Free Order - District Court of Connecticut - Connecticut

Case 2:89-cv-00859-AHN

Document 524-3

Filed 09/11/2006

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DCF Court Monitor's 2006 Protocol for Outcome Measures 3 and 15 August 2006 Final Draft

Assessment of Risk upon Review
Are there clear risk factors present that are not being appropriately assessed and addressed by the assigned Social Worker and/or Social Work Supervisor and therefore are placing the child at serious risk as it applies to safety, well-being or permanency? 1. Yes No 2. 3. UTD ­ No SWS narratives in LINK during this period

(If risks present serious concern, refer case to Review Supervisor so that Ombudsman can be notified to address situation.)

Case ID Number: ___________________

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DCF Court Monitor's 2006 Protocol for Outcome Measures 3 and 15
Administrative:
A1. Reviewer Name: 1. Kathy Acosta 2. Deb Collins 3. Mary Corcoran 4. Liz Cyr 5. Tom Gallese 6. Juliann Harris 7. 8. 9. 10. 11. MaryAnn Hartmann Ray Mancuso Jorge Martinez Barbara O'Connell Fred North 13. 14. 15. 16. 17. Susan Marks Roberts Joni Beth Roderick Sandra Tapia Michelle Turco Other (Indicate below)

A2. Date of Case Review LINK Extraction: ________/_________/_________ (MM/DD/YYYY) A3. Date of TPC/ACR Attended: ________/_________/________ (MM/DD/YYYY) A4. Date of Review of Treatment Plan post TPC/ACR: ______/_______/______ (MM/DD/YYYY) A5. Quarter of Review for Outcome Measure 3: _________ (enter as qtr-year: e.g. 1-06) A6. Period of Review for Outcome Measure 15 (enter month and year of prior plan to date of current plan reviewed for OM 3: ________/__________ through __________/ ___________ mm / yyyy mm / yyyy A7. Review Supervisor's Initials: ____________

Descriptive Information:
D1. LINK Case Number: _________________ D2. Date the case was most recently opened/reopened: ____/_____/_______(MM/DD/YYYY) D3. What was the cause for DCF's involvement on this date? Check all that apply . a. Abandonment 1. Yes b. c. d. e. f. g. h. i. j. k. l. Domestic Violence Educational Neglect Emotional Neglect Emotional Abuse/Maltreatment Medical Neglect Moral Neglect Physical Abuse Physical Neglect Sexual Abuse Substance Abuse/Mental Health (parent) 1. 1. 1. 1. 1. 1. 1. 1. 1. 1. 1. 1. Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

2. 2. 2. 2. 2. 2. 2. 2. 2. 2. 2. 2. 2.

No No No No No No No No No No No No No

Voluntary Services Request for medical/mental health/substance abuse/behavioral health of child m. Child's TPR prompted new case open under child's name

Case ID Number: ___________________

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D3a. Primary Reason cited: __________________________ (of those listed in chart above, indicate primary reason) D4. What is the name of the assigned Social Worker that wrote (or was responsible to write) the treatment plan for the quarter under review? _________________________________________________ (Last Name, First Name) D5. What is the name of the assigned Social Work Supervisor at the time of the treatment plan for the quarter under review? _________________________________________________ (Last Name, First Name) D6. Social Worker's Area Office: 1. Bridgeport 2. Danbury Greater New Haven 3. Hartford 4. 5. Manchester Meriden 6. Middletown 7. 8. New Britain New Haven Metro 9. 10. Norwalk Norwich 11. Stamford 12. 13. Torrington Waterbury 14. Willimantic 15. D7. What type of case assignment is noted in LINK record? 1. CPS In-home family (IHF) case 2. CPS child-in-placement (CIP) case Voluntary Services in-home family (VSIHF) case 3. Voluntary Services child-in-placement (VSCIP) case 4. 5. Associated CIP Family Case (ACIPF) 6. Associated Voluntary Services Family Case (ACSCIPF) D8. LINK Family Case or Child's Name: _______________________________________ (Last Name, First Name) D9. Child's Date of Birth: ______/_______/________ (MM/DD/YYYY) (enter 11/11/9999 if IHF, VSIHF or ACIPF/ACSCIPF) D10. Current legal status 1. Not Committed 2. Committed Dually Committed 3. TPR/Statutory Parent 4. 5. Order of Temporary Custody 96 hour hold 6. Protective Supervision 7. 8. N/A - In-home CPS case with no legal involvement N/A - In-home Voluntary Service 9. D10.a Does child in placement have involvement with juvenile justice system? 1. Yes No 2. 3. N/A ­ In-home CPS or voluntary service case

Case ID Number: ___________________

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D11. Race (Child's or Family Case Name): 1. American Indian or Alaskan Native 2. Asian Black/African American 3. Native Hawaiian 4. 5. White Unknown 6. Blank (no race selected in LINK) 7. 8. UTD Multiracial 9. D12. Ethnicity (Child's or Family Case Name): 1. Hispanic 2. Non-Hispanic Blank (no ethnicity selected in LINK) 3. Unknown 4. D13. For Child in Placement has TPR been filed? 1. Yes 2. No N/A ­ Compelling Reason noted in LINK 3. N/A ­ child's goal and length of time in care do not yet require termination of parental 4. rights 5. N/A ­ In-home case (CPS or Voluntary Services) D13.a Enter the date of filing here: ________/_________/__________ (11/11/9999 if not applicable) D13.b Has TPR been granted? 1. Yes No 2. 3. N/A ­ DCF did not file TPR N/A ­ In-home case (CPS or Voluntary Services) 4. D13.c Enter date that TPR was granted: ________/________/_________ (11/11/9999 if not applicable)

D14. Date of most recent removal episode? _________/___________/____________ (MM/DD/YYYY) D15. How many consecutive months has this child been in out-of-home placement as of date of this review (or date of case closure during the period)? 1. < 1 month 2. 1- 6 months 7-12 months 3. 13-18 months 4. 5. 19-24 ,months >24 months 6. N/A - no child in placement (in-home case) 7. D15.a Has child's length of stay exceeded the 15 of the last 22 months benchmark set by ASFA? 1. Yes 2. No N/A ­ In-home case (CPS or Voluntary Services) 3. 4. N/A ­ TPR has already been filed or granted

Case ID Number: ___________________

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D16. What is the child or family's stated goal on the most recent approved treatment plan in place during the period? 1. Reunification Adoption 2. Transfer of Guardianship 3. 4. Long Term Foster Care with a licensed Relative APPLA: Permanent Non-Relative Foster Care 5. 6. APPLA: Other 7. In-Home Goals ­ Safety/Well Being Issues UTD ­ Plan incomplete, unapproved or missing for this period 8. Goal indicated is not an approved DCF Goal 9. D16.a If "APPLA: Other" specify here: 1. Independent Living 2. Specialized Care to Transition to DMHAS or DMR Native American Tribal Placement 3. N/A 4. D17. What is the stated concurrent plan? 1. Reunification Adoption 2. 3. Transfer of Guardianship Long Term Foster Care with a licensed Relative 4. APPLA: Permanent Non-Relative Foster Care 5. 6. APPLA: Other In-Home Goals ­ Safety/Well Being Issues 7. None 8. 9. UTD ­ Plan incomplete, unapproved or missing for this period D17.a If "APPLA:Other" is indicated for the preceding question, specify here: 1. Independent Living Specialized Care to Transition to DMHAS or DMR 2. 3. Native American Tribal Placement N/A 4.

Case ID Number: ___________________

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D18. a ­ D18.z Please circle the appropriate response to indicate which individuals attended the TPC/ACR or had a documented engagement with DCF in the treatment planning efforts during this period? Please enter type of provider attending and relationship of "other" if present at the meeting. Engagement documented Attended the TPC/ACR 1. Yes 2. No 99. N/A 1. Yes 2. No 99. N/A Child Age 12 or older 1. Yes 2. No 99. N/A 1. Yes 2. No 99. N/A Mother 1. Yes 2. No 99. N/A 1. Yes 2. No 99. N/A Father 1. Yes 2. No 99. N/A 1. Yes 2. No 99. N/A Foster Parent 1. Yes 2. No 99. N/A 1. Yes 2. No 99. N/A Active Service Provider 1: Active Service Provider 2: Active Service Provider 3: Active Service Provider 4: Attorney/GAL for child Attorney for parent Other DCF staff Other 1: Other 2: 1. Yes 1. Yes 1. Yes 1. 1. 1. 1. Yes Yes Yes Yes 2. No 2. No 2. No 2. 2. 2. 2. No No No No 99. N/A 99. N/A 99. N/A 99. 99. 99. 99. N/A N/A N/A N/A 1. Yes 1. Yes 1. Yes 1. 1. 1. 1. Yes Yes Yes Yes 2. No 2. No 2. No 2. 2. 2. 2. No No No No 99. N/A 99. N/A 99. N/A 99. 99. 99. 99. N/A N/A N/A N/A

1. Yes

2. No

99. N/A

1. Yes

2. No

99. N/A

D19. Current residence of identified child on the date of this review: 1. In-state non-relative licensed DCF foster care setting In-state licensed relative DCF foster care setting 2. In-state private provider foster care setting 3. 4. In-state residential setting In state hospital setting 5. Out-of-state non-relative foster care setting 6. 7. Out of state relative foster care setting Out-of state residential setting 8. 9. Out-of-state hospital setting Home of biological parent, adoptive parent or legal guardian 10. Shelter 11. 12. Temporary Emergency Foster Care Placement Detention center/CJTS 13. Safe Home 14. Group Home 15. CHAP/TLAP 16. AWOL/Unknown 17. 18. Other ____________________________(specify) 19. N/A - Associated CIP Family Case N/A - In-home family case 20. D.20. If child had been in out-of-home care during the period, but was reunified prior to the date of this review, please enter the date of reunification _________/__________/ ___________ (mm/dd/yyyy)

Case ID Number: ___________________

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D21. If treatment case is closed at point of review, was closure achieved due to: 1. Reunification 2. Adoption Transfer of Guardianship 3. Long Term Foster Care with a licensed Relative 4. 5. APPLA: Permanent Non-Relative Foster Care APPLA: Other 6. In-Home Goals ­ Safety/Well Being Issues 7. 8. Child Aged Out /Child Refused further services In-Home Case Goals Achieved 9. N/A ­ Case Remains Open with DCF 10. D22. If applicable, enter the time frame from the date of case open or most current placement episode date to the date of case closure. ____________ (Round to the nearest month)

End of Descriptive Information

Notes:

Case ID Number: ___________________

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Outcome Measure 3 - Treatment Planning The overarching principle that reviewers must consider is: Is DCF's treatment planning practice adequate to meet the children and families' needs to resolve the presenting issues (CPS/Voluntary Service/FWSN) and advance the case to safe and appropriate closure? The following guidelines are provided for consistent application of scoring within each of the following eight sections and overall determination of compliance achieved by DCF for the cases selected each quarter. In addition to the eight detailed sections of the treatment plan, the Exit Plan requires three essential elements of the plan be in place to achieve a passing grade. A plan that fails any of these essential elements will not receive a Very Good score even in the event that it achieves the numerical score deemed acceptable using the following five point scoring tool in each of the eight sections. These essential elements require that the plan be: Approved by a SWS Less than seven months old Written in the primary language of the client The Monitor's Review will utilize the attached treatment planning protocol, which encompasses the requirements of Outcome Measure 3 outlined in the Exit Plan. The process of review includes a full reading of the LINK record for the six month period leading up to the ACR, as well as prior pertinent LINK information in accordance with the Technical Advisory Committee recommendation which indicates, "In order to be best informed about recent practice, reviewers must also generally review (skim) the entire case record to better understand the family and the child's history and the needs so that the actions taken by the department can be viewed in the context of a complete understanding of the child and family." This LINK review will be followed with attendance at that ACR or family conference, and at a point no less than 14 calendar days from the attended meeting, the reviewer will revisit the LINK record to review the recorded treatment plan document.

Case ID Number: ___________________

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Outcome Measure 3 Scoring Guide1 Optimal Score ­ 5 The reviewer finds evidence of all essential treatment planning efforts for both the standard of compliance and all relevant consideration items. Very Good Score ­ 4 The reviewer finds evidence that essential elements for the standard of compliance are substantially present given the review of relevant consideration items. Marginal Score ­ 3 There is an attempt to include the essential elements for compliance but the review finds that substantial elements for compliance as detailed by the Department's protocol are not present. Some relevant considerations have not been incorporated into the process. Poor Score ­ 2 The reviewer finds a failure to incorporate the most essential elements for the standard of compliance detailed in the Department's protocol. The process does not take into account the relevant considerations deemed essential, and the resulting document is in conflict with record review findings and observations during attendance at the ACR. Absent/Adverse Score ­ 1 The reviewer finds no attempt to incorporate the standard for compliance or relevant considerations identified by the Department's protocol. As a result there is no treatment plan less than 7 months old at the point of review or the process has been so poorly performed that it has had an adverse affect on case planning efforts.

Full guidelines will be referenced within the Reviewers' Handbook. In short ­ those sections resulting in a score of 4 or 5 will generally be considered passing. Overall determination of a score of "Appropriate Treatment Plan" or "Not an Appropriate Treatment Plan" will be based upon the reviewer's documented consideration of each of the individual sections as they relate to a comprehensive plan to address the issues that require ongoing DCF involvement.

1

Case ID Number: ___________________

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Part I: General Family Assessment
I.1. Reason for DCF Involvement.
Standard for Compliance: The plan provides a description of the risk factors for the child/family as identified in the most current referral or provides details of the supports and services requested for the primary and acute behaviors identified on the VSA request. Circle Score:
5 4 3 2 1 Optimal Very Good Marginal Poor Absent/Adverse

Considerations: Is there evidence that indicate that the child/family has been provided with an explanation of why DCF is involved? If participants were present at the ACR, did the child/family appear to understand the reason for continued DCF involvement as it was discussed at the TPC/ACR? If participants were present at the ACR, did the providers appear to understand the reason for continued DCF involvement as it was discussed at the TPC/ACR? Reviewer notes from Case Review/Attendance at ACR/Review of Treatment plan as they relate to this section of the Treatment planning process:

Case ID Number: ___________________

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I.2. Identifying Information
Standard for Compliance: The worker has identified case participants and their inter-relationships. Considerations: Circle Score:
5 4 3 2 1 Optimal Very Good Marginal Poor Absent/Adverse

Is there age or date of birth and race/ethnicity information provided on all family members living in the home? Has the worker identified the relationship between each adult to the children living within the home? Does the worker identify the non-custodial birth/adoptive parent and provide a brief statement as to their relationship to his/her child residing in the home? (If whereabouts unknown, or if there is no ongoing relationship, this should be documented in a very brief statement.) Does this section include pertinent religious, medical, mental health, employment, criminal activity or educational information if important to setting the baseline for goal establishment? Are cultural connections and the positive/negative nature of the relationships or experiences that the family has experienced included? Have family and community support networks been explored/identified? Reviewer notes from Case Review/Attendance at ACR/Review of Treatment plan as they relate to this section of the Treatment planning process:

Case ID Number: ___________________

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I.3. Strengths/Needs/Other Issues
Standards for Compliance: The input of the family/child is considered/addressed in the treatment plan.2 The treatment plan emphasizes individual child and/or family strengths. Circle Score:
5 4 3 2 1 Optimal Very Good Marginal Poor Absent/Adverse

Considerations: What outreach and engagement strategies is DCF using to build a working partnership with the child and family? Are current needs and strengths evident from both the worker/DCF perspective and the perspective of the client(s)? Has the social worker considered all available information including the provider's written and verbal comments, formal summary assessments, past history and recent progress; and included those that are pertinent?3 Reviewer notes from Case Review/Attendance at ACR/Review of Treatment plan as they relate to this section of the Treatment planning process:

Notes: The client statement of issues needs and strengths should be the result of a discussion with the client in which the client is given the opportunity to indicate how they view the issues. Items to consider are: the client's perspective on what led to/required DCF involvement, how they feel they are progressing toward case closure, their self identified strengths, and any barriers they feel are preventing them from their goals. This may be a discussion at the ACR or one documented in LINK narrative preceding the finalization of the treatment plan in LINK. As the Technical Advisory Committee indicates, "In order to be best informed about recent practice, reviewers must also generally review (skim) the entire case record to better understand the family and the child's history and the needs so that the actions taken by the Department can be viewed in the context of a complete understanding of the child and family."
3

2

Case ID Number: ___________________

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I.4. Present Situation and Assessment to Date of the Review
Standard for Compliance: The risks, safety concerns, and needs for the child and family are identified within the worker's assessment of the family/child's current level of functioning. Circle Score:
5 4 3 2 1 Optimal Very Good Marginal Poor Absent/Adverse

Considerations: Are the identified risks, safety concerns, and needs documented in the LINK record within the six-month period leading up to the TPC/ACR meeting and any risks or needs identified at that meeting4 included into the planning document as appropriate? Does section include a summary statement of referrals, substantiations, and services provided to assist the client to reduce the risks identified to the date of the most recent ACR? Notes: This is the social worker's attempt to synthesize the data they have gathered and draw conclusions regarding the level of risk, well-being and direction of the permanency plan. It is the jumping off point for the development of the next six month's goals and plan. Reviewer notes from Case Review/Attendance at ACR/Review of Treatment plan as they relate to this section of the Treatment planning process:

As the Technical Advisory Committee indicates, "In order to be best informed about recent practice, reviewers must also generally review (skim) the entire case record to better understand the family and the child's history and the needs so that the actions taken by the Department can be viewed in the context of a complete understanding of the child and family."

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Case ID Number: ___________________

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Part II - Development of the Goals and Steps
II.1. Determining the Goals/Objectives
Standards for Compliance: Clear, prioritized goals/objectives are stated within the treatment plan for the client(s), providers, and DCF that are consistent with the family assessment. For child in placement age 16 or older: the plan includes the required Independent Living Plan or Adolescent Discharge plan if required by case circumstances. There is evidence5 that the family/child has been involved in development of the goals/objectives. Considerations: Are stated goals/objectives for the child/family connected to the reason for DCF's continued involvement? Do the goals reflect concurrent planning efforts where there is a stated concurrent plan? Reviewer notes from Case Review/Attendance at ACR/Review of Treatment plan as they relate to this section of the Treatment planning process:

Circle Score:
5 4 3 2 1 Optimal Very Good Marginal Poor Absent/Adverse

5

Either observed via attendance at the ACR or as documented LINK narrative to that effect.

Case ID Number: ___________________

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II.2. Progress
Standard for Compliance: The plan reflects the progress towards goals in the last six month period as evaluated by DCF with input from the family.

Circle Score:
5 Optimal 4 Very Good 3 Marginal 2 Poor 1 Absent/Adverse 99 N/A ­ too early to note progress

Considerations: Is there evidence that the family been informed of the consequences of not taking the necessary action to meet the prior plan's requirements? Has the social worker focused on the strengths of the client, and professionals during the 6 month period? Have barriers been identified to progress so that future efforts are informed by the treatment planning process? Notes: If the plan is an initial treatment plan and there are investigation goals and/or action steps identified, progress related to these should be indicated. If no goals and/or actions steps were set during the investigation phase, the social worker should indicate that the plan is the initial plan and therefore it is too early to note progress.

Reviewer notes from Case Review/Attendance at ACR/Review of Treatment plan as they relate to this section of the Treatment planning process:

Case ID Number: ___________________

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II.3. Action Steps to Achieving Goals Identified for the Upcoming Six Month Period
Standards for Compliance: There are clearly stated action steps for each goal and the responsible parties (DCF, providers, and all active family members) for each goal are identified.

Considerations: Are action steps for goal achievement SMART? Specific ­ the identified party knows exactly what needs to be done and why. o Measurable ­ The identified party will know when the goal has been achieved o Achievable ­ The goal can be achieved during the designated time period given the action steps recorded. o Realistic ­ The goal is "doable" for the identified party. o Time Limited ­ Clear timelines are established for the action steps to achieve the goal. Is there evidence that the family/child has been involved in development of the action steps? Has the family been informed of the consequences of not taking the necessary action in the upcoming six-month period? Are the stated steps and goals consistent with the 553 documentation? Are the state steps and goals reflective of the permanency goal? o Notes: This is the section that informs the families of all expectations within the next six-month planning cycle and is therefore deemed the most critical. Each goal should adopt the SMART elements as detailed in the directional guide. If certain action steps are legally mandated, these should be identified as such. Reviewer notes from Case Review/Attendance at ACR/Review of Treatment plan as they relate to this section of the Treatment planning process:

Circle Score:
5 4 3 2 1 Optimal Very Good Marginal Poor Absent/Adverse

Case ID Number: ___________________

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II.4. Planning for Permanency
Standard for Compliance: The plan contains the identification of an appropriate case permanency goal6 (based on the circumstances of the case) using one of the current approved terms: o Reunification o Adoption o Transfer of Guardianship o Long Term Foster Care with a licensed Relative o APPLA: Permanent Non-Relative Foster Care o APPLA: Other Independent Living Specialized Care to Transition to DMHAS or DMR Native American Tribal Placement o In-Home Goals ­ Safety/Well Being Issues There is an identification of a concurrent goal and plan if the case permanency goal is reunification. There is a visitation plan for parents and siblings for cases involving a child in placement. It should describe the frequency, duration and type of visitation permitted between parents and their children, between siblings, and between other relatives as necessary. In cases with court involvement, the treatment plan goal or concurrent plan goal as stated in the document coincides with the court approved permanency goal for the child. Considerations: Are the action steps consistent with the permanency goal? If appropriate given the circumstances of the case has a concurrent plan been developed where the goal is other than reunification? For in-home cases, did the worker and family develop a plan that could be followed in the event that circumstances require the removal of their children or inability to reunify? (This plan would identify relative or other persons known to child as a potential resource for placement. If no resources have been identified, this should be indicated.) Notes: Reviewer notes from Case Review/Attendance at ACR/Review of Treatment plan as they relate to this section of the Treatment planning process:

Circle Score:
5 4 3 2 1 Optimal Very Good Marginal Poor Absent/Adverse

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TPR is not a permanency goal; it is an action step toward achieving permanency. The concurrent goal must be clearly stated in this section with a brief statement of the timing and activities that DCF is going to take toward achieving the concurrent plan.

Case ID Number: ___________________

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Scoring Sheet:
Currency of Treatment Plan: T1. Is there a documented treatment plan in LINK that is less than seven months old at the point of review? 1. Yes 2. No 3. UTD - No Plan and/or ACR Language Requirement: L.1. Was the family or child's language needs accommodated? 1. Yes 2. No 3. UTD L.2. Check the reasons that apply to determination of response to L.1. below: 1. Meeting not conducted/translated in primary language 2. Treatment Plan document not written in primary language 3. Both Treatment Plan and meeting language requirements were not met 99 N/A ­ Both Treatment Plan and meeting language requirement met SWS Approval: SWS1. Has this treatment plan been approved by the SWS? 1. Yes 2. No 3. UTD ­ No Plan less than 7 months old

Part I: General Family Assessment Ratings: For each sub section write in the reviewer rating.
I.1: I.2: _____ _____ I.3: I.4: _____

____

Part II: Development of Goals & Action Steps Ratings: For each sub section write in the reviewer rating.
II.1: II.2: _____ _____ II.3: II.4: _____ _____

OR.1. Overall score7:

1. Appropriate Treatment Plan 2. Not an Appropriate Treatment Plan

The reviewer handbook provides guidance on overall determination. While ratings of 5 and 4 reflecting high standards and best case practices will generally be considered necessary for a finding of "Appropriate Treatment Plan", instructions to the reviewers and supervisors for this process will stress that a reviewer's determination is not tied to a numerical scoring system but rather will based on their overall review of all domains and elements of the case. This will allow reviewers to make informed decisions and over-ride the rare case in which one domain with a lower score does not substantially impact the overall quality of performance. To ensure the validity of this process, the tool will provide space in which all scoring must be justified or defended by the reviewers. All cases will initially be reviewed in pairs and then screened by Monitoring Supervisors prior to data entry. Any case which falls into the category of over-ride utilization will not only be reviewed by the Monitoring Supervisors, but will also be forwarded to the TAC for their review.

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Reviewer notes from Case Review/Attendance at ACR/Review of Treatment plan as they relate to the overall determination of ranking for the development and finalization of the Treatment plan reviewed:

Case ID Number: ___________________

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End of section for Treatment Plan (OM3)

Case ID Number: ___________________

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Outcome Measure 15 - Needs Met The overarching principle for reviewers to consider is: Is DCF's treatment planning practice, referral and provision of services adequate to meet the children and families' needs, resolve presenting issues, and advance the case to safe and appropriate closure? The following guidelines are provided for consistent application of scoring within each of the following sections for specific elements of Outcome Measure 15 and the overall scoring that will determine the level of compliance achieved by DCF for the cases selected each quarter. The Monitor's Review will utilize the attached Needs Met protocol, which encompasses the requirements of Outcome Measure 15 outlined in the Exit Plan. The review process looks at the impact of the prior treatment plan and actions implemented up through the current treatment plan development. The review includes a review of the prior treatment plan, a full reading of the LINK record for the six month period leading up to the current TPC/ACR, attendance at that meeting, and at a point no less than 14 calendar days from the ACR, the reviewer will revisit the LINK record to review the current recorded treatment plan document. While reviewers are focusing on the most recent case practice, they will research prior LINK documentation to obtain information and background as necessary to make informed decisions as it relates to DCF's ability to assess and meet the needs of the children and families during the six month period. In the event that a case selected for review is open in treatment less than 6 months, the review will incorporate the investigation findings/assessment to determine the needs identified for a child or family.

Case ID Number: ___________________

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Outcome Measure 15 Score Guide8 Optimal Score ­ 5 The reviewer finds evidence that DCF has met all elements identified for the standards of compliance, and that DCF's assessment and service provision has incorporated all relevant consideration items. Very Good Score ­ 4 The reviewer finds evidence that the essential elements for the standards of compliance are substantially present via DCF's assessment and service provision as it relates to the relevant considerations items. Marginal Score ­ 3 There is an attempt to include the essential elements for the standards of compliance. However, the reviewer finds substantial elements for compliance are not present. Some relevant considerations have not been incorporated into DCF's assessment and service provision. Poor Score ­ 2 The reviewer finds a failure to incorporate the most essential elements for the standards of compliance. The process does not take into account the relevant considerations deemed essential in assessment and service provision. The resulting document is in conflict with record review findings and observations during attendance at the ACR. Absent/Adverse Score ­ 1 The reviewer finds no attempt or a total disregard of the standards for compliance and relevant considerations in the case documentation. As a result there is no treatment plan less than 7 months old at the point of review or the needs assessment and service provision process has been so poorly performed that it has had an adverse affect on case planning efforts.
Not Applicable to This Case ­ 99 To be selected if the case is not indicated as an applicable case type below the considerations listed within the Directional Guide.

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Full guidelines will be referenced within the Reviewers' Handbook. In short ­ those sections resulting in a score of 4 or 5 will generally be considered passing. Overall determination of a "Needs Met" or "Needs Not Met" score will be based upon the reviewer's documented consideration of each of the individual sections as well as service provision and case management efforts as a whole.

Case ID Number: ___________________

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Using the scoring guide for OM 15 indicated prior, review each section based upon the standards for compliance and considerations indicated for that particular section. I. Safety ­ Answer only the section that applies to this case; if child was in both settings during the six month period, fill in both section's scores. I.1 In-Home
Standard for Compliance: The child(ren) is/are currently in an environment that is safe from known and manageable risks of harm. Risk factors, such as but not limited to: domestic violence, substance abuse, mental health or parenting, and participants strengths have been adequately assessed with input from service providers, family, and DCF staff involved in this case and the necessary support services to address safety and risk factors related to the reason for initial or ongoing DCF involvement have been identified and provided in a timely manner. Services to address assessed needs newly identified during the treatment planning period or that have been carried over from the prior planning period have been identified and incorporated into the action steps for the current treatment plan cycle in accordance with SMART guidelines. Legal action required to ensure the child(ren)'s safety have been taken in a timely and informed manner. Considerations: Were services9 identified by the court or through DCF's treatment planning process provided appropriate in relation to the identified needs? Does the review indicate that the service providers have a clear understanding of what it will take to achieve successful results and outcomes? Is this reflected in their discussion/reporting of parent/child progress? During the treatment planning process were providers and family given the opportunity to take part in the discussion related to the progress in the last six month period and in developing the plan of action and goals for the upcoming period? Is the resulting treatment plan reflective of the input and information within the case record? Is child's safety discussed at the ACR? Have realistic expectations been set for the family in regard to improving the level of risk within the home setting? Has there been any repeat maltreatment of the child during the six-month period? Have there been episodes of domestic violence reported within the home during the past six month period? Have informal supports within the community been identified at the ACR or within the treatment plan document?

Circle Score:
5 Optimal 4 Very Good 3 Marginal 2 Poor 1 Absent/Adverse 99 ­ N/A

Reviewer Notes:

9

This includes the full array of services as they relate to safety.

Case ID Number: ___________________

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I. Safety ­ Answer only the section that applies to this case; if child was in both settings during the six month period, fill in both section's scores. I.2. Children in Placement
Standard for Compliance Risk factors, such as but not limited to: domestic violence, substance abuse, parenting, or the child's behaviors have been adequately assessed with input from service providers, family, and DCF staff involved in this case and the appropriate support services to address safety and risk factors related to the reason for initial or ongoing DCF involvement have been identified and provided in a timely manner. The child is currently in an environment that is safe from known and manageable risks of harm. Services to address assessed needs newly identified during the treatment planning period or that have been carried over from the prior planning period, have been identified and incorporated into the action steps for the current treatment plan cycle. Circle Score:
5 Optimal 4 Very Good 3 Marginal 2 Poor 1 Absent/Adverse 99 ­ N/A

Considerations: Were services10 identified by the court or through DCF's treatment planning process provided appropriate in relation to the identified needs? Have child's high risk behaviors been reduced through provision of services? Have there been any substantiated reports of abuse/maltreatment while in care? Is provider and family input considered regarding the family's ability to achieve the safety goals set during the prior six month period? During the treatment planning process were providers and family given the opportunity to take part in developing the plan of action and goals for the upcoming period? Is the treatment plan reflective of the input at the ACR and information within the case record? Is child's safety within the foster or residential care placement discussed at the ACR? Is child's safety during visits with family discussed at the ACR?

Reviewer Notes:

10

This includes the full spectrum of services as they relate to safety ­ see Crosswalk of Services for listing.

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II. Permanency

II.1 Securing the Permanent Placement - Action Plan for the Next Six Months
Standard for Compliance As warranted by the length of time in care and specific to the child's needs, action steps are underway, or are identified in the most recent treatment plan to secure (or maintain) the permanent placement that is most appropriate to the child's needs given DCF's assessment and the information and feedback of the family and providers. Circle Score:
5 Optimal 4 Very Good 3 Marginal 2 Poor 1 Absent/Adverse 99 ­ N/A

Considerations Is the goal realistic given the current status of the child and family ­ specifically, has the child been in care for 15 of the last 22 months with little or no movement toward a permanent resource (biological family through reunification or with permanency placement resources via adoption, TOG, LTFC)? Does the child in placement, for which the courts have ruled no further reunification efforts, have an identified caregiver that will endure through the child's independence, either through Adoption, Transfer of Guardianship, or Long Term Foster Care? Where indicated, are PPSP contracts or other services in place or identified to begin to support the current placement in the next six month period? Are appropriate recruitment efforts by DCF and/or private providers being utilized to recruit an appropriate placement resource to meet the individualized needs of this child? Are barriers to achieving reunification or the permanent placement addressed?

Reviewer Notes:

Case ID Number: ___________________

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II. Permanency

II.2 DCF Case Management - Legal Action to Achieve the Permanency Goal During the Prior Six Months
Standard for Compliance The Department has taken the necessary steps during the previous six months to move toward achieving a permanent resource for the child through prompt legal action. The family has been advised of the permanency goal, and the implications of a failure to abide by the required action steps set forth by the courts order or within the treatment plan. Considerations: Is the stated permanency goal (or concurrent plan) consistent with the federally approved goals and the court approved goal where there is court involvement? In cases with a stated goal of reunification were all court ordered preservation services provided (reasonable efforts) in a timely manner? Did the feedback from family and providers indicate that the stated goal remained an appropriate permanency plan for this child? Were the prior plan's action steps to achieve adoption, transfer of guardianship, independent living or long term foster care implemented over the course of six months leading up to the ACR attended? Were case management efforts during the past six month period consistent with MAP determinations (where present)?

Circle Score:
5 4 3 2 1 Optimal Very Good Marginal Poor Absent/Adverse

Reviewer Notes:

Case ID Number: ___________________

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II. Permanency

II.3 DCF Case Management ­ Recruitment for Placement Providers to achieve the Permanency Goal during the prior Six Months
Standard for Compliance The Department has taken the necessary steps during the previous six months to move toward achieving a permanent resource for the child through its recruitment efforts. Considerations: Were the prior plan's action steps to achieve adoption, transfer of guardianship, independent living or long term foster care implemented over the course of six months leading up to the ACR attended? For TPR'd children in placement, was the child registered on the Adoption Resource Exchange (unless a documented exception applied)? Where indicated, were PPSP contracts or other services in place or identified to begin to support the current placement in the next six month period? Is there evidence of appropriate recruitment efforts by DCF and/or private providers being utilized to recruit an appropriate placement resource to meet the individualized needs of this child?

Circle Score:
5 Optimal 4 Very Good 3 Marginal 2 Poor 1 Absent/Adverse 99 ­ N/A

Reviewer Notes:

Case ID Number: ___________________

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II. Permanency

II.4 DCF Case Management - Contracting or Providing Services to achieve the Permanency Goal during the prior Six Months
Standard for Compliance The Department has taken the necessary steps during the previous six months to move toward achieving a permanent resource for the child(ren) through internal case management and contracting for services. An Independent Living Plan (ILP) has been developed for children in placement of age 15.5 or older. Considerations: In cases with a stated goal of reunification have all court ordered preservation services been provided (reasonable efforts) in a timely manner? Were the prior plan's action steps to achieve adoption, transfer of guardianship, independent living or long term foster care implemented over the course of six months leading up to the ACR attended? Was the child been in care with a permanency goal that remained unmet for greater than 12 months? If child had been in care for 15 or the last 22 months, were ASFA guidelines appropriately considered in the development of the permanency goal, and where applicable was an exception to ASFA documented? In cases where APPLA is cited as a goal, were more permanent goals considered and ruled out? What is the level of emphasis put on the child's ILP during the period? Did child receive independent living, life skills, or transitional living services deemed appropriate? If housing is a barrier to reunification, has the Department assisted parent with Section 8 process, considered flex funding, or identified other means to address this barrier(s)? If other barriers were identified, did DCF attempt to address those barriers during the prior six month period?

Circle Score:
5 Optimal 4 Very Good 3 Marginal 2 Poor 1 Absent/Adverse 99 ­ N/A

Reviewer Notes:

Case ID Number: ___________________

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III. Well-Being (Medical, Dental, Behavioral & Mental Health) III.1 Medical Needs
Standards of Compliance Have the necessary medical interventions and services identified for this child(ren) been provided? Considerations: For children in out-of-home placement o Are newly emergent medical needs of children in home and in placement during the past six month period assessed and responded to in a timely and appropriate manner? o If an MDE was required during the six month period, does the treatment plan assessment include the recommendations and appropriate services to address the medical needs? o Is the child current with routine well care, in that health maintenance needs been met through adherence to EPSDT standards for well checks and child is current with vaccinations? o Are special medical training, equipment or supports currently being provided, so that the child/family or placement provider has the necessary tools to ensure optimal level of health given child's diagnosis/condition? o Does the documentation indicate that use of psychotropic medications is being managed and reviewed by qualified medical personnel as appropriate? For in-home cases: o Have chronic medical needs for children active in DCF's in home cases been addressed with parents? o Are special medical training, equipment or supports currently being provided, so that the child/family or placement provider has the necessary tools to ensure optimal level of health given child's diagnosis/condition? For both in-home and child in out-of-home placement cases: o Is there evidence that the family and active providers in this case were given the opportunity to provide input into the identification of needs and services that may meet those needs? o Where non-routine medical needs were present, was ARG or outside specialist involvement noted? o Were there documented efforts by DCF to overcome access barriers to appropriate medical care? o Was there improvement or stabilization of health as a result of DCF and provider intervention efforts? o Did DCF make appropriate efforts to engage parents in the process of attending to medical needs of children? o Was there discussion of the medical issues related to this child(ren) during the ACR, and did necessary adjustments to the current treatment plan result?

Circle Score:
5 4 3 2 1 Optimal Very Good Marginal Poor Absent/Adverse

Reviewer Notes:

Case ID Number: ___________________

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III. Well-Being (Medical, Dental, Mental Health) III.2. Dental
Standards of Compliance Have the necessary dental interventions and services identified for this child been provided? Considerations: For children in out-of-home placement: o Have routine dental needs been addressed in accordance with EPSDT standards by qualified dental personnel? o If an MDE was required during the six month period, does the treatment plan assessment include the recommendations and appropriate services to address the dental needs? o Have newly emergent dental needs of children in placement been assessed and responded to in a timely and appropriate manner? In-home cases: o Have chronic or acute dental needs for children active in DCF's in home cases been addressed with parents? For both in-home and Child in out-of-home placement cases: o Is there evidence that the family and active providers in this case were given the opportunity to provide input into the identification of needs and services that may meet those needs? o Where non-routine dental needs were present, was ARG or outside specialist involvement noted? o Were there documented efforts by DCF to overcome barriers to access for appropriate dental care? o Did DCF make appropriate efforts to engage parents in the process of attending to dental needs of children? o Was there discussion of the dental issues related to this child(ren) during the ACR, and did necessary adjustments to the current treatment plan result?

Circle Score:
5 4 3 2 1 Optimal Very Good Marginal Poor Absent/Adverse

Reviewer Notes:

Case ID Number: ___________________

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III. Well-Being (Medical, Dental, Behavioral & Mental Health) III.3 Mental Health, Behavioral and Substance Abuse Services
Standard of Compliance Mental Health and Substance Abuse Service Needs for children and families were assessed and addressed during the past six months with ongoing input from qualified mental health professionals and family informing the current treatment planning process. Specialized services were provided as necessary to meet the individualized needs of the child and family to achieve the case goals. Considerations For children in out-of-home placement cases: o If an MDE was required during the six month period, does the treatment plan assessment include the recommendations and appropriate services to address the mental health needs? o Have the necessary mental health interventions and services identified in the child's MDE been provided? For both in-home and child in out-of-home placement cases o Were there referrals to service and/or assistance with navigation of the system and payment as appropriate to parents or caregivers to assist them in actively participating in the plan to improve the level of functioning and achieve the permanency goal? o Is there evidence that the family and active providers in this case were given the opportunity to provide input into the identification of needs and services that may meet those needs? o Where mental health or substance abuse needs were present (for children or parents), was ARG or outside specialist involvement noted? o What were the DCF actions to overcome access barriers to appropriate services? o Did DCF engage parents and children in identifying issues/needs and subsequently the services to address those needs? o Was there discussion of the mental health or substance abuse treatment during the ACR, and did necessary adjustments to the current treatment plan result?

Circle Score:
5 4 3 2 1 Optimal Very Good Marginal Poor Absent/Adverse

Reviewer Notes:

Case ID Number: ___________________

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IV. Well-Being (Other Special Considerations11 or Service Needs) IV.1 Child's Current Placement
Standard for Compliance The child's current placement or living arrangement is the least restrictive, most family like setting, is stable and consistent with his needs, age, ability, culture and peer group. Considerations If child's placement is in a Safe Home, Shelter, Permanency Diagnostic Center or other short term placement did it exceed 60 days in the 6 month period preceding attendance at ACR?12 Has child exceeded two placement changes (three providers) during the last 12 month period? Has the foster or adoptive parent been provided with adequate training and supports to maintain the child in their home? Is the child receiving the necessary services/interventions or supports necessary to support the current placement? Has worker documented concerns related to the appropriateness of the current placement? Has the ARG been involved related to placement issues for this child(ren) and were those recommendations considered and utilized? Are services in place to maintain family relationships during placement where appropriate? Are social recreational activities being provided as appropriate to the age, ability and interest of the child while in care? Was there a discussion of the appropriateness of the current placement for this child(ren) during the ACR, and did necessary adjustments to the current treatment plan result if determined necessary? Is there evidence of requests for a different level of out-of-home care?

Circle Score:
5 Optimal 4 Very Good 3 Marginal 2 Poor 1 Absent/Adverse 99 ­ N/A

Reviewer Notes:

Domestic Violence, Support and Training services may be captured under the category of "Safety" or "WellBeing" as determined appropriate by the reviewer. 12 Through record review and attendance at the ACR, the reviewer will determine if an exception to the 60 day rule was in the best interest of the child due to proper and active discharge planning efforts, or a lack of more appropriate placement resource.

11

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IV. Well-Being (Other Special Considerations or Service Needs) IV.2 Education
Standard for Compliance Child has been assessed for early intervention or special educational needs where such action is indicated by the child's behaviors or educational difficulties. DCF has taken appropriate action on behalf of the child and family so that needs identified through assessment process are being addressed through the receipt of identified service interventions. Circle Score:
5 4 3 2 1 Optimal Very Good Marginal Poor Absent/Adverse

Considerations Where special educational needs were present and of a nature requiring consultation, was ARG involvement noted? Have necessary PPT meetings and assessments been scheduled/held? Is child academically achieving to his/her potential ­ If there is an IEP in place, does the IEP need to be revisited? Has child attended school with regularity since DCF involvement? Is there evidence that the family and active providers in this case were given the opportunity to provide input into the identification of needs and services that may meet those needs? If child has required changes in school districts, was that disruption of their education due to the needs of the child, or limited placement pool? Was there discussion of the educational issues related to this child(ren) during the ACR, and did necessary adjustments to the current treatment plan result?

Reviewer Notes:

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The following section is for informational purposes. It is primarily included to identify systemic service gaps for further study. This data, through the measures identified for each scoring element, will have already been incorporated into reviewer's determination of ranking as it relates to the identified considerations and standards of compliance. The presence of a barrier does not, in itself, result in a score of "Needs Not Met". Reviewer discretion is required. Directions: Complete the table on page 33 related to service needs identified in the prior plan that are unmet/unaddressed at the point of the TPC/ACR attended. Service Need Type and Barriers to Services Tables are provided below for reference.

Barriers to Services
1. Approval process 2. Child hospitalized 3. Client refused service 4. Delay in referral by worker 5. Hours of operation (Alt. hours needed) 6. Insurance Issues 7. Financing unavailable 8. Gender-specific service not available male 9. Gender-specific service not available female 10. Service not available in primary language 11. Service does not exist in the community 12. Services not available for age group 13. Service deferred pending completion of another 14. Referred service is unwilling to engage client 15. Transportation unavailable 16. Placed on waiting list 17. No slots were available 18. No service identified to address this need 66. UTD from treatment plan or narrative 77. Skip ­ No barriers documented 88. N/A ­ client engaged in recommended service 99. Other (please note in space provided)

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Identified Categories of Needs & the Crosswalk of Services for the Service Provider Type
Identified Need Type 1. Childcare 2. Dental 3. Domestic Violence 4. Education 5. Employment 6. Housing 7. Medical Subcategory of Services/Programs Associated with the Identified Need 1. After School Programs 2. Childcare (Daycare) 1. Dental Screenings & Evaluation 2. Dental or Orthodontic Services 1. Domestic Violence Services Programs- Victim 3. Prevention Programs (Violence) 2. Domestic Violence Services Programs- Perpetrator 4. Domestic Violence Shelter 1. Educational Screening or Evaluation 3. Individualized Programs per IEP Evaluation 2. Head Start 4. Tuition for Private School/College 1. Job Coaching/Placement 1. Community Housing Assistance (CHAP) 3. Housing Assistance (Section 8) 2. Emergency Shelter (Adult/Family) 4. Transitional Living Program 1. Developmental Screening or Evaluation 6. Occupational Therapy 2. Health /Medical Screening or Evaluation 7. Physical Therapy 3. Healthy Start 8. Prenatal Services 4. Hospitalization, Medical 9. Other Medical Intervention 5. Medication Management 1. Anger Management 14. One to One Services 2. Behavior Management 15. Other State Agency Programs (DMR, 3. Care Coordination DMHAS, MSS) 4. Crisis Counseling 16. Peer Counseling 5. Day Treatment/Partial Hospitalization 17. Problem Sexual Behavior Evaluation 6. Emergency Mobile Psychiatric Services 18. Problem Sexual Behavior Therapy 7. Extended Day Treatment 19. Psychiatric Evaluation 8. Family or Marital Counseling 20. Psychiatric Hospitalization 9. Group Counseling 21. Psychological or Psychosocial Evaluation 10. Individual Counseling 22. Sex Abuse Evaluation 11. In-Home Treatment (MDFT, MST, FFT) 23. Sexual Abuse Victim Therapy 12. Juvenile Justice Intermediate Evaluation 24. Therapeutic Child Care 13. Mental Health Screening or Evaluation 25. Other 1. Adoption Recruitment 8. Permanency Diagnostic Center 2. Basic Foster Care 9. Permanent Family Residence Homes 3. Crisis Stabilization Beds 10. Relative Foster Care 4. Group Home 11. Residential Facility 5. Matching/Placement/Processing (includes ICO) 12. SAFE Homes 6. Maternity Home 13. Therapeutic Foster Care 7. Medically Complex Foster Care 14. Youth Shelters 1. Detoxification 7. Substance Abuse Prevention 2. Drug/Alcohol Education 8. Substance Abuse Screening/Evaluation 3. Drug/Alcohol Testing 9. Supportive Housing for Recovering Families 4. Inpatient Substance Abuse Treatment (SHRF) 5. Outpatient Substance Abuse Treatment 6. Relapse Prevention Programs 1. Family Advocacy 15. Parenting Classes 2. Adoption Supports (PPSP) 16. Parenting Groups 3. Delinquency Prevention 17. Peer Mediation 4. Family Preservation 18. Positive Youth Development Program 5. Family Reunification 19. Preparation for Adult Living Settings 6. Family Stabilization 20. Respite Services 7. Flex Funds for Basic Needs 21. Services for the Disabled (TDD/TTY) 8. Foster Care Support 22. Social Recreational Programs 9. In-Home Parent Education and Support 23. Supervised Visitation 10. Juvenile/Criminal Diversion 24. Translation Services 11. Maintaining Family Ties 25. VNA Services 12. Medically Fragile Services/Support 26. WIC Services 13. Mentoring 27. Young Parents Program 14. Outreach, Tracking and Reunification Programs 28. Other 1. Adoption Training 3. Life Skills Training 2. Foster Parent Training 1. Worker/Child Visitation 3. Provider Contact 2. Worker Parent Visitation 4. Case Management/Support/Advocacy

8. Mental Health

9. Out-of-home Care

10. Substance Abuse

11. & 12. Support Services 11 = Out-of-home 12 = In-Home

13. Training 14. DCF

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OM15.1 ­ OM15.25 1. What was the identified need and service listed from the prior treatment plan that remained unresolved/unmet at the point of the recently attended ACR13? (Column 1) 2. What is the subcategory of service? (Column II) ­ If other, after selecting 99 write in service type 3. Was this need and service or action step incorporated into the current treatment plan? (Column III) 4. Who is the intended recipient of the service identified? (Column IV) 5. What was the primary barrier identified that prevented families or children from having their medical, dental, mental health or other service needs met? (Column V) I
Identified Category of Service Need Type

II

III
Was this need and service or action step incorporated into the current treatment plan? 1. Yes 2. No

IV
Identified Recipient for Service Need 1 = child 2 = parent 3 = family unit 4 = foster parent/caretaker

V
What was the primary barrier that prevented families or children from having their medical, dental, mental health or other service needs met?

Subcategory of Service

Ex. 3

2

1

2

5

OM15.26 Are there service needs not identified in the current treatment plan, but that are clearly identified within the 6 months of LINK documentation reviewed, DCF-553, or attendance at the ACR? 1. Yes 2. No OM15.27 ­ OM15.42 Please identify the service need, service, recipient, and if possible the barrier that led to a failure to identify a need so clearly identified within the record. I II III IV
Identified Category of Service Need Type Identified Recipient for Service Need 1 = child 2 = parent 3 = family unit 4 = foster parent/caretaker

Subcategory of Service

Relevant Comments

Ex. 3

1

1

MDE findings not incorporated into plan development

13

The reviewer is to use both the prior treatment plan and form 553 to identify needs.

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OM 15 Scoring Sheet:
Part I: Safety Ratings (you will only respond to one of the sections based on case assigned): For the applicable sub section write in the reviewer rating.
I.1: I.2. _____ _____

Part II: Permanency Ratings:

For each sub section write in the reviewer rating.
II.1: II.2: II.3: II.4: _____ _____ _____ _____

Part III: Well Being (Medical Dental, Mental Health) Ratings: For each sub section write in the reviewer rating.
III.1: III.2: III.3: _____ _____ _____

Part IV: Well Being (Other Considerations) Ratings: reviewer rating.
IV.1: IV.2: _____ _____

For each sub section write in the

OR.1. Overall Score14: 1. Needs Met 2. Needs Not Met

The reviewer handbook provides guidance on overall determination. While ratings of 5 and 4 reflecting high standards and best case practices will generally be considered necessary for a finding of "Needs Met", instructions to the reviewers and supervisors for this process will stress that a reviewer's determination is not tied to a numerical scoring system but rather will based on their overall review of all domains and elements of the case. This will allow reviewers to make informed decisions and over-ride the rare case in which one domain with a lower score does not substantially impact the overall quality of performance. To ensure the validity of this process, the tool will provide space in which all scoring must be justified or defended by the reviewers. All cases will initially be reviewed in pairs and then screened by Monitoring Supervisors prior to data entry. Any case which falls into the category of over-ride utilization will not only be reviewed by the Monitoring Supervisors, but will also be forwarded to the TAC for their review.

14

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Reviewer Notes:

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