretary McCabe an opportunity to take the initiative to create deep and fundamental reforms. We are pleased that he has reached out to us to forge a new partnership and trust that it will be one that fully responds to the crisis in Maryland’s child welfare system. 22 THE STATE BOARD Ted Kirk, Chairperson Representing Frederick and Montgomery Counties Nettie Anderson- Burrs, Vice- Chairperson Representing Allegany, Garrett, and Washington Counties LaDean Barksdale Representing Anne Arundel, Carroll, and Howard Counties Deidre Bosley Representing Baltimore and Harford Counties Carol Carson Representing Caroline, Cecil, Kent, Queen Anne’s and Talbot Counties Rev. Cameron Carter Representing Baltimore City Deborah Harburger Representing the Governor Dorethea Henry Representing Dorchester, Somerset, Wicomico, and Worcester Counties Mae Kastor Representing Baltimore City Sylvia Smith Representing Baltimore City James Trent Representing Calvert, Charles, Prince George’s, and Saint Mary’s Counties 23 APPENDIX I Summary of Findings of Child and Family Services Review Below is a summary prepared by CRBC staff pointing out highlights of the federal report on Maryland’s performance in the Child and Family Services Review. OUTCOMES Domain Item Score Safety Children are protected from abuse and neglect • Baltimore City met this outcome in 100% of 22 cases 87.2% ANI 1. Timeliness of investigations 88% Strength 2. Repeat maltreatment • Scarcity of services available for families • Practice of closing cases without addressing all maltreatment issues • Need to address substance abuse and domestic violence 87% ANI Safety Children safely maintained in their own homes • Maryland can be effective in addressing risk and providing services, but performance is inconsistent 81.3% ANI 3. Services to prevent removal • Lack of service provision to address identified needs after a comprehensive risk assessment and safety assessment • Lack of adequate post- reunification services in some counties 83% ANI 4. Risk of harm reduced • Ability of workers to assess risk or plan to reduce risk • Safety of children in group homes • Inexperience and youth of group home staff 84% ANI Permanency Children have permanency and stability of living arrangements 26.7% ANI 5. Foster care ( out- of- home placement) re- entry • Anne Arundel after care services praised • Parental substance abuse or mental health relapse • Lack of adequate post- reunification services in some counties 71% ANI 6. Stability of out- of- home placements • Relative placements are often stable • 18 of 29 children had one placement during review period and another 5 had 2 placements • Insufficient number of foster family and group home providers • Poor matching of children with placement resources, particularly for older children and teens • Too many children in some foster homes • Lack of training and services to support foster parents when placement stability is threatened 79% ANI 7. Permanency goal is in child’s best interests • Court practices a key barrier to timely and appropriate goals • Stakeholders say courts maintain the goal of reunification even when the prognosis for reunification is poor �� Waiver of reunification services not used • Concurrent permanency planning exists in form but not in function • Too many plans for long- term care, including young children 34% ANI 8. Reunification, guardianship, or placement with relatives is achieved within one year • Lack of awareness of strategies needed to achieve permanent placement with relatives, especially guardianship • Lack of services to parents or lack of timely services 38% ANI 24 Domain Item Score Adoption is achieved within two years • Inadequate effort • Lengthy TPR appeals process • Lack of placement resources • TPR delays include o Late notice to parents o Delays in scheduling hearing o Granting continuances o Court waits too long to set plan of adoption • Failure to use mediation early • Failure to use waiver of reunification • Inconsistent use of dual licensure 42% ANI Other planned permanent living arrangements are achieved • Too many plans of LTFC – it is increasing • Relative caregivers reluctant to adopt • Older youth may not receive Independent Living services, especially in group homes 56% ANI Permanency Continuity of family relationships 64.3% ANI Proximity of placement 96% SC Placement with siblings • Lack of resources or lack of effort to place together 71% ANI Visiting with parents and siblings in care • Different caseworkers in same family • Lack of reimbursement for foster families who provide transportation 67% ANI Preserving connections • DSS lacks resources • Fathers rarely included 71% ANI Relative placement • Sometimes focus only on one side of the family • Lack of search for absent fathers or late search 72% ANI Relationship of child in care with parents 64% ANI Well- Being Families have enhanced capacity to care for children 61.2% ANI Needs and services of child, parent, and caregivers are assessed • Needed services not rendered or inappropriate services rendered for the child • Parental needs often not assessed or assessment missed underlying needs ( e. g., substance abuse or mental health) • Needed services for parents or foster parents not rendered • Lack of availability of MH and substance abuse treatment 63% ANI Child and family involvement in case planning • Caseworker creates the plan and gives to parent for signature • Fathers routinely not involved 71% ANI Worker visits with child 86% SC Worker visits with parents • Minimal or no contact with fathers 68% ANI Well- Being Services to meet educational needs of child • Caseworkers need training • Some local schools resistant to agency and foster parent efforts 86.5% ANI 25 Domain Item Score Well- Being Services to meet health needs of child 80.4% ANI Physical health of child • Shortage of dentists available to serve Medicaid patients 91% SC Mental health of child • Services not given for identified need • Parents refuse to consent to MH treatment • Lack of available MH services for children 69% ANI Systemic Statewide Information System • Inaccurate data made it difficult to select CFSR sample; cannot accurately locate kids in care • CIS/ FACTS lack user- friendly query system • Workers have no direct inquiry access • CIS/ FACTS Data cannot be shared with local systems • Caseworkers not trained in entering or interpreting system codes • LDSS cannot create their own management reports ANI Case Review System • Case plans not routinely developed for children placed with relatives • Many cases without signed service agreements • Periodic reviews occur, but courts may not adequately consider CRBC recommendations • Court continuances • Notification to caregivers of court reviews needs improvement ANI Quality Assurance System • Standards in place to ensure quality service and child safety/ health • Lack of mechanism to monitor and enforce CAPS corrective action • System monitors only for compliance and does not provide feedback on the quality of services and outcomes ANI Training • Initial and ongoing training for staff • Training for caregivers and adoptive parents SC Service Array • Critical service gaps: o Bilingual services o MH services o Services for children leaving residential facilities o Substance abuse services o Services for DJS co- committed youth • Only half of eligible children receiving independent living funds • Problems in individualizing services ANI Agency Responsiveness to the Community • Consultation with stakeholder in developing Child and Family Services Plan and annual progress reports • Services coordinated with other federal programs SC Foster/ Adoptive Parent Licensing, Recruitment, Retention • Standards in place for foster families and institutions • Criminal history checks are completed • Diligent recruitment so that diversity of foster parents reflects diversity of child population • Problems with inter- jurisdictional placements SC |
