There is no Margin of Error:A C l A h t Child lfA Calm Approach to Child welfare

Center Hosted WebcastCultural Change SessionCultural Change Session

Friday May 16, 2008Alan Abramowitz and Ron Zychowski

OBJECTIVESOBJECTIVES• System challenge • Identify Fixy g

– Panic impact – Unintended Results

y– Remove Bias– Educate to options

• Community ReviewThreatened harm

– Do No Harm– Leadership

– Threatened harm– Investigator

observations• State Policy

– Safe Family – Passion and Bias– Conflict necessary

Longitudinal Studies

yPreservation

– Task Force on Child Welfare– Longitudinal Studies Welfare

THE PROBLEM IN CHILD WELFARETHE PROBLEM IN CHILD WELFARE

• Mistakes happen35.335

40

Florida

• Fix is total focus– It will be fixed, but…

20

25

30California

Illinois

New York

Ohio

– Unintended results• Inefficient 8.8

10

15

20 Ohio

• Ineffective 0

5

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

Years

• Palm Beach child deaths over past 15Palm Beach child deaths over past 15 years and spikes from Kathleen Chapman articlearticle

The “deck is stacked” against theagainst the

“best interest of the child”

• Question: Why does Quality Assurance support virtually every removal?support virtually every removal?– Discussion– Quality Assurance challenge– Solution

• Question: Why historically have investigators been asked to resign when a child is hurt that gwas not removed?– Discussion– Why this decision is adverse to childreny– Solution

DO NO HARMDO NO HARM

Hippocratic Oath – Excerpt Classical Version

“… I will apply dietetic f h b fimeasures for the benefit

of the sick according to my ability and judgment;my ability and judgment; I will keep them from harm injustice ”harm injustice…

PROTECTING A CHILD

A professional judgment based on all the facts and determining services which willfacts and determining services which will mitigate risk, if possible.

-

The Math of Passion Max Weber (1864-1920)

• Social Workers have passion

• Passion + Bias =

• Passion – Bias =

• Bias can be increased or decreased

1995 U.S. OpenC fid LConfidence Lost

Agassi compiled a career-best 26-match winning streak, which ended when he lost in a hugely anticipated U.S. Open final to SamprasSampras.

Andrea Agassi had just attained been #1 in world

Foster Care panic!Foster Care panic!

Drastic change in child removalDrastic change in child removal called a foster care “spike”

C fli t di dConflict discouraged

Negative impact of spike on systemNegative impact of spike on system of care

N ti i t hild ltiNegative impact on children resulting from spike

Community develop plan

TEAM FINDINGTEAM FINDING• Remove bias

Conflict has positive effect– Conflict has positive effect– Leadership needed– Team ApproachTeam Approach

• Remove fear – Support staff– Understand harm of removal– Decision on right level in org chart

• Shelter rate– Spike at all levels of organization

Spikes harm children– Spikes harm children

• Food Stamps, CashFood Stamps, Cash Assistance and Medicaid

• Poverty is the number one• Poverty is the number one indicator of abuse or neglectStress impact• Stress impact

• Partner collaboration – Look at quality of life

TOGETHER WE REMOVE BIASAn Approach which removed bias in the 5th Circuit

Circuit 5 Children Served

5000

4000

4500

5000

2500

3000

3500 Children

2000

Jun-0

5Sep

-05Dec

-05Mar-

06Ju

n-06

Sep-06

Dec-06

Mar-07

Source

Who: J. JohnsonWhat: HSn ReportWhen: 06/14/07

J S D M J S D M

2007 MIT Study2007 MIT Study

15,000 children / No high risk cases ConclusionsConclusions

1. Arrested at least once1. Stayed with family: 14%2 W t t f t 44%2. Went to foster care: 44%

2. Became teen moms1. Stayed with family: 33%2. Went to foster care: 56%

3. Held a job 3 months1. Stayed with family: 33%y y %2. Went to foster care: 20%

2006 Minnesota Studyy“The Impact of Foster Care on Development”

• Kincare better outcomes than foster care– 189 children longitudinal study

Si il lt t t f f t d l ti– Similar maltreatments for foster care and relative care (in home, out of home, and control group)

• “Children placed into unfamiliar foster careChildren placed into unfamiliar foster care showed ‘higher levels of internalizing of problems compared with children reared by maltreating caregivers children in familia caremaltreating caregivers, children in familia care, and children who receive adequate care giving.”

Chapin Hall / Jim Casey:Chapin Hall / Jim Casey:• Chapin Hall: The 500,000 children in foster care p ,

are more likely than other kids to drop out of school, commit crimes, abuse drugs and become teen parentsbecome teen parents.

• Jim Casey: Confirms kids who can remain in• Jim Casey: Confirms kids who can remain in their homes do better than in foster care… Some kids, for their own safety, need to be removed from their families, but in marginal cases of abuse, more should be done to keep them togethertogether.

Children in Out of Home Care P f P th th i P i S h lPerform Poorer than their Peers in School• Score substantially lower than other youthScore substantially lower than other youth

on the FCAT• Twice as likely to be held back a greatTwice as likely to be held back a great• Two and Half time more likely diagnosed

with a “less severe” learning disabilitywith a less severe learning disability• Seven times more likely to be diagnosed

with a “severe” disability.with a severe disability.• Twice as likely to have disciplinary

problemsproblems

FORMER FOSTER YOUTHLIKELY TO ACHIEVE SELF SUFFICIENCY AS O C S SU C C S

ADULTS• Were employed at same rate, but earnedWere employed at same rate, but earned

¼ th the median wage for their age group.• Four times more likely to receive foodFour times more likely to receive food

stamps and nine times more likely to receive Temporary Assistance to Needy p y yFamilies.

• 17 times more likely to be homelessy• Three times more likely to be in prison or

probation.p

FLORIDA POLICYFoster Care Waiver returns Florida to

Safe Family PreservationSafe Family Preservation:

Enables funds to be used for– Enables funds to be used for … prevention, intensive in-home services to prevent placement of children outside p pthe home, reunification and foster care….

– Funding incentives in line with the goals of providing services that help familiesof providing services that help families remain intact whenever possible.

FLORIDA POLICY –General Butterworths Task Force on Child Welfare

Recommendations: theRecommendations: … the Department and Community Based Care Lead AgenciesBased Care Lead Agencies explore the promise of the IV-E waiver implemented in Octoberwaiver implemented in October 2006 and the opportunity to use available funds to preventavailable funds to prevent removal by providing intensive and effective home servicesand effective home services.

Other Culture Changes NeededOther Culture Changes Needed

• Communication• Communication– Continuous Community information sharing is critical– Sharing good news with protective investigators on cases will remove bias

• Quality Assurance (oversight)J d t l t C iti l thi ki– Judgmental to Critical thinking

– Goal of Improvement not judgment– Need to recognize that CBC is impacted by cbc (lower case letters)– Must not shift to “best practices” instead of “best interest”

Di i li A ti• Disciplinary Action– Look at career as well, not just the case– Are children better served with employee on team or with a new employee– Decision should be understood by staff and must be transparent with staff

• Tracking Front Door– Understand removals impact on CBC outcomes – Clearest way to determine if CBC will succeed or fail

• Measure success in a “child first” waiver world– Must plan savings to front end prevention– If abuse / neglect occurs community already failed

“ There is no margin of“… There is no margin of error when working witherror when working with children. No one is allowedchildren. No one is allowed a bad day…”y

-- Secretary Bob Butterworth, Statewide Dependency Summit 2007