Report Background and Purpose The North Carolina Department of Health and Human Services has the responsibility under General Statute 108A-74, to evaluate and provide technical assistance to county departments of social services to assure child welfare programs are in compliance with state law, rules, and policy. The evaluation entails a review of program protocols and practices, which can include a review of case records and data sources, to determine the program s level of functioning and risk. Focus of the Program Evaluation The North Carolina Department of Health and Human Services, Division of Social Services (NCDSS), in partnership with (MCDSS), conducted a program evaluation of the child welfare program in Moore County. The focus of the evaluation was on Child Protective Services (CPS) Assessments completed by MCDSS. The evaluation included an examination of records for service delivery during CPS Assessment Services. The reviewed assessment cases were selected to provide insight into these potential program risks and concerns. Since the sample selected was targeted, the review data is only reflective of CPS Assessment activities although there are broader program ramifications. This evaluation provides a baseline of the agency s functioning in this program area to measure progress in enhancing services and is a starting point for developing a continuous quality improvement planning process. Program Evaluation On July 12-14, 2016 the program monitoring team consisting of three NCDSS staff and four county staff conducted an on-site program evaluation which included a review of CPS Assessment cases. The cases reviewed included: 66 Screened-in reports 47 CPS Assessment Cases The universe from which the case review sample was selected included assessments completed between October 2015 and April 2016. The review team focused on the required procedures and best practices in child welfare using standardized review tools. Key Observations/ Findings and Recommendations This report outlines four key findings/observations and recommendations identified during the monitoring process within the Child Protective Services program area. I. Safety Assessments II. Quality Case Contacts and Documentation III. Case Decision Making IV. Timeliness 1 P age
During the calendar year 2015, experienced a significant number of vacancies, operating at an average rate of 53% of the agency s fulltime equivalent positions filled within child welfare services, which includes Child Protective Services Assessments, Child Protective Services, In Home Services, and Foster Care and Adoption Services. This has improved to 65.7% in the first half of calendar year 2016. During the agency s data review on February 24, 2016, MCDSS identified difficulty in ensuring that staff complete all the training requirements due to the high vacancy rate in CPS Assessments. At the time of that meeting, there were 7 staff that had not attended position specific training in their practice area. MCDSS is continuing to work on this area since there is a relationship between training attendance and strong practice in county child welfare agencies. I. Findings/Observations: Safety Assessments When assessing a CPS report, the county child welfare agency must complete a North Carolina Safety Assessment to address the safety issues and the caregiver's capacity to ensure safety for the children. The safety assessments using the North Carolina Safety Assessment (DSS-5231) as the guide shall be completed: 1) at the time of the initial home visit, and prior to allowing the child to remain in the household; 2) prior to the case decision; 3) prior to the removal of a child from the home; 4) prior to the return home in cases where the caregiver temporarily places the child outside the home as a part of the safety response; 5) at any point a new report is received; and 6) at any other point that safety issues are revealed. If a child is determined to be not safe or found to be conditionally safe, the social worker shall develop the safety response with the parent or caregiver and any other resource identified to assure safety or shall file a petition for juvenile court intervention. The case review found: Safety assessments were completed in 82% (54 of 66) of the assessment cases reviewed at time of initiation. Safety assessments accurately reflected information obtained in 80% (52 of 65) of the assessment cases reviewed. Safety assessments adequately addressed information that ensured safety to the child in 75% (45 of 60) of the assessment cases reviewed. When new concerns arose in 11 already open assessment cases, a new safety assessment and response was completed in five of those incidents. During the debriefing, reviewers noted that in some assessment cases the social worker documented in narrative that a safety Assessment was completed but the Safety Assessment (DSS-5231) could not be located in the document management system, leading to a discussion regarding filing protocols in that system that are used inconsistently among child welfare workers. In 49% (32 of 65) of the assessment cases reviewed, the supervisor signed the Safety Assessment within 24 hours according to best practice. At least 80% (52 of 65) of the Safety Assessments were signed by the supervisor during the time the CPS Assessment was open. Reviewers commented that there was significant inconsistency among the child welfare workers in the quality of the documentation of concerns in safety assessments. Recommendations I: Safety Assessments MCDSS develop and implement a means of ensuring that all Child Welfare Workers complete NC Safety Assessments at the time of initiation and at any time new concerns necessitate. Safety Assessments and the subsequent safety response should be used to aid in decision-making. MCDSS develop a means for training (and retraining, as necessary) both social workers and supervisors around completing Safety Assessments properly, completely, and adequately addressing 2 P age
issues to ensure safety. MCDSS develop a means to assure that all documentation relevant to the safety of a child is filed appropriately in the document management system. MCDSS continue to complete the position specific training requirements for all child welfare staff. II. Finding/Observations: Quality Case Contacts and Documentation NCDSS policy states in all reports accepted for a CPS Assessment, face-to-face interviews shall be conducted with all alleged victim children within the statutory time requirements, or there shall be documentation to reflect diligent efforts made to see the children within these timeframes. Furthermore, face-to-face interviews with the parents or primary caretakers with whom the child resides shall be conducted the same day the child is seen. If interviews are not conducted on the same day as the child is seen, there shall be documentation to reflect diligent efforts made or rationale for delaying the interview that does not compromise the safety of the child. Face-to-face interviews with other adults known to be living in the child's household shall be conducted within seven days of initiating the CPS Assessment, or there shall be documentation to reflect efforts made. In 89% of the assessment cases reviewed, all victim children were seen and interviewed within response times. Of the victim children not seen and interviewed, 14% (1 of 7) had clear documentation of diligent efforts to see and interview the children. In 80% of the assessment cases reviewed, parents and caretakers who reside in the home were seen and interviewed the same day as the children. Of the parents and caretakers not seen, 47% (7 of 15) did have clear documentation of diligent efforts to see and interview them. In 82% (14 of 17) of the applicable assessment cases reviewed, all other non-primary caretaker adults residing in the home were seen and interviewed within seven days. Of the non-primary caretakers residing in the home who were not seen or interviewed, 100% had documented efforts to see and interview them. In 97% of the assessment cases reviewed, there was documentation that the allegations were discussed and addressed with the alleged perpetrators at the time of first contact. Contact with the non-resident parent occurred in 58% (23 of 40) of the assessment cases reviewed. If non-resident parent was not contacted, there was justification documented that it was not in the best interest of the child (for safety reasons) to contact him/her in 58% of the assessment cases. NCDSS policy states that documentation must be current within 7 days. Documentation of all case activities shall be in the record as well as appropriate written justification when policy requirements are not met. Documentation will include a description of the case work and services to address the child and family s needs on a continual basis that are designed to shape the scope of the work with the child s parents. Documentation addressing ongoing risk, safety, and health of the children and documentation of interviews, observations, and actions taken during the assessment was seen in 83% of the assessment cases reviewed. From initiation to case decision (case closure), the agency maintained sufficient contact with the child and family in 70% of the assessment cases reviewed. Reviewers noted that there was a range of thoroughness and quality in documentation, ranging from surface interviews to well documented comprehensive interviews and information gathering. Recommendations: Quality Case Contacts and Documentation MCDSS develop and implement a strategy of ensuring social workers have maintained regular and consistent face to face contacts with children and families during assessments. MCDSS develop and implement agency procedures surrounding timely, purposeful documentation of case activities. 3 P age
III. Finding/Observations: Case Decision Making NCDSS policy states the North Carolina Case Decision Summary shall be completed during the case decision staffing and must document answers to specific questions. Documentation and completion of the structured decision making tools are a means of organizing data and guiding the decision making process. According to data provided on outcomes, MCDSS has a higher rate of recurrence of maltreatment with 10.2% compared to 6.9% for North Carolina. This is the percentage of children who have a second substantiated or In Need of Services finding within 12 months. This is an area needing further evaluation. In 87% of the assessment cases reviewed, the case decision was well documented and appropriate. As noted above, during the debriefing conference, state and county reviewers noted that there was a wide range of quality in documentation, including documentation on the Structured Decision Making tools. Recommendations: Case Decision Making MCDSS evaluate further the potential causes for the rate of recurrence of maltreatment working toward action steps to decrease the rate. MCDSS ensure that staff are trained, knowledgable, and compliant with policy around use of the structured decision-making tools for guiding case decisions. MCDSS develop and implement ways and means to assure consistency in supervisory oversight around decision-making and quality of documentation in CPS Assessments. IV. Finding/Observations: Timeliness When reports of suspected child abuse, neglect, or dependency are received, the Director of a county social services agency is charged with conducting a prompt and thorough assessment of the allegations in accordance with N.CG.S 7B-302. Furthermore, NCDSS outlines in policy that CPS Assessment case decisions shall: be made within 30 days for an Investigative Assessment or within 45 days for a Family Assessment, or there shall be documentation to reflect the rationale to extend the CPS Assessment beyond the required timeframes. By design of the evaluation, of the 47 CPS cases reviewed, 45%, or 21, exceeded the 30-45 day time frame in policy. In 27% (7 of 26) assessment cases reviewed, there was documentation justifying the delayed closing. The following information about timeliness in 2016 was available via a state report (CYA-004): Total Assessments MCDSS State Completed over 30 Days Investigative Assessments 73.9% 62.7% Family Assessments 53% 36.4% Contributory factors that may impact the timeliness of case decisions include the agency s substantial vacancy rate among child welfare staff, multiple reports being screened and accepted on a family that already has an open CPS Assessment Case, and the agency s internal policy that a case decision cannot be made until all the case documentation is complete. Recommendations: Timeliness MCDSS develop and implement a means of ensuring timely closure of CPS Assessments when appropriate and possible, as well as ensuring documentation of justification when CPS Assessments are not able to be closed within required timeframes. 4 P age
Additional Information The leadership of was actively engaged in the evaluation process and interested in advancing a continuous quality improvement system to assure safety, permanence, and well-being of children they serve. Several strengths were noted during the program evaluation by MCDSS and NCDSS staff: Of the 66 reports accepted for CPS Assessment, the response time was appropriate for the allegations reported 98% of the time. Of the 66 reports accepted for CPS Assessment, 98% of the reports were assigned to the most appropriate assessment track. Home visits to where the child and family resides was completed in 100% of the assessment cases reviewed. In 98% of the cases reviewed, the case decisions were completed, signed by a supervisor, and had a 2 nd level staffing. In 93% of the cases reviewed, risk assessments were completed. The DSS 5104 was keyed into the State system within 10 days 96% of the time. Administrators credit their Staff Mentor Program in helping to retain new staff with the agency. The purpose of this program is to pair seasoned staff with new staff to provide peer training related to their job duties. Subsequent Steps The Moore County DSS will develop and submit a plan to NCDSS to address the findings and recommendations identified during the program monitoring process within 30 days of receipt of this report. A template is available that you may use to develop your plan. It is important to remember during plan development that the goal is not to add more activities, but to examine how existing activities can be changed to be more efficient. The NCDSS interim point of contact for Moore County DSS is Program Monitoring Team Supervisor Jeff Olson (due to a vacancy). The Program Monitoring Team, in conjunction with Adgenda Turner, Children s Program Representative (CPR), will assist in the development of the program development plan and provide or arrange any technical assistance needed by your agency to implement the plan. Please submit the plan to Jeff Olson at jeffrey.olson@dhhs.nc.gov AND to Adgenda Turner, CPR, at adgenda.turner@dhhs.nc.gov. Once the plan is implemented, NCDSS will provide oversight, technical assistance, and training as outlined in the program improvement plan. The plan will be reviewed every 6 months with the Program Monitor, to include a review of data in addition to the program development plan. The NCDSS appreciates Moore County DSS s commitment to improving outcomes for children and families and looks forward to working toward continuous quality improvement. 5 P age