1 no child who has already been maltreated should ever be hurt again on our watch. provider g-force...
TRANSCRIPT
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No child who has already
been maltreated should
ever be hurt again on our
watch.
Provider G-Force MeetingDivision of Family & Children ServicesApril 12, 2010
Focus: Reducing Incidents of Substantiated Maltreatment in Care
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Spotlight on Hypotheses 3 & 4(Developed at the March 2010 Provider G-Force Meeting)
Hypothesis 3: High levels of substantiated maltreatment in care are being driven by confusion around broad definitions.
Hypothesis 4: What we do for children in foster care, and the providers who care for them, in the first 30 days affects child and organizational outcomes.
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April 2010 Provider G-Force Agenda
I. Provider Findings: Follow up from March 2010 Provider G-Meeting (Hypothesis 4)
II. DFCS Findings: Review of Substantiated Maltreatment in Care within First 30 Days of Entering Care (Hypothesis 4)
III. Andy Barclay: Perspectives on Maltreatment in Care
IV. Analysis of Maltreatment in Care Cases Substantiated for Inadequate or Lack of Supervision & Inadequate Medical Care (Hypothesis 3)
V. Homework Assignment for May 2010 Provider G-Meeting
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Provider Findings: Follow up from March 2010 Provider G-Force Meeting
Hypothesis 4: What we do for children in foster care, and the providers who care for them, in the first 30 days affects child and organizational outcomes.
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Analysis of Children Entering Providers’ Care between February 22, 2010 & April 7, 2010
Questions Addressed:
Is this child a good match for your facility’s resources?
Did you assign someone to work with the child?
What has been the level of communication with the DFCS case manager?
Are there any emerging issues with this child?
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CPA: Children Entering Care
119 children entered providers’ care during this period.
The number of previous placements ranged from none to ten.
Children ranged in age from 7 days to 18.
All indicated someone had been assigned to work closely with the child.
Only 2 indicated child not a good match for them.
Communication with DFCS: Good (78), Average (30), and Poor (5).
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CPA: Emerging Issues
Behavioral Health Concerns
Mild depression
Required psychiatric hospitalization
Hospitalized due to PCP in system (16 year-old)
Recent AWOL
Behavior problems / Possible disruption
Educational Concerns
Recently expelled from school / may be moving to a CCI (16 year old)
Medical Concerns
Child pretends to be ill
Medical issues
Other
No visitation schedule
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CCI: Children Entering Care
99 children entered facilities between February 22, 2010 and April 7, 2010.
The average age of the children was 14.
The number of previous placements ranged from none to at least twenty with an average of four.
Only one said poor communication with DFCS; most good to average.
Only two children indicated to not be a good match for the facility’s resources (children were noted to be involved in chronic fighting and cutting behavior).
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CCI: Emerging Issues
Behavioral Health
Abandonment / Adjustment Issues
Aggressive behavior
Chronic fighting
Chronic smoking / nicotine dependence
Clinical prognosis is poor
Suicidal / Cutting behavior
High anxiety
Compulsive behavior
Behavioral Health Continued
Sex offender treatment
Sexual promiscuity
Educational Concerns
Expelled from school
Truancy
Other Concerns
Medical condition
Turning 18 in May and will not have completed high school
Temporary DFCS case managers
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Provider Findings: Substantiated Maltreatment Cases
Providers responded to the following questions:
What were the circumstances involved in the substantiated maltreatment incident?
What were the unmet behavior needs that may have led to the substantiated maltreatment incident?
What could have been done or done differently to prevent the substantiated maltreatment?
What were some of the lessons learned as a result of this substantiated maltreatment incident?
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CCI: Circumstances Involved in the Substantiated Maltreatment Incident
Children leaving facility without approval / incident not reported by staff timely
Staff and child confrontation
Inadequate medical attention / follow-up
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Unmet Behavior Needs
No opportunity to pursue relationships
Youth not ready for a community-based placement
Greater level of supervision needed
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What Could Have Been Done to Prevent the Substantiated Maltreatment Incident from Occurring?
CCI
Discussion of self-confidence and age-appropriate relationships
Conflictual relationship between staff and youth. This staff should not have accompanied youth to next placement.
Increased training for staff on supervision during “high activity” times (chores, meals, free times)
CPA
Extensive training for foster parents on disciplinary policy
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Lessons Learned as Result of the Substantiated Maltreatment Incident
CCI
Alternate patterns of bed checks to minimize youth familiarity with staff behavior.
Emphasis on de-engagement skills with staff so they are not drawn into conflicts with youth.
Increased staff during critical periods.
Restrict access to chemicals
Ensure adequate supervision and medical care
CPA
Closer monitoring of homes by case managers
More individualized time with children by case managers
Greater vigilance needed in assessing/detecting potential red flags
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DFCS Findings: Review of Children with Substantiated Maltreatment in Care Incidents in First 30 Days
Qualitative case review completed on all cases
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Case Review Analysis of Substantiated Cases Presented at March 2010 Provider G Meeting
After detailed case review completed of substantiated cases presented at the March 2010 Provider G Meeting, we found that only 63% of the substantiated incidents actually occurred after the child entered foster care.
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Length of Time in Care Prior to Substantiated Maltreatment
Length of Time in Care at Time of Incident
Number of Children
1 month or less 22
2 to 3 months 26
4 to 6 months 33
7 to 12 months 56
13 to 24 months 55
25 to 36 months 39
37 to 48 months 13
49 to 72 months 18
73 months or more 10
Total 272
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Findings Related to Children Not in the Foster Care at the Time of the Substantiated Incident
Of the 202 substantiated incidents initially thought to have occurred during the first 30 days in care, only 22 were determined during that period.
There were also 19 cases that were substantiated maltreatment in care but the actual incident date was more than 30 days after coming into care.
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Strategies to Increase Accuracy of SHINES: Maltreatment in Care Reporting
Train case managers on appropriate procedures for documenting maltreatment in care
Provide clarity on definitions related to maltreatment in care
Immediate notification to staff when data problems discovered
Routine SHINES queries and case reviews to ensure accuracy of SHINES information
Development of a Special Investigation Unit
Enhance SHINES to increase business intelligence related to maltreatment in care (mandatory fields, prompts, etc.)
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DFCS: Insights Gained from In depth Review of Cases
Georgia can better define it’s policy definition of maltreatment and practice guidance for handling investigations of “institutional abuse” that includes foster home and kinship/relative settings.
Clarity regarding the CPS/Licensing interface.
Provide better guidance when reports occur in pre-adoptive homes including the unique needs of children and their pre-adoptive parents during and after the investigation process
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Analysis of Substantiated Maltreatment in Care within 30 Days of Entering Care
Hypothesis 4: What we do for children in foster care, and the providers who care for them, in the first 30 days affects child and organizational outcomes.
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Summary of Characteristics of Children with Substantiated Maltreatment in First 30 Days
Substantiated maltreatment incident for half of the cases was inadequate or lack of supervision.
There were 14 boys and 8 girls with substantiated maltreatment incidents.
Twenty-one of the 22 children had been in at least one other placement prior to current placement: 19 had one placement prior and two had already been in two placements. The one child not in previous placement was only 9 days old but siblings had been in a previous placement.
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Qualitative Findings Regarding Children in Care for 30 Days or Less
Angela Coulon, Carla Simms &
Katherine Herren
- Nature of the Maltreatment Incidents -
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Substantiated Inadequate Supervision Circumstancesfor Children Who Had Been in Care for 30 Days or Less
Case manager found two children home alone when she went to the foster home to pick them up for court.
Three children left home alone while foster parent took her daughter to college. When she returned, 9 day old child was unresponsive and later died.
Case manager visited foster home and found home to be filthy. In addition, the child, who has special needs, was alone and unsupervised by a lake.
Two children involved but therapist reported that one of the children had a burn on her left arm; no information on how child was burned.
Five children involved in sexual encounter at a Resource Center.
Seventeen year old reported that foster father kissed and rubbed her in several places.
12 year old alleged that a friend of the foster parent grabbed him by the shirt and threw him against the wall.
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Substantiated Physical & Sexual Abuse Circumstances for
Children Who Had Been in Care for 30 Days or Less
Foster Parent spanked 3 year-old child with a belt for misbehaving in school. During the spanking, child was hit in the face with the belt and a welt left on his face.
Four year-old child had "claw marks" going down both sides of her face. Child was also ill and in need of medical attention.
Three year-old child was spanked by an uncle sustained injuries (bruises).
Twelve year old child had "grab-type" marks and scratches on his arm from wrist to shoulder.
Foster Parent reported that foster child used the hand of the foster parent to self-masturbate.
Sixteen year old child reported that a staff member at the CCI was sexually inappropriate with her.
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Perspectives on Maltreatment in Care: Andy Barclay
Review of DFCS Maltreatment in Care Cases
What is Maltreatment in Care?
Federal / National Perspective on Maltreatment in Care
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Hypothesis Three: High levels of Substantiated Maltreatment in Care are Being Driven by Confusion Around Broad Definitions
Data review of 272 children with substantiated maltreatment incidents between June 2008 and February 2010
Qualitative reviews of Inadequate Supervision and Inadequate Medical Care (two predominant categories)
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Characteristics of Children with Substantiated Maltreatment in Care Incidents
Age: Average age of 10
Time in Care: Average of 15 months and a Median of 10 months in care
Time in Current Placement: Average of 5 months with a median of 3 months
Number of Placements: 43% of children were in their first placement while 46% had been in one previous placement prior to current placement at time of the substantiated maltreatment incident
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Region Number of Cases Percent of Total in State
1 12 4.4%
2 20 7.4%
3 28 10.3%
4 15 5.5%
5 11 4.0%
6 15 5.5%
7 3 1.1%
8 15 5.5%
9 10 3.7%
10 5 1.8%
11 13 4.8%
12 12 4.4%
13 47 17.3%
14 16 5.9%
15 11 4.0%
16 14 5.1%
17 25 9.2%
Total 272
Regions of Substantiated Maltreatment Incidents from
June 2008 – February 2010
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Placement Type of Substantiated Maltreatment in Care Cases from June 2008 – February 2010
Number of Cases Percent of Total
CCI 66 24.3%
CPA 49 18.0%
DFCS Foster Home 97 35.7%
Relative 10 3.7%
Adoptive Home 6 2.2%
Hospital 5 1.8%
Non Relative Paid 4 1.5%
Other Resource 4 1.5%
YDC 5 1.8%
Other 26 9.6%
Total 272
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Number of Previous Placements for Children with Substantiated Maltreatment in Care Incidents from June 2008 through February 2010
Number of previous placement
Number of Children Percent
0 116 42.6%
1 124 45.6%
2 26 9.6%
3 6 2.2%
Total 272
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Qualitative Review Findings
Analysis of the following substantiated incidents:
Inadequate or Lack of Supervision
Inadequate Medical Care / Medical Neglect
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Inadequate or Lack of Supervision
Absence of supervision generally refers to:
Caretaker physically absent
Caretaker physically present but involved in other tasks
Level of supervision not sufficient for to meet child’s vulnerability
Knowledge and skill set of staff does not match the needs of the child
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Inadequate Medical Care
Inadequate medication generally involves:
Child not provided with prescription medication or no follow-up to medication management.
Caregiver refusing to provide medical care or did not provide timely.
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Emerging Hypotheses
Children with high number of placements Lack stability Need for more intense services and support
Critical “smoke” factors are being missed before the “fire” Silent child Inadequate professional lens for emerging risk Transition practice for children in care Caseworker
Recruitment, selection and setting of values and standards for foster parents and facility staff may be selecting-in the wrong people for the job Are we assessing for a different job than we are giving
them?
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Homework for May 2010 Provider G-Force Meeting DFCS:
Explore the data around children with high number of placements
Providers: Identify 5-10 kids with serious medical issues,
pull cases, understand from removal to placement (ex: feeding tube)
Be prepared for discussion around emerging hypotheses 6 and 7
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Monday, May 10, 2010
Next Provider G-Force Meeting