Critical Incident Rapid Response Team

Transcription

1 Critical Incident Rapid Response Team September 13, 2017

2 Critical Incident Rapid Response Team SunCoast Region Circuit 6 Pasco County, Florida Table of Contents Executive Summary 3 Introduction 5 Case Participants 6 Child Welfare Summary 6 System of Care Review 7 Practice Assessment 7 Organizational Assessment 8 Service Array 9 Critical Incident Rapid Response Team Report 2 P a g e

3 Executive Summary On July 25, 2017, the department received notification that was found unresponsive after sleeping in bed with his mother, appeared to be under the influence during her interview and admitted to taking a benzodiazepine (sedative) ; however, she was unable to provide proof of having a prescription. father, was not sleeping in the bed with the mother and infant when the incident occurred. During his interview, he was observed to be fidgety and he subsequently admitted that he had been smoking spice. The cause of death is currently pending, and it is unknown at this point if the death was due to an unsafe sleep environment or undetected medical issues given that the infant was reportedly in a separate sleeping mechanism on the bed. The incident occurred during an open investigation that was received three weeks prior due to concerns for ability to care for the newborn due to her history of mental health and substance abuse issues, as well as other stressors in the home. Because there was also a verified report involving sibling, which was received within 12 months of the death, DCF Secretary Mike Carroll deployed a Critical Incident Rapid Response Team (CIRRT) to Pasco County to review the prior interventions with the family and to assess for any potential systemic issues within the local system of care. The review team consisted of representatives from DCF s Office of Child Welfare and the Central Region, Children s Legal Services from the Southeast Region, Hillsborough County Sheriff s Office Child Protective Investigations Division (Suncoast Region), Circles of Care (substance abuse and mental health provider in the Central Region), Partnership for Safe Families (community-based care provider in the Northeast Region), and the Child Protection Team medical director from the Central Region (off-site). The team reviewed the case records involving all key case participants and conducted interviews with child welfare professionals involved in the most recent prior abuse investigations and service case. The following agencies were interviewed during the review: Child Protective Investigations (CPI) staff of the Pasco County Sheriff s Office, the Safe at Home program, Operation PAR substance abuse program, Eckerd Community Based Care (ECA) communitybased care lead agency, Gulf Coast Jewish Family and Community Services, Inc. case management agency, and the Office of the State Attorney, which is responsible for children s legal services in the circuit. Practice Assessment After the initial identification in July 2016, intensive services were provided by Safe at Home. Organizational Assessment Overall, child welfare staff were experienced and caseloads were manageable. While communication appears strong at the leadership level; there is a lack of collaboration regarding case specific information between front line professionals. Critical Incident Rapid Response Team Report 3 P a g e

4 During the 2017 investigation, there was a delay in processing the referral for Family Support Services and having a counselor make contact with the family. Service Array There is a full array of services available within the community to address the needs of the families served and modifications to the array of services are made as needs change. Critical Incident Rapid Response Team Report 4 P a g e

5 Introduction On July 25, 2017, the department received notification that was found unresponsive after sleeping in bed with his mother, appeared to be under the influence during her interview and admitted to taking, a benzodiazepine (sedative) ; however, she was unable to provide proof of having a prescription. father,, was not sleeping in the bed with the mother and infant when the incident occurred. During his interview, he was observed to be fidgety and he subsequently admitted that he had been smoking spice. The cause of death is currently pending, and it is unknown at this point if the death was due to an unsafe sleep environment or undetected medical issues given that the infant was reportedly in a separate sleeping mechanism on the bed. The incident occurred during an open investigation that was received three weeks prior due to concerns for ability to care for the newborn due to her history of mental health and substance abuse issues, as well as other stressors in the home. When was born he was admitted to the NICU as he had aspirated and was also exhibiting withdrawal symptoms. Both father,, tested positive at the time the report was received on July 3, 2017, and, on July 17, 2017, the family was referred for Family Support Services through Eckerd Community Alternatives; however, services had not been implemented by the time of death. Because there was a verified report, involving sibling,, that occurred within 12 months of death, DCF Secretary Mike Carroll deployed a Critical Incident Rapid Response Team (CIRRT) to Pasco County on July 27, 2017, to review the prior interventions with the family and to assess for any potential systemic issues within the local system of care. This report represents the CIRRT s findings, the child welfare history, and a system of care review, including practice assessment, organizational impact, and array of available services. Critical Incident Rapid Response Team Report 5 P a g e

6 ~ FLORIDA DEPARTMENT OF CHILDREN AND FAMILIES M.YfLFMUUES.COM Case Participants Child Welfare Summary During se~on, the parents reportedly separated. -became uncooperative; however,--successfully completed the program. Safe at Home subsequently closed ~5, 2017, and conducted a six-week follow up At that time, ----were observed and no concerns were noted. reported that she was expecting a child nd denied that she and re back together. A second investigation was received on July 3, 2017, due to concerns ability to care for the newborn due to her h health and substance abuse issues, as well as other stressors in the born he was admitted to the family was referred for Family Support Services through Eckerd Community Alternatives on July 17, 2017; however, services had not been initiated by the time of the death and the investigation remained open. Critical Incident Rapid Response Team Report-- 6 I Page

7 ~ FLORIDA DEPARTMENT OF CHILDREN AND FAMILIES M.YfLFMUUES.COM System of Care Review This review is designed to provide an assessment of the child welfare system's interactions with the family and to identify issues that may have influenced the system's response and decision-making. In this case, both strengths and opportunities for improvement were identified in the following areas. Although the following findings were not a contributing factor in death, they provide opportunities for improvement that will benefit to the local system of care. Practice Assessment PURPOSE: This practice assessment examines whether the child welfare professionals' actions and decision making regarding the family were consistent with the department's policies and protocols. FINDING A: After the initial identification in July 2016, intensive services were provided by Safe at Home. As a result of the assessment completed in July 2016, due to concerns regarding the parents' long term abuse of illegal substances, the CPI correctly identified as an unsafe child. Safety plans were developed, utilizing relatives and a daycare provider as safety managers. The case was accepted for in-home non-judicial services through the Safe at Home Program on September 15, The Safe at Home Program provides intensive services to the family with the primary goal of keeping the children safe without entering the dependency system. The Safe at Home program utilized a team approach, including a certified case manager, a master's level counselor, and a family advocate. Home visits were completed an average of four times per week; two visits each by the case manager and counselor. Staffings, which included participation from the family and the professionals working with the family, occurred bi-weekly. Safe at Home provided services to the family for approximately five months, The parents were also provided with random substance screens and with drug tests performed at Sober Solutions, Incorporated, which is one of the few laboratories in the area with the capability to test for spice. Prior to successful closure of Safe at Home services in February, 1111 progress in her goals of abstinence from illegal/non-prescribed substances, While successfully completed the program, did not. He initially made progress but relapsed on spice and, in January 2017, moved to Clearwater, Florida. He ceased to maintain contact with the Safe at Home case manager or Family Engagement Specialist. The safety plan was modified Critical Incident Rapid Response Team Report-- 7 1Page

8 At closure, the Safe at Home Counselor advised, that if the father comes to the home or visits, he must be clean and sober; and that any failure to remove from the father's presence if he is intoxicated will be considered a failure to protect. agreed to comply should the father appear to be under the influence of any substance. On April 7, 2017, the Safe at Home counselor met with for a six-week follow up visit and doing well. was expecting the birth of to occur,, and medical needs were being addressed. remained out of the home. Organizational Assessment Safety PURPOSE: This section examines the level of staffing, experience, caseload, training, and performance as potential factors in the management of this case. FINDING A: Overall, child welfare staff were experienced and caseloads were manageable. The CPI responsible for the most recent investigation, received in July 2017, had been a CPI for approximately 16 months and holds a bachelor s degree in sociology. The unit supervisor had more than five years of child welfare experience and holds a bachelor s degree in human services. The CPI was responsible for a caseload of 15 open investigations, similar to the other CPIs in the unit and the sheriff s office. Due to the intensive level of intervention provided by Safe at Home program, caseloads are capped at eight families. The primary case manager assigned to the family had 13 years of child welfare experience and was recently promoted to a supervisory position. The case manager holds a bachelor s degree in social science. The counselor/therapist assigned to the Safe at Home team working with the family had 13 years of child welfare experience and has a master s degree in mental health counseling. The supervisor had more than eight years of child welfare experience and holds a bachelor s degree in human services. FINDING B: While communication appears strong at the leadership level; there is a lack of collaboration regarding case specific information between front line professionals. Staff at the leadership level, across all agencies, including the sheriff s office, the Office of the State Attorney, the lead agency, and subcontracted case management report strong communication and collaboration. All agencies actively participate in bi-weekly data meetings facilitated by ECA. In-home non-judicial case receiving services through the Safe at Home program are staffed every other week, providing a forum to share case specific information. The most recent investigation regarding the family was received on July 3, 2017, prior to being discharged home from the hospital after his birth, three weeks earlier. The CPI contacted the Safe at Home case manager who advised that he would have concerns if was back in the home. Although expressed a desire to live apart from, the parents were both living in the home of the grandmother. Since the closure of the Safe at Home case in February 2017, the family had experienced several significant changes, including the parents reconciling and the birth of a new baby. A staffing would have been beneficial in ensuring that relevant information was shared. Critical Incident Rapid Response Team Report 8 P a g e

9 FINDING C: During the 2017 investigation, there was a delay in processing the referral for Family Support Services and having a counselor make contact with the family. During the initial assessment of the most recent abuse report, received on July 3, 2017, the CPI identified that safe while in the care of. It was noted that drug screen results reflected she was only using her prescribed, she had successfully completed the Safe at Home non-judicial program in February, and was living with the grandmother. Although was living in the home, both the mother and grandmother wanted him to move. On July 17, 2017 the CPI made a referral for family support services to assist. The referral noted that the mother had minimal support from her family and had engaged in services from the past. The referral was sent to the ECA point of contact for referrals and the referral was forwarded to the Safe at Home program to be assigned to the family support services program on July 18, The program has a target of making contact and responding to request for family support and diversion cases within 48 hours form the time the CPI made the referral. In this case, the CPI and a staff member from the family support services program discussed the case via a phone call on July 18, 2017; however, services had not been initiated at the time of death. The process for making referrals has changed and all referrals for prevention, family support, and diversion services are now sent to an group which includes several staff, with different levels of responsibility, eliminating barriers in service implementation. Service Intervention/Array PURPOSE: This section assesses the inventory of services within the child welfare system of care. FINDING A: There is a full array of services available within the community to address the needs of the families served and modifications to the array of services are made as needs change. In Pasco County, Gulf Coast Jewish Family and Community Services, Inc. is the case management agency providing prevention and diversion services to families. Programs include prevention programs for safe children. In-home non-judicial services for children determined to be unsafe are provided to families through the Safe at Home Program. Additionally, a new safety monitoring program was initiated in July 2017, that provides an immediate response to CPIs calling from the field to implement services to families at risk of having their children removed. The new program aligns with services needed in the community based on the new practice model. The family in this case received intensive, in-home non-judicial services through Safe at Home for approximately five months. While successfully completed the program in February 2017, moved from the home prior to completing the program. After completion of the Safe at Home program, service for the family stopped. The program does not provide a transition to other services, such as targeted case management. It is noted that moved back in the home after the Safe at Home program was closed. Operation PAR is the primary substance abuse provider in the county and provides a variety of in-patient and out-patient services to clients. Provided valid releases of information have been signed, the program has a point of contact for CPIs and case managers to obtain information Critical Incident Rapid Response Team Report 9 P a g e

10 regarding joint clients. Operation PAR recently provided joint training to CPIs, case managers, and CLS on opiate abuse and methadone as a treatment for the addiction. DACCO is the substance abuse provider in Hillsborough County and also provides services to Pasco County residences in need of substance abuse treatment. Operation PAR and DACCO both operate methadone clinics, which includes substance abuse counseling for clients. In addition to prescribed, both parents admitted to smoking spice, a synthetic marijuana, which is very difficult to detect in drug screens as the formulas change constantly. The case manager from Safe at Home utilized enhanced spice drug tests through Sober Solutions Laboratory to help detect usage. Mental health providers are available and accessible to clients in Pasco County. While both parents reported a history of mental health diagnoses, they were not receiving counseling through a clinic;. Critical Incident Rapid Response Team Report 10 P a g e