Free Order - District Court of Connecticut - Connecticut

Case 2:89-cv-00859-AHN

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Juan F. v Rell Exit Plan
Civil Action No. H-89-859 (AHN)
Exit Plan Outcome Measures Summary Report Third Quarter 2006 July 1-September 30, 2006

November 2006

Submitted by: Exit Planning Division 505 Hudson Street 10th Floor Hartford, CT 06106 Tel: 860-550-6300

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Exit Plan Outcome Measures Summary Report Third Quarter 2006

Cover Letter .....................................................................................................................3 Commissioner Dunbar's Highlights for Third Quarter 2006 Exit Plan Report ............... 4 Outcome Measure Overview Chart ............................................................................... 12 Status of Work Matrix ...................................................................................................14

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November 18, 2006 Ray Mancuso Court Monitor DCF Court Monitor's Office 300 Church Street Wallingford, CT 06492 Dear Mr. Mancuso, We are pleased to submit our Third Quarter 2006 Exit Plan Report marking our most successful quarter and signifying real and focused work on improving services to the children and families of Connecticut. Out of the 22 reported measures, the Department met 17 measures. For the first time under the Exit Plan, the Department met the goal of 100% ensuring that mentally ill and mentally retarded youth are discharged appropriately to adult services. For the second time in a row the Department demonstrated success in reducing reliance on residential placements, showing great focus and commitment with this most challenging area of our work. As you know, this was also the first quarter measuring 3 (treatment planning) and 15 (needs met) using the new case review tool developed by all parties to the case. Currently, 16 of the outcome measures are automated reports. In the Third Quarter 2006 Exit Plan Report, EPOMS: 3, 10, 13, 15, 20 and 21 remain case reviews. For the next reporting period, the Department is prepared to move EPOM 10 (sibling placement) to an automated report. As with our past Quarterly Exit Reports we continue to conduct supplemental case reviews for EPOM 8 and 9 that identify met or not met outcomes for the n/a cases. We have expanded this practice and have randomly reviewed cases for several other EPOMs to assure the quality and accuracy of our reporting. For the Third Quarter Report a full case review (of all 136 cases) for EPOM 9 (TOG) was conducted in order to best identify and address data entry errors that were apparent. In addition, we also reviewed cases for EPOM 16, 17 and 22. The result of these reviews are summarized in the footnote section of the Quarterly Data Table. The back-up data has been forwarded to you for your confirmation and shows the total number of cases reviewed for this quarter. The Department staff continues to set an example of high standards for practice and the data and case reviews are confirming the benefits of this focus. We acknowledge that we still have much work to do and that the basis for true quality improvement is contingent upon our continued evaluation and enhancement of our work with children and families. Respectfully,

Darlene Dunbar, MSW Commissioner

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Third Quarter 2006 Exit Plan Report Commissioner Highlights As we near the end of the third year under the Juan F. Exit Plan, it becomes increasingly clear that the value of this reform lies well beyond 22 statistical measures and now extends into widespread practice changes that are becoming institutionalized in the work of our staff. Department staff continue to demonstrate not only that they are improving and sustaining performance as measured by the Exit Plan Outcome Measures ­ but that the values that stand behind the measures are the same values staff operationalize in their work. This cultural shift promises to impact our social work practice in ways that will reach beyond the 22 outcomes. Workers now don't just talk about meeting "benchmarks" ­ but rather about the underlying principles they represent: supporting and working as partners with families; thorough assessments and planning; meeting individualized needs; achieving permanency; maintaining safety; and enhancing well-being for all children. This internalizing of the values represented by outcome measures and the reflection of those values in practice has become so common that sometimes "the numbers" fail to tell the whole story of the changes that have taken place. For example, recently a 17 year old boy who had been in care many years was adopted. Staff never gave up on finding permanency for this youth although the adoption was not finalized to meet the timeliness of adoption outcome measure. Being timely with any adoption is a core value of the Department, but when that can't be achieved, what matters most for staff and the Department is that the adoption succeeded, just as it did for this adolescent boy. Although the importance of the reform goes well beyond the numbers, the numbers demonstrate sustained progress. During the 3rd Quarter of 2006, Department staff met 17 outcomes ­ the highest number to date. (Two years ago, 4 outcomes were attained, and one year ago, 9 outcomes were met.) The goals for the appropriate discharge for children with mental health needs and mental retardation was met for the first time this quarter. Six outcomes recorded the highest performance ever over the 11 quarters of the Exit Plan, and another three outcomes matched highs established in previous quarters. But more important than any one-time achievement is that staff continue to show sustained high level of performance. A dozen measures have been met for three or more consecutive quarters. Five outcomes have been met for eight or more consecutive quarters. Staff continue to demonstrate that when a goal is met, they can continue to perform at high levels over the long term. Improvements have become ingrained in practice, and staff deserve great credit for their enthusiastic embrace of the principles behind the measures. It is impressive to see the determination of staff in consolidating advances already made even while they are asked to do more in other areas of our work such as family conferencing and treatment planning. But although staff have made a great deal of progress, they fully recognize that significant challenges remain. Everyone who works at the Department knows that professionals who serve children and families can never be fully satisfied with every intervention. There is always more to do and more to do better. And, it is with this in mind that the current accomplishments and challenges are presented below.

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ACCOMPLISHMENTS This quarterly report shows we met the following 17 outcomes: · · · · · · · · · · · Commencement of Investigations: The goal of 90 percent was exceeded for the eighth quarter in a row with a current achievement of 98.7 percent, the highest since measurement began for the Exit Plan in the Fourth Quarter of 2004. Completion of Investigations: Workers completed investigations in a timely manner in 94.2 percent of cases, also exceeding the goal of 85 percent for the eighth consecutive quarter. This tied the highest percentage ever for this measure. Search for Relatives: For the fourth consecutive quarter time, staff achieved the 85 percent goal for relative searches and met this requirement for 93.1 percent of children. Maltreatment of Children in Out-of-Home Care: The Department sustained achievement of the goal of 2 percent or less for the eleventh consecutive quarter with an actual measure of 0.8 percent. Timely Reunification: For the fifth consecutive quarter, this measure exceeded the 60 percent goal with a mark of 62.5 percent. Timely Transfer of Guardianship: For the third of the last six quarters, staff exceeded the 70 percent goal with 70.2 percent for achieving a transfer within two years of a child's removal. Re-entry into Care: For the second of the last three quarters, staff exceeded the 7 percent goal for re-entry into care with an actual rate of 4.3 percent ­ the lowest since the beginning of measurement for this outcome. Multiple Placements: For the tenth consecutive quarter, the Department exceeded the 85 percent goal with a rate of 95.6 percent, also the best performance recorded under the Exit Plan. Foster Parent Training: For the tenth consecutive quarter, the Department met the 100 percent goal. Placement within Licensed Capacity: For the third quarter under the Exit Plan, staff met the 96 percent goal with an actual rate of 96.6 percent. Worker-To-Child Visitation In Out Of Home Cases: Staff reached their highest level of performance ever and exceeded the 85 percent goal for visitation of children in out-of-home cases for the fourth consecutive quarter by hitting the mark in 92.5 percent of applicable cases. Worker to Child Visitation in In-Home Cases: For the fourth consecutive quarter, workers met required visitation frequency in 85.7 percent of cases, thereby exceeding the 85 percent standard. The percent of in-home cases where visitation standards were met has more than doubled since the Exit Plan measures began at the start of 2004. Caseload Standards: For the tenth consecutive quarter, no Department social worker carried more cases than the Exit Plan standard. Reduction in Residential Care: For the second consecutive quarter, staff kept the share of children in DCF care who are in a residential placement to less than 11 percent. As of November 12, 2006, there were 234 fewer children in residential care than in April 2004 ­ a reduction of 26.3 percent. Discharge Measures: For the fifth consecutive quarter and the sixth time overall under the Exit Plan, staff met the 85 percent goal for ensuring children discharged 5

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at age 18 from state care had attained either educational and/or employment goals by achieving an appropriate discharge in 100 percent of applicable cases. This is the highest performance in this measure in the Exit Plan's history. Discharge of Mentally Ill and Mentally Retarded children: Staff also attained 100 percent in this measure of the appropriateness of discharge for children with these special needs for the first time under the Exit Plan and met the Exit Plan goal for the first time ever. Multi-disciplinary Exams: For the third consecutive quarter, staff met the 85 percent goal by ensuring that 86 percent of children entering care received a timely multi-disciplinary exam.

While it is satisfying that we met 17 goals in the quarter and more than any previous quarter, most important is that we are sustaining previous measures. One of the most difficult to meet and one that has received much attention and energy is in balancing our reliance on residential placements in relation to other types of placements. Having reduced the reliance upon residential placements and staying below an 11 percent goal for the second consecutive quarter demonstrates that structural and service developments, as well as practice changes, have a sustained impact. The Managed Service Systems in each area office and in the Central Office continue to plan on a child-by-child basis the most appropriate level of care that enables as many children as possible to remain in community settings. In addition, 37 therapeutic group homes opened since July 2005 are giving us more community options for children. These group homes play an important part in reducing the number of children in an out-of-state residential placement by 288 children in the 25-month period ending October 1, 2006 ­ a 41 percent reduction. The Administrative Services Organization (ASO), which began operation in January 2006, is providing critical information about specific children and how well services are meeting their individual needs. The ASO also is generating important data about the need for specific services in specific areas of Connecticut that will assists us in serving children and building a stronger system overall. Timely permanency continues to be an area of both great progress and great need. The goals for timely reunification have been met in five consecutive quarters, for timely adoption in four of seven quarters, and for timely transfer of guardianship in three of the last six quarters. Despite having missed the goal in the 3rd quarter for the timeliness of adoptions, we have substantially improved upon the 10.7 percent of timely adoptions recorded in early 2004. In comparison, more than 30 percent of adoptions were timely in five of the last seven quarters. Part of the improvement is a result of the Multidisciplinary Assessment for Permanency (MAP) system in each area office, which has ensured that a legal consultation regarding permanency planning occurs early in every case. Despite the improvements in the timeliness of permanency, we recognize this area requires continued vigilance and more progress before we can say we are doing our best work for each and every child we serve.

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CHALLENGES The Department has continued its impressive inroads toward the goal of being the best child welfare organization possible. But part of being a top-notch agency is in knowing what needs improvement and what needs to be done to effect those improvements. Treatment planning continues as a major focus of our efforts to improve. New methodology to measure this key aspect of our work has been established and case reviews indicate that much work remains to be accomplished in this area for us to optimally serve children and families. The Court Monitor's review of 34 cases shows that appropriate treatment plans were developed in 54 percent of cases compared to 10 percent in the 3rd quarter of 2004. We are pleased by this progress, although the Department has considerable progress to make in order to reach the goal. Family conferencing remains a key strategy to improve treatment planning and our work overall. Multiple trainings statewide have been completed, and we are now engaged in extensive coaching in each area office to work with staff in identifying opportunities for this vitally important tool for engaging families as a key source of strength for children. Work with staff, supervisors and managers is ongoing to establish strategies to overcome barriers to family conferencing including family resistance, confidentiality, domestic violence and substance abuse issues, as well as ways to involve people who may not be family members but who have valuable connections to a child such as a coach or a teacher. Efforts to establish family conferencing extend beyond DCF staff. Training in family conferencing is now underway with private service providers to facilitate a more complete partnership with families. Family conferencing also is an area of focus for new domestic violence consultants who are starting their work in every area office with DCF staff to assess families and plan services for families where domestic violence is prevalent. The outcome for meeting children's needs also is the focus of much attention and energy at the Department. Similar to treatment plans, a new methodology and a recent case review indicates the need for considerably more work in this area. The Court Monitor review showed that needs was met in 62 percent of cases compared to 53 percent in the 1st quarter of 2004. Again we are a considerable distance from the goal. While this overarching measure of our work and the equally foundational measure of treatment planning present special challenges, we are developing a significant number of initiatives that will impact these two outcomes as well as lead to even more generalized advances in how we do our work and the quality of services we offer children and families. Initiatives that will improve assessments, treatment plans, and case decisions include the following: · Structured Decision Making: An evidence-based approach to delivering child welfare services that has proven valid and reliable. The decision to open a case for ongoing services is based upon an actuarial assessment of risk that is not individually predictive but assigns categories of risk based upon the family circumstances. Importantly this de-links case opening from an underlying 7

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substantiation, distinguishes safety from risk, and has tools that focus workers on assessing family strengths as well as needs. This will produce greater consistency in our work and will help in targeting resources to where they can be most effective. Importantly, this consistency offers one way to mitigate the disproportionality seen in child welfare across the nation. All staff will be trained starting January and will be completed by April. Implementation will take place as the training rolls out through the offices. · Global Appraisal Of Individual Needs: An evidence- based tool that was primarily designed for assessing treatment needs related to substance abuse. There are multiple versions that are essentially subsets of the full GAIN and are valid and reliable instruments. We have on staff in cooperation with the UCONN Health Center a nationally certified GAIN trainer who is in the process of training our investigation staff to employ the GAIN Short Scale as a part of our investigation protocol in all cases. Two offices, Bridgeport and New Britain, have been trained to date with a plan to complete all offices within the next 6 months. Our Intensive Family Preservation Providers are being trained in the administration of the GAIN Quick Scale and its follow up to implement as a part of their assessment services with the plan to complete that training by November of this year.

Initiatives that will improve how we deliver services include the following: · Differential Response: A recognized "promising practice" in child welfare that has been piloted in the Hartford community for the past 2 years. This approach will be taken statewide next fiscal year and the remainder of this fiscal year is dedicated to planning, policy and implementation readiness. DRS utilizes a nonblaming, strength-based, assessment approach to engage families in identifying needs for the majority of accepted reports to the Hotline. There is no associated substantiation or placement of any adult on the Central Registry. The traditional forensic-based approach of a CPS investigation will be utilized only for those cases indicating serious injury or risk of immediate harm to a child. Available research indicates better child welfare outcomes with this approach with no attendant increase in instances of child maltreatment. Intensive Safety Planning (ISP) At OTC Stage: Designed to provide intensive services immediately upon removal so a child can be safety returned home before the 20 day contested OTC trial. DCF staff will utilize the SDM Safety Assessment to guide the removal decision. These services, which will be delivered as a specific program by our existing IFP providers, also will be informed by the GAIN Quick assessment tool. The SDM Safety Assessment tool will be readministered as a guide in the decision regarding returning the child home. The model design is to provide the concrete services necessary to mitigate safety factors, and safety rather than risk will be the criteria for the return of the child. We anticipate this service will begin in most of the state by November and be available statewide by December.

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Initiatives that will improve specific services offered to children and families include the following: · Building Stronger Families: An evidence-based, integrated, in-home model for helping families with parents who need substance abuse treatment and children over the age of 7 who have suffered maltreatment and have mental health treatment needs. The Annie Casey Foundation supports this approach which currently is being piloted in New Britain and is a modification of the MST model. Services are being expanded to New Haven beginning in January 2007. Intensive Home Based Services aka "Family-Based Recovery" Treatment (for substance abusing parent): Similar to Building Stronger Families except that the children are under age 2. Targets substance abuse of parents and maltreatment issues. This in-home substance abuse treatment program focuses on parenting skills and repairing parent/child attachment issues. In the process of awarding 4 contracts and 1 region (northwest) is being re-bid. Each of the five programs will serve 12 families at a time. Services are expected to begin in January. Project SAFE Outreach And Engagement: Now in Hartford and New Haven, this program will become a component of ISP (see above) starting November. Case managers work in the home to address substance abuse. High participation is anticipated in contrast to traditional Project SAFE outcomes. Supportive Housing for Families: The Supportive Housing for Recovering Families Program (SHRF) offers family support services and safe housing to families involved with DCF. The program serves families statewide through a network of contractors managed by The Connection, Inc. Case management services are funded through DCF. Housing is funded through a combination of DCF funds, DSS Rental Assistance Program (RAP) certificates, and federal Section 8 Housing Vouchers. The program was recently expanded (July 06) to serve an additional 100 families increasing the total program capacity to 465 families. Short-Term Assessment Resource (STAR) Centers: STAR Centers are now replacing the outdated shelter system across Connecticut. Instead of reliance on traditional shelters, which have struggled to meet the changing needs of children, "STAR" Centers around the state will offer treatment and support planning for a more effective course of care.

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Taken together and in the context of all the other developments at the Department, we are equipping staff with an impressive array of tools to continue to make improvements in how we serve families and children and in the quality of services provided. At the same time, we recognize that more work remains to be accomplished and that challenges will always be present in the complex responsibilities that our staff face daily. We must also be forthright about the inadequacy of our foster family placement resources. Nationally, as in Connecticut, recruiting new foster homes and retaining foster 9

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homes presents a challenge. The Department continues work along several fronts to improve this resource. First, a significant infusion of management resources took place earlier this year. Five new program supervisors now focus exclusively on recruitment and retention in area offices around the state. Work continues to create quality standards for recruitment and retention activities across the 14 offices so that a uniform service delivery system and uniform levels of activity are established as well as enhanced data collection. In addition, the Department continues to research best practices around the nation as well as conduct research on attitudes among foster parents and the general public to improve recruitment and retention efforts. Because this resource is essential to meeting the placement and service goals we are making progress towards as a Department, this area of work will continue to have the focused attention from top leadership in the Department and local efforts will be earnestly supported. And, as the Department enters its final stages of producing its multiyear master plan for foster care, a plan produced with considerable input from sources internal and external to DCF, we expect 2007 to be a pivotal year for realizing the state's potential for developing family foster care. The plan's development has already resulted in positive changes, and we are confident that the steady stream of activities we are committing to over time will evolve our resource.

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Department staff in the area offices and in the central office are taking great advantage of the opportunity presented by the Exit Plan to make strides in our work with children and families. Due to the complicated nature of this work, there will always be the need to continue improvements. There can be no saying "good enough" when working with vulnerable children and families in challenging situations. At the same time, it is clear that staff already have instituted dramatic improvements in our work. None of the outcomes can be taken for granted, but many of the outcomes are firmly established in the routines of our practice. Challenges remain, but we are making important headway and are prepared to institute further structural reforms that promise further improvements. Staff have demonstrated that they have embraced the values that lie behind the Exit Plan outcomes and that those values are driving all of their work. This will have positive effects that will spread far beyond the 22 measures.

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3Q July 1-September 30, 2006 Exit Plan Report

Outcome Measure Overview
Measure Measure Baseline 1Q 2004 2Q 2004 3Q 2004 4Q 2004 1Q 2005 2Q 2005 3Q 2005 4Q 2005 1Q 2006 2Q 2006 3Q 2006

1: Investigation Commencement 2: Investigation Completion 3: Treatment Plans**

>=90% >=85% >=90%

X 73.7% X 58% 9.3% 1.2% 57.8% 12.5% 60.5% 57% 6.9% X X 94.9% X Monthly Quarterly X 69.2% 13.5% 61% X 5.6%

X 64.2% X 93% 9.4% 0.5% X 10.7% 62.8% 65% X X X 88.3% 53% 72% 87% 39% 73.1% 13.9% 74% 43% 19.0%

X 68.8% X 82% 8.9% 0.8% X 11.1% 52.4% 53% X 95.8% 100% 92.0% 57% 86% 98% 40% 100% 14.3% 52% 64% 24.5%

X 83.5% 10% 44.6% 9.4% 0.9% X 29.6% 64.6% X X 95.2% 100% 93.0% 53% 73% 93% 46% 100% 14.7% 93% 56% 48.9%

91.2% 91.7% 17% 49.2% 8.9% 0.6% X 16.7% 63.3% X X 95.5% 100% 95.7% 56% 81% 91% 33% 100% 13.9% 83% 60% 44.7%

92.5% 92.3% X 65.1% 8.2% 0.8% X 33% 64.0% X X 96.2% 100% 97% X 77.9% 93.3% X 100% 13.7% X X 55.4%

95.1% 92.3% X 89.6% 8.5% 0.7% X 25.2% 72.8% X X 95.7% 100% 95.9% X 86.7% 95.7% 81.9% 100% 12.6% X X 52.1%

96.2% 93.1% X 89.9% 9.1% 0.8% 64.2% 34.4% 64.3%* 96% 7.2% 95.8% 100% 94.8% X 83.3% 92.8% 78.3% 99.8% 11.8% 96% 78% 54.6%

96.1% 94.2% X 93.9% 7.3% 0.6% 61% 30.7% 72.4% 94% 7.6% 96% 100% 96.2% X 85.6% 91.9% 85.6% 100% 11.6% 92% 70% 72.1%

96.2% 94.2% X

96.4% 93.1% X

98.7% 94.2% 54%

4: Search for Relatives* >=85% 5: Repeat Maltreatment 6: Maltreatment OOH Care 7: Reunification* 8: Adoption 9: Transfer of Guardianship 10: Sibling Placement* 11: Re-Entry 12: Multiple Placements 13: Foster Parent Training 14: Placement Within Licensed Capacity 15: Needs Met** 16: Worker-Child Visitation (OOH)* 17: Worker-Child Visitation (IH)* 18: Caseload Standards+ 19: Residential Reduction 20: Discharge Measures 21: Discharge to DMHAS and DMR 22: MDE <=7% <=2% >=60% >=32% >=70% >=95% <=7% >=85% 100% >=96% >=80% >=85% 100% >=85% 100% <=11% >=85% 100% >=85%

93.1% 2/15/07* 5/15/07*
6.3% 0.4% 66.4% 40.8% 60.7% 75% 6.7% 96.2% 100% 95.2% X 86.8% 93.1% 86.2% 100% 11.3% 85% 95% 91.1% 7.0% 0.7% 64.4% 36.9% 63.1% 77% 7.5% 96.6% 100% 94.5% X 86.5% 90.9% 87.6% 100% 10.8% 91% 97% 89.9% 7.9% 0.8% 62.5% 27% 70.2% 83% 4.3% 95.6% 100% 96.7% 62% 92.5% 91.5% 85.7% 100% 10.9% 100% 100% 86%

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Results based on Case Reviews
OM 4 7, 11 Comments Link report posted for 3Q 2006 reflecting status of children entering care for the 1Q 2006 period. This is consistent with the Exit Plan measure definition. Refer to 1Q 2006 column. LINK data via ROM report (as of 4Q 2005). Case Review no longer necessary. For 3Q 2006 Adoption results, 6 were n/a. A Case review was conducted to determine the status of these n/a cases. Adoption: The following shows the results of the 6 case review: 0 met, 4 not met and 2 were non-applicable (1 was a duplicate and 1 adoption via probate for) and dropped from the totals. Re-calculated statewide results (total of 111adoptions): 27% (30) met and 73% (81) not met. 8, 9 TOG results. A case review was conducted to determine the status of all 135 cases. TOG: The following shows the results of the case review: 73 met and 31 not met and 31 not-applicable (all n/a were reunify back to parent/legal guardian). Re-calculated statewide results show (total of 104 transfers of guardianship): TOG -70.2% met the goal and 29.8 % not met.

10 16, 17

ROM with full supplemental case review. As of 3Q 2005 the Department will include the one visit per quarter results for OM 16. This method reports all children in care who had 1 (one) visit during the quarter period. The LINK system is unable to determine if the visits were made by the assigned social worker as indicated in the Exit Plan.

Treatment Plans**
** Conducted by the Court Monitor's Office.

2006 1Q N/A 2Q N/A 3Q 54% (refer to Court Monitor's Report for results of their case review)

2006 In addition, two (2) additional areas were evaluated: Treatment plan must be written and treatment conference conducted in the family's primary language and treatment plans developed in conjunction with parents/child/service providers (for example, treatment plan modifications as a result of input from the ACR). 1Q N/A 2Q N/A 3Q 100% (refer to Court Monitor's Report for results of their case review)

Caseload Standards +
2006 1Q As of May 15, 2006 the Department met the 100% compliance mark. The sixty (60) cases over 100% caseload utilization meet the exception criteria (cases over 100% and not over for 30 days or more). 2Q As of August 15, 2006 the Department met the 100% compliance mark. The thirty (30) cases over 100% caseload utilization meet the exception criteria (cases over 100% and not over for 30 days or more). 3Q As of September 30, 2006 the Department met the 100% compliance mark. The forty (40) cases over 100% caseload utilization meet the exception criteria (cases over 100% and not over for 30 days or more).

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Method of Measurement

Key Action Steps
A) Developed LINK capacity to document and measure commencement time and modifications to commencement time. Provided corresponding LINK training to staff. Completed

Status

B) Revision of policy #34-3-3 "Conducting the Investigation"- To direct that the Social Completed. Work Supervisor can approve modification of commencement times. Previously, Program Supervisor approval was required and was inefficient.

1. Commencement of Investigation: to assure that assessments of safety can quickly be determined and increases collaborative interviewing and intervention. 90% of all reports must be commenced same calendar day, 24 hours or 72 hours depending on referral code.

C) Area Offices use LINK data reports to assess staffing levels in investigations and take Ongoing. any supervisory or practice improvement steps necessary to ensure performance goals.

2006 3Q ­ 98.7%

LINK report (ROM supplemental report)

D) Central Office will work with any Area Office not meeting goal as reported. Central Ongoing. Office Liaison teams assigned to all 14 area offices. The teams include: Positive Outcomes for Children leads, Quality Improvement Division liaison, Training Academy liaison, and LINK staff. Together with the Quality Improvement Program Supervisor and Area Director, the Central Office Liaison team assists in conducting case reviews, conducting learning forums and presentations and informing the area office of outcome measure data results. E) Area Office Quality Improvement Plans to reflect areas for improvement. Ongoing.

A) Implement a quality review process in each Area Office that serves as a tickler system Completed. at 28, 35, and 40 days and calls for any corrective action plans. B) Developed a quality review process for the Special Investigations Unit through Hotline. C) Area Office Quality Improvement Plans to reflect areas for improvement. Completed. Ongoing.

2. Completion of Investigation: to assure that case assessment and disposition is handled in a timely manner. 2006 3Q ­ 94.2% 85% of all reports shall have their investigations completed within 45 calendar days of acceptance. LINK report (ROM supplemental report)

D) Central Office will work with any Area Office not meeting goal as reported. Central Ongoing. Office Liaison teams assigned to all 14 area offices. The teams include: Positive Outcomes for Children leads, Quality Improvement Division liaison, Training Academy liaison, and LINK staff. Together with the Quality Improvement Program Supervisor and Area Director, the Central Office Liaison team assists in conducting case reviews, conducting learning forums and presentations and informing the area office of outcome measure data results. E) Developed standards for the release of information that assists with the sharing of information between DCF and community providers and/or other state agencies. Completed.

F) The department proposed legislation requesting a change in the statutory requirement PASSED: Effective October 1, 2005. Staff informed via all staff of completing investigations within 30 days. This request change extended the statutory Commissioner e-mail and via the newly developed SWS Guide to Exit requirement to 45 days to comport with the Exit Plan. Plan and Practice Points.

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Method of Measurement

Key Action Steps
A) Train and implement in all area offices on the agency's new Family Conferencing Model, develop & implement a method to evaluate its success and/or areas needing improvement through feedback from families, staff, management and providers.

Status
Phase II in process which involves consultation and coaching for all Area Offices, outreach to Behavioral Health partners, and development of a partnership with Area Office Domestic Violence consultants (Novemeber 2006). December 2006 expected completion of Family Conference Evaluation Report. Development of a Family Conference Training Video underway with an expected completion date of January 2007. Released September 2006.

B) Develop a web-based Uniform Case summary-prototype that provides a quick case summary view and helps to improve data entry.

C) Development of an enhanced assessment model through Structured Decision-Making Implementation targeted for January 2007. (SDM). Steering committee established. D) The Managed Service System develops a process for review and coordination of Ongoing. discharge plans for all children in residential care and to identify all community resources in support of children to remain in their communities. E) Continue to advance major training activities treatment planning and concurrent Concurrent Planning Training completed for social work supervisors and planning and modify current LINK screens for Treatment Plans and enhance methods for managers; make-up sessions at the Training Academy currently scheduled. case documentation (short-term=Pilot; long term=SharePoint Pilot testing new template Treatment Planning Training completed for the newly revised guide. and tool underway).

3. Treatment Plans: to provide a familycentered foundation from which all case service planning will occur-timeframes, roles and responsibilities-and a means for assessing service outcomes and needs met. Within 60 days of case opening in treatment, or 60 days from date of placement- whichever comes sooner. Random reviews done by DCF and Court Monitor.

2006 3Q ­ 54%

Case Review

F) Central Office will work with any Area Office not meeting goal as reported. Central Instituted 7/04 and ongoing. Office Liaison teams assigned to all 14 area offices. The teams include: Positive Outcomes for Children leads, Quality Improvement Division liaison, Training Academy liaison, and LINK staff. Together with the Quality Improvement Program Supervisor and Area Director, the Central Office Liaison team assists in conducting case reviews, conducting learning forums and presentations and informing the area office of outcome measure data results. G) Area offices have broadened the consultation capacity of the Area Resource Group to Domestic violence specialists have been added to the hiring of Global assist in the development of a treatment plan for complex cases requiring significant Assessment Specialists. October 2006 supports (i.e. Parents with Cognitive Limitations, Medically Complex cases, etc.). H) Expand Area Office's capacity of teleconference for the ACR process into the Family Completed. Conferencing arena placed in Newsletter and foster parent pay checks. I) Train Area Office staff, particularly Social Work Supervisors, on the treatment plan Completed and included in SWS Guide. Completed the development of a elements necessary under the Exit Plan, methods and practices useful to successful structured treatment plan (tools and process) for use by area offices treatment planning. Newly revised and comprehensive Treatment Plan Guide developed. (optional use). Dissemination to all staff by Fall 2006. Developed tools and guidance to assist staff in integrating treatment planning into worker/client visits and supervisory conferences. J) Implement Multidisciplinary Assessment for Permanency (MAP) for each area office. All area offices have integrated MAP into practice. QID/ACR divisions Legal consult completed for all children in out of home care at 6 months (prior to the conducting ongoing evaluation to determine feasibility to broaden use of ACR). This brings together legal, medical, behavioral health, and cps staff to identify MAP. outstanding issues that need to be addressed before filing the permanency plan.

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Method of Measurement

Key Action Steps

Status

A) Implemented the Placement Resource Search window in one central place in LINK for Completed. Exception "tracking" report posted on intranet and created for accurate and easily accessible documentation of placement resource search efforts and use by the area office staff. institute tickler system at fifth month to identify those cases that do not have a window.

B) Use family conferencing model to assist in the identification of appropriate relative resources early on in the life of the case. C) Revise Search ­ Requests for Identifying Information policy (41-40-8) and Affidavit

Ongoing.

Awaiting approval.

D) Provide training and guidelines to social work staff regarding all possible "search" options (i.e. tools, websites, etc.) and implement the use of Locate Plus software when normal search efforts fail.

Complete. Utilization review for 2006 indicates that all area offices are active and online with Locate Plus Basic Plan or above.

4. Search for Relatives: to increase the availability of supports for children consistent with the goal of keeping them within their community and in maintaining lifelong family ties. DCF shall conduct searches for relatives, extended or informal networks, friends, family, former foster parents or other significant persons known to the child. Must be documented in LINK.

E) Started Casey Family Programs Supporting Kinship Care Collaborative in the Bridgeport area office.

Completed.

2006 3Q ­ 93.1% Data reflects 2006 Qtr 1 due to a 6-month lag

LINK report (ROM supplemental report)

F) Central Office will work with any Area Office not meeting goal as reported. Central Ongoing. Office Liaison teams assigned to all 14 area offices. The teams include: Positive Outcomes for Children leads, Quality Improvement Division liaison, Training Academy liaison, and LINK staff. Together with the Quality Improvement Program Supervisor and Area Director, the Central Office Liaison team assists in conducting case reviews, conducting learning forums and presentations and informing the area office of outcome measure data results.

G) Area Office Quality Improvement Plans to reflect areas for improvement.

Ongoing.

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Method of Measurement

Key Action Steps
A) Develop various data analysis tools such as ROM and Chapin Hall to support evidencebased practice and strengthen the method in which social work supervisors and program supervisors direct and assess case decision making and need for services.

Status
ROM is currently providing numerous reports that are Exit Outcome related (exception reports) and reports meeting the Exit Planning Data reporting criteria. All Area Offices have received training. ROM training is offered as an in-service (refresher and advanced) out of the Training Academy or at the Area Offices. Tracking of utilization and customer support is ongoing. Completed and ongoing. Implementation target for January 2007.

B) Increase the consistency of handling and identifying repeat maltreatment via training and supervision. Correspondingly review and revise policy to reflect practice. C) Development of an enhanced assessment model through Structured Decision-Making (SDM). Steering Committee established.

D) Central Office will work with any Area Office not meeting goal as reported. Central Office Instituted 7/04 and ongoing. Liaison teams assigned to all 14 area offices. The teams include: Positive Outcomes for Children leads, Quality Improvement Division liaison, Training Academy liaison, and LINK staff. Together with the Quality Improvement Program Supervisor and Area Director, the Central Office Liaison team assists in conducting case reviews, conducting learning forums and presentations and informing the area office of outcome measure data results.

5. Repeat Maltreatment: to reduce incidents of maltreatment and maintain and provide services to children in order for them to remain with their families and in their communities. No more than 7% of children who are victims of substantiated maltreatment during a 6-month period shall be the substantiated victims of additional maltreatment during a subsequent 6-month period. 2006 3Q ­ 7.9% LINK report (ROM supplemental report)

E) Critical Response Reviews/Special Case Reviews Study (CRR/SCR) committee established to look at patterns of incidents, agency process and procedures, and if any training/practice improvement steps are necessary. F) Parent/Child Centers (PEAS) established to provide screening and assessments, targeted hands-on parenting education and family support services to parents, caregivers, family members, and children up to 8 years of age who are referred by the department. G) Development of a CT Behavioral Health Partnership a collaboration between the Department of Children and Families, the Department of Social Services, and Value Options, Inc. to revise the fiscal and administrative structure of publicly funded behavioral health services for HUSKY A children and Adults, HUSKY B children and Non-Medicaid eligible children who are DCF involved and who present with complex behavioral health needs. Oversight and consultation around this initiative is provided by the Behavioral Health Oversight Council, a legislatively mandated body that meets monthly with the Departments and VO. VO operates and Administrative Services Organization (ASO) that is contracted by the Departments to provide clinical review of each child/adult who presents for a behavioral health service, authorize, track and monitor care, prepare utilization and quality assurance reports to the Departments. The ASO is also responsible for identifying service gaps, tracking and monitoring children in delayed discharge status and informing both DSS and DCF around service enhancement or new service delivery. H) Develop new Intensive Reunification Services through RFP to offer an array of services to families along a continuum that promotes reunification/permanency for children using federal funds. I) Expanded intensive in-home services such as IICAPS and MST for those children with behavioral health issues in order to avoid re-entry into care through budget options. J) The ISP Program will provide short-term, intensive, home-based services to families initiated within 48 hours of a child's removal from the home. The purpose of this initiative will be to provide concrete services focused on mitigating safety factors to a level where reunification, within 20 days of the removal, can be considered.

Currently a database has been established to collect all findings from the CRRs and SCR (conducted by Child Welfare League of America). Results are used to inform Area Office management teams. Completed. PEAS assigned to all area offices.

ASO authorizes all Medicaid funded behavioral health services for the eligible HUSKY and DCF populations and care for children who utilize residential and group home levels of care. Daily census reports are produced and identify all who receive services and status of their progress within that level of care. ASO staff (Systems Managers) work closely with Area Offices to finalize and implement recommendations within the Local Area Development Plans (LADP) which serve as local blueprints for further system and service development Peer Specialists are providing direct clinical support and education to consumers and parents around available services and supports and are working with Systems Managers to implement various goals and action steps within the LADPs. Intensive Care Managers are also assigned to Area Offices and are working with staff to help develop appropriate discharge plans for children using highly restrictive levels of care or for those "stuck" in Emergency Departments. Completed. Pilot sites in Waterbury and Manchester have continued and the programs are currently being evaluated to identify if modifications to the

program (e.g. target population and referral criteria) are necessary.
Budget approved (July 2006) for a 1.2 million expansion. Providers have been selected for Middletown, Waterbury, and Norwalk/Stamford Area Offices. The initial phase of pre-service training on Global Appraisal of Individual Need ­ Quick tool and SDM (specifically the Risk Assessment tool) orientation of both ISP and IFP staff is complete. ISP services for first set of contracts to start by 12/1/06 and those under the second set of contracts will begin late 12/06. Processing of contract with Advance Behavioral Health for data management of the GAIN-Q data will be completed by 11/15/06.

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Method of Measurement

Key Action Steps
A) Develop various data analysis tools such as ROM and Chapin Hall to support evidence-based practice and strengthen the method in which social work supervisors and program supervisors direct and assess case decision making and need for services.

Status
ROM is currently providing numerous reports that are Exit Outcome related (exception reports) and reports meeting the Exit Planning Data reporting criteria. All Area Offices have received training. ROM training is offered as an in-service (refresher and advanced) out of the Training Academy or at the Area Offices. Tracking of utilization and customer support is ongoing.

B) Moved Special Investigations management from Hotline to a direct report under Bureau Chief for Child Welfare. In addition, to provide consistency with investigating and tracking of foster care maltreatment, reports of abuse/neglect concerning foster families have been moved to the Special Investigation Unit and are now centralized.

Completed.

6. Maltreatment in care - Out-of-home: to assure children's safety while in out-ofhome care, improve placement stability, and reduce additional trauma. No more than 2% of children in out of home care shall be the victims of substantiated maltreatment by substitute caretaker.

2006 3Q ­ 0.8%

LINK report (ROM supplemental report)

C) Develop and implement a corrective action plan protocol for all regulatory violations Completed. and all out-of-home substantiations. Incorporate any corrective action plans into Foster Family Support Plan.

D) Central Office will work with any Area Office not meeting goal as reported. Central Ongoing. Office Liaison teams assigned to all 14 area offices. The teams include: Positive Outcomes for Children leads, Quality Improvement Division liaison, Training Academy liaison, and LINK staff. Together with the Quality Improvement Program Supervisor and Area Director, the Central Office Liaison team assists in conducting case reviews, conducting learning forums and presentations and informing the area office of outcome measure data results.

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Method of Measurement

Key Action Steps
A) Area Office Quality Improvement Plans to reflect areas for improvement. Ongoing.

Status

B) Implement Multidisciplinary Assessment for Permanency (MAP) for each area office. All area offices have integrated MAP into practice. QID/ACR divisions Legal consult completed for all children in out of home care at 6 months (prior to the conducting ongoing evaluation to determine feasibility to broaden use of ACR). This brings together legal, medical, behavioral health, and cps staff to identify MAP. outstanding issues that need to be addressed before filing the permanency plan. C) Expansion of Supportive Housing Contract ­ Connection Inc. by $2.1 million; increase capacity to serve 345 families in Hartford, Bridgeport, Danbury and Torrington areas. Establish priority access for family preservation/reunification referrals. D) Implementation of formalized supervisory conference- SWS to discuss viability of current permanency goal for all children in OOH care at 3 months. Completed. Connections (80 contract) provides quarterly and yearly reports. DCF monitoring program and in 2005 demonstrated a 90% success rate. Assistant Bureau Chief for Child Welfare with technical assistance from IS and Results Management has developed a series of permanency management reports to better track and resolve barriers to achieving permanency. These reports are available through the DCF intranet site. ROM is currently providing numerous reports that are Exit Outcome related (exception reports) and reports meeting the Exit Planning Data reporting criteria. All Area Offices have received training. ROM training is offered as an in-service (refresher and advanced) out of the Training Academy or at the Area Offices. Tracking of utilization and customer support is ongoing.
Completed. Pilot sites in Waterbury and Manchester have continued and the programs are currently being evaluated to identify if modifications to the

7. Reunification: to reduce the length of time children are in care, minimize trauma from separation, allow opportunities for children to maintain connectedness to family and community, help parents safeguard their homes, and recognize the importance of expediting permanency planning. 60% of children who are reunified with parents/guardians shall be reunified within 12 months of their most recent removal from home.

E) Develop ROM reports to strengthen the tracking of Federal ASFA timelines (reunification within 12 months of most recent placement) and the identification of family/child characteristics or gaps in services that become barriers to the successful achievement of this outcome measure.

2006 3Q ­ 62.5%

ROM report with supplemental case review.

F) Develop new Intensive Reunification Services through RFP to offer an array of services to families along a continuum that promotes reunification/permanency for children using federal funds. Targeted for Waterbury, Manchester. G) Expand intensive in-home services such as IICAPS and MST for those children with behavioral health issues in order to avoid re-entry into care through budget options. H) Concurrent Planning Training will be offered to staff (targeting social workers with OOH cases) that focuses on enhancing skills. Curriculum secured through the NRC.

program (e.g. target population and referral criteria) are necessary. Budget approved (July 2006) for a 1.2 million expansion. Completed. Next Phase will address integration into the Training Academy pre-service and in-service trainings.

I) Ensure Flex Funds policy and guidelines support reunification efforts and postCompleted. reunification needs by meeting emergency needs that if not addressed result in crisis and often re-entry into care. J) Central Office will work with any Area Office not meeting goal as reported. Central Ongoing. Office Liaison teams assigned to all 14 area offices. The teams include: Positive Outcomes for Children leads, Quality Improvement Division liaison, Training Academy liaison, and LINK staff. Together with the Quality Improvement Program Supervisor and Area Director, the Central Office Liaison team assists in conducting case reviews, conducting learning forums and presentations and informing the area office of outcome measure data results. K) Provide training and guidelines to social work staff regarding all possible "search" options (i.e. tools, websites, etc.) and implement the use of Locate Plus software when normal search efforts fail. Complete. Utilization review for 2006 indicates that all area offices are active and online with Locate Plus Basic Plan or above.

L) Parent/Child Centers (PEAS) established to provide screening and assessments, Completed. PEAS programs assigned to area offices. targeted hands-on parenting education and family support services to parents, caregivers, family members, and children up to 8 years of age who are referred by the department.

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Method of Measurement

Key Action Steps

Status

M) Development of a CT Behavioral Health Partnership a collaboration between the ASO authorizes all Medicaid funded behavioral health services for the Department of Children and Families, the Department of Social Services, and Value eligible HUSKY and DCF populations and care for children who utilize Options, Inc. to revise the fiscal and administrative structure of publicly funded behavioral residential and group home levels of care. Daily census reports are health services for HUSKY A children and Adults, HUSKY B children and Nonproduced and identify all who receive services and status of their progress Medicaid eligible children who are DCF involved and who present with complex within that level of care. ASO staff (Systems Managers) work closely with behavioral health needs. Oversight and consultation around this initiative is provided by Area Offices to finalize and implement recommendations within the Local the Behavioral Health Oversight Council, a legislatively mandated body that meets Area Development Plans (LADP) which serve as local blueprints for monthly with the Departments and VO. VO operates and Administrative Services further system and service development Peer Specialists are providing Organization (ASO) that is contracted by the Departments to provide clinical review of direct clinical support and education to consumers and parents around each child/adult who presents for a behavioral health service, authorize, track and monitor available services and supports and are working with Systems Managers to care, prepare utilization and quality assurance reports to the Departments. The ASO is implement various goals and action steps within the LADPs. Intensive also responsible for identifying service gaps, tracking and monitoring children in delayed Care Managers are also assigned to Area Offices and are working with discharge status and informing both DSS and DCF around service enhancement or new staff to help develop appropriate discharge plans for children using highly service delivery. restrictive levels of care or for those "stuck" in Emergency Departments.
N) The ISP Program will provide short-term, intensive, home-based services to families initiated within 48 hours of a child's removal from the home. The purpose of this initiative will be to provide concrete services focused on mitigating safety factors to a level where reunification, within 20 days of the removal, can be considered. Providers have been selected for Middletown, Waterbury, and Norwalk/Stamford Area Offices. The initial phase of pre-service training on Global Appraisal of Individual Need ­ Quick tool and SDM (specifically the Risk Assessment tool) orientation of both ISP and IFP staff is complete. ISP services for first set of contracts to start by 12/1/06 and those under the second set of contracts will begin late 12/06. Processing of contract with Advance Behavioral Health for data management of the GAIN-Q data will be completed by 11/15/06.

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Method of Measurement

Key Action Steps
A) Implement Multidisciplinary Assessment for Permanency (MAP) for each area office. Legal consult completed for all children in out of home care at 6 months (prior to the ACR). This brings together legal, medical, behavioral health, and cps staff to identify outstanding issues that need to be addressed before filing the permanency plan.

Status
All area offices have integrated MAP into practice. QID/ACR divisions conducting ongoing evaluation to determine feasibility to broaden use of MAP.

Ongoing. 3 memos distributed between 2004 and May 2005 clarifying perceived B) Continued reinforcement by permanency managers clarifying the "perceived wait period" for adoption finalization (staff was reporting that they had to "wait" 12 months after placement to finalize wait period reinforcement of parameters to be completed by area office management. adoption--effort is aimed at clearing up confusion with the law). C) Decentralize the processing of finalizing adoptions. Each area office will be responsible for this function to streamline. Subsidy requests will continue to be processed through OFAS. Training and implementation completed. D) Secured budget option to create greater incentives for adoption ­ including support to adoptive parents, tuition for college and enhanced SW training. E) Concurrent Planning Training will be offered to staff (targeting social workers with OOH cases) that focuses on enhancing skills. Curriculum secured through the NRC. Completed.

Implemented. Phase II in development. Policy updates completed and awaiting publication. Completed. Next Phase will address integration into the Training Academy preservice and in-service trainings.

F) Allocation of $250,000 for specific recruitment activities: Expand the support and development of Ongoing tracking and evaluation of the program has identified the need for restructuring some of the Ministries to further enhance license capacities and support. recruitment initiatives to meet the special cultural and ethnic needs of our children that will provide stable and long-lasting permanency using in-house, private contract and faith-based networks. G) Data reports (i.e. LINK Reports, ROM tool and Chapin Hall) to track individual/unit performance, ROM is currently providing numerous reports that are Exit Outcome related identify trends and target supervisory discussions for children in Out-of-Home care. (exception reports) and reports meeting the Exit Planning Data reporting criteria. All Area Offices have received training. ROM training is offered as an in-service (refresher and advanced) out of the Training Academy or at the Area Offices. Tracking of utilization and customer support is ongoing.

8. Adoption: promotes and emphasizes permanency for children in out-of-home care, decreases trauma, and focuses DCF and courts in an effort to make adoptions more timely and successful. 32% of the children who are adopted shall have their adoptions finalized within 24 months of most recent removal from home.

2006 3Q ­ 27%

LINK report (ROM supplemental report)

H) Resource Family Development model to promote long-lasting support resources for children in out of home care. This effort promises early identification of permanent resources and helps to reduce placement instability. The Department has moved towards this model and imbedded the core values into materials and speaking points for recruitment efforts, marketing materials, and in the PRIDE curriculum (revised and being offered as of June 2005). I) Revise Permanency Planning policy to standardize the approval process for selecting appropriate families for available children and ensuring successful and timely identification of adoptive parents. J) Development of a CT Behavioral Health Partnership a collaboration between the Department of Children and Families, the Department of Social Services, and Value Options, Inc. to revise the fiscal and administrative structure of publicly funded behavioral health services for HUSKY A children and Adults, HUSKY B children and Non-Medicaid eligible children who are DCF involved and who present with complex behavioral health needs. Oversight and consultation around this initiative is provided by the Behavioral Health Oversight Council, a legislatively mandated body that meets monthly with the Departments and VO. VO operates and Administrative Services Organization (ASO) that is contracted by the Departments to provide clinical review of each child/adult who presents for a behavioral health service, authorize, track and monitor care, prepare utilization and quality assurance reports to the Departments. The ASO is also responsible for identifying service gaps, tracking and monitoring children in delayed discharge status and informing both DSS and DCF around service enhancement or new service delivery.

Final recommendations, from the Facilitated Dialogues, support the transition to a resource family model that increases the role of foster families in supporting birth families and permanency for children. Tools were further enhanced to ensure better matching of foster families to children.

Completed.

K) Collaborative with Casey Family Services to increase adoption-competent mental health practitioners in the community to increase support for adoptive families. L) DCF contracted with CAFAP to operate KID HERO line to allow for longer hours and quicker turn Completed March 1, 2005. around for foster parent inquiries. M) Provide training and guidelines to social work staff regarding all possible "search" options (i.e. tools, websites, etc.) and implement the use of Locate Plus software when normal search efforts fail.

ASO authorizes all Medicaid funded behavioral health services for the eligible HUSKY and DCF populations and care for children who utilize residential and group home levels of care. Daily census reports are produced and identify all who receive services and status of their progress within that level of care. ASO staff (Systems Managers) work closely with Area Offices to finalize and implement recommendations within the Local Area Development Plans (LADP) which serve as local blueprints for further system and service development Peer Specialists are providing direct clinical support and education to consumers and parents around available services and supports and are working with Systems Managers to implement various goals and action steps within the LADPs. Intensive Care Managers are also assigned to Area Offices and are working with staff to help develop appropriate discharge plans for children using highly restrictive levels of care or for those "stuck" in Emergency Departments. Completed. Post-adoption support services available through UCONN Health Center.

Complete. Utilization review for 2006 indicates that all area offices are active and online with Locate Plus Basic Plan or above.

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Method of Measurement

Key Action Steps
A) Area Office Quality Improvement Plans to reflect areas for improvement and progress. Ongoing.

Status

B) Implement a Licensing Review Team for consideration of waivers for relative Completed. caregivers who have been denied licensure due to substantiated CPS history and/or criminal history. C) Revised subsidized guardianship policy (41-50-1 through 41-50-14) to reflect current Completed. practice and ASFA timeframes. D) Revise Permanency Planning Team policy (48-14-6 through 48-14-6.5) to refle